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Effect of epidural stimulation of the lumbosacral spinal cord on voluntary movement, standing, and assisted stepping after motor complete paraplegia: a case study

Harkema, Susan and Gerasimenko, Yury and Hodes, Jonathan and Burdick, Joel and Angeli, Claudia and Chen, Yangsheng and Ferreira, Christie and Willhite, Andrea and Rejc, Enrico and Grossman, Robert G. and Edgerton, V. Reggie (2011) Effect of epidural stimulation of the lumbosacral spinal cord on voluntary movement, standing, and assisted stepping after motor complete paraplegia: a case study. Lancet, 377 (9781). pp. 1938-1947. ISSN 0140-6736 . https://resolver.caltech.edu/CaltechAUTHORS:20110706-083953684

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Abstract

Background: Repeated periods of stimulation of the spinal cord and training increased the ability to control movement in animal models of spinal cord injury. We hypothesised that tonic epidural spinal cord stimulation can modulate spinal circuitry in human beings into a physiological state that enables sensory input from standing and stepping movements to serve as a source of neural control to undertake these tasks. Methods: A 23-year-old man who had paraplegia from a C7–T1 subluxation as a result of a motor vehicle accident in July 2006, presented with complete loss of clinically detectable voluntary motor function and partial preservation of sensation below the T1 cord segment. After 170 locomotor training sessions over 26 months, a 16-electrode array was surgically placed on the dura (L1–S1 cord segments) in December 2009, to allow for chronic electrical stimulation. Spinal cord stimulation was done during sessions that lasted up to 250 min. We did 29 experiments and tested several stimulation combinations and parameters with the aim of the patient achieving standing and stepping. Findings: Epidural stimulation enabled the man to achieve full weight-bearing standing with assistance provided only for balance for 4·25 min. The patient achieved this standing during stimulation using parameters identified as specific for standing while providing bilateral load-bearing proprioceptive input. We also noted locomotor-like patterns when stimulation parameters were optimised for stepping. Additionally, 7 months after implantation, the patient recovered supraspinal control of some leg movements, but only during epidural stimulation. Interpretation: Task-specific training with epidural stimulation might reactivate previously silent spared neural circuits or promote plasticity. These interventions could be a viable clinical approach for functional recovery after severe paralysis.


Item Type:Article
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http://dx.doi.org/10.1016/S0140-6736(11)60547-3DOIUNSPECIFIED
http://www.sciencedirect.com/science/article/pii/S0140673611605473PublisherUNSPECIFIED
Additional Information:© 2011 Elsevier Ltd. Available online 19 May 2011. This study was funded by the National Institutes of Health and Christopher and Dana Reeve Foundation. We thank Milan Dimitrijevic, Karen Minassian, Frank Rattay, and Antonio Buccalo for the conceptual and technical formulation of the present experiments; Michael Sofroniew, David Magnuson, and Jeff rey Petruska for their feedback on the manuscript; and the research team members who did experiments and provided intense training. Finally, we thank the research patient whose dedication, motivation, and perseverance made these findings possible.
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Christopher and Dana Reeve FoundationUNSPECIFIED
Issue or Number:9781
Record Number:CaltechAUTHORS:20110706-083953684
Persistent URL:https://resolver.caltech.edu/CaltechAUTHORS:20110706-083953684
Official Citation:Susan Harkema, Yury Gerasimenko, Jonathan Hodes, Joel Burdick, Claudia Angeli, Yangsheng Chen, Christie Ferreira, Andrea Willhite, Enrico Rejc, Robert G Grossman, V Reggie Edgerton, Effect of epidural stimulation of the lumbosacral spinal cord on voluntary movement, standing, and assisted stepping after motor complete paraplegia: a case study, The Lancet, Volume 377, Issue 9781, 4 June 2011-10 June 2011, Pages 1938-1947, ISSN 0140-6736, DOI: 10.1016/S0140-6736(11)60547-3. (http://www.sciencedirect.com/science/article/pii/S0140673611605473)
Usage Policy:No commercial reproduction, distribution, display or performance rights in this work are provided.
ID Code:24310
Collection:CaltechAUTHORS
Deposited By: Ruth Sustaita
Deposited On:06 Jul 2011 16:14
Last Modified:03 Oct 2019 02:55

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