Targeted Neurotechnology Restores Walking in Humans with Spinal Cord Injury

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. 

The scientific and technical impact of the study can be summarized as:

• The findings support the urgent need to develop dedicated neurotechnologies based on targeted spinal cord stimulation that enables motor control after SCI to support rehabilitation in the clinic, at home, and in the community
• The neurotechnological spinal-cord intervention described here immediately restored voluntary control of walking in three individuals with severe or complete paralysis via targeted stimulation of proprioceptive feedback circuits through recruitment of selected posterior roots
• The intervention strategy relies on rapid personalization of spatiotemporal EES sequences to continuously coincide with intended movements, thereby augmenting the excitability of the motoneuron pools engaged by the natural flow of task-specific sensory information
• This spatiotemporal convergence enables robust natural control of leg movements compared to other empirical stimulation paradigms

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