Spatiotemporal neuromodulation of the spinal cord combined with robot-assisted training in humans with spinal cord injury (STIMO): Technological and conceptual framework

We previously showed that spatiotemporal neuromodulation of the lumbar spinal cord enables the control of flexion and extension of paralyzed legs in animal models of spinal cord injury. Gravity-assisted gait rehabilitation enabled by this neuromodulation promoted a neuroplasticity of residual descending pathways that restored supraspinal control of leg motor control after spinal cord injury. Here, we introduce the technological and conceptual framework of the clinical study STIMO. The objective of STIMO is to evaluate the immediate effects of spatiotemporal neuromodulation on leg motor control, and the long-term effects of an extensive gravity-assisted training on motor recovery in eight participants with a chronic, incomplete spinal cord injury. STIMO exploits an implantable pulse generator with real-time triggering capabilities that allows closed-loop control of epidural electrical stimulation of the lumbar spinal cord. We designed and implemented wireless control systems that linked detection of residual leg movements to adjustment of the spatial location, temporal structure and parameters of stimulation. During training, a robotic platform assists trunk movements in order to maximize gravity-dependent gait interactions during highly participative locomotion within a large and safe environment. An algorithm automatically configures multidirectional forces applied to the trunk based on patient-specific needs. This gravity-assist enables natural walking in non-ambulatory individuals. In addition, monthly evaluations are performed to assess the neuromuscular and biomechanical evolution of the trained individuals. This unified framework provides a cutting-edge environment to evaluate and train individuals with spinal cord injury and offers the tools to gain insights into the potential of this combined treatment to augment neural plasticity and functional recovery after spinal cord injury.

Authors
*C. G. LE GOFF1,3, F. B. WAGNER1, J.-B. MIGNARDOT1,3, M. CAPOGROSSO6, I. SEÁÑEZ-GONZÁLEZ1, M. CABAN7, R. HEIMGARTNER1, N. FUMEAUX1, F. RASCHELLA2, A. WATRIN7, M. VAT4,7, M. AVANTHAY3, I. FODOR3, K. VAN DEN KEYBUS3, G. EBERLE3, B. SCHURCH3,5, S. CARDA3, E. PRALONG4, M. BOLLIGER8, J. VON ZITZEWITZ1, R. BUSCHMAN9, N. BUSE9, V. DELATTRE7, S. MICERA2,10, T. DENISON9, H. LAMBERT7, A. CURT8, K. MINASSIAN1,11, J. BLOCH4,3, G. COURTINE1,3;

1Ctr. for Neuroprosthetics and Brain Mind Inst., 2Ctr. for Neuroprosthetics and Inst. of Bioengineering, EPFL, Lausanne, Switzerland; 3Clin. Neurosci., 4Neurosurg., 5Neuro-urology, CHUV, Lausanne, Switzerland; 6Dept. of Med., Univ. of Fribourg, Fribourg, Switzerland; 7G-Therapeutics, Lausanne, Switzerland; 8Balgrist Univ. Hosp., Zurich, Switzerland; 9Medtronic, Minneapolis, MN; 10Biorobotics Inst., Scuola Superiore Sant’Anna, Pisa, Italy; 11Ctr. for Med. Physics and Biomed. Engin., Med. Univ. of Vienna, Vienna, Austria
Disclosures
C.G. Le Goff: None. F.B. Wagner: None. J. Mignardot: None. M. Capogrosso: None. I. Seáñez-González: None. M. Caban: A. Employment/Salary (full or part-time):; G-Therapeutics. R. Heimgartner: None. N. Fumeaux: None. F. Raschella: None. A. Watrin: A. Employment/Salary (full or part-time):; G-Therapeutics. M. Vat: A. Employment/Salary (full or part-time):; G-Therapeutics. M. Avanthay: None. I. Fodor: None. K. van den Keybus: None. G. Eberle: None. B. Schurch: None. S. Carda: None. E. Pralong: None. M. Bolliger: None. J. Von Zitzewitz: A. Employment/Salary (full or part-time):; G-Therapeutics. R. Buschman: A. Employment/Salary (full or part-time):; Medtronic. N. Buse: A. Employment/Salary (full or part-time):; Medtronic. V. Delattre: A. Employment/Salary (full or part-time):; G-Therapeutics. S. Micera: None. T. Denison: A. Employment/Salary (full or part-time):; Medtronic. H. Lambert: A. Employment/Salary (full or part-time):; G-Therapeutics. A. Curt: None. K. Minassian: None. J. Bloch: E. Ownership Interest (stock, stock options, royalty, receipt of intellectual property rights/patent holder, excluding diversified mutual funds); G-Therapeutics. G. Courtine: E. Ownership Interest (stock, stock options, royalty, receipt of intellectual property rights/patent holder, excluding diversified mutual funds); G-Therapeutics.
Grant Support
International Foundation for Research in Paraplegia (IRP)
Grant Support
Michel-Adrien Voirol Foundation
Grant Support
Firmenich Foundation
Grant Support
Pictet Group Charitable Foundation
Grant Support
Panacée Foundation
Grant Support
Canton du Valais
Grant Support
Wings for Life
Grant Support
Marie-Curie EPFL fellowship program
Grant Support
Swiss National Science Foundation including the National Center of Competence in Research (NCCR) in Robotics

LINK: Society for Neuroscience

This entry was posted in Chronic Spinal Cord Injury Research, Neuroscience Abstracts, Rehabilitation, Spinal Research. Bookmark the permalink.