Altering Spinal Cord Excitability Enables Voluntary Movements after Chronic Complete Paralysis in Humans
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New research reveals strong evidence that epidural stimulation in patients with severe spinal cord injuries (SCI) can be effective in recovering voluntary movement. Study results are published in Brain, a medical journal with the Oxford University Press.
The study, funded in part by the Christopher & Dana Reeve Foundation and National Institutes of Health, found that four young men who were classified with a chronic motor complete spinal cord injury years were able to move their legs in the presence of epidural electrical stimulation.
The research team has uncovered a fundamentally new intervention strategy that can dramatically affect recovery of voluntary movement in individuals with complete paralysis even years after injury. The research brings up new possibilities for how to develop interventions that will help people recover movement they have lost.
The epidural stimulation process mimics signals the brain normally transmits to initiate movement and re-engages the spinal cord with its neural network to control and direct muscle movements.
When coupled with rehabilitative therapy, the impact of epidural stimulation intensified. Over the course of the study, the researchers noted that the participants were able to activate movements with less stimulation, demonstrating the ability of the spinal network to learn and improve nerve functions.
The research was conducted by an international team of scientists at the University of Louisville, UCLA and the Pavlov Institute of Physiology, and was funded in part by the Christopher & Dana Reeve Foundation and the National Institute of Biomedical Imaging and Bioengineering (NBIB), as well as the Kessler Foundation, the Leona M. and Harry B. Helmsley Charitable Trust, University of Louisville and Jewish Hospital and St. Mary's Foundation, Frazier Rehab Institute and University Hospital.
Due to the immediate results and recovery following the implantation of the epidural stimulator, researchers speculate that some sensory nerve pathways may be intact post-injury and therefore able to facilitate voluntary movements.
In addition to regaining voluntary movement in their hips, ankles and toes, the four research participants have displayed a myriad of improvements in their overall health, including the increase of muscle mass, regulation of their blood pressure, reduced fatigue and an overall transformational to their sense of well-being. Additionally, all four are able to bear weigh independently.
These results build on an initial study – published in May 2011 in Lancet – that reported recovery of a significant number of motor functions in the first participant, Rob Summers, due to epidural stimulation.
Researchers are optimistic that with continued advancements of the epidural stimulator, individuals with a complete spinal cord injury will be able to bear weight independently, maintain balance and work towards stepping.
These findings, which are reported in the neurological journal Brain, bring significant hope to the nearly six million Americans living with paralysis, including 1.275 million spinal cord injuries, who currently face no effective evidence-based treatments for spinal cord injury.