A case study of percutaneous epidural stimulation to enable motor control in two men after spinal cord injury

Nature Communications, 2023 · DOI: 10.1038/s41467-023-37845-7 · Published: April 21, 2023

Simple Explanation

This study investigated the use of percutaneous spinal cord epidural stimulation (SCES) in two men with complete spinal cord injury to improve motor control. The participants received temporary and permanent SCES implants, and spinal mapping was performed to optimize stimulation configurations for volitional movement, standing, and stepping. The results showed that SCES enabled increased muscle activation and movement below the injury level, reduced assistance during exoskeleton-assisted walking, and, in one participant, enabled independent standing and stepping.

Study Duration

12 Months

Participants

Two men with chronic motor complete spinal cord injury

Evidence Level

Level IV, Case Study

Key Findings

1
Percutaneous SCES enabled voluntary increased muscle activation and movement below the injury in both participants.
2
Both participants voluntarily modulated induced torques but not always in the intended directions.
3
One participant achieved independent standing with minimal upper extremity self-balance assistance, independent stepping in parallel bars, and overground ambulation with a walker.

Research Summary

This case report describes early results of two persons with clinically sensory-motor complete and a motor complete SCI enrolled in a clinical trial investigating the effects of percutaneous SCES for motor function We report enabling of various voluntary movements, and enhancement of muscle activity and physical performance during exoskeleton-assisted walking (EAW) in both participants. The current report shows percutaneous SCES may enable motor control leading to functional improvements not possible with SCES off.

Practical Implications

Rehabilitation Enhancement

Percutaneous SCES holds promise for enhancing rehabilitation programs for individuals with spinal cord injury by enabling motor functions.

Accessibility of SCES

The use of percutaneous leads may increase the accessibility of SCES-enabled motor control for persons with SCI, especially those ineligible for paddle implantation due to scarring or hardware.

Improved Walking Performance

SCES can improve exoskeleton-assisted walking performance, allowing for faster walking speeds and reduced reliance on exoskeleton assistance.

Study Limitations

1
The study only included two participants, limiting the generalizability of the findings.
2
Modest lead migration occurred in both participants, which may have influenced the results.
3
The study acknowledges that torque modulation may be physiologically trivial and influenced by compensatory movements.

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