Patient moves paralyzed legs with help from electrical stimulation of spinal cord

April 10, 2017

Electrical stimulation of the spinal cord (credit: Mayo Clinic)

Electrical stimulation of the spinal cord and intense physical therapy have been used by Mayo Clinic researchers to help Jared Chinnock intentionally move his paralyzed legs, stand, and make steplike motions for the first time in three years. The chronic traumatic paraplegia case marks the first time a patient has intentionally controlled previously paralyzed functions within the first two weeks of stimulation.

The case was documented April 3, 2017 in an open-access paper in Mayo Clinic Proceedings. The researchers say these results offer further evidence that a combination of this technology and rehabilitation may help patients with spinal cord injuries regain control over previously paralyzed movements, such as steplike actions, balance control, and standing.

“We’re really excited, because our results went beyond our expectations,” says neurosurgeon Kendall Lee, M.D., Ph.D., principal investigator and director of Mayo Clinic’s Neural Engineering Laboratory. “These are initial findings, but the patient is continuing to make progress.”

Chinnock injured his spinal cord at the sixth thoracic vertebrae in the middle of his back three years earlier. He was diagnosed with a “motor complete spinal cord injury,” meaning he could not move or feel anything below the middle of his torso.

Electrical stimulation

The study started with the patient going through 22 weeks of physical therapy. He had three training sessions a week to prepare his muscles for attempting tasks during spinal cord stimulation, and was tested for changes regularly. Some results led researchers to characterize his injury further as “discomplete,” suggesting dormant connections across his injury may remain.

Following physical therapy, he underwent surgery to implant an electrode in the epidural space near the spinal cord below the injured area. The electrode is connected to a computer-controlled device under the skin in the patient’s abdomen that which sends electrical current to the spinal cord, enabling the patient to create movement.*

The data suggest that people with discomplete spinal cord injuries may be candidates for epidural stimulation therapy, but more research is needed into how a discomplete injury contributes to recovering function, the researchers note.

After a three-week recovery period from surgery, the patient resumed physical therapy with stimulation settings adjusted to enable movements. In the first two weeks, he intentionally was able to control his muscles while lying on his side, resulting in leg movements, make steplike motions while lying on his side and standing with partial support, and stand independently using his arms on support bars for balance. Intentional (volitional) movement means the patient’s brain is sending a signal to motor neurons in his spinal cord to move his legs purposefully. (credit: Mayo Clinic)

* The Mayo Clinic received permission from the FDA for off-label use.  The Mayo researchers worked closely with the team of V. Reggie Edgerton, Ph.D., at UCLA on this study, which replicates earlier research done at the University of Louisville. Teams from Mayo Clinic’s departments of Neurosurgery and Physical Medicine and Rehabilitation, and the Division of Engineering collaborated on this project. The research was funded by Craig H. Neilsen Foundation, Jack Jablonski BEL13VE in Miracles Foundation, Mayo Clinic Center for Clinical and Translational Sciences, Mayo Clinic Rehabilitation Medicine Research Center, Mayo Clinic Transform the Practice, and The Grainger Foundation.

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Mayo Clinic |Epidural Stimulation Enables Motor Function After Chronic Paraplegia

Abstract of Enabling Task-Specific Volitional Motor Functions via Spinal Cord Neuromodulation in a Human With Paraplegia

We report a case of chronic traumatic paraplegia in which epidural electrical stimulation (EES) of the lumbosacral spinal cord enabled (1) volitional control of task-specific muscle activity, (2) volitional control of rhythmic muscle activity to produce steplike movements while side-lying, (3) independent standing, and (4) while in a vertical position with body weight partially supported, voluntary control of steplike movements and rhythmic muscle activity. This is the first time that the application of EES enabled all of these tasks in the same patient within the first 2 weeks (8 stimulation sessions total) of EES therapy.