Journal
BRAIN
Volume 137, Issue -, Pages 1394-1409Publisher
OXFORD UNIV PRESS
DOI: 10.1093/brain/awu038
Keywords
human spinal cord injury; epidural stimulation; voluntary movement
Categories
Funding
- US National Institutes of Health, NIBIB [R01EB007615]
- NIGMS [P30 GM103507]
- Christopher and Dana Reeve Foundation
- Leona M. and Harry B. Helmsley Charitable Trust
- Kessler Foundation
- University of Louisville Foundation
- Jewish Hospital
- St. Mary's Foundation
- Frazier Rehab Institute
- University of Louisville Hospital
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A diagnosis of motor complete spinal cord injury carries a dim prognosis for recovery. However, Angeli et al. show that epidural stimulation of the spinal cord can modulate the spinal circuitry to enable completely paralysed individuals to voluntarily control muscles of their legs and recover intentional movement years after injury.Previously, we reported that one individual who had a motor complete, but sensory incomplete spinal cord injury regained voluntary movement after 7 months of epidural stimulation and stand training. We presumed that the residual sensory pathways were critical in this recovery. However, we now report in three more individuals voluntary movement occurred with epidural stimulation immediately after implant even in two who were diagnosed with a motor and sensory complete lesion. We demonstrate that neuromodulating the spinal circuitry with epidural stimulation, enables completely paralysed individuals to process conceptual, auditory and visual input to regain relatively fine voluntary control of paralysed muscles. We show 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. We have uncovered a fundamentally new intervention strategy that can dramatically affect recovery of voluntary movement in individuals with complete paralysis even years after injury.
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