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Reversing 21 years of chronic paralysis via non-invasive spinal cord neuromodulation: a case study.

ABSTRACT: OBJECTIVE:The objective of the current study was to investigate if a non-invasive spinal cord neuromodulation modality could restore sensorimotor functions in a patient with chronic spinal cord injury (SCI). METHODS:In this study, transcutaneous electrical stimulation (tES) to the spinal cord was utilized to restore sensorimotor functions in a chronic SCI patient who sustained a traumatic C7 cervical cord injury 21 years ago. At baseline, the patient had very limited volitional movement in her right leg, and her left leg was completely paralyzed. tES parameters were optimized in eight stimulation sessions before the treatment. The therapeutic stimulation involved biphasic tES, applied to T11 and L1 spinal levels during a 1-hour standing and walking training, 2-4 times per week for 16 weeks. RESULTS:Our pre-treatment tests indicated that a shorter burst duration (100 µsec) was more effective than a longer burst duration of tES in improving functional movements. After 32 training sessions with tES, the patient regained significant left-leg volitional movements (grade 0 to grade 10 according to the ISNCSCI scale). Right-leg motor scores also increased from 17 to 21. The tES treatment also improved her pinprick sensation (from 73 to 79). Upon completion of the treatment (52 sessions), the patient's standing ability noticeably improved. She could stabilize her knee to stand without any assistance. She could also squat while holding onto a walker. INTERPRETATION:These promising results demonstrate beneficial effects of non-invasive tES in regaining volitional control of plegic lower limbs in patients with chronic paralysis.

SUBMITTER: Alam M

PROVIDER: S-EPMC7261759 | biostudies-literature | 2020 May

REPOSITORIES: biostudies-literature

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Reversing 21 years of chronic paralysis via non-invasive spinal cord neuromodulation: a case study.

Alam Monzurul M Ling Yan To YT Wong Arnold Y L AYL Zhong Hui H Edgerton Victor Reggie VR Zheng Yong-Ping YP

Annals of clinical and translational neurology 20200520 5

<h4>Objective</h4>The objective of the current study was to investigate if a non-invasive spinal cord neuromodulation modality could restore sensorimotor functions in a patient with chronic spinal cord injury (SCI).<h4>Methods</h4>In this study, transcutaneous electrical stimulation (tES) to the spinal cord was utilized to restore sensorimotor functions in a chronic SCI patient who sustained a traumatic C7 cervical cord injury 21 years ago. At baseline, the patient had very limited volitional mo ...[more]

PMID: 32436278

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Project description:Paralysis of the upper extremities following cervical spinal cord injury (SCI) significantly impairs one's ability to live independently. While regaining hand function or grasping ability is considered one of the most desired functions in tetraplegics, limited therapeutic development in this direction has been demonstrated to date in humans with a high severe cervical injury. The underlying hypothesis is that after severe cervical SCI, nonfunctional sensory-motor networks within the cervical spinal cord can be transcutaneously neuromodulated to physiological states that enable and amplify voluntary control of the hand. Improved voluntary hand function occurred within a single session in every subject tested. After eight sessions of non-invasive transcutaneous stimulation, combined with training over 4 weeks, maximum voluntary hand grip forces increased by ∼325% (in the presence of stimulation) and ∼225% (when grip strength was tested without simultaneous stimulation) in chronic cervical SCI subjects (American Spinal Injury Association Impairment Scale [AIS] B, n = 3; AIS C, n = 5) 1-21 years post-injury). Maximum grip strength improved in both the left and right hands and the magnitude of increase was independent of hand dominance. We refer to the neuromodulatory method used as transcutaneous enabling motor control to emphasize that the stimulation parameters used are designed to avoid directly inducing muscular contractions, but to enable task performance according to the subject's voluntary intent. In some subjects, there were improvements in autonomic function, lower extremity motor function, and sensation below the level of the lesion. Although a neuromodulation-training effect was observed in every subject tested, further controlled and blinded studies are needed to determine the responsiveness of a larger and broader population of subjects varying in the type, severity, and years post-injury. It appears rather convincing, however, that a "central pattern generation" phenomenon as generally perceived in the lumbosacral networks in controlling stepping neuromodulator is not a critical element of spinal neuromodulation to regain function among spinal networks.

Dataset Information

Reversing 21 years of chronic paralysis via non-invasive spinal cord neuromodulation: a case study.

Publications

Reversing 21 years of chronic paralysis via non-invasive spinal cord neuromodulation: a case study.

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