Walking naturally after spinal cord injury using a brain–spine interface

Abstract

A spinal cord injury interrupts the communication between the brain and the region of the spinal cord that produces walking, leading to paralysis1,2. Here, we restored this communication with a digital bridge between the brain and spinal cord that enabled an individual with chronic tetraplegia to stand and walk naturally in community settings. This brain–spine interface (BSI) consists of fully implanted recording and stimulation systems that establish a direct link between cortical signals3 and the analogue modulation of epidural electrical stimulation targeting the spinal cord regions involved in the production of walking4–6. A highly reliable BSI is calibrated within a few minutes. This reliability has remained stable over one year, including during independent use at home. The participant reports that the BSI enables natural control over the movements of his legs to stand, walk, climb stairs and even traverse complex terrains. Moreover, neurorehabilitation supported by the BSI improved neurological recovery. The participant regained the ability to walk with crutches overground even when the BSI was switched off. This digital bridge establishes a framework to restore natural control of movement after paralysis.

Recovery of walking after paralysis by regenerating characterized neurons to their natural target region

“…We posit that applying the principles demonstrated here of (i) identifying and regenerating the axons of functionally relevant neuronal subpopulations, (ii) determining the requirements for reactivating neuron-specific developmental growth programs, (iii) identifying chemoattractants able to guide different types of transected axons past lesions to reach their natural target regions, and eventually combining these biological repair principles with complementary neuromodulation strategies ( 10 , 14 , 48 ), will unlock the framework to achieve meaningful repair of the injured spinal cord and may expedite repair after other forms of central nervous system injury and disease ( 49 – 51 ).…”

History and Future of Spinal Cord Stimulation

“…Spine surgery has advanced with a better understanding of sagittal balance and new techniques that lead to better outcomes. 75,76 However, SCS technology has also advanced with newer leads and stimulation paradigms associated with improved outcomes. In fact, data now support using SCS for patients with low back pain who have never undergone lumbar decompression with or without fusion.…”

Reactive oxygen species targeted biomaterials for spinal cord injury therapy

“…[17,[83][84][85] electrical stimulation wearable loading for SCI therapy. [72,86,87] This has helped three patients (NCT04632290, NCT02936453) with chronic paraplegia regain the ability to walk by reactivating spinal cord neurons through epidural electrical stimulation. [86] These clinical trials are exciting and still progressing to developing commercial materials for SCI repair.…”