Targeted neurotechnology restores walking in humans with spinal cord injury

Fabien B Wagner^#^{1

2}, Jean-Baptiste Mignardot^#^{1

2}, Camille G Le Goff-Mignardot^#^{1

2}, Robin Demesmaeker^{1

2}, Salif Komi^{1

2}, Marco Capogrosso³, Andreas Rowald^{1

2}, Ismael Seáñez^{1

2}, Miroslav Caban^{4

5}, Elvira Pirondini^{1

2

6}, Molywan Vat⁷, Laura A McCracken^{1

2}, Roman Heimgartner^{1

2}, Isabelle Fodor², Anne Watrin⁴, Perrine Seguin^{1

2}, Edoardo Paoles⁴, Katrien Van Den Keybus², Grégoire Eberle², Brigitte Schurch², Etienne Pralong⁷, Fabio Becce⁸, John Prior⁹, Nicholas Buse¹⁰, Rik Buschman¹⁰, Esra Neufeld¹¹, Niels Kuster^{11

12}, Stefano Carda², Joachim von Zitzewitz⁴, Vincent Delattre⁴, Tim Denison^{10

13}, Hendrik Lambert⁴, Karen Minassian^#^{1

2}, Jocelyne Bloch^#^{2

7

14}, Grégoire Courtine^#^{15

16

17

18}

Affiliations

¹ Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, Swiss Federal Institute of Technology (EPFL), Lausanne, Switzerland.
² Department of Clinical Neuroscience, Lausanne University Hospital (CHUV), Lausanne, Switzerland.
³ Platform of Translational Neuroscience, Department of Neuroscience and Movement Science, University of Fribourg, Fribourg, Switzerland.
⁴ GTXmedical, Lausanne, Switzerland.
⁵ Institute of Bioengineering, Swiss Federal Institute of Technology (EPFL), Lausanne, Switzerland.
⁶ Department of Radiology and Medical Informatics, University of Geneva, Geneva, Switzerland.
⁷ Department of Neurosurgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland.
⁸ Department of Diagnostic and Interventional Radiology, Lausanne University Hospital (CHUV), Lausanne, Switzerland.
⁹ Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital (CHUV), Lausanne, Switzerland.
¹⁰ Medtronic, Minneapolis, MN, USA.
¹¹ Foundation for Research on Information Technologies in Society (IT'IS), Zurich, Switzerland.
¹² Department for Information Technology and Electrical Engineering, Swiss Federal Institute of Technology (ETHZ), Zurich, Switzerland.
¹³ Department of Engineering Science, University of Oxford, Oxford, UK.
¹⁴ Faculty of Biology and Medicine, University of Lausanne (UNIL), Lausanne, Switzerland.
¹⁵ Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, Swiss Federal Institute of Technology (EPFL), Lausanne, Switzerland. gregoire.courtine@epfl.ch.
¹⁶ Department of Clinical Neuroscience, Lausanne University Hospital (CHUV), Lausanne, Switzerland. gregoire.courtine@epfl.ch.
¹⁷ Department of Neurosurgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland. gregoire.courtine@epfl.ch.
¹⁸ Faculty of Biology and Medicine, University of Lausanne (UNIL), Lausanne, Switzerland. gregoire.courtine@epfl.ch.

^# Contributed equally.

PMID: 30382197
DOI: 10.1038/s41586-018-0649-2

Targeted neurotechnology restores walking in humans with spinal cord injury

Fabien B Wagner et al. Nature. 2018 Nov.

. 2018 Nov;563(7729):65-71.

doi: 10.1038/s41586-018-0649-2. Epub 2018 Oct 31.

