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Nat Med. 2018 Nov;24(11):1677-1682. doi: 10.1038/s41591-018-0175-7. Epub 2018 Sep 24.

Neuromodulation of lumbosacral spinal networks enables independent stepping after complete paraplegia.

Author information

1
Rehabilitation Medicine Research Center, Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA.
2
Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA.
3
Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic, Rochester, MN, USA.
4
Department of Biomedical Engineering, Mayo Clinic, Rochester, Minnesota, USA.
5
Institute of Fundamental Medicine and Biology, Kazan Federal University, Kazan, Russia.
6
Department of Integrative Biology and Physiology, University of California Los Angeles, Los Angeles, CA, USA.
7
Department of Neurosurgery, Center for Neuroregeneration, Houston Methodist Research Institute, Houston, TX, USA.
8
Pavlov Institute of Physiology, Russian Academy of Sciences, St. Petersburg, Russia.
9
Rehabilitation Medicine Research Center, Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA. lee.kendall@mayo.edu.
10
Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA. lee.kendall@mayo.edu.
11
Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, USA. lee.kendall@mayo.edu.
12
Rehabilitation Medicine Research Center, Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA. zhao.kristin@mayo.edu.
13
Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, USA. zhao.kristin@mayo.edu.

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.

PMID:
30250140
DOI:
10.1038/s41591-018-0175-7

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