Neuromodulation of lumbosacral spinal networks enables independent stepping after complete paraplegia
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 co...
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| Veröffentlicht in: | Nature medicine 2018-11, Vol.24 (11), p.1677-1682 |
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| creator | Gill, Megan L. Grahn, Peter J. Calvert, Jonathan S. Linde, Margaux B. Lavrov, Igor A. Strommen, Jeffrey A. Beck, Lisa A. Sayenko, Dimitry G. Van Straaten, Meegan G. Drubach, Dina I. Veith, Daniel D. Thoreson, Andrew R. Lopez, Cesar Gerasimenko, Yury P. Edgerton, V. Reggie Lee, Kendall H. Zhao, Kristin D. |
| description | 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.
In a human subject with chronic paraplegia, a combination of epidural electrical stimulation and long-term rehabilitative training have culminated in the first report of unassisted, voluntary independent stepping in a paralyzed individual. |
| doi_str_mv | 10.1038/s41591-018-0175-7 |
| format | Article |
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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.
In a human subject with chronic paraplegia, a combination of epidural electrical stimulation and long-term rehabilitative training have culminated in the first report of unassisted, voluntary independent stepping in a paralyzed individual.</description><identifier>ISSN: 1078-8956</identifier><identifier>EISSN: 1546-170X</identifier><identifier>DOI: 10.1038/s41591-018-0175-7</identifier><identifier>PMID: 30250140</identifier><language>eng</language><publisher>New York: Nature Publishing Group US</publisher><subject>631/378/1687/1825 ; 631/378/2632 ; 692/700/565/491 ; Biomedical and Life Sciences ; Biomedical engineering ; Biomedicine ; Body weight ; Brain ; Cancer Research ; Care and treatment ; Electrical stimuli ; Extremities ; Fitness equipment ; Health aspects ; Hip ; Infectious Diseases ; Legs ; Letter ; Lumbosacral region ; Medicine ; Metabolic Diseases ; Methods ; Molecular Medicine ; Motor activity ; Networks ; Neural stimulation ; Neuromodulation ; Neurosciences ; Paralysis ; Paraplegia ; Patient outcomes ; Physiology ; Rehabilitation ; Sensorimotor system ; Spinal cord injuries ; Stability ; Support systems ; Training ; Weight</subject><ispartof>Nature medicine, 2018-11, Vol.24 (11), p.1677-1682</ispartof><rights>The Author(s), under exclusive licence to Springer Nature America, Inc. 2018</rights><rights>COPYRIGHT 2018 Nature Publishing Group</rights><rights>Copyright Nature Publishing Group Nov 2018</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c642t-f537b86e9d0178d92526a02dd2dd2b0cd07e631d318c92d370e56b12c1755e33</citedby><cites>FETCH-LOGICAL-c642t-f537b86e9d0178d92526a02dd2dd2b0cd07e631d318c92d370e56b12c1755e33</cites><orcidid>0000-0001-7197-9082</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1038/s41591-018-0175-7$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1038/s41591-018-0175-7$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30250140$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Gill, Megan L.</creatorcontrib><creatorcontrib>Grahn, Peter J.</creatorcontrib><creatorcontrib>Calvert, Jonathan S.</creatorcontrib><creatorcontrib>Linde, Margaux B.</creatorcontrib><creatorcontrib>Lavrov, Igor A.</creatorcontrib><creatorcontrib>Strommen, Jeffrey A.</creatorcontrib><creatorcontrib>Beck, Lisa A.</creatorcontrib><creatorcontrib>Sayenko, Dimitry G.</creatorcontrib><creatorcontrib>Van Straaten, Meegan G.</creatorcontrib><creatorcontrib>Drubach, Dina I.</creatorcontrib><creatorcontrib>Veith, Daniel D.</creatorcontrib><creatorcontrib>Thoreson, Andrew R.</creatorcontrib><creatorcontrib>Lopez, Cesar</creatorcontrib><creatorcontrib>Gerasimenko, Yury P.</creatorcontrib><creatorcontrib>Edgerton, V. Reggie</creatorcontrib><creatorcontrib>Lee, Kendall H.</creatorcontrib><creatorcontrib>Zhao, Kristin D.</creatorcontrib><title>Neuromodulation of lumbosacral spinal networks enables independent stepping after complete paraplegia</title><title>Nature medicine</title><addtitle>Nat Med</addtitle><addtitle>Nat Med</addtitle><description>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.
