Epidural spinal-cord stimulation facilitates recovery of functional walking following incomplete spinal-cord injury

Carhart, Michael; He, Jiping; Herman, Richard; D'Luzansky, S.; Willis, Wayne T.

doi:10.1109/tnsre.2003.822763

Cited by 151 publications

(126 citation statements)

References 39 publications

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“…Epidural stimulation in combination with step training also has been reported to improve locomotor ability in clinically incomplete spinal cord subjects. The data presented to support this conclusion, however, are equivocal and complicated by the fact that the subject's injury was incomplete and had some stepping capability without the epidural stimulation/step training intervention (Carhart et al, 2004).…”

Section: Epidural Stimulationmentioning

confidence: 91%

Training locomotor networks

Edgerton

Courtine

Gerasimenko

et al. 2008

Brain Research Reviews

277

205

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For a complete adult spinal rat to regain some weight-bearing stepping capability, it appears that a sequence of specific proprioceptive inputs that are similar, but not identical, from step to step must be generated over repetitive step cycles. Furthermore, these cycles must include the activation of specific neural circuits that are intrinsic to the lumbosacral spinal cord segments. For these sensorimotor pathways to be effective in generating stepping, the spinal circuitry must be modulated to an appropriate excitability level. This level of modulation is sustained from supraspinal input in intact, but not spinal, rats. In a series of experiments with complete spinal rats, we have shown that an appropriate level of excitability of the spinal circuitry can be achieved using widely different means. For example, this modulation level can be acquired pharmacologically, via epidural electrical stimulation over specific lumbosacral spinal cord segments, and/or by use-dependent mechanisms such as step or stand training. Evidence as to how each of these treatments can "tune" the spinal circuitry to a "physiological state" that enables it to respond appropriately to proprioceptive input will be presented. We have found that each of these interventions can enable the proprioceptive input to actually control extensive details that define the dynamics of stepping over a range of speeds, loads, and directions. A series of experiments will be described that illustrate sensory control of stepping and standing after a spinal cord injury and the necessity for the "physiological state" of the spinal circuitry to be modulated within a critical window of excitability for this control to be manifested. The present findings have important consequences not only for our understanding of how the motor pattern for stepping is formed, but also for the design of rehabilitation intervention to restore lumbosacral circuit function in humans following a spinal cord injury.

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Section: Epidural Stimulationmentioning

confidence: 91%

Training locomotor networks

Edgerton

Courtine

Gerasimenko

et al. 2008

Brain Research Reviews

277

205

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“…Appropriate levels of ESCS can promote stepping movements and even locomotion in humans [96,[116][117][118] and animals (rodents and cats) [119][120] with SCIs.…”

Section: Neuroprostheses For Rehabilitationmentioning

confidence: 99%

Activity-dependent plasticity in spinal cord injury

Lynskey

Belanger²,

Jung³

2008

JRRD

142

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Abstract-The adult mammalian central nervous system (CNS) is capable of considerable plasticity, both in health and disease. After spinal neurotrauma, the degrees and extent of neuroplasticity and recovery depend on multiple factors, including the level and extent of injury, postinjury medical and surgical care, and rehabilitative interventions. Rehabilitation strategies focus less on repairing lost connections and more on influencing CNS plasticity for regaining function. Current evidence indicates that strategies for rehabilitation, including passive exercise, active exercise with some voluntary control, and use of neuroprostheses, can enhance sensorimotor recovery after spinal cord injury (SCI) by promoting adaptive structural and functional plasticity while mitigating maladaptive changes at multiple levels of the neuraxis. In this review, we will discuss CNS plasticity that occurs both spontaneously after SCI and in response to rehabilitative therapies.

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“…Epidural stimulation is also efficient in inducing locomotor rhythms in decerebrate and spinal cats (Gerasimenko et al 2003Iwahara et al 1991b) as well as spinal rats (Ichiyama et al 2005;Iwahara et al 1991a). This approach is also promising in spinal cord injured patients where rhythmic activity was evoked by epidural stimulation (Carhart et al 2004;Dimitrijevic et al 1998;Herman et al 2002;Minassian et al 2004;Shapkova and Schomburg 2001). The optimal localization to induce locomotion with epidural stimulation differed between authors, however.…”

Section: Introductionmentioning

confidence: 99%

Nonlocomotor and Locomotor Hindlimb Responses Evoked by Electrical Microstimulation of the Lumbar Cord in Spinalized Cats

Barthélemy¹,

Leblond²,

Provencher³

et al. 2006

Journal of Neurophysiology

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hindlimb responses evoked by electrical microstimulation of the lumbar cord in spinalized cats. J Neurophysiol 96: 3273-3292, 2006. First published August 30, 2006 doi:10.1152/jn.00203.2006. As a preliminary step to using intraspinal microstimulation (ISMS) for rehabilitation purposes, the distribution of various types of hindlimb responses evoked by ISMS in spinal cats (T 13 ) is described. The responses to ISMS applied through a single electrode was assessed, before and after an intravenous injection of clonidine (noradrenergic agonist), using kinematics and electromyographic recordings in subacute (5-7 days, untrained) or chronic (3-5 wk trained on a treadmill) spinal cats. ISMS was applied in the dorsal, intermediate and ventral areas of segments L 3 -L 7 , from midline to 3 mm laterally. Uni-and bilateral nonlocomotor responses as well as rhythmical locomotor responses were evoked. In the subacute cats, ipsilateral flexion was elicited in the dorsal region of L 3 -L 7 , whereas ipsilateral extension was evoked more ventrally and mainly in the caudal segments. Dorsal stimuli could induce ipsilateral flexion followed by ipsilateral extension. Sites inducing bilateral flexion and bilateral extension were similarly distributed to those evoking ipsilateral flexion and extension in the rostrocaudal axis but were evoked from more medial sites. Ipsilateral flexion with crossed extension was evoked from intermediate and ventral zones of all segments and lateralities. Unilateral ipsilateral locomotion was rarely observed. Contralateral locomotion was more frequent and mainly evoked medially, whereas bilateral locomotion was evoked exclusively from dorsal regions. With some exceptions, those distribution gradients were similar in the four conditions (subacute, chronic, pre-and postclonidine), but the proportion of each response could vary. The distribution of ISMS-evoked responses is discussed as a function of known localization of interneurons and motoneurons.

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Epidural spinal-cord stimulation facilitates recovery of functional walking following incomplete spinal-cord injury

Cited by 151 publications

References 39 publications

Training locomotor networks

Training locomotor networks

Activity-dependent plasticity in spinal cord injury

Nonlocomotor and Locomotor Hindlimb Responses Evoked by Electrical Microstimulation of the Lumbar Cord in Spinalized Cats

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