Altering spinal cord excitability enables voluntary movements after chronic complete paralysis in humans

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Article discusses results from an ongoing study of stand and step training in combination with epidural stimulation in individuals with chronic motor complete spinal cord injury (SCI). This study demonstrates the ability of four individuals with chronic complete motor paralysis to execute voluntary tasks with selectivity of appropriate motor pools in the presence of epidural stimulation. High fidelity sensorimotor translation of visual and auditory signals were processed to control the timing and amount of force generated during the movements. In three of the four subjects, voluntary movement with epidural stimulation soon after implantation, even in the two subjects who had complete loss of both motor and sensory functions. By neuromodulating the spinal circuitry at sub-threshold motor levels with epidural stimulation, completely paralyzed individuals can process conceptual, auditory, and visual input to regain specific voluntary control of paralyzed muscles. The authors contend that they have uncovered a fundamentally new intervention strategy that can dramatically affect recovery of voluntary movement in individuals with complete paralysis even years after injury. The findings suggest that neuromodulation of the sub-threshold motor state of excitability of the lumbosacral spinal networks was the key to recovery of intentional movement in four of four individuals diagnosed as having complete paralysis of the legs.

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