Single Lead Epidural Spinal Cord Stimulation Targeted Trunk Control and Standing in Complete Paraplegia

J. Clin. Med., 2022 · DOI: 10.3390/jcm11175120 · Published: August 30, 2022

Simple Explanation

This case study explores using a single spinal cord stimulation lead to help someone with complete paraplegia regain trunk control and the ability to stand. The study reports that after implantation and reprogramming of a single lead, the participant experienced immediate restoration of trunk control and was able to stand. The participant, a 25-year-old male with a T3 complete SCI, had a device implanted that sent electrical pulses to his spinal cord. Initially, two leads were placed, but one migrated outside of the epidural space. The remaining lead was then configured to target specific muscles. By adjusting the settings on this single lead, researchers were able to stimulate the abdominal muscles for trunk control and the leg muscles for standing. This approach shows promise for restoring motor function in people with complete spinal cord injuries.

Study Duration

Not specified

Participants

A 25-year-old male with T3 complete AIS A

Evidence Level

Level 4, Case Report

Key Findings

1
Reprogramming a single spinal cord stimulation lead resulted in immediate restoration of trunk control during a seated position, even with upper extremity perturbation.
2
Adjusting the single lead enabled immediate standing in the participant.
3
Electromyography (EMG) confirmed the activation of the rectus abdominus and lower extremity muscles.

Research Summary

This case report details the use of a single percutaneous spinal cord epidural stimulation (scES) lead to restore trunk control and standing in a 25-year-old male with T3 complete paraplegia. After one of the two implanted leads migrated, the remaining lead was reprogrammed to target specific muscles, resulting in immediate trunk control and the ability to stand with a walker. The study suggests that targeted stimulation of lumbosacral segments using a single midline lead can effectively restore motor function in individuals with complete SCI, even before therapeutic training.

Practical Implications

Clinical Application

Percutaneous scES using a single lead can be a viable option for restoring trunk control and standing in individuals with complete SCI.

Mapping Strategies

The study highlights the importance of detailed spinal motor mapping to identify optimal stimulation configurations for targeted muscle activation.

Rehabilitation Potential

scES may enhance functional recovery by enabling motor control and facilitating supraspinal control and afferent feedback during standing and other activities.

Study Limitations

1
The study is a single case report, limiting the generalizability of the findings.
2
Lead migration occurred, which could affect the long-term efficacy and reliability of the stimulation.
3
The long-term effects of single-lead scES on motor recovery and functional independence were not assessed.

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