Enhancement of Voluntary Motor Function Following Spinal Cord Stimulation - Case Study

Barolat, Giancarlo; Myklebust, Joel B.; Wenninger, William

doi:10.1159/000100160

Cited by 27 publications

(28 citation statements)

References 9 publications

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“…Barolat et al. were among the first to report regained supraspinal control over some movements of the otherwise paralyzed lower limbs after severe SCI that was present only under epidural SCS. There, the stimulation was set to induce paresthesias in the lower limbs, but was subthreshold for muscle activation.…”

Section: Discussionmentioning

confidence: 99%

Augmentation of Voluntary Locomotor Activity by Transcutaneous Spinal Cord Stimulation in Motor‐Incomplete Spinal Cord‐Injured Individuals

et al. 2015

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The level of sustainable excitability within lumbar spinal cord circuitries is one of the factors determining the functional outcome of locomotor therapy after motor-incomplete spinal cord injury. Here, we present initial data using noninvasive transcutaneous lumbar spinal cord stimulation (tSCS) to modulate this central state of excitability during voluntary treadmill stepping in three motor-incomplete spinal cord-injured individuals. Stimulation was applied at 30 Hz with an intensity that generated tingling sensations in the lower limb dermatomes, yet without producing muscle reflex activity. This stimulation changed muscle activation, gait kinematics, and the amount of manual assistance required from the therapists to maintain stepping with some interindividual differences. The effect on motor outputs during treadmill-stepping was essentially augmentative and step-phase dependent despite the invariant tonic stimulation. The most consistent modification was found in the gait kinematics, with the hip flexion during swing increased by 11.3° ± 5.6° across all subjects. This preliminary work suggests that tSCS provides for a background increase in activation of the lumbar spinal locomotor circuitry that has partially lost its descending drive. Voluntary inputs and step-related feedback build upon the stimulation-induced increased state of excitability in the generation of locomotor activity. Thus, tSCS essentially works as an electrical neuroprosthesis augmenting remaining motor control.

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Section: Discussionmentioning

confidence: 99%

Augmentation of Voluntary Locomotor Activity by Transcutaneous Spinal Cord Stimulation in Motor‐Incomplete Spinal Cord‐Injured Individuals

et al. 2015

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“…Yet, SCS could generate full weight-bearing standing without manual facilitation when the stimulation frequency was set at 15 Hz. Additionally, 7 months after implantation, epidural SCS revealed residual voluntary control of some lower limb movements that was only present when stimulation was supplied (see also [79]). …”

Section: Epidural Lumbar Spinal Cord Stimulation For the Generation Omentioning

confidence: 96%

Neuromodulation of lower limb motor control in restorative neurology

Minassian

Hofstoetter

Tansey

et al. 2012

Clinical Neurology and Neurosurgery

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One consequence of central nervous system injury or disease is the impairment of neural control of movement, resulting in spasticity and paralysis. To enhance recovery, restorative neurology procedures modify altered, yet preserved nervous system function. This review focuses on functional electrical stimulation (FES) and spinal cord stimulation (SCS) that utilize remaining capabilities of the distal apparatus of spinal cord, peripheral nerves and muscles in upper motor neuron dysfunctions. FES for the immediate generation of lower limb movement along with current rehabilitative techniques is reviewed. The potential of SCS for controlling spinal spasticity and enhancing lower limb function in multiple sclerosis and spinal cord injury is discussed. The necessity for precise electrode placement and appropriate stimulation parameter settings to achieve therapeutic specificity is elaborated. This will lead to our human work of epidural and transcutaneous stimulation targeting the lumbar spinal cord for enhancing motor functions in spinal cord injured people, supplemented by pertinent human research of other investigators. We conclude that the concept of restorative neurology recently received new appreciation by accumulated evidence for locomotor circuits residing in the human spinal cord. Technological and clinical advancements need to follow for a major impact on the functional recovery in individuals with severe damage to their motor system.

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“…Thirty years ago, these residual translesional connections were recognized as potential basis for future recovery strategies . Clinical studies in multiple sclerosis and SCI revealed many cases of motor function augmented and voluntary movement enabled by SCS. Edgerton, Harkema and colleagues recently revisited this therapeutic potential of SCS in four individuals with (motor‐)complete SCI .…”

Section: Limited Translesional Descending Input As a Source Of Contromentioning

confidence: 99%

Spinal Cord Stimulation and Augmentative Control Strategies for Leg Movement after Spinal Paralysis in Humans

Minassian

Hofstoetter

2016

CNS Neurosci Ther

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Severe spinal cord injury is a devastating condition, tearing apart long white matter tracts and causing paralysis and disability of body functions below the lesion. But caudal to most injuries, the majority of neurons forming the distributed propriospinal system, the localized gray matter spinal interneuronal circuitry, and spinal motoneuron populations are spared. Epidural spinal cord stimulation can gain access to this neural circuitry. This review focuses on the capability of the human lumbar spinal cord to generate stereotyped motor output underlying standing and stepping, as well as full weight-bearing standing and rhythmic muscle activation during assisted treadmill stepping in paralyzed individuals in response to spinal cord stimulation. By enhancing the excitability state of the spinal circuitry, the stimulation can have an enabling effect upon otherwise "silent" translesional volitional motor control. Strategies for achieving functional movement in patients with severe injuries based on minimal translesional intentional control, task-specific proprioceptive feedback, and next-generation spinal cord stimulation systems will be reviewed. The role of spinal cord stimulation can go well beyond the immediate generation of motor output. With recently developed training paradigms, it can become a major rehabilitation approach in spinal cord injury for augmenting and steering trans- and sublesional plasticity for lasting therapeutic benefits.

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Enhancement of Voluntary Motor Function Following Spinal Cord Stimulation - Case Study

Cited by 27 publications

References 9 publications

Augmentation of Voluntary Locomotor Activity by Transcutaneous Spinal Cord Stimulation in Motor‐Incomplete Spinal Cord‐Injured Individuals

Augmentation of Voluntary Locomotor Activity by Transcutaneous Spinal Cord Stimulation in Motor‐Incomplete Spinal Cord‐Injured Individuals

Neuromodulation of lower limb motor control in restorative neurology

Spinal Cord Stimulation and Augmentative Control Strategies for Leg Movement after Spinal Paralysis in Humans

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