FES assisted standing in people with incomplete spinal cord injury: a single case design series

Crosbie, Jack; Tanhoffer, Aldre I. P.; Fornusek, Ché

doi:10.1038/sc.2013.158

Cited by 11 publications

(6 citation statements)

References 15 publications

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“…This work was followed up with similar demonstrations in individuals with motor complete paralysis for intentional control of movements of the lower limbs (Angeli et al, 2014 ; Grahn et al, 2017 ) as well as independent stepping during EES activation (Gill et al, 2018 ). Similarly, in clinical studies, central and peripheral electrical stimulation improved sensorimotor function (Guiraud et al, 2014 ; Possover, 2014 ), such as weight-bearing, standing (Crosbie et al, 2014 ), and walking (Herman et al, 2002 ; Hardin et al, 2007 ; Karimi et al, 2013 ; Possover, 2014 ). Emerging evidence suggests that closed-loop and/or phasic EES is more efficacious in promoting functional recovery in humans than tonic stimuli.…”

Section: Introductionmentioning

confidence: 91%

Epidural Electrical Stimulation: A Review of Plasticity Mechanisms That Are Hypothesized to Underlie Enhanced Recovery From Spinal Cord Injury With Stimulation

Eisdorfer

Smit

Keefe

et al. 2020

Front. Mol. Neurosci.

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Spinal cord injury (SCI) often results in lifelong sensorimotor impairment. Spontaneous recovery from SCI is limited, as supraspinal fibers cannot spontaneously regenerate to form functional networks below the level of injury. Despite this, animal models and humans exhibit many motor behaviors indicative of recovery when electrical stimulation is applied epidurally to the dorsal aspect of the lumbar spinal cord. In 1976, epidural stimulation was introduced to alleviate spasticity in Multiple Sclerosis. Since then, epidural electrical stimulation (EES) has been demonstrated to improve voluntary mobility across the knee and/or ankle in several SCI patients, highlighting its utility in enhancing motor activation. The mechanisms that EES induces to drive these improvements in sensorimotor function remain largely unknown. In this review, we discuss several sensorimotor plasticity mechanisms that we hypothesize may enable epidural stimulation to promote recovery, including changes in local lumbar circuitry, propriospinal interneurons, and the internal model. Finally, we discuss genetic tools for afferent modulation as an emerging method to facilitate the search for the mechanisms of action.

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Section: Introductionmentioning

confidence: 91%

Epidural Electrical Stimulation: A Review of Plasticity Mechanisms That Are Hypothesized to Underlie Enhanced Recovery From Spinal Cord Injury With Stimulation

Eisdorfer

Smit

Keefe

et al. 2020

Front. Mol. Neurosci.

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“…In FES, low-level electrical pulses are applied to paretic or paralyzed muscles to restore or improve their functional capacity (see Figure 1 ) (Thompson et al, 2014 ). In clinical and community settings, one of the most commonly available and well-studied FES exercise modalities is FES-evoked cycling (Crosbie et al, 2014 ). van der Scheer et al ( 2021 ) summarized FES cycling exercise intervention studies found that FES cycling exercise improved lower-body muscle health (e.g., muscle mass, fiber type composition) in adults with SCI.…”

Section: Electrical Stimulation Neuromodulationmentioning

confidence: 99%

Restoring Sensorimotor Function Through Neuromodulation After Spinal Cord Injury: Progress and Remaining Challenges

et al. 2021

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Spinal cord injury (SCI) is a major disability that results in motor and sensory impairment and extensive complications for the affected individuals which not only affect the quality of life of the patients but also result in a heavy burden for their families and the health care system. Although there are few clinically effective treatments for SCI, research over the past few decades has resulted in several novel treatment strategies which are related to neuromodulation. Neuromodulation—the use of neuromodulators, electrical stimulation or optogenetics to modulate neuronal activity—can substantially promote the recovery of sensorimotor function after SCI. Recent studies have shown that neuromodulation, in combination with other technologies, can allow paralyzed patients to carry out intentional, controlled movement, and promote sensory recovery. Although such treatments hold promise for completely overcoming SCI, the mechanisms by which neuromodulation has this effect have been difficult to determine. Here we review recent progress relative to electrical neuromodulation and optogenetics neuromodulation. We also examine potential mechanisms by which these methods may restore sensorimotor function. We then highlight the strengths of these approaches and remaining challenges with respect to its application.

