Effect of epidural stimulation of the lumbosacral spinal cord on voluntary movement, standing, and assisted stepping after motor complete paraplegia: a case study
- PMID: 21601270
- PMCID: PMC3154251
- DOI: 10.1016/S0140-6736(11)60547-3
Effect of epidural stimulation of the lumbosacral spinal cord on voluntary movement, standing, and assisted stepping after motor complete paraplegia: a case study
Abstract
Background: Repeated periods of stimulation of the spinal cord and training increased the ability to control movement in animal models of spinal cord injury. We hypothesised that tonic epidural spinal cord stimulation can modulate spinal circuitry in human beings into a physiological state that enables sensory input from standing and stepping movements to serve as a source of neural control to undertake these tasks.
Methods: A 23-year-old man who had paraplegia from a C7-T1 subluxation as a result of a motor vehicle accident in July 2006, presented with complete loss of clinically detectable voluntary motor function and partial preservation of sensation below the T1 cord segment. After 170 locomotor training sessions over 26 months, a 16-electrode array was surgically placed on the dura (L1-S1 cord segments) in December 2009, to allow for chronic electrical stimulation. Spinal cord stimulation was done during sessions that lasted up to 250 min. We did 29 experiments and tested several stimulation combinations and parameters with the aim of the patient achieving standing and stepping.
Findings: Epidural stimulation enabled the man to achieve full weight-bearing standing with assistance provided only for balance for 4·25 min. The patient achieved this standing during stimulation using parameters identified as specific for standing while providing bilateral load-bearing proprioceptive input. We also noted locomotor-like patterns when stimulation parameters were optimised for stepping. Additionally, 7 months after implantation, the patient recovered supraspinal control of some leg movements, but only during epidural stimulation.
Interpretation: Task-specific training with epidural stimulation might reactivate previously silent spared neural circuits or promote plasticity. These interventions could be a viable clinical approach for functional recovery after severe paralysis.
Funding: National Institutes of Health and Christopher and Dana Reeve Foundation.
Copyright © 2011 Elsevier Ltd. All rights reserved.
Conflict of interest statement
No authors have any conflicts of interest.
Figures
Comment in
-
Spinal cord injury: time to move.Lancet. 2011 Jun 4;377(9781):1896-8. doi: 10.1016/S0140-6736(11)60711-3. Lancet. 2011. PMID: 21601272 No abstract available.
Similar articles
-
Effects of Lumbosacral Spinal Cord Epidural Stimulation for Standing after Chronic Complete Paralysis in Humans.PLoS One. 2015 Jul 24;10(7):e0133998. doi: 10.1371/journal.pone.0133998. eCollection 2015. PLoS One. 2015. PMID: 26207623 Free PMC article.
-
Effects of Stand and Step Training with Epidural Stimulation on Motor Function for Standing in Chronic Complete Paraplegics.J Neurotrauma. 2017 May 1;34(9):1787-1802. doi: 10.1089/neu.2016.4516. Epub 2016 Oct 5. J Neurotrauma. 2017. PMID: 27566051 Free PMC article.
-
Recovery of sensory and supraspinal control of leg movement in people with chronic paraplegia: a case series.Arch Phys Med Rehabil. 2014 Apr;95(4):610-4. doi: 10.1016/j.apmr.2013.10.030. Epub 2013 Nov 19. Arch Phys Med Rehabil. 2014. PMID: 24269993
-
Spinal Cord Stimulation and Augmentative Control Strategies for Leg Movement after Spinal Paralysis in Humans.CNS Neurosci Ther. 2016 Apr;22(4):262-70. doi: 10.1111/cns.12530. Epub 2016 Feb 18. CNS Neurosci Ther. 2016. PMID: 26890324 Free PMC article. Review.
-
Epidural stimulation: comparison of the spinal circuits that generate and control locomotion in rats, cats and humans.Exp Neurol. 2008 Feb;209(2):417-25. doi: 10.1016/j.expneurol.2007.07.015. Epub 2007 Aug 1. Exp Neurol. 2008. PMID: 17850791 Free PMC article. Review.
Cited by
-
Unaltered Responses of Distal Motor Neurons to Non-Targeted Thoracic Spinal Cord Stimulation in Chronic Pain Patients.Pain Ther. 2024 Oct 18. doi: 10.1007/s40122-024-00670-x. Online ahead of print. Pain Ther. 2024. PMID: 39424774
-
Initial feasibility evaluation of the RISES system: An innovative and activity-based closed-loop framework for spinal cord injury rehabilitation and recovery.J Rehabil Assist Technol Eng. 2024 Oct 8;11:20556683241280242. doi: 10.1177/20556683241280242. eCollection 2024 Jan-Dec. J Rehabil Assist Technol Eng. 2024. PMID: 39421013 Free PMC article.
-
An open-access lumbosacral spine MRI dataset with enhanced spinal nerve root structure resolution.Sci Data. 2024 Oct 15;11(1):1131. doi: 10.1038/s41597-024-03919-4. Sci Data. 2024. PMID: 39406785 Free PMC article.
-
Neuromodulation in Spinal Cord Injury Using Transcutaneous Spinal Stimulation-Mapping for a Blood Pressure Response: A Case Series.Neurotrauma Rep. 2024 Sep 20;5(1):845-856. doi: 10.1089/neur.2024.0066. eCollection 2024. Neurotrauma Rep. 2024. PMID: 39391052
-
Operation of spinal sensorimotor circuits controlling phase durations during tied-belt and split-belt locomotion after a lateral thoracic hemisection.bioRxiv [Preprint]. 2024 Sep 14:2024.09.10.612376. doi: 10.1101/2024.09.10.612376. bioRxiv. 2024. PMID: 39314446 Free PMC article. Preprint.
References
-
- Grillner S. Neurobiological bases of rhythmic motor acts in vertebrates. Science. 1985;228:143–9. - PubMed
-
- Rossignol S, Barriere G, Frigon A, et al. Plasticity of locomotor sensorimotor interactions after peripheral and/or spinal lesions. Brain Res Rev. 2008;57(1):228–40. - PubMed
-
- Grillner S, Wallén P. Central pattern generators for locomotion, with special reference to vertebrates. Ann Rev Neurosci. 1985;8:233–61. - PubMed
-
- Grillner S. The motor infrastructure: from ion channels to neuronal networks. Nat Rev Neurosci. 2003;4(7):573–86. - PubMed
Publication types
MeSH terms
Grants and funding
LinkOut - more resources
Full Text Sources
Other Literature Sources
Medical
Miscellaneous