{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T14:52:19Z","timestamp":1786978339329,"version":"build-2736575974"},"reference-count":69,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2025,2,10]],"date-time":"2025-02-10T00:00:00Z","timestamp":1739145600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100012446","name":"Canadian Spinal Research Organization American Spinal Research Organization","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100012446","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100009647","name":"Ministry of Health","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100009647","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000049","name":"Ontario Neurotrauma Foundation","doi-asserted-by":"publisher","award":["719G"],"award-info":[{"award-number":["719G"]}],"id":[{"id":"10.13039\/501100000049","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Physiotherapy Res Intl"],"published-print":{"date-parts":[[2025,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Improving hand and arm function is an important goal for individuals with cervical spinal cord injury (cSCI). Activity Based Therapy (ABT) is a neurorestorative approach that incorporates a high intensity, long duration and effortful engagement to garner sensory\u2010motor improvements. Spinal cord stimulation is a neuromodulation modality that can restore sensory\u2010motor function. Spinal cord stimulation can elevate the excitability of the spinal neural network and potentially enhance the neurorestorative benefits of ABT. However, there is scarce evidence on the combined effects of ABT and spinal cord stimulation on UL recovery after cSCI.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This report aims to describe how theory informed the design and development of a Phase 1 study on a new UL intervention combining ABT and transcutaneous cervical spinal cord stimulation (tCSCS) (short form:ABT\u2010tCSCS) delivered simultaneously for individuals with cSCI.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>The design of the ABT\u2010tCSCS was guided by theory\u2010based frameworks such as the Rehabilitation treatment specification system and the Template for Intervention Description and Replication guide. The ABT\u2010TCSCS aimed to improve somatosensory\u2010motor deficits and function in the UL after cSCI. The ABT\u2010tCSCS intervention was developed through the following stages: (a) Description of the active ingredients, mechanism of action, and targets of the ABT\u2010tCSCS; (b) Tailoring of ABT\u2010tCSCS; and (c) Development of treatment regimen guidelines for the delivery of the ABT\u2010tCSCS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>ABT constitutes 4 types of exercises, including cardio\u2010fitness, resistance, postural\/weightbearing, and functional exercises, for activation of the neuromuscular system below the level of lesion to target somatosensory\u2010motor impairments. In tCSCS, electrical stimulation is delivered at a frequency of 30\u201350\u00a0Hz at 500\u20131000\u00a0\u03bcs between C3\u2010C7. The spinal neural networks of the cervical region are stimulated to neuromodulate the descending motor commands which control the muscles. ABT\u2010tCSCS will be delivered simultaneously over 28 sessions (1\u00a0h\/session, 3x\/week over 9\u201310\u00a0weeks).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Combined ABT\u2010tCSCS is a new intervention for neurorestoration of the upper limbs after cSCI.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trail Registration<\/jats:title>\n                    <jats:p>\n                      ClinicalTrials.gov ID:\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"https:\/\/clinicaltrials.gov\/study\/NCT06472986\">NCT06472986<\/jats:ext-link>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/pri.70036","type":"journal-article","created":{"date-parts":[[2025,2,11]],"date-time":"2025-02-11T08:44:42Z","timestamp":1739263482000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Combined Activity\u2010Based Therapy and Cervical Spinal Cord Stimulation: Active Ingredients, Targets and Mechanisms of Actions to Optimize Neurorestoration of Upper