الفهرس 
Spinal cord injuryOnly 14 pages are availabe for public view
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Abstract
SCI has been recognized for thousands of years as one of the most devastating injuries one can suffer. The majority of individuals with SCI have injuries that are functionally incomplete.
Impaired hand function significantly limits the ability of individuals with cervical SCI to perform manual activities of daily living.
The aim of the work was to determine the effect of massed practice versus massed practice with somatosensory stimulation on upper extremity function and cortical plasticity in patients with incomplete cervical SCI.
This study included 25 patients with incomplete cervical SCI, incomplete according to American Spinal Cord Injury Association Impairment Scale (ASIA, 2000).
Patients underwent full medical history, thorough clinical and neurological examination including motor examination (power, deep tendon reflexes, and tone), sensory examination (pin prick and light touch), PR examination and ASIA impairment scale of SCI.
Assessment of maximal grip force using digital dynamometer, upper extremity and hand fuction testing using WMFT and JTHFT timed scores. Magnetic Resonance Imaging to verify the level of the injury, MEP’s from the thenar muscles were elicited using TMS applied over the scalp measuring the motor threshold, latency and amplitude of the MEP’s.
The patients were classified into 3 groups:
First group: 10 patients received massed practice training directed to the upper extremity having the lower motor score. It focused on continuous repetition of tasks in each of 5 categories: gross movement, grip, grip with rotation, pinch and pinch with rotation, 5 times per week for 3 weeks, 2 hours per session.
Second group: 10 patients received somatosensory stimulation of the median nerve at the level of the wrist besides the massed practice. Patients received trains of electrical stimulation delivered at 1 Hz, each train consisted of 5 single pulses at 1 ms duration delivered at 10 Hz with stimulus intensity just below that which evoked an observable twitch in any of the muscles innervated by the median nerve for 2 hours.
Third group: 5 patients as a control group, receiving traditional rehabilitation program.
The pinch grip force showed a highly statistically significant increase after the treatment in group (II) (p < 0.001), a significant increase in grip force in group (I) (p < 0.05) and no significant difference in the control group (p> 0.05). Group II (MP+SS) demonstrated a significantly greater increase in pinch grip strength than group I (MP) and group III (p<0.05).
As for the functional tests WMFT and JTHFT, there was a significant decrease in time after the treatment in both groups (I) and (II) (p < 0.05). There was no significant difference between pre and post treatment values in group (III) (p > 0.05). Patients in groups (I) and (II) demonstrated a greater improvement as regards the functional tests compared with patients in group (III) but the difference was not of statistical significance.
Comparison between pre and post treatment TMS measures in group (I), (II) revealed, a significant decrease in the motor threshold (p<0.05) while there was no significant difference in group (III). Groups (I) and (II) showed a greater decrease in the motor threshold than group (III).
As for the amplitude and latencies of the MEP’s, there was no statistically significant difference between pre and post-treatment values in the 3 groups.