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  • Researchers Report Another Success in Using Electrical Stimulation to Restore Voluntary Movement in a Patient With Paralysis

    In brief:

    • Researchers replicated a study from 2014 that used electrical stimulation to enable patients with spinal cord injury and paralysis to make voluntary leg motions
    • Current study focused on a patient with clinically motor-complete spinal cord injury who had sustained the injury 3 years prior to the study
    • Before implanting the epidural electrical stimulation device, the patient underwent 22 weeks of motor training sessions with a physical therapist
    • After device implantation (and postrecovery) the patient achieved success after 2 weeks, including the ability to stand independently and make "steplike" motions while standing

    Researchers from the Mayo Clinic announced that they have successfully replicated an earlier study that used spinal cord electrical stimulation to help an individual intentionally move his paralyzed legs. The latest success, reported in Mayo Clinic Proceedings, was achieved in less than 2 weeks after beginning the stimulation program, and included 22 weeks of extensive physical therapy beforehand. Authors of the study include Meegan Van Straaten, PT, and Megan Gill, DPT.

    The initial goal of the research was to replicate a study published in 2014 that succeeded in using epidural electrical stimulation (EES) to enable 4 individuals with varying degrees of paralysis to voluntarily move their legs. However, authors of the latest project write that they wanted to go even further and find out if EES could enable voluntary control over "rhythmic, steplike activities," and could achieve that goal in a relative short time. The answer? Yes.

    The study subject was a 26-year-old man who had sustained a traumatic spinal cord injury at the 6th thoracic vertebrae 3 years earlier. While he was diagnosed with sensory and motor complete (as defined by the American Spinal Injury Association impairment scale) SCI prior to the study, during the motor training phase of the project researchers identified a portion of neural tissue that remained intact across the injured site, a condition they termed "discomplete" SCI. Even so, the patient was unable to experience sensation and could not voluntarily move his legs prior to the EES program..

    The EES device itself was surgically implanted in the patient's abdomen and connected to a 16-contact electrode array on the epidural surface of the spinal cord just below the injury site. The patient underwent 3 weeks of postsurgical recovery before the EES tests and training began.

    Before that phase of the study, however, the patient was engaged in motor training sessions performed by a physical therapist (PT) at a rate of 3 90-minute sessions a week for 22 weeks. The sessions were designed to prepare his muscles for the movements he would attempt during the EES phase. They consisted of lower extremity stretching (15 minutes), locomotor training on a treadmill with body support and assistance at the legs and pelvis (45 minutes), and balance and strengthening exercises while sitting and standing (30 minutes).

    Once motor training and surgery recovery were complete, researchers began working with the patient to achieve volitional movement. After 8 sessions of 5-7 hours each, conducted over 2 weeks, the patient was able to move his legs while lying on his side, make "steplike" motions while lying on his side and while standing with support, and engage in full weight-bearing independent standing using his arms for support on bars. "For the first time, all of these functions, which were absent before EES, were enabled in the presence of the first 2 weeks … in the same participant," authors write.

    "The results of this case report, combined with previous reports … suggest that subfunctional neural connections are likely present in some cases of clinically motor complete … SCI, and these neural connections can be identified and used for enabling volitional control of motor function via EES," authors write, adding that combined with earlier studies, results "provide further evidence that spinal cord neuromodulation strategies combined with intense motor rehabilitation can facilitate functional recovery even when initiated years after the occurrence of a motor complete spinal injury."

    Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.

    Comments

    • I am 64 years young and am a survivor of Polio which I was afflicted with in 1953 at 18 months old. My left upper arm and shoulder were impacted with paralysis at that early age. At age 64 I have post polio syndrome that is limiting the use of my left arm. Would electrical stimulation help to rejuvenate the nerves and muscles damaged by Polio? I am a willing subject for clinical trials.

      Posted by Susan Sutich on 4/14/2017 2:57 PM

    • Hello Susan, Because your weakness was caused by the polio virus destroying many of the motor nerve cells in your spinal cord, you would not be a candidate for ES to improve your strength. In fact, the surviving motor nerve fibers have adopted as many orphaned muscle fibers as they could [by about 6 months after the onset of your polio infection]. Your muscles are running a marathon to do what they can do and after a number of years you have developed the overuse post-polio syndrome. Over exercise of your own volition and/or with electrical stimulation would only increase your symptoms. Do not allow anyone to give you false hopes and protect the function that you have. Sincerely, Joyce

      Posted by Joyce Campbell, Ph.D., P.T.,E.N. on 4/20/2017 12:03 PM

    • Hi, my friend who is 27 recently had a motorbike incident in which she retained an SCI at C3 so has completed paralysis from the neck down. Because of this she cannot breathe on her own or swallow food. She is a very strong person and mentally completely fine. Everything I have read on EES has been for walking on patients with paraplegia not quadriplegia, so I was wondering if she could be a candidate for trials and if it could restore movement for her arms as well?

      Posted by Alice on 5/21/2017 6:31 PM

    • Hello my name is Tatiana I had a C6 SCI incomplete Aisa D, I'm able to walk with braces. My left leg has more motor function while my right leg muscles struggle to contract or even move. Fortunately I try my best to contact every muscle that I'm able to use but there are some I can't feel in which I can feel that there's a blockage at the place where to connection stops working. I was wonder if this can improve my steps, motor function in my pursue to walk again. I'm will to go through the trail!

      Posted by Tatiana Villarreal on 8/8/2017 3:00 AM

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