Gait rehabilitation enabled by epidural electrical stimulation of lumbar segments in a person with a chronic incomplete SCI

Various studies in animal models showed that robot-assisted gait rehabilitation enabled by epidural electrical stimulation of the lumbar spinal cord improves the recovery of leg motor control after spinal cord injury. Recent studies showed that this stimulation is also capable of activating lumbar spinal circuits in paraplegic people. Here, we conducted a preliminary study to evaluate the therapeutic impact of a gait rehabilitation program enabled by an overground robotic bodyweight support and continuous epidural electrical stimulation in a non-ambulatory person with a chronic incomplete spinal cord injury. The participant suffered a herniated disc collapse at the cervical level, which led to severe deficits on the left leg and moderate impairments on the right leg (AIS-C). After following a conventional rehabilitation program for more than one year after injury, she was not able to walk overground, even with assistive devices. She had previously been implanted with an epidural electrode array over lumbar spinal cord segments to alleviate neuropathic pain in the legs. We searched the electrode configurations in this array that targeted the muscles that the participant could not access voluntarily. Continuous stimulation through these electrode configurations improved a number of relevant gait parameters during locomotion. The participant then underwent a gait rehabilitation program that was conducted overground using a multidirectional robotic support system, and facilitated with the personalized stimulation protocols. After completion of the gait rehabilitation program, the participant was able to use a walker to progress overground without robotic assistance and without stimulation. Her WISCI-II score had thus increased from zero to thirteen, while her AIS score converted from C to D. Urodynamic examination revealed the disappearance of uninhibited bladder contractions and detrusor sphincter dyssynergia. This study provides preliminary evidence that robot-assisted gait rehabilitation enabled by epidural electrical stimulation may promote clinically relevant neurological improvements that persist without stimulation.

Abstract Authors
*C. G. LE GOFF1,3, J.-B. MIGNARDOT1,3, R. VAN DEN BRAND1,3, M. CAPOGROSSO2, I. FODOR4, G. EBERLE4, B. SCHURCH5, S. CARDA3,4, J. VON ZITZEWITZ1, J. BLOCH3,6, G. COURTINE1,3;
1Brain Mind Institute, Ctr. for Neuroprosthetics, 2Ctr. for Neuroprosthetics, Inst. of Bioengineering, Ecole Polytechnique Federale De Lausanne, Lausanne, Switzerland; 3Clin. Neurosci., 4Neurorehabilitation, 5Neuro-urology, 6Neurosurg., Univ. Hosp. of Vaud (CHUV), Lausanne, Switzerland
Disclosures
C.G. Le Goff: None. J. Mignardot: None. R. van den Brand: None. M. Capogrosso: None. I. Fodor: None. G. Eberle: None. B. Schurch: None. S. Carda: None. J. von Zitzewitz: None. J. Bloch: None. G. Courtine: None.

LINK: Session 158 – Spinal Cord Injury and Plasticity

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