Feb 7, 2022

IT’IS Modeling Pipeline Is Key Component in Restoring Mobility after Severe Spinal Cord Injury

Nature Medicine publishes STIMO study results showing that biomimetic epidural electrical stimulation based on personalized in silico treatment modeling in Sim4Life enables patients with clinically complete spinal cord injury to walk, stand, cycle, and swim again.

We are excited to announce that the results of the “Stimulation Movement Overground” (STIMO, NCT02936453) study were published in NATURE Medicine today, entitled, “Activity-dependent spinal cord neuromodulation rapidly restores trunk and leg motor functions after complete paralysis.” The study is a report on three patients with complete sensorimotor paralysis due to spinal cord injury who regained standing, walking, cycling, swimming, and trunk control capabilities as well as progressive recovery of full-weight-bearing capacities after biomimetic epidural electrical stimulation (EES) delivered with newly designed and validated multi-electrode paddle leads.

Patient-specific treatment modeling with Sim4Life provided by the IT’IS Foundation and it’s Z43 partner, ZMT Zurich MedTech AG, was key for identifying the safest and most effective surgical positioning of the new paddle electrode array, consisting of 16 electrodes that target the sacral, lumbar, and low-thoracic dorsal root ensemble associated with leg and trunk movements. High-end computational modeling in Sim4Life also enabled the generation of detailed, realistic, and personalized computational models of the interactions between EES and the spinal cord neural activity array arrangements, which were used in silico to optimize the implant design and ensure proper coverage of the relevant patient population.

The three patients achieved important milestones, including being able to walk independently on a treadmill within 1 hour on the first day of stimulation, with optimized gait patterns after 1–3 days. During five months of neurorehabilitation, patients progressed to walking for 10 meters in 6 minutes without any assistance, riding a recumbent trike powered with both the arms and the legs, and controlling trunk postures well enough to practice leisure activities such as boxing, enjoying a drink while standing at a bar, or paddling a canoe on a lake.

The tools for the modeling pipeline applied in the STIMO study were developed by EPFL and IT’IS as part of the RESTORE project which was completed in 2019. Prep2Go – the successor project to RESTORE launched in 2020 and in which IT’IS and ZMT are also involved – is making excellent progress in the development of a comprehensive and highly automated treatment planning workflow that can be used by clinical staff with limited modeling experience and is powered by our online simulation platform o2S2PARC.

Several videos are available as supplementary information to the paper – watch the videos here and see some of the fantastic milestones achieved by the three STIMO study participants. For the modeling enthusiasts, here are the links to the explorable models on o2S2PARC – please note that downloading may take up to a minute:


Several news outlets have covered the story, including CNN, BBC and LaStampa.