PMC6589948_01
Magnetic resonance imaging taken at 6 months.
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Magnetic resonance imaging taken at 6 months reconfirmed the diagnosis (Figure 1).
Sensation charts. Top, Initial sensation at 6 months. Bottom, Sensation at 18 months
post, a 12-month intervention with spinal and functional electrical stimulation. Red =
pin prick, Green = pressure, Blue = temperature (ice).
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No light/deep pressure or pinprick sensation was noted below the T8 level (Figure 2). Currently, he consistently responds to scattered patches of sensation in all dermatomes through S2, more responses on his left than his right (Figure 2).
Functional electrical stimulation electrode placement. A, Anterior view, abdominal
and quadriceps electrode placement. B, Posterior view, latissimus, gluteals, and
gastrocnemius electrode placement. C, Sit to stand functional electrical stimulation
activity for isometric, concentric, and eccentric muscle activation.
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Initially gluteals, quadriceps, and gastrocnemius were stimulated bilaterally (Figure 3). After 6 weeks, back extensors were added to the protocol (Figure 3).
Electrode placement lower spine. A, Posterior view, electrodes at T12-L2 and plantar
surface of feet bilaterally. B, Anterior view, bilateral iliac crests.
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One two-channel stimulator (EMPI Continuum TENS mode) was used with either 3.1 cm (later changed to 5 cm) round electrodes or 5 x 5 cm over the spine at T12-L2 and 5 x 5 cm return electrodes placed over either the iliac crest or the plantar surface of the foot (Figure 4). As the program continued, the 2 return electrodes were moved from the iliac crests to the plantar surface of the feet (Figure 4).
Electrodes placement for transcutaneous spinal cord stimulation C7 to T12 using one
channel.
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T12 was added to explore the possibility that his upper spinal abnormality could be addressed for increased trunk and respiratory function (Figure 5). The transcutaneous spinal cord stimulation protocol was administered daily (2 x daily at 17 months) for 30 minutes by the parents with the infant in a supportive sitting or standing device. T12 (Figure 5). The same device and stimulation parameters were used for both morning and afternoon protocols.