Combined cervical transcutaneous with lumbosacral epidural stimulation improves voluntary control of stepping movements in spinal cord injured individuals
Introduction: Lumbosacral spinal cord neuromodulation has shown the ability to restore voluntary control and stepping in individuals with chronic spinal cord injury.Methods: We combined cervical transcutaneous and lumbar epidural stimulation to explore the brain-spinal connectomes and their influenc...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2023-02-01
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| Series: | Frontiers in Bioengineering and Biotechnology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fbioe.2023.1073716/full |
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| author | Claudia A. Angeli Claudia A. Angeli Claudia A. Angeli Yury Gerasimenko Yury Gerasimenko Yury Gerasimenko |
| author_facet | Claudia A. Angeli Claudia A. Angeli Claudia A. Angeli Yury Gerasimenko Yury Gerasimenko Yury Gerasimenko |
| author_sort | Claudia A. Angeli |
| collection | DOAJ |
| description | Introduction: Lumbosacral spinal cord neuromodulation has shown the ability to restore voluntary control and stepping in individuals with chronic spinal cord injury.Methods: We combined cervical transcutaneous and lumbar epidural stimulation to explore the brain-spinal connectomes and their influence in spinal excitability and interlimb coupling. Four individuals with a prior implanted lumbosacral spinal cord epidural stimulator participated in the study. We assessed lower extremity muscle activity and kinematics during intentional stepping in both non-weight bearing and weight-bearing environments.Results: Our results showed an inhibition of motor evoked potentials generated by spinal cord epidural stimulation when cervical transcutaneous stimulation is applied. In contrast, when intentional stepping is performed in a non-weight bearing setting, range of motion, motor output amplitude, and coordination are improved when cervical transcutaneous and lumbar epidural stimulations are combined. Similarly, with both stimulations applied, coordination is improved and motor output variability is decreased when intentional stepping is performed on a treadmill with body weight support.Discussion: Combined transcutaneous cervical and epidural lumbar stimulation demonstrated an improvement of voluntary control of stepping in individuals with chronic motor complete paralysis. The immediate functional improvement promoted by the combination of cervical and lumbar stimulation adds to the body of evidence for increasing spinal excitability and improvement of function that is possible in individuals with chronic paralysis. |
| first_indexed | 2024-04-10T18:15:02Z |
| format | Article |
| id | doaj.art-b04040479cd44d34a34b299e3749ab3d |
| institution | Directory Open Access Journal |
| issn | 2296-4185 |
| language | English |
| last_indexed | 2024-04-10T18:15:02Z |
| publishDate | 2023-02-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Bioengineering and Biotechnology |
| spelling | doaj.art-b04040479cd44d34a34b299e3749ab3d2023-02-02T09:29:25ZengFrontiers Media S.A.Frontiers in Bioengineering and Biotechnology2296-41852023-02-011110.3389/fbioe.2023.10737161073716Combined cervical transcutaneous with lumbosacral epidural stimulation improves voluntary control of stepping movements in spinal cord injured individualsClaudia A. Angeli0Claudia A. Angeli1Claudia A. Angeli2Yury Gerasimenko3Yury Gerasimenko4Yury Gerasimenko5Bioengineering Department, J. B. Speed School of Engineering, University of Louisville, Louisville, KY, United StatesKentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, United StatesFrazier Rehabilitation Institute, University of Louisville Health, Louisville, KY, United StatesKentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, United StatesDepartment of Physiology, University of Louisville, Louisville, KY, United StatesPavlov Institute of Physiology, St. Petersburg, RussiaIntroduction: Lumbosacral spinal cord neuromodulation has shown the ability to restore voluntary control and stepping in individuals with chronic spinal cord injury.Methods: We combined cervical transcutaneous and lumbar epidural stimulation to explore the brain-spinal connectomes and their influence in spinal excitability and interlimb coupling. Four individuals with a prior implanted lumbosacral spinal cord epidural stimulator participated in the study. We assessed lower extremity muscle activity and kinematics during intentional stepping in both non-weight bearing and weight-bearing environments.Results: Our results showed an inhibition of motor evoked potentials generated by spinal cord epidural stimulation when cervical transcutaneous stimulation is applied. In contrast, when intentional stepping is performed in a non-weight bearing setting, range of motion, motor output amplitude, and coordination are improved when cervical transcutaneous and lumbar epidural stimulations are combined. Similarly, with both stimulations applied, coordination is improved and motor output variability is decreased when intentional stepping is performed on a treadmill with body weight support.Discussion: Combined transcutaneous cervical and epidural lumbar stimulation demonstrated an improvement of voluntary control of stepping in individuals with chronic motor complete paralysis. The immediate functional improvement promoted by the combination of cervical and lumbar stimulation adds to the body of evidence for increasing spinal excitability and improvement of function that is possible in individuals with chronic paralysis.https://www.frontiersin.org/articles/10.3389/fbioe.2023.1073716/fullspinal neuromodulationlocomotionspinal cord injurytranscutaneous stimulationepidural stimulation |
| spellingShingle | Claudia A. Angeli Claudia A. Angeli Claudia A. Angeli Yury Gerasimenko Yury Gerasimenko Yury Gerasimenko Combined cervical transcutaneous with lumbosacral epidural stimulation improves voluntary control of stepping movements in spinal cord injured individuals Frontiers in Bioengineering and Biotechnology spinal neuromodulation locomotion spinal cord injury transcutaneous stimulation epidural stimulation |
| title | Combined cervical transcutaneous with lumbosacral epidural stimulation improves voluntary control of stepping movements in spinal cord injured individuals |
| title_full | Combined cervical transcutaneous with lumbosacral epidural stimulation improves voluntary control of stepping movements in spinal cord injured individuals |
| title_fullStr | Combined cervical transcutaneous with lumbosacral epidural stimulation improves voluntary control of stepping movements in spinal cord injured individuals |
| title_full_unstemmed | Combined cervical transcutaneous with lumbosacral epidural stimulation improves voluntary control of stepping movements in spinal cord injured individuals |
| title_short | Combined cervical transcutaneous with lumbosacral epidural stimulation improves voluntary control of stepping movements in spinal cord injured individuals |
| title_sort | combined cervical transcutaneous with lumbosacral epidural stimulation improves voluntary control of stepping movements in spinal cord injured individuals |
| topic | spinal neuromodulation locomotion spinal cord injury transcutaneous stimulation epidural stimulation |
| url | https://www.frontiersin.org/articles/10.3389/fbioe.2023.1073716/full |
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