Filippo Agnesi, Daniele Emedoli, Luigi Albano, Simone Romeni, Filippo Gasperotti, Federico Colombo, Edoardo Pompeo, Mario Sacco, Veronica Fossati, Chiara Ciucci, Laura Toni, Elena Losanno, Andrea Tettamanti, Federica Alemanno, Luigia Brugliera, Paola Castellazzi, Jeffrey D Padul, Lina R Barzaghi, Carlo Mandelli, Cinzia Mura, Heike Caravati, Carla Butera, Ubaldo Del Carro, Antonella Castellano, Andrea Falini, Jacopo Carpaneto, Tommaso Proietti, Solaiman Shokur, Federica Agosta, Massimo Filippi, Sandro Iannaccone, Pietro Mortini, Silvestro Micera
This simple and potentially scalable method successfully leverages clinically available spinal cord stimulators to allow locomotion even in patients unable to produce voluntary contractions below the lesion, advancing accessible neuromodulation for motor-complete spinal cord injury.
BACKGROUND: Spinal cord stimulation is emerging as a novel approach to restore movement in patients affected by spinal cord injury. Recent advances have shown restoration of locomotion in patients with complete motor lesions using sophisticated new systems including a brain machine interface. Despite the great potential, this approach is hindered by the inherent complexity and absence of approvals for clinical use.
METHODS: Here, we tested a novel strategy to restore locomotion in patients with motor-complete spinal cord injury using voluntary trunk movements to modulate the motor output produced by a commercially available epidural spinal cord stimulator.
FINDINGS: Four participants with thoracic AIS A-B injuries gained volitional modulation of stimulation-enabled movement without external interfaces or brain decoding, achieving standing and walking over four months of rehabilitation. The approach transformed passive stimulation into self-initiated movement, enabling functional mobility.
CONCLUSIONS: This simple and potentially scalable method successfully leverages clinically available spinal cord stimulators to allow locomotion even in patients unable to produce voluntary contractions below the lesion, advancing accessible neuromodulation for motor-complete spinal cord injury.
FUNDING: This work was funded by Università Vita-Salute San Raffaele, Boston Scientific Spa, Fondazione Cariplo, Bertarelli Foundation, #NEXTGENERATIONEU (NGEU), and the Ministry of University and Research (MUR).