It is well accepted that severe spinal cord injury (SCI) leads to functional disconnection of ascending and descending spinal pathways, impairing neural circuitry through and below the SCI. However, in clinically complete SCI, defined as American Spinal Injury Association Impairment Scale (AIS) level A, a portion of neural tissue commonly remains intact across the injury site1 and may provide nonspecific supraspinal influence on sublesional spinal circuitry.2, 3, 4, 5 This injury profile is defined as “discomplete.”
MAYO Clinic Is Enabling Task-Specific Volitional Motor Functions via Spinal Cord Neuromodulation in a Human With Paraplegia
Man Paralyzed from Spinal Cord Injury can moves legs Thanks to Epidural Neurostimulator
All the procedures for this study were performed with the approval of the Mayo Clinic Institutional Review Board and with an Investigational Device Exemption from the US Food and Drug Administration. The participant was a 26-year-old man who sustained a traumatic T6 AIS-A SCI 3 years before study enrollment. Immediately after his injury, he underwent a spinal fusion of the fifth to eleventh thoracic vertebrae and participated in in-patient physical rehabilitation for approximately 2 months to achieve independence during activities of daily living from a wheelchair. Once discharged from in-patient rehabilitation, the patient underwent 5 weeks of outpatient SCI rehabilitation. After those 5 weeks, he performed only self-directed upper limb strengthening and general lower limb stretching without any other form of formal neuromuscular training until enrollment in this study.
On enrollment, the patient’s motor and sensory characteristics were documented by clinical examination and electrophysiologic measures. The American Spinal Injury Association Examination as defined by the International Standards for the Classification of Spinal Cord Injury was used to determine the extent of the SCI, including the neurologic level and the “completeness” of the injury. Electrophysiologic measures included upper and lower limb somatosensory evoked potentials and transcranial magnetic motor evoked potentials recorded over select upper and lower limb muscles. This was followed by 22 weeks of motor training. An EES system was then implanted in the region of the lumbar enlargement, followed by 3 weeks of postoperative recovery and 8 sessions of volitional motor performance testing in the presence of EES over a 2-week period