Altering spinal cord excitability enables voluntary movements after chronic complete paralysis in humans

Brain, 2014 · DOI: 10.1093/brain/awu038 · Published: May 1, 2014

Spinal Cord Injury Neurology Neurorehabilitation

Simple Explanation

This research shows that people with complete paralysis can regain some voluntary movement with the help of epidural stimulation. This stimulation helps to activate the spinal cord, allowing individuals to process signals from the brain and control their muscles. The study involved implanting a device that sends electrical signals to the spinal cord. This device, along with training, helped patients to move their legs in response to commands and even to visual or auditory cues. The findings suggest that even years after a spinal cord injury, the spinal cord can still be stimulated to enable movement. This offers a new approach for treating paralysis and improving the quality of life for affected individuals.

Study Duration

Not specified

Participants

4 males with complete paralysis

Evidence Level

Level IV, Case Series

Key Findings

1
Epidural stimulation of the lumbosacral spinal cord enables individuals with chronic complete motor paralysis to execute intentional movements of the legs.
2
Participants could modulate motor tasks according to visual and auditory cues, demonstrating high-fidelity sensorimotor translation.
3
Repetitive training with epidural stimulation resulted in increased voluntary effort with higher forces and lower stimulation voltages in some individuals.

Research Summary

This study demonstrates that individuals with chronic complete motor paralysis can regain voluntary control of leg movements with epidural stimulation of the lumbosacral spinal cord. The research highlights the ability of the spinal circuitry to process sensory information and execute movements in response to visual and auditory cues, even after years of complete paralysis. The findings suggest a new intervention strategy for improving motor function in individuals with complete paralysis, emphasizing the importance of neuromodulation and activity-dependent plasticity.

Practical Implications

Therapeutic Interventions

Epidural stimulation with activity-dependent plasticity can be used to develop effective therapeutic interventions for recovery of movement in individuals with chronic complete motor paralysis.

Reclassification of Paralysis

The study emphasizes the importance of reconsidering the mechanisms contributing to paralysis and resolving the uncertainty associated with classifying a patient as clinically complete.

Future Technology

Future experiments with improved technology are needed to take the most advantage functionally of these neurophysiological findings in people after severe spinal cord injury.

Study Limitations

1
The exact mechanisms that enabled these surprising results cannot be definitively identified.
2
The acquired ability to have fine motor control and fidelity of movement in the presence of epidural stimulation currently has limitations when attempting to translate functional benefit to daily life.
3
The lack of a usable interactive patient interface with embedded control algorithms makes the movements as used before injury limited.

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