In a recent clinical study out of Lausanne University Hospital in Switzerland, neuroscientist Jocelyne Bloch and her team of researchers tested the viability of closed-loop Epidural Electrical Stimulation (EES) for patients with chronic incomplete spinal cord injury (SCI). They wanted to see if the implanted neurostimulator, along with overground robot assisted rehabilitation training, would help patients regain the ability to walk.
Spinal cord injuries often result in significant damage to long nerve fibers called axons, which are responsible for carrying nerve impulses to and away from the brain. In an able-bodied person, these axons run sensory input (like the classic example of pain from touching a hot stove) to the brain, which then sends an impulse back in response (i.e. the reflex to yank your hand away from the stove). After a SCI, however, these axons can be physically severed, unable to regrow and resume communication with the brain due to the presence of heavy scar tissue. In essence, this scar tissue creates a roadblock that reduces or eliminates the patient’s control over some or all of their body.
Using years of prior research on SCI and the axons involved, Bloch’s team identified specific bundles of nerve fibers which exist in and exit the lower spine. Because different nerve bundles stimulate different muscle groups, the researchers got to work using cadavers, MRI, and CT scans to investigate the potential of stimulating specific bundles and producing movement in various areas of the body. After developing a virtual model that allowed them to explore how an implanted electrode’s location may impact nerve stimulation, the team produced an implant with 16 individual electrodes that would allow control over which bundles were activated.
Bloch and her colleagues then recruited three patient volunteers, each of whom had lost use of their legs following incomplete SCI, to receive the implant. Afterward the researchers conducted fine-tuning of the implant while the patients were lying down, eliminating any unwanted movements. Within a day, the patients were able to take steps on a treadmill as long as they were supported.
The following days involved fine-tuning and overground robot assisted rehabilitation (a type of rehabilitation training sometimes seen with paralyzed patients, in which a harness is utilized to support the patient’s body weight). Three days of practice enabled the patients to walk around the room with sufficient support; further along, they were able to stand without external support and take steps using only a walker. Separate programs allowed the patients to ride bicycles and paddle a kayak, while one patient in particular gained the ability to climb stairs. Rehabilitation training at Lausanne University Hospital lasted about six months in total, though the patients were provided with a home-use system to complement their training outside of the hospital.
Bloch and her team hope to produce additional electrode arrangements that will help recover motor abilities in other parts of the body, while also personalizing the electrode arrangement for individual patients. Though it involves quite an invasive procedure, this clinical study offers promise to patients with SCI who have lost movement in their limbs.
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