A case study of percutaneous epidural stimulation to enable motor control in two men after spinal cord injury

Abstract

Two persons with chronic motor complete spinal cord injury (SCI) were implanted with percutaneous spinal cord epidural stimulation (SCES) leads to enable motor control below the injury level (NCT04782947). Through a period of temporary followed by permanent SCES implantation, spinal mapping was conducted primarily to optimize configurations enabling volitional control of movement and training of standing and stepping as a secondary outcome. In both participants, SCES enabled voluntary increased muscle activation and movement below the injury and decreased assistance during exoskeleton-assisted walking. After permanent implantation, both participants voluntarily modulated induced torques but not always in the intended directions. In one participant, percutaneous SCES enabled motor control below the injury one-day following temporary implantation as confirmed by electromyography. The same participant achieved independent standing with minimal upper extremity self-balance assistance, independent stepping in parallel bars and overground ambulation with a walker. SCES via percutaneous leads holds promise for enhancing rehabilitation and enabling motor functions for people with SCI.

Peak Slope Ratio of the Recruitment Curves Compared to Muscle Evoked Potentials to Optimize Standing Configurations with Percutaneous Epidural Stimulation after Spinal Cord Injury

“…The inclusion and exclusion criteria were previously listed in detail [ 27 ]. Briefly, persons with a traumatic, motor complete spinal cord injury (SCI) with a neurological level of injury below C5 and age between 18 to 60 years were included.…”

“…This is a two-step process where temporary implantation precedes permanent implantation of pSCES [ 27 ]. The pSCES system (Intellis Epidural Stimulator, Medtronic, Minneapolis, MN, USA) was used to electrically stimulate the lumbosacral enlargement.…”

“…The pSCES system (Intellis Epidural Stimulator, Medtronic, Minneapolis, MN, USA) was used to electrically stimulate the lumbosacral enlargement. Details on the surgical implantation of the temporary percutaneous leads have been previously reported [ 27 ].…”

“…Percutaneous spinal cord epidural stimulation (pSCES) has been used to restore motor recovery in persons with SCI [ 27 , 28 , 29 ]. The term “percutaneous” refers to the specific surgical technique implemented in the placement of the leads in the epidural space.…”

“…The term “percutaneous” refers to the specific surgical technique implemented in the placement of the leads in the epidural space. One of the two participants showed restoration of locomotor-like activity that facilitated overground ambulation [ 27 ]. Additionally, we have further explored the potential of using interleaved configurations after implantation of pSCES to restore overground mobility [ 28 ].…”