Targeted neurotechnology restores walking in humans with spinal cord injury

  title={Targeted neurotechnology restores walking in humans with spinal cord injury},
  author={Fabien B. Wagner and Jean-Baptiste Mignardot and Camille G Le Goff-Mignardot and Robin Demesmaeker and Salif Komi and Marco Capogrosso and Andreas Rowald and Ismael Se{\'a}{\~n}ez and Miroslav Caban and Elvira Pirondini and Molywan Vat and Laura A. McCracken and Roman Heimgartner and Isabelle Fodor and Anne Watrin and Perrine S{\'e}guin and Edoardo Paoles and Katrien Keybus and Gr{\'e}goire Eberle and Brigitte Schurch and Etienne Pralong and Fabio Becce and John O. Prior and Nicholas Buse and Rik Buschman and Esra Neufeld and Niels Kuster and Stefano Carda and Joachim von Zitzewitz and Vincent Delattre and Tim Denison and Hendrik Lambert and Karen Minassian and Jocelyne Bloch and Gr{\'e}goire Courtine},
Spinal cord injury leads to severe locomotor deficits or even complete leg paralysis. Here we introduce targeted spinal cord stimulation neurotechnologies that enabled voluntary control of walking in individuals who had sustained a spinal cord injury more than four years ago and presented with permanent motor deficits or complete paralysis despite extensive rehabilitation. Using an implanted pulse generator with real-time triggering capabilities, we delivered trains of spatially selective… 

Transcutaneous Spinal Cord Stimulation Restores Hand and Arm Function After Spinal Cord Injury

It is demonstrated that non-invasive transcutaneous electrical stimulation of the spinal networks restores movement and function of the hands and arm for people with both complete paralysis and long-term spinal cord injury.

An intracortical neuroprosthesis immediately alleviates walking deficits and improves recovery of leg control after spinal cord injury

An intracortical neuroprosthetic device able to deliver electrical stimulation at motor cortex level, on-demand, in phase coherence with locomotion in rats is developed, suggesting that targeting cortical circuits could be effective in promoting motor recovery in patients with SCI.

Activity-dependent spinal cord neuromodulation rapidly restores trunk and leg motor functions after complete paralysis.

A computational framework was established that informed the optimal arrangement of electrodes on a new paddle lead and guided its neurosurgical positioning and software supporting the rapid configuration of activity-specific stimulation programs that reproduced the natural activation of motor neurons underlying each activity.

Targeted transcutaneous cervical spinal cord stimulation promotes upper limb recovery in spinal cord and peripheral nerve injury

Targeted transcutaneous stimulation of the cervical spinal cord can substantially and rapidly improve volitionally evoked muscle activity and force, even with minimal physical therapy, in two individuals with SCI.

Spinal cord stimulation for spinal cord injury patients with paralysis: To regain walking and dignity

Following the success of translational research, chronic paralyzed subjects due to SCI regained their voluntary control and function of overground walking and even stepping for some, leading into a new hope to help SCI patients to walk and regain their independent life again.

Electrical Stimulation Of The Cervical Dorsal Roots Enables Functional Arm And Hand Movements In Monkeys With Cervical Spinal Cord Injury

It is shown that electrical stimulation of the cervical spinal cord enabled three monkeys with cervical SCI to execute functional, three-dimensional, arm movements and a synergistic interaction between spared descending pathways and electrical stimulation enabled this restoration of voluntary motor control.

Immediate Effects of Transcutaneous Spinal Cord Stimulation on Motor Function in Chronic, Sensorimotor Incomplete Spinal Cord Injury

Investigating the immediate effects during single-sessions of tonic tSCS on ankle control, spinal excitability, and locomotion in ten individuals with chronic, sensorimotor iSCI found the three with the lowest as well as the one with the highest walking function scores showed positive stimulation effects, including increased maximum walking speed, or more continuous and faster stepping at a self-selected speed.

Enhancing rehabilitation and functional recovery after brain and spinal cord trauma with electrical neuromodulation

Promising treatment options have emerged from research in recent years using neurostimulation to enable or enhance intense training, however, characterizing long-term benefits and side-effects in clinical trials and identifying patient subsets who can benefit are crucial.

Epidural Electrical Stimulation of the Cervical Dorsal Roots Restores Voluntary Upper Limb Control in Paralyzed Monkeys

The neural function of surviving spinal circuits is exploited to restore voluntary arm and hand control in three monkeys with spinal cord injury using spinal cord stimulation, and the efficacy and reliability of the approach hold realistic promises of clinical translation.

Epidural Electrical Stimulation Of The Cervical Dorsal Roots Restores Voluntary Arm Control In Paralyzed Monkeys

The neural function of surviving spinal circuits is exploited to restore voluntary arm and hand control in three monkeys with spinal cord injury using spinal cord stimulation, and the efficacy and reliability of the approach hold realistic promises of clinical translation.



Restoring Voluntary Control of Locomotion after Paralyzing Spinal Cord Injury

An electrochemical neuroprosthesis and a robotic postural interface designed to encourage supraspinally mediated movements in rats with paralyzing lesions triggered a cortex-dependent recovery that may improve function after similar injuries in humans.

Spatiotemporal neuromodulation therapies engaging muscle synergies improve motor control after spinal cord injury

Spatiotemporal neuromodulation therapies improved gait quality, weight-bearing capacity, endurance and skilled locomotion in several rodent models of spinal cord injury and are directly translatable to strategies to improve motor control in humans.

Recovery of Over‐Ground Walking after Chronic Motor Complete Spinal Cord Injury

Persons with motor complete spinal cord injury, signifying no voluntary movement or sphincter function below the level of injury but including retention of some sensation, do not recover independent

A Brain–Spinal Interface Alleviating Gait Deficits after Spinal Cord Injury in Primates

The implantable components integrated in the brain–spine interface have all been approved for investigational applications in similar human research, suggesting a practical translational pathway for proof-of-concept studies in people with spinal cord injury.

Epidural spinal-cord stimulation facilitates recovery of functional walking following incomplete spinal-cord injury

It is proposed that ESCS facilitated locomotor recovery in this patient by augmenting the use-dependent plasticity created by partial weight bearing therapy and facilitating the transfer of the learned gait into over ground ambulation.

Altering spinal cord excitability enables voluntary movements after chronic complete paralysis in humans.

It is shown that neuromodulation of the sub-threshold motor state of excitability of the lumbosacral spinal networks was the key to recovery of intentional movement in four of four individuals diagnosed as having complete paralysis of the legs.

Closed-loop neuromodulation of spinal sensorimotor circuits controls refined locomotion after complete spinal cord injury

A closed-loop system that will essentially “auto-tune” the neuromodulation device, allowing the paralyzed patient—or, in their study, the paralyzed rat—to move freely, without worrying about adjusting electrical pulse width, amplitude, or frequency is created.

Electrical spinal cord stimulation must preserve proprioception to enable locomotion in humans with spinal cord injury

Simulations showed that burst stimulation and spatiotemporal stimulation profiles mitigate the cancellation of proprioceptive information, enabling robust control over motor neuron activity, demonstrating the importance of stimulation protocols that preserve proprioception information to facilitate walking with EES.

Human spinal locomotor control is based on flexibly organized burst generators.

The data imply that the human lumbar spinal cord circuits can form burst-generating elements that flexibly combine to obtain a wide range of locomotor outputs from a constant, repetitive input.