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  4. Activity-dependent spinal cord neuromodulation rapidly restores trunk and leg motor functions after complete paralysis
 
research article

Activity-dependent spinal cord neuromodulation rapidly restores trunk and leg motor functions after complete paralysis

Rowald, Andreas  
•
Komi, Salif  
•
Demesmaeker, Robin  
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February 7, 2022
Nature Medicine

Epidural electrical stimulation (EES) targeting the dorsal roots of lumbosacral segments restores walking in people with spinal cord injury (SCI). However, EES is delivered with multielectrode paddle leads that were originally designed to target the dorsal column of the spinal cord. Here, we hypothesized that an arrangement of electrodes targeting the ensemble of dorsal roots involved in leg and trunk movements would result in superior efficacy, restoring more diverse motor activities after the most severe SCI. To test this hypothesis, we established a computational framework that informed the optimal arrangement of electrodes on a new paddle lead and guided its neurosurgical positioning. We also developed software supporting the rapid configuration of activity-specific stimulation programs that reproduced the natural activation of motor neurons underlying each activity. We tested these neurotechnologies in three individuals with complete sensorimotor paralysis as part of an ongoing clinical trial (www.clinicaltrials.gov identifier NCT02936453). Within a single day, activity-specific stimulation programs enabled these three individuals to stand, walk, cycle, swim and control trunk movements. Neurorehabilitation mediated sufficient improvement to restore these activities in community settings, opening a realistic path to support everyday mobility with EES in people with SCI.

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Type
research article
DOI
10.1038/s41591-021-01663-5
Web of Science ID

WOS:000752184200001

Author(s)
Rowald, Andreas  
Komi, Salif  
Demesmaeker, Robin  
Baaklini, Edeny  
Hernandez-Charpak, Sergio Daniel  
Paoles, Edoardo
Montanaro, Hazael
Cassara, Antonino
Becce, Fabio
Lloyd, Bryn
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Date Issued

2022-02-07

Publisher

NATURE PORTFOLIO

Published in
Nature Medicine
Volume

28

Start page

260

End page

271

Subjects

Biochemistry & Molecular Biology

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Cell Biology

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Medicine, Research & Experimental

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Biochemistry & Molecular Biology

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Cell Biology

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Research & Experimental Medicine

•

physiological noise

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electrical-stimulation

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epidural stimulation

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tendon vibration

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muscle

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activation

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mechanisms

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locomotion

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recovery

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deficits

Editorial or Peer reviewed

REVIEWED

Written at

EPFL

EPFL units
MIPLAB  
Available on Infoscience
February 28, 2022
Use this identifier to reference this record
https://infoscience.epfl.ch/handle/20.500.14299/185898
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