Limb Function After Cervical Spinal Cord Injury"],"prefix":"10.1002","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1544-5155","authenticated-orcid":false,"given":"Urvashy","family":"Gopaul","sequence":"first","affiliation":[{"name":"KITE Research Institute\u2010 Toronto Rehabilitation Institute University Health Network  Toronto Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7860-9463","authenticated-orcid":false,"given":"Mark Theodore","family":"Bayley","sequence":"additional","affiliation":[{"name":"KITE Research Institute\u2010 Toronto Rehabilitation Institute University Health Network  Toronto Canada"},{"name":"Temerty Faculty of Medicine University of Toronto  Toronto Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2332-5986","authenticated-orcid":false,"given":"Sukhvinder","family":"Kalsi\u2010Ryan","sequence":"additional","affiliation":[{"name":"KITE Research Institute\u2010 Toronto Rehabilitation Institute University Health Network  Toronto Canada"},{"name":"Temerty Faculty of Medicine University of Toronto  Toronto Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,2,10]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1152\/japplphysiol.00515.2006"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/00005768\u2010199904000\u201000016"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.5014\/ajot.2024.050533"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1146\/annurev\u2010neuro\u2010062111\u2010150527"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1089\/neu.2004.21.1371"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1080\/10790268.2020.1739894"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1177\/1545968305274517"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.apmr.2007.11.021"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pmr.2007.02.002"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1523\/jneurosci.2374\u201019.2020"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1080\/09638288.2021.1923072"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.3389\/fphys.2022.831372"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1055\/s\u20102004\u2010817879"},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.14336\/ad.2014.1105"},{"key":"e_1_2_12_16_1","doi-asserted-by":"publisher","DOI":"10.1007\/bf00235013"},{"key":"e_1_2_12_17_1","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2017.00017"},{"key":"e_1_2_12_18_1","doi-asserted-by":"publisher","DOI":"10.1123\/jab.26.2.240"},{"key":"e_1_2_12_19_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598\u2010018\u201033123\u20105"},{"key":"e_1_2_12_20_1","doi-asserted-by":"publisher","DOI":"10.1179\/2045772314y.0000000246"},{"key":"e_1_2_12_21_1","doi-asserted-by":"publisher","DOI":"10.1089\/neu.2017.5461"},{"key":"e_1_2_12_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.rehab.2015.05.003"},{"key":"e_1_2_12_23_1","doi-asserted-by":"publisher","DOI":"10.1089\/neu.2015.4008"},{"key":"e_1_2_12_24_1","doi-asserted-by":"publisher","DOI":"10.1177\/0269215514556087"},{"key":"e_1_2_12_25_1","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2016.00242"},{"key":"e_1_2_12_26_1","doi-asserted-by":"publisher","DOI":"10.3200\/jmbr.36.2.212\u2010224"},{"key":"e_1_2_12_27_1","doi-asserted-by":"publisher","DOI":"10.1088\/1741\u20102552\/abe358"},{"key":"e_1_2_12_28_1","doi-asserted-by":"publisher","DOI":"10.1016\/s0140\u20106736(11)60547\u20103"},{"key":"e_1_2_12_29_1","doi-asserted-by":"publisher","DOI":"10.1310\/sci1904\u2010288"},{"key":"e_1_2_12_30_1","doi-asserted-by":"publisher","DOI":"10.1097\/NPT.0b013e3181fbe692"},{"key":"e_1_2_12_31_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.g1687"},{"key":"e_1_2_12_32_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0192013"},{"key":"e_1_2_12_33_1","doi-asserted-by":"publisher","DOI":"10.1089\/cpb.2005.8.187"},{"key":"e_1_2_12_34_1","doi-asserted-by":"publisher","DOI":"10.1109\/tnsre.2021.3049133"},{"key":"e_1_2_12_35_1","doi-asserted-by":"publisher","DOI":"10.1109\/tnsre.2018.2834339"},{"key":"e_1_2_12_36_1","doi-asserted-by":"publisher","DOI":"10.3390\/healthcare12070703"},{"key":"e_1_2_12_37_1","doi-asserted-by":"publisher","DOI":"10.1016\/s0749\u20100712(