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1. Walking naturally after spinal cord injury using a brain-spine interface.

Author

Lorach H, Galvez A, Spagnolo V, Martel F, Karakas S, Intering N, Vat M, Faivre O, Harte C, Komi S, Ravier J, Collin T, Coquoz L, Sakr I, Baaklini E, Hernandez-Charpak SD, Dumont G, Buschman R, Buse N, Denison T, van Nes I, Asboth L, Watrin A, Struber L, Sauter-Starace F, Langar L, Auboiroux V, Carda S, Chabardes S, Aksenova T, Demesmaeker R, Charvet G, Bloch J, and Courtine G

Subjects
Humans, Quadriplegia etiology, Quadriplegia rehabilitation, Quadriplegia therapy, Reproducibility of Results, Leg physiology, Male, Brain physiology, Brain-Computer Interfaces, Electric Stimulation Therapy instrumentation, Electric Stimulation Therapy methods, Spinal Cord physiology, Spinal Cord Injuries complications, Spinal Cord Injuries rehabilitation, Spinal Cord Injuries therapy, Walking physiology, Neurological Rehabilitation instrumentation, Neurological Rehabilitation methods
Abstract

A spinal cord injury interrupts the communication between the brain and the region of the spinal cord that produces walking, leading to paralysis 1,2 . Here, we restored this communication with a digital bridge between the brain and spinal cord that enabled an individual with chronic tetraplegia to stand and walk naturally in community settings. This brain-spine interface (BSI) consists of fully implanted recording and stimulation systems that establish a direct link between cortical signals 3 and the analogue modulation of epidural electrical stimulation targeting the spinal cord regions involved in the production of walking 4-6 . A highly reliable BSI is calibrated within a few minutes. This reliability has remained stable over one year, including during independent use at home. The participant reports that the BSI enables natural control over the movements of his legs to stand, walk, climb stairs and even traverse complex terrains. Moreover, neurorehabilitation supported by the BSI improved neurological recovery. The participant regained the ability to walk with crutches overground even when the BSI was switched off. This digital bridge establishes a framework to restore natural control of movement after paralysis., (© 2023. The Author(s).)

Published
2023
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2. Targeted neurotechnology restores walking in humans with spinal cord injury.

Author

Wagner FB, Mignardot JB, Le Goff-Mignardot CG, Demesmaeker R, Komi S, Capogrosso M, Rowald A, Seáñez I, Caban M, Pirondini E, Vat M, McCracken LA, Heimgartner R, Fodor I, Watrin A, Seguin P, Paoles E, Van Den Keybus K, Eberle G, Schurch B, Pralong E, Becce F, Prior J, Buse N, Buschman R, Neufeld E, Kuster N, Carda S, von Zitzewitz J, Delattre V, Denison T, Lambert H, Minassian K, Bloch J, and Courtine G

Subjects
Activities of Daily Living, Computer Simulation, Electromyography, Epidural Space, Humans, Leg innervation, Leg physiology, Leg physiopathology, Locomotion physiology, Male, Motor Neurons physiology, Muscle, Skeletal innervation, Muscle, Skeletal physiology, Muscle, Skeletal physiopathology, Paralysis physiopathology, Paralysis surgery, Spinal Cord cytology, Spinal Cord physiology, Spinal Cord physiopathology, Spinal Cord Injuries physiopathology, Spinal Cord Injuries surgery, Biomedical Technology, Electric Stimulation Therapy, Paralysis rehabilitation, Spinal Cord Injuries rehabilitation, Walking physiology
Abstract

Spinal cord injury leads to severe locomotor deficits or even complete leg paralysis. Here we introduce targeted spinal cord stimulation neurotechnologies that enabled voluntary control of walking in individuals who had sustained a spinal cord injury more than four years ago and presented with permanent motor deficits or complete paralysis despite extensive rehabilitation. Using an implanted pulse generator with real-time triggering capabilities, we delivered trains of spatially selective stimulation to the lumbosacral spinal cord with timing that coincided with the intended movement. Within one week, this spatiotemporal stimulation had re-established adaptive control of paralysed muscles during overground walking. Locomotor performance improved during rehabilitation. After a few months, participants regained voluntary control over previously paralysed muscles without stimulation and could walk or cycle in ecological settings during spatiotemporal stimulation. These results establish a technological framework for improving neurological recovery and supporting the activities of daily living after spinal cord injury.

Published
2018
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