Research: Targeted neurotechnology restores walking in humans with spinal cord injury

046 spinal cord stimulation 3

The therapy is promising, but it is not a cure due to the different natures of the many spinal cord injuries out there.

"All the patients could walk using body weight support within one week", says Blotch.

Sebastian Tobler's spinal cord injury was so severe that doctors were not able to offer him a walking rehabilitation program, so he built himself a recumbent hand tricycle - which has since had electrical stimulation technology added.

The handful of results "is giving us a lot of confidence that this solution is real and even people with complete paralysis can regain stepping movements", says Chet Moritz, an associate professor of rehabilitation medicine at the University of Washington, who wrote an accompanying editorial in Nature about the most recent findings. However, scientists think that the treatment will become more and more popular during following years.

The researchers had to adjust the details for each of the three patients in the study, adapting to the individual measurements of each person's spinal cord.

The implant is placed beneath the dura mater, directly onto the spinal cord. "The targeted stimulation must be as precise as a Swiss watch".

"These neural pathways are by and large still intact and viable", says Chad Bouton, the director of the Center for Bioelectronic Medicine at the Feinstein Institute for Medical Research in NY, who wasn't involved in the latest study.

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The research represents cutting-edge progress in the field of spinal cord injuries, according to Sylvia Gustin, neuroscientist and psychologist at Neuroscience Research Australia (NeuRA) and the University of New South Wales, who was not involved in the study. Any natural information coming up from the leg into the spine-like physical sensations and position in space-might collide with the stimulator's artificial signal, causing them to cancel each other out. This device, manufactured by Medtronic, is already on the market for deep brain stimulation for Parkinson's disease.

David Mzee, 28, suffered full paralysis of his left leg after an accident in 2010, but after the five-month program, he can walk for up to two hours with a walker using electrical stimulation, or take steps over shorter distances by himself.

"If you stimulate the entire spinal cord, you will activate all the muscles at the same time and block leg movement", Courtine said. "It's turning up the volume, turning up the excitability of the spinal circuits below the injury".

"This is intense training, and without [patients having] the will to recover it would not work", he said. Courtine, G. (2018). Electrical spinal cord stimulation must preserve proprioception to enable locomotion in humans with spinal cord injury.

Courtine and his team used the tablet to turn the pattern of stimulation on and off depending on where the participants' feet were in relation to the ground.

Lead researcher Gregoire Courtine said the targeted stimulation technique works by reconnecting communication pathways between the legs and the brain, which have been damaged by a spinal injury. They even built personalized model spinal cords to lie in an electricity-conducting salty fluid, allowing the team to work out precisely where each electrode needed to be inserted during surgery. Walking actually came in fourth, behind sexual function, bladder and bowel movement, and the ability to control body posture. This implant helped them walk.



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