02)00035\u20105"},{"key":"e_1_2_12_38_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.arrct.2022.100218"},{"key":"e_1_2_12_39_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.arrct.2022.100218"},{"key":"e_1_2_12_40_1","doi-asserted-by":"publisher","DOI":"10.1179\/2045772314y.0000000263"},{"key":"e_1_2_12_41_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1525\u20101594.2011.01216.x"},{"key":"e_1_2_12_42_1","doi-asserted-by":"publisher","DOI":"10.1523\/jneurosci.3440\u201003.2004"},{"key":"e_1_2_12_43_1","doi-asserted-by":"publisher","DOI":"10.1523\/jneurosci.16\u201014\u201004529.1996"},{"key":"e_1_2_12_44_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm10020195"},{"key":"e_1_2_12_45_1","doi-asserted-by":"publisher","DOI":"10.1152\/jn.00325.2006"},{"key":"e_1_2_12_46_1","doi-asserted-by":"publisher","DOI":"10.1152\/jn.00542.2017"},{"key":"e_1_2_12_47_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12283\u2010016\u20100206\u2010x"},{"issue":"4","key":"e_1_2_12_48_1","first-page":"249","article-title":"Functional Significance of Spinal Cord Lesion Level","volume":"36","author":"Long C. I.","year":"1955","journal-title":"Archives of Physical Medicine and Rehabilitation"},{"key":"e_1_2_12_49_1","doi-asserted-by":"publisher","DOI":"10.1177\/1545968316644344"},{"key":"e_1_2_12_50_1","doi-asserted-by":"publisher","DOI":"10.1177\/0269215514536411"},{"key":"e_1_2_12_51_1","doi-asserted-by":"publisher","DOI":"10.3389\/fresc.2021.724003"},{"key":"e_1_2_12_52_1","doi-asserted-by":"publisher","DOI":"10.1186\/1743\u20100003\u201012\u20109"},{"key":"e_1_2_12_53_1","doi-asserted-by":"publisher","DOI":"10.1177\/1545968319893298"},{"key":"e_1_2_12_54_1","doi-asserted-by":"publisher","DOI":"10.1038\/sj.sc.3100875"},{"key":"e_1_2_12_55_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41393\u2010021\u201000644\u20102"},{"key":"e_1_2_12_56_1","doi-asserted-by":"publisher","DOI":"10.1177\/1545968310392924"},{"key":"e_1_2_12_57_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1532\u20105415.2005.53203.x"},{"key":"e_1_2_12_58_1","volume-title":"Motor Control and Learning: A Behavioural Emphasis","author":"Schmidt R. A.","year":"2005"},{"key":"e_1_2_12_59_1","doi-asserted-by":"publisher","DOI":"10.1186\/1741\u20107015\u20108\u201018"},{"key":"e_1_2_12_60_1","doi-asserted-by":"publisher","DOI":"10.1152\/jn.00367.2022"},{"key":"e_1_2_12_61_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.n2061"},{"key":"e_1_2_12_62_1","doi-asserted-by":"publisher","DOI":"10.1038\/sj.sc.3101638"},{"key":"e_1_2_12_63_1","doi-asserted-by":"publisher","DOI":"10.1038\/nrn1668"},{"key":"e_1_2_12_64_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0260166"},{"key":"e_1_2_12_65_1","doi-asserted-by":"publisher","DOI":"10.1016\/0014\u20104886(68)90041\u20101"},{"key":"e_1_2_12_66_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.apmr.2018.09.112"},{"key":"e_1_2_12_67_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaneurol.2017.5055"},{"key":"e_1_2_12_68_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clinph.2019.11.056"},{"key":"e_1_2_12_69_1","doi-asserted-by":"publisher","DOI":"10.1038\/sc.2016.129"},{"key":"e_1_2_12_70_1","doi-asserted-by":"publisher","DOI":"10.1109\/tnsre.2020.3048592"}],"container-title":["Physiotherapy Research International"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/pri.70036","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,5,22]],"date-time":"2025-05-22T05:20:21Z","timestamp":1747891221000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/pri.70036"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,2,10]]},"references-count":69,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2025,4]]}},"alternative-id":["10.1002\/pri.70036"],"URL":"https:\/\/doi.org\/10.1002\/pri.70036","archive":["Portico"],"relation":{},"ISSN":["1358-2267","1471-2865"],"issn-type":[{"value":"1358-2267","type":"print"},{"value":"1471-2865","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,2,10]]},"assertion":[{"value":"2024-09-03","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-01-29","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-02-10","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70036"}}