Walking naturally after spinal cord injury using a brain-spine interface.

A spinal cord injury interrupts the communication between the brain and the region of the spinal cord that produces walking, leading to paralysis1,2. Here, we restored this communication with a digital bridge between the brain and spinal cord that enabled an individual with chronic tetraplegia to stand and walk naturally in community settings. This brain-spine interface (BSI) consists of fully implanted recording and stimulation systems that establish a direct link between cortical signals3 and the analogue modulation of epidural electrical stimulation targeting the spinal cord regions involved in the production of walking4-6. A highly reliable BSI is calibrated within a few minutes. This reliability has remained stable over one year, including during independent use at home. The participant reports that the BSI enables natural control over the movements of his legs to stand, walk, climb stairs and even traverse complex terrains. Moreover, neurorehabilitation supported by the BSI improved neurological recovery. The participant regained the ability to walk with crutches overground even when the BSI was switched off. This digital bridge establishes a framework to restore natural control of movement after paralysis.

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

Epidural electrical stimulation (EES) targeting the dorsal roots of lumbosacral segments restores walking in people with spinal cord injury (SCI). However, EES is delivered with multielectrode paddle leads that were originally designed to target the dorsal column of the spinal cord. Here, we hypothesized that an arrangement of electrodes targeting the ensemble of dorsal roots involved in leg and trunk movements would result in superior efficacy, restoring more diverse motor activities after the most severe SCI. To test this hypothesis, we established a computational framework that informed the optimal arrangement of electrodes on a new paddle lead and guided its neurosurgical positioning. We also developed software supporting the rapid configuration of activity-specific stimulation programs that reproduced the natural activation of motor neurons underlying each activity. We tested these neurotechnologies in three individuals with complete sensorimotor paralysis as part of an ongoing clinical trial ( www.clinicaltrials.gov identifier NCT02936453). Within a single day, activity-specific stimulation programs enabled these three individuals to stand, walk, cycle, swim and control trunk movements. Neurorehabilitation mediated sufficient improvement to restore these activities in community settings, opening a realistic path to support everyday mobility with EES in people with SCI.

High-heeled walking decreases lumbar lordosis.

An estimated 78% of women regularly walk in high heels. However, up to 58% complain about low back pain, which is commonly thought to be caused by increased lumbar lordosis. However, the extent to which a subject's posture is modified by high-heeled shoes during dynamic activities remains unknown. Therefore, we sought to evaluate whether low- or high-heeled shoes influence the kinematics of the pelvis and the spine during walking. Twenty-three inexperienced women, and seventeen women experienced in wearing high-heeled shoes, all aged 20-55 years, were measured barefoot and while wearing low- (4cm) and high-heeled (10cm) shoes during gait at a self-selected speed. A 22-camera motion capture system was used to assess the gait patterns for each condition. No significant inter-experience-group kinematic differences were found. In contrast to the results of some studies, our results show that the heels' height does indeed influence the motion of the pelvis and the spine during walking, whereby low-heeled shoes influenced the subjects' trunk kinematics during gait less than high-heeled shoes compared to barefooted walking. However, inexperienced high-heel wearers showed less thoracic curvature angle while wearing high-heels than while wearing low-heels. Importantly, both groups exhibited significantly lower maximum and minimal lumbar and thoracic curvature angles when wearing high-heeled shoes compared to the barefoot condition. As a result, it seems that low back pain might be associated with other factors induced by high-heels.