RESUMO
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.
Assuntos
Traumatismos da Medula Espinal , Estimulação da Medula Espinal , Humanos , Perna (Membro) , Paralisia/reabilitação , Medula Espinal/fisiologia , Traumatismos da Medula Espinal/reabilitação , Caminhada/fisiologiaRESUMO
Spasticity is a common sign of central nervous system lesions and its management is difficult because it is usually associated with other symptoms of upper motoneuron syndrome (paresis, spastic dystonia, contractures, ). We propose an interprofessional evaluation, which demonstrates that a standardized evaluation, a common approach and a gait analysis improve the therapeutic decision.
La spasticité est très fréquente après une lésion du système nerveux central, et sa prise en charge demeure difficile, car elle se combine avec d'autres symptômes caractéristiques du syndrome du motoneurone supérieur (parésie, dystonie spastique, contractures ). Afin de faciliter le choix thérapeutique, nous présentons le modèle d'une évaluation interprofessionnelle, qui démontre qu'une évaluation standardisée, une approche commune et une analyse de la marche permettent une meilleure prise en charge thérapeutique.
Assuntos
Sistema Nervoso Central/lesões , Sistema Nervoso Central/fisiopatologia , Espasticidade Muscular/diagnóstico , Espasticidade Muscular/terapia , Análise da Marcha , Humanos , Espasticidade Muscular/fisiopatologiaRESUMO
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 stimulation to the lumbosacral spinal cord with timing that coincided with the intended movement. Within one week, this spatiotemporal stimulation had re-established adaptive control of paralysed muscles during overground walking. Locomotor performance improved during rehabilitation. After a few months, participants regained voluntary control over previously paralysed muscles without stimulation and could walk or cycle in ecological settings during spatiotemporal stimulation. These results establish a technological framework for improving neurological recovery and supporting the activities of daily living after spinal cord injury.
