Effect of Epidural stimulation of the lumbosacral spinal cord on voluntary movement, standing, and assisted stepping after motor complete paraplegia: a case study
By S. Harkema, Y. Gerasimenko, J. Hodes, Joel W. Burdick, C. Angeli, Yangsheng Chen, Christie K. Ferreira, Andrea Willhite, E. Rejc, R. Grossman and 1 more. The Lancet, 2011
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Summary Background Repeated periods of stimulation of the spinal cord and training seems to have amplified the ability to consciously control movement. Methods An individual three years post C7-T1 subluxation presented with a complete loss of clinically detectable voluntary motor function and partial preservation of sensation below the T1 cord segment. Following 170 locomotor training sessions, a 16-electrode array was surgically placed on the dura (L1-S1 cord segments) to allow for chronic electrical stimulation. After implantation and throughout stand retraining with epidural stimulation, 29 experiments were performed. Extensive stimulation combinations and parameters were tested to achieve standing and stepping. Findings Epidural stimulation enabled the human lumbosacral spinal circuitry to dynamically elicit full weight-bearing standing with assistance provided only for balance for 4·25 minutes in a subject with a clinically motor complete SCI. This occurred when using stimulation at parameters optimized for standing while providing bilateral load-bearing proprioceptive input. Locomotor-like patterns were also observed when stimulation parameters were optimized for stepping. In addition, seven months after implantation, the subject recovered supraspinal control of certain leg movements, but only during epidural stimulation. Interpretation Even after a severe low cervical spinal injury, the neural networks remaining within the lumbosacral segments can be reactivated into functional states so that it can recognize specific details of ensembles of sensory input to the extent that it can serve as the source of neural control. In addition, newly formed supraspinal input to this same lumbosacral segments can re-emerge as another source of control. Task specific training with epidural stimulation may have reactivated previously silent spared neural circuits or promoted plasticity. This suggests that 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.
Subfields: Pathology and Forensic Medicine, Surgery
View Paper: https://www.semanticscholar.org/paper/b17887e5eeb928aa679fbc75bae1feb997061cbd
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Citations in the corpus
- The marginalized identities of sense-makers: Reframing engineering student retention (2010, background): “Leading medical journals predominantly publish large-N controlled studies, but they also continue to publish small-N and even N 5 1 case studies that illuminate mechanisms and lead to hypotheses (Harkema et al., 2011; Jungebluth et al., 2011).”
- Inverse Reinforcement Learning via Function Approximation for Clinical Motion Analysis (2017, methodology): “The electrodes configuration and stimulation signal pattern are manually selected by the clinician [1].”
- A Computational Model for Epidural Electrical Stimulation of Spinal Sensorimotor Circuits (2013, methodology): “DOI:10.1523/JNEUROSCI.1688-13.2013 Copyright © 2013 the authors 0270-6474/13/3319326-15$15.00/0 and stimulation parameter modulates specific aspects of standing, stepping, and isolated movements (Minassian et al., 2004; Courtine et al., 2009; Harkema et al., 2011; Lyalka et al., 2011).”