Neuromodulation of lumbosacral spinal networks enables independent stepping after complete paraplegia

Megan L. Gill; Peter J. Grahn; Jonathan S. Calvert; Margaux B. Linde; Igor A. Lavrov; Jeffrey A. Strommen; Lisa A. Beck; Dimitry G. Sayenko; Meegan G. Van Straaten; Dina I. Drubach; Daniel D. Veith; Andrew R. Thoreson; Cesar Lopez; Yury P. Gerasimenko; V. Reggie Edgerton; Kendall H. Lee; Kristin D. Zhao

doi:10.1038/s41591-018-0175-7

Neuromodulation of lumbosacral spinal networks enables independent stepping after complete paraplegia

Megan L. Gill, Peter J. Grahn, Jonathan S. Calvert, Margaux B. Linde, Igor A. Lavrov, Jeffrey A. Strommen, Lisa A. Beck, Dimitry G. Sayenko, Meegan G. Van Straaten, Dina I. Drubach, Daniel D. Veith, Andrew R. Thoreson, Cesar Lopez, Yury P. Gerasimenko, V. Reggie Edgerton, Kendall H. Lee, Kristin D. Zhao

Research output: Contribution to journal › Article › peer-review

144 Scopus citations

Abstract

Spinal sensorimotor networks that are functionally disconnected from the brain because of spinal cord injury (SCI) can be facilitated via epidural electrical stimulation (EES) to restore robust, coordinated motor activity in humans with paralysis^1–3. Previously, we reported a clinical case of complete sensorimotor paralysis of the lower extremities in which EES restored the ability to stand and the ability to control step-like activity while side-lying or suspended vertically in a body-weight support system (BWS)⁴. Since then, dynamic task-specific training in the presence of EES, termed multimodal rehabilitation (MMR), was performed for 43 weeks and resulted in bilateral stepping on a treadmill, independent from trainer assistance or BWS. Additionally, MMR enabled independent stepping over ground while using a front-wheeled walker with trainer assistance at the hips to maintain balance. Furthermore, MMR engaged sensorimotor networks to achieve dynamic performance of standing and stepping. To our knowledge, this is the first report of independent stepping enabled by task-specific training in the presence of EES by a human with complete loss of lower extremity sensorimotor function due to SCI.

Original language	English (US)
Pages (from-to)	1677-1682
Number of pages	6
Journal	Nature Medicine
Volume	24
Issue number	11
DOIs	https://doi.org/10.1038/s41591-018-0175-7
State	Published - Nov 1 2018

ASJC Scopus subject areas

General Biochemistry, Genetics and Molecular Biology

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Gill, M. L., Grahn, P. J., Calvert, J. S., Linde, M. B., Lavrov, I. A., Strommen, J. A., Beck, L. A., Sayenko, D. G., Van Straaten, M. G., Drubach, D. I., Veith, D. D., Thoreson, A. R., Lopez, C., Gerasimenko, Y. P., Edgerton, V. R., Lee, K. H., & Zhao, K. D. (2018). Neuromodulation of lumbosacral spinal networks enables independent stepping after complete paraplegia. Nature Medicine, 24(11), 1677-1682. https://doi.org/10.1038/s41591-018-0175-7

Gill, ML, Grahn, PJ, Calvert, JS, Linde, MB, Lavrov, IA, Strommen, JA, Beck, LA, Sayenko, DG, Van Straaten, MG, Drubach, DI, Veith, DD, Thoreson, AR, Lopez, C, Gerasimenko, YP, Edgerton, VR, Lee, KH & Zhao, KD 2018, 'Neuromodulation of lumbosacral spinal networks enables independent stepping after complete paraplegia', Nature Medicine, vol. 24, no. 11, pp. 1677-1682. https://doi.org/10.1038/s41591-018-0175-7

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abstract = "Spinal sensorimotor networks that are functionally disconnected from the brain because of spinal cord injury (SCI) can be facilitated via epidural electrical stimulation (EES) to restore robust, coordinated motor activity in humans with paralysis1–3. Previously, we reported a clinical case of complete sensorimotor paralysis of the lower extremities in which EES restored the ability to stand and the ability to control step-like activity while side-lying or suspended vertically in a body-weight support system (BWS)4. Since then, dynamic task-specific training in the presence of EES, termed multimodal rehabilitation (MMR), was performed for 43 weeks and resulted in bilateral stepping on a treadmill, independent from trainer assistance or BWS. Additionally, MMR enabled independent stepping over ground while using a front-wheeled walker with trainer assistance at the hips to maintain balance. Furthermore, MMR engaged sensorimotor networks to achieve dynamic performance of standing and stepping. To our knowledge, this is the first report of independent stepping enabled by task-specific training in the presence of EES by a human with complete loss of lower extremity sensorimotor function due to SCI.",

author = "Gill, {Megan L.} and Grahn, {Peter J.} and Calvert, {Jonathan S.} and Linde, {Margaux B.} and Lavrov, {Igor A.} and Strommen, {Jeffrey A.} and Beck, {Lisa A.} and Sayenko, {Dimitry G.} and {Van Straaten}, {Meegan G.} and Drubach, {Dina I.} and Veith, {Daniel D.} and Thoreson, {Andrew R.} and Cesar Lopez and Gerasimenko, {Yury P.} and Edgerton, {V. Reggie} and Lee, {Kendall H.} and Zhao, {Kristin D.}",

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N2 - Spinal sensorimotor networks that are functionally disconnected from the brain because of spinal cord injury (SCI) can be facilitated via epidural electrical stimulation (EES) to restore robust, coordinated motor activity in humans with paralysis1–3. Previously, we reported a clinical case of complete sensorimotor paralysis of the lower extremities in which EES restored the ability to stand and the ability to control step-like activity while side-lying or suspended vertically in a body-weight support system (BWS)4. Since then, dynamic task-specific training in the presence of EES, termed multimodal rehabilitation (MMR), was performed for 43 weeks and resulted in bilateral stepping on a treadmill, independent from trainer assistance or BWS. Additionally, MMR enabled independent stepping over ground while using a front-wheeled walker with trainer assistance at the hips to maintain balance. Furthermore, MMR engaged sensorimotor networks to achieve dynamic performance of standing and stepping. To our knowledge, this is the first report of independent stepping enabled by task-specific training in the presence of EES by a human with complete loss of lower extremity sensorimotor function due to SCI.

AB - Spinal sensorimotor networks that are functionally disconnected from the brain because of spinal cord injury (SCI) can be facilitated via epidural electrical stimulation (EES) to restore robust, coordinated motor activity in humans with paralysis1–3. Previously, we reported a clinical case of complete sensorimotor paralysis of the lower extremities in which EES restored the ability to stand and the ability to control step-like activity while side-lying or suspended vertically in a body-weight support system (BWS)4. Since then, dynamic task-specific training in the presence of EES, termed multimodal rehabilitation (MMR), was performed for 43 weeks and resulted in bilateral stepping on a treadmill, independent from trainer assistance or BWS. Additionally, MMR enabled independent stepping over ground while using a front-wheeled walker with trainer assistance at the hips to maintain balance. Furthermore, MMR engaged sensorimotor networks to achieve dynamic performance of standing and stepping. To our knowledge, this is the first report of independent stepping enabled by task-specific training in the presence of EES by a human with complete loss of lower extremity sensorimotor function due to SCI.

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Neuromodulation of lumbosacral spinal networks enables independent stepping after complete paraplegia

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