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“…Many studies have reported that FES can improve long-term motor (90) and sensory recovery (204) in people, including standing (48), walking (105,130), and hand function (106,129). In 2007, Hardin et al (96) reported a 22-year-old patient who was 18 months after a C5–6 incomplete (AIS/ISCOS C) SCI and had an implanted eight-channel FES system for walking.…”

Section: Mechanisms Of Fes-mediated Motor Controlmentioning

confidence: 99%

“…In the last 3 years, several groups reported that epidural stimulation (57,58,180,244) of the spinal cord of people with chronic severe SCI restore weight-bearing (9,220) and voluntary motor function (5,98). Many clinical studies suggest that both central and peripheral electrical stimulation improve long-term motor (90) and sensory recovery (204), including standing (48), walking (96,105,130,204), and hand function (106,129).…”

Section: Introductionmentioning

confidence: 99%

Electrical Stimulation and Motor Recovery

Young

2015

Cell Transplant

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In recent years, several investigators have successfully regenerated axons in animal spinal cords without locomotor recovery. One explanation is that the animals were not trained to use the regenerated connections. Intensive locomotor training improves walking recovery after spinal cord injury (SCI) in people, and >90% of people with incomplete SCI recover walking with training. Although the optimal timing, duration, intensity, and type of locomotor training are still controversial, many investigators have reported beneficial effects of training on locomotor function. The mechanisms by which training improves recovery are not clear, but an attractive theory is available. In 1949, Donald Hebb proposed a famous rule that has been paraphrased as "neurons that fire together, wire together." This rule provided a theoretical basis for a widely accepted theory that homosynaptic and heterosynaptic activity facilitate synaptic formation and consolidation. In addition, the lumbar spinal cord has a locomotor center, called the central pattern generator (CPG), which can be activated nonspecifically with electrical stimulation or neurotransmitters to produce walking. The CPG is an obvious target to reconnect after SCI. Stimulating motor cortex, spinal cord, or peripheral nerves can modulate lumbar spinal cord excitability. Motor cortex stimulation causes long-term changes in spinal reflexes and synapses, increases sprouting of the corticospinal tract, and restores skilled forelimb function in rats. Long used to treat chronic pain, motor cortex stimuli modify lumbar spinal network excitability and improve lower extremity motor scores in humans. Similarly, epidural spinal cord stimulation has long been used to treat pain and spasticity. Subthreshold epidural stimulation reduces the threshold for locomotor activity. In 2011, Harkema et al. reported lumbosacral epidural stimulation restores motor control in chronic motor complete patients. Peripheral nerve or functional electrical stimulation (FES) has long been used to activate sacral nerves to treat bladder and pelvic dysfunction and to augment motor function. In theory, FES should facilitate synaptic formation and motor recovery after regenerative therapies. Upcoming clinical trials provide unique opportunities to test the theory. INTRODUCTIONIn the past decade, several prominent laboratories have shown axonal regeneration in animal spinal cord injury (SCI) models, but locomotor recovery did not follow regeneration (277). For example Lu et al. (159,160) and He's group (156,282) regenerated many axons that synapsed with neurons in the lower spinal cord, but the animals did not recover walking. To explain the lack of locomotor recovery, the investigators assume that insufficient numbers of regenerated axons have formed synapses with appropriate neurons in the lower spinal cord to support locomotion. Another explanation for the lack of locomotor recovery after complete SCI and regeneration is that the animals did not learn to use their newly regrown connections.Regenerated fibe...

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FES assisted standing in people with incomplete spinal cord injury: a single case design series

Cited by 11 publications

References 15 publications

Epidural Electrical Stimulation: A Review of Plasticity Mechanisms That Are Hypothesized to Underlie Enhanced Recovery From Spinal Cord Injury With Stimulation

Epidural Electrical Stimulation: A Review of Plasticity Mechanisms That Are Hypothesized to Underlie Enhanced Recovery From Spinal Cord Injury With Stimulation

Restoring Sensorimotor Function Through Neuromodulation After Spinal Cord Injury: Progress and Remaining Challenges

Electrical Stimulation and Motor Recovery

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