Fabien B. Wagner, Jean-Baptiste Mignardot, Camille G. Le Goff-Mignardot, Robin Demesmaeker, Salif Komi, Marco Capogrosso, Andreas Rowald, Ismael Seáñez, Miroslav Caban, Elvira Pirondini, Molywan Vat, Laura McCracken, Roman Heimgartner, Isabelle Fodor, Anne Watrin, Perrine Seguin, Edorardo Paoles, Katrien Van Den Keybus, Grégoire Eberle, Brigitte Schurch, Etienne Pralong, Fabio Becce, John Prior, Nicholas Buse, Rik Buschman, Esra Neufeld, Niels Kuster, Stefano Carda, Joachim von Zitzewitz, Vincent Delattre, Tim Denison, Hendrik Lambert, Karen Minassian, Jocelyne Bloch, and Grégoire Courtine, Nature, Volume 563, Issue 7729, pages 65–71, online 31 October 2018, doi: https://doi.org/10.1038/s41586-018-0649-2
Spinal cord injury (SCI) leads to severe locomotor deficits or even complete paralysis of the legs. Here, we introduce targeted spinal cord stimulation neurotechnologies that enable voluntary control of walking in non-ambulatory individuals who suffered a SCI more than four years ago. Using an implanted pulse generator with real–time triggering capabilities, we delivered spatially selective epidural electrical stimulation (EES) trains to the lumbosacral spinal cord with timing that coincided with intended movement. This spatiotemporal stimulation immediately re-established adaptive control of paralyzed muscles during walking. Locomotor performance improved during rehabilitation. After a few months, participants regained voluntary control over previously paralyzed muscles without stimulation and could walk or bike in ecological settings during spatiotemporal stimulation. These results establish a technological framework to improve neurological recovery and support activities of daily living after SCI.
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