Neurostimulation on lumbosacral nerves as a new treatment for spinal cord injury impairments and its impact on cortical activity: a narrative review

Frontiers in Human Neuroscience, 2024 · DOI: 10.3389/fnhum.2024.1478423 · Published: December 13, 2024

Spinal Cord Injury Neurology Rehabilitation

Simple Explanation

Spinal cord injuries (SCI) disrupt neural connections, leading to motor, sensory, and autonomic dysfunction. This review focuses on a promising rehabilitation technique called laparoscopic implantation of neuroprosthesis (LION). The LION technique involves surgically implanting electrodes on lumbosacral nerves to stimulate paralyzed muscles. Recent studies show improvements in mobility, sexual function, and bladder/bowel control in SCI patients after LION therapy. This review explores the physiological mechanisms behind these improvements, such as neuroplasticity and autonomic activity modulation. It also discusses potential future applications and modifications of the LION therapy.

Study Duration

Not specified

Participants

30 subjects with chronic spinal cord injury in Lemos et al. (2023)

Evidence Level

Narrative Review

Key Findings

1
The LION procedure has shown improvements in mobility, with some patients regaining walker-assisted gait, especially in their homes. Patients also became less dependent on adapted environments.
2
Nearly half of the patients improved their urinary incontinence category, experiencing fewer leakage episodes. Nighttime urinary incontinence also improved in a significant percentage of patients.
3
Most patients experienced a reduction in bowel movement time, aligning with findings from sacral anterior root stimulator (SARS) studies, which reported enhanced bowel management and reduced reliance on laxatives.

Research Summary

This review outlines the etiology, physiological consequences, and long-term impacts of SCI under neuromodulation therapies, focusing on the potential of the laparoscopic implantation of neuroprosthesis (LION) procedure as an innovative approach for SCI rehabilitation. Lemos et al. (2023) demonstrated how the LION procedure, conjugated with rehabilitation, can rescue different physiological functions of patients with spinal cord injury. The procedure had a significant impact on mobility measures, with all patients showing improvement in mobility and most patients able to initiate gait training. Observations also revealed that patients with complete SCI experienced measurable recovery in tactile sensitivity after undergoing the LION procedure. These results suggest there must be some flow of ascending information from the stimulated nerves to the somatosensory cortex.

Practical Implications

Improved Rehabilitation Outcomes

Neuromodulation techniques like LION, when combined with traditional rehabilitation, can offer enhanced recovery of motor, sensory, and autonomic functions for individuals with SCI.

Personalized Treatment Strategies

The LION procedure requires individualized programming to cater to the specific injury characteristics and functional goals of each patient, suggesting the need for personalized neuromodulation protocols.

Integration with BCI

Integrating the LION procedure with brain-computer interface (BCI) approaches could eliminate the need for remote control commands, creating a direct link between neural signals and sensory feedback, thus optimizing rehabilitation outcomes.

Study Limitations

1
Accessibility, affordability, durability, feasibility, and scalability of the LION approaches still need to be improved.
2
The LION procedure often requires individualized programming, which can present challenges in standardizing the approach.
3
A more in-depth understanding of the mechanisms underlying the LION procedure is crucial.

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