Authors

Affiliations

¹ Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, Swiss Federal Institute of Technology (EPFL), Lausanne, Switzerland.
² Department of Clinical Neuroscience, Lausanne University Hospital (CHUV), Lausanne, Switzerland.
³ Platform of Translational Neuroscience, Department of Neuroscience and Movement Science, University of Fribourg, Fribourg, Switzerland.
⁴ GTXmedical, Lausanne, Switzerland.
⁵ Institute of Bioengineering, Swiss Federal Institute of Technology (EPFL), Lausanne, Switzerland.
⁶ Department of Radiology and Medical Informatics, University of Geneva, Geneva, Switzerland.
⁷ Department of Neurosurgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland.
⁸ Department of Diagnostic and Interventional Radiology, Lausanne University Hospital (CHUV), Lausanne, Switzerland.
⁹ Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital (CHUV), Lausanne, Switzerland.
¹⁰ Medtronic, Minneapolis, MN, USA.
¹¹ Foundation for Research on Information Technologies in Society (IT'IS), Zurich, Switzerland.
¹² Department for Information Technology and Electrical Engineering, Swiss Federal Institute of Technology (ETHZ), Zurich, Switzerland.
¹³ Department of Engineering Science, University of Oxford, Oxford, UK.
¹⁴ Faculty of Biology and Medicine, University of Lausanne (UNIL), Lausanne, Switzerland.
¹⁵ Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, Swiss Federal Institute of Technology (EPFL), Lausanne, Switzerland. gregoire.courtine@epfl.ch.
¹⁶ Department of Clinical Neuroscience, Lausanne University Hospital (CHUV), Lausanne, Switzerland. gregoire.courtine@epfl.ch.
¹⁷ Department of Neurosurgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland. gregoire.courtine@epfl.ch.
¹⁸ Faculty of Biology and Medicine, University of Lausanne (UNIL), Lausanne, Switzerland. gregoire.courtine@epfl.ch.

^# Contributed equally.

PMID: 30382197
DOI: 10.1038/s41586-018-0649-2

Abstract

Spinal cord injury leads to severe locomotor deficits or even complete leg paralysis. Here we introduce targeted spinal cord stimulation neurotechnologies that enabled voluntary control of walking in individuals who had sustained a spinal cord injury more than four years ago and presented with permanent motor deficits or complete paralysis despite extensive rehabilitation. Using an implanted pulse generator with real-time triggering capabilities, we delivered trains of spatially selective stimulation to the lumbosacral spinal cord with timing that coincided with the intended movement. Within one week, this spatiotemporal stimulation had re-established adaptive control of paralysed muscles during overground walking. Locomotor performance improved during rehabilitation. After a few months, participants regained voluntary control over previously paralysed muscles without stimulation and could walk or cycle in ecological settings during spatiotemporal stimulation. These results establish a technological framework for improving neurological recovery and supporting the activities of daily living after spinal cord injury.

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Comment in

A giant step for spinal cord injury research.
Moritz C. Moritz C. Nat Neurosci. 2018 Dec;21(12):1647-1648. doi: 10.1038/s41593-018-0264-4. Nat Neurosci. 2018. PMID: 30382195 No abstract available.
Paralysed people walk again after spinal-cord stimulation.
[No authors listed] [No authors listed] Nature. 2018 Nov;563(7729):6. doi: 10.1038/d41586-018-07237-9. Nature. 2018. PMID: 30382215 No abstract available.
Restoring walking.
Yates D. Yates D. Nat Rev Neurosci. 2019 Jan;20(1):1. doi: 10.1038/s41583-018-0109-x. Nat Rev Neurosci. 2019. PMID: 30518965 No abstract available.

References

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1. Jones, M. L. et al. Activity-based therapy for recovery of walking in individuals with chronic spinal cord injury: results from a randomized clinical trial. Arch. Phys. Med. Rehabil. 95, 2239–2246 (2014). - DOI
1. Field-Fote, E. C., Lindley, S. D. & Sherman, A. L. Locomotor training approaches for individuals with spinal cord injury: a preliminary report of walking-related outcomes. J. Neurol. Phys. Ther. 29, 127–137 (2005). - DOI
1. Edgerton, V. R. et al. Training locomotor networks. Brain Res. Rev. 57, 241–254 (2008). - DOI
1. Côté, M. P., Murray, M. & Lemay, M. A. Rehabilitation strategies after spinal cord injury: inquiry into the mechanisms of success and failure. J. Neurotrauma 34, 1841–1857 (2017). - DOI

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Targeted neurotechnology restores walking in humans with spinal cord injury

Affiliations

Targeted neurotechnology restores walking in humans with spinal cord injury

Authors

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Abstract

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References

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LinkOut - more resources

Full Text Sources

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