Neurostimulation of Spinal Cord Restores Assisted Ambulation

 

September 27, 2018—In a case study published in Nature Medicine(September 26, 2018), a combined approach of spinal cord stimulation and physical therapy has successfully enabled a man, age 29, who had lower-body paralysis to step independently over ground with a wheeled walker. Trainer assistance at the hips or a body-weight support (BWS) system were also in use for safety and balance. This patient has also been able to step bilaterally on a treadmill without BWS or trainer assistance.

The patient had sustained spinal cord injury (SCI) in a motorcycle accident in 2013 that resulted in complete sensorimotor paralysis of the lower extremities. In 2016, this patient had 22 sessions of physical therapy prior to implantation of an epidural electrical stimulator (EES). As previously reported (Mayo Clinic Proceedings. 2017;92(4):544-554.), this restored his ability to control step-like activity while suspended with BWS or while lying on his side. Since then, the patient has had 43 weeks of multimodal rehabilitation using dynamic task-specific training that engaged sensorimotor networks as measured by the EES system. 

To the knowledge of the authors reporting the case this is the first use multimodal rehabilitation with EES to result in independent stepping in a person who previously had complete loss of lower extremity sensorimotor function due to SCI. This case, if repeatable, may completely change prognosis and care for patients with lower body paralysis. 

 

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