The Effect of Exoskeleton-Assisted Walking and Transcutaneous Spinal Cord Stimulation on Measures of Bone Strength in Persons with Spinal Cord Injury

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PROJECT SUMMARY/ABSTRACT Dr. Christopher M. Cirnigliaro has been working with researchers as a Research Health Science Specialist/Research Coordinator to the National Center for the Medical Consequences of Spinal Cord Injury for almost 20 years. Over this time, he has displayed an extraordinary commitment to improving the health and general welfare of Veterans with spinal cord injury (SCI). As the Senior Research Coordiantor, Dr. Cirnigliaro has helped author an impressive list of publications for his stage of professional development, having just received his doctoral degree; his name appears on over 50 original articles (first author on 9) and 2 review articles (first author on both). Under the tutelage of Dr. William A. Bauman, he completed 2 projects for his Ph.D. dissertation work that have been significant in advancing our approach and understanding of bone disease in persons with SCI. There is a paucity of research that have successfully implemented rehabilitation and/or exercise training interventions to mitigate the bone loss after acute spinal cord injury (SCI), or possibly reverse bone loss that has already occurred in chronic SCI. Advanced ambulatory strategies that can restore sublesional bone in persons with SCI would reduce the morbidity and days lost from work associated with fractures, a known secondary complication of profound and prolonged immobilization. More important, improvements in sublesional bone would also improve confidence of patients to engage in recreational endeavors and improve their independence and ease when performing activities of daily living. The protocol proposed in my CDA-1 application that compares the effects of exoskeleton-assisted walking (EAW) alone versus EAW plus transcutaneous spinal cord stimulation (TSCS) and the finite element (FE) approach, along with traditional radiologic measurements, represents a continuation of previous work aimed at reducing the risk of fracture by improving bone health in persons with SCI. A successful outcome would be associated with increased bone strength that would be anticipated to have a direct impact on expanding treatment options for rehabilitation. In addition to completing the CDA-1 protocol proposed, Dr. Cirnigliaro will complete additional hands-on research activities, specific academic courses and seminars, and extensive mentoring from a team of experts in the field of SCI research. The CDA-1 will provide Dr. Cirnigliaro the opportunity to complete this clinically relevant research plan and improve his knowledge base, develop new skills, and grow professionally so he can mature into an independent VA RR&D Service clinical scientist.