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BREAKTHROUGH NEUROTECHNOLOGY FOR TREATING PARALYSIS

11/06/18

Breakthrough neurotechnology for treating paralysis

Three patients with chronic paraplegia were able to walk over ground thanks to precise
electrical stimulation of their spinal cords via a wireless implant. In a double study
published in Nature and Nature Neuroscience, Swiss scientists Grégoire Courtine (EPFL
and CHUV/Unil) and Jocelyne Bloch (CHUV/Unil) show that, after a few months of
training, the patients were able to control previously paralyzed leg muscles even in the
absence of electrical stimulation.

Three paraplegics who sustained cervical spinal cord injuries many years ago are now able
to walk with the aid of crutches or a walker thanks to new rehabilitation protocols that
combine targeted electrical stimulation of the lumbar spinal cord and weight-assisted
therapy.

This latest study, called STIMO (STImulation Movement Overground), establishes a new
therapeutic framework to improve recovery from spinal cord injury. All patients involved in
the study recovered voluntary control of leg muscles that had been paralyzed for many
years. Unlike the findings of two independent studies published recently in the United
States on a similar concept, neurological function was shown to persist beyond training
sessions even when the electrical stimulation was turned off. The STIMO study, led by the
Ecole Polytechnique Fédérale de Lausanne (EPFL) and the Lausanne University Hospital
(CHUV) in Switzerland, is published in the 1 November 2018 issues of Nature and Nature
Neuroscience.

“Our findings are based on a deep understanding of the underlying mechanisms which we
gained through years of research on animal models. We were thus able to mimic in real
time how the brain naturally activates the spinal cord,” says EPFL neuroscientist Grégoire
Courtine.

“All the patients could walk using body weight support within one week. I knew
immediately that we were on the right path,” adds CHUV neurosurgeon Jocelyne Bloch,
who surgically placed the implants in the patients.
“The exact timing and location of the electrical stimulation are crucial to a patient’s ability
to produce an intended movement. It is also this spatiotemporal coincidence that triggers
the growth of new nerve connections,” says Courtine.

This study achieves an unprecedented level of precision in electrically stimulating spinal
cords. “The targeted stimulation must be as precise as a Swiss watch. In our method, we
implant an array of electrodes over the spinal cord which allows us to target individual
muscle groups in the legs,” explains Bloch. “Selected configurations of electrodes are
activating specific regions of the spinal cord, mimicking the signals that the brain would
deliver to produce walking.”

The challenge for the patients was to learn how to coordinate their brains’ intention to
walk with the targeted electrical stimulation. But that did not take long. “All three study
participants were able to walk with body-weight support after only one week of
calibration, and voluntary muscle control improved tremendously within five months of
training”, says Courtine. “The human nervous system responded even more profoundly to
the treatment than we expected.”

Helping the brain help itself

The new rehabilitation protocols based on this targeted neurotechnology lead to improved
neurological function by allowing the participants to actively train natural overground
walking capabilities in the lab for extensive periods of time, as opposed to passive training
like exoskeleton-assisted stepping.

During rehabilitation sessions, the three participants were able to walk hands-free over
more than one kilometer with the help of targeted electrical stimulation and an intelligent
bodyweight-support system. Moreover, they exhibited no leg-muscle fatigue, and so there
was no deterioration in stepping quality. These longer, high-intensity training sessions
proved crucial for triggering activity-dependent plasticity – the nervous system’s intrinsic
ability to reorganize nerve fibers – which leads to improved motor function even when the
electrical stimulation is turned off.

Previous studies using more empirical approaches, such as continuous electrical
stimulation protocols, have shown that a select few paraplegics can indeed take steps with
the help of walking aids and electrical stimulation, but only over short distances and as long
as the stimulation is on. As soon as the stimulation is turned off, the patients immediately
return to their previous state of paralysis and are no longer able to activate leg
movements.

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