In a human subject with chronic paraplegia, a combination of epidural electrical stimulation and long-term rehabilitative training have culminated in the first report of unassisted, voluntary independent stepping in a paralyzed individual.</description><subject>631/378/1687/1825</subject><subject>631/378/2632</subject><subject>692/700/565/491</subject><subject>Biomedical and Life Sciences</subject><subject>Biomedical engineering</subject><subject>Biomedicine</subject><subject>Body weight</subject><subject>Brain</subject><subject>Cancer Research</subject><subject>Care and treatment</subject><subject>Electrical stimuli</subject><subject>Extremities</subject><subject>Fitness equipment</subject><subject>Health aspects</subject><subject>Hip</subject><subject>Infectious Diseases</subject><subject>Legs</subject><subject>Letter</subject><subject>Lumbosacral region</subject><subject>Medicine</subject><subject>Metabolic Diseases</subject><subject>Methods</subject><subject>Molecular Medicine</subject><subject>Motor activity</subject><subject>Networks</subject><subject>Neural stimulation</subject><subject>Neuromodulation</subject><subject>Neurosciences</subject><subject>Paralysis</subject><subject>Paraplegia</subject><subject>Patient outcomes</subject><subject>Physiology</subject><subject>Rehabilitation</subject><subject>Sensorimotor system</subject><subject>Spinal cord injuries</subject><subject>Stability</subject><subject>Support systems</subject><subject>Training</subject><subject>Weight</subject><issn>1078-8956</issn><issn>1546-170X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>8G5</sourceid><sourceid>BENPR</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNqNkltrFTEQxxex2Fr9AL7IgiD6sDWXzW7yWIqXQmlBi_gWssnsdms22SZZ1G9vltOLR44gucyQ_GbCTP5F8QKjI4wofxdrzASuEOZ5taxqHxUHmNVNhVv07XH2UcsrLlizXzyN8RohRBETT4p9ighDuEYHBZzDEvzkzWJVGr0rfV_aZep8VDooW8Z5dNk4SD98-B5LcKqzEMvRGZghby6VMcGcsaFUfYJQaj_NFhKUswoqe8OonhV7vbIRnt_aw-Lyw_vLk0_V2cXH05Pjs0o3NUlVz2jb8QaEyeVwIwgjjULEmHV2SBvUQkOxoZhrQQxtEbCmw0Tn4hlQeli82aSdg79ZICY5jVGDtcqBX6IkGBOCasp5Rl_9hV77JeRSVyq3RzSC1Q_UoCzI0fU-BaXXpPKYtRRjzMX6bLWDGsBB7qB30I_5eIs_2sHnYWAa9c6At1sBmUnwMw1qiVGefvn8_-zF12329R_sFSibrqK3yyqEuA3iDaiDjzFAL-cwTir8khjJVYpyI0WZpShXKco2x7y87fDSTWDuI-60lwGyAWK-cgOEhy_4d9bfYs3lNg</recordid><startdate>20181101</startdate><enddate>20181101</enddate><creator>Gill, Megan L.</creator><creator>Grahn, Peter J.</creator><creator>Calvert, Jonathan S.</creator><creator>Linde, Margaux B.</creator><creator>Lavrov, Igor A.</creator><creator>Strommen, Jeffrey A.</creator><creator>Beck, Lisa A.</creator><creator>Sayenko, Dimitry G.</creator><creator>Van Straaten, Meegan G.</creator><creator>Drubach, Dina I.</creator><creator>Veith, Daniel D.</creator><creator>Thoreson, Andrew R.</creator><creator>Lopez, Cesar</creator><creator>Gerasimenko, Yury P.</creator><creator>Edgerton, V. 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Reggie</au><au>Lee, Kendall H.</au><au>Zhao, Kristin D.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Neuromodulation of lumbosacral spinal networks enables independent stepping after complete paraplegia</atitle><jtitle>Nature medicine</jtitle><stitle>Nat Med</stitle><addtitle>Nat Med</addtitle><date>2018-11-01</date><risdate>2018</risdate><volume>24</volume><issue>11</issue><spage>1677</spage><epage>1682</epage><pages>1677-1682</pages><issn>1078-8956</issn><eissn>1546-170X</eissn><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.
In a human subject with chronic paraplegia, a combination of epidural electrical stimulation and long-term rehabilitative training have culminated in the first report of unassisted, voluntary independent stepping in a paralyzed individual.</abstract><cop>New York</cop><pub>Nature Publishing Group US</pub><pmid>30250140</pmid><doi>10.1038/s41591-018-0175-7</doi><tpages>6</tpages><orcidid>https://orcid.org/0000-0001-7197-9082</orcidid></addata></record> |
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| subjects | 631/378/1687/1825 631/378/2632 692/700/565/491 Biomedical and Life Sciences Biomedical engineering Biomedicine Body weight Brain Cancer Research Care and treatment Electrical stimuli Extremities Fitness equipment Health aspects Hip Infectious Diseases Legs Letter Lumbosacral region Medicine Metabolic Diseases Methods Molecular Medicine Motor activity Networks Neural stimulation Neuromodulation Neurosciences Paralysis Paraplegia Patient outcomes Physiology Rehabilitation Sensorimotor system Spinal cord injuries Stability Support systems Training Weight |
| title | Neuromodulation of lumbosacral spinal networks enables independent stepping after complete paraplegia |
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