Revolutionary implant helps paralysed patients walk again

A small group of paraplegic patients have once again been able to take steps after researchers implanted a device to electrically stimulate their spinal cords.

Two separate teams of scientists have revealed for the first time that the technique, together with physical training, has allowed three out of the five individuals treated to walk again after losing all voluntary movement below the site of the injury.

“It is incredible to be able to be in there and actually see them taking their first steps,” said Dr Claudia Angeli of Kentucky Spinal Cord Injury Research Centre at the University of Louisville, and a co-author of one of the studies.

“It is an emotional time for the individual [themselves] because it is something that they have been told they are never going to be able to do again.”

In a study published in the New England Journal of Medicine, Angeli and colleagues report that they implanted an array of 16 electrodes in the lower back of four patients, paralysed after mountain bike or traffic accidents several years before.

The device, originally developed many years ago for pain control, was placed below the site of injury, covering regions that send sensorimotor signals to the legs while a battery was implanted in the abdominal wall, allowing the frequency of the stimulation, its intensity and duration, to be tweaked wirelessly.

Electrical activity produced by muscles in the legs was monitored during the sessions.

The approach – called epidural stimulation – works on the principle that there are still some small signals from the brain that cross the site of the spinal cord injury – even though these are not enough on their own to generate voluntary movement.

“We know the spinal cord has the ability to organise very detailed motor activity,” said Angeli.

“But before the injury it was getting commands from the brain and it was getting information from the environment as well.”

The injury, she said, disrupts this.

“The spinal cord is isolated, it potentially still receives information from the environment, but it is losing the big driver, which was the brain.”

Angeli said that it is thought that when the implanted device is turned on, the resulting electrical stimulation raises the excitability of the spinal cord – in a sense making it more alert.

“It is like it is more aware, it actually can listen to that little whisper from the brain that is still there and it can generate the motor pattern,” said Angeli, adding that training to link movements with these signals is crucial.

All four of the individuals had lost all motor control below the site of the injury, although two had some level of sensation.

After implantation of the device and locomotor training, the latter two were eventually able to walk over ground unassisted.

One was able to walk after 81 sessions of stimulation over 15 weeks, although she had to use a walking frame, while the other was able to walk after 278 sessions over 85 weeks, requiring either parallel bars or holding people’s hands. In total he was able to walk just over 90 metres without a break.

The other two individuals became able to stand and sit independently and one was also able to make some stepping motions on a treadmill when supported – however the other sustained a spontaneous hip fracture after one week of training and only began training again a year later.

A separate paper by researchers from the Mayo clinic in Minnesota and UCLA, published in the journal Nature Medicine, also reports success with the same approach.

The team revealed that after 43 weeks of training with the implant a 29-year-old man, paralysed after a snowmobile accident and left with no sensation or voluntary motion below the injury, could walk without help on a treadmill – holding on to the rails – and across the ground, albeit with a moving frame and a little human help to maintain balance. He did not, however, regain sensation in his legs.

Professor Gregoire Courtine from the EPFL research institute in Switzerland, who was not involved in either study, said he welcomed the research. But he said a key problem was that the current applied to the electrodes was continuous, meaning it can only be of low intensity – which may not result in the “whisper” from the brain being heard loudly enough by the legs.

Courtine said he is working to solve this issue by synchronising the electrical stimulation with intended movements – his previous work in monkeys used brain implants to pick up on movement signals from the brain and send them to the legs, bypassing the site of injury and allowing a greater amplification of the signal to produce more robust muscle activity.

Mike Milner, CEO of the Nicholls Spinal Injury Foundation was also cautious, saying while the research looked promising, the charity supports another approach to tackle spinal injury using special cells taken from a patient’s nose, as well as nerve fibres, to patch the site of the injury.

“We are looking for not only a natural, or biological, cure for paralysis – but a permanent one,” he said.

this is only for your information, kindly take the advice of your doctor for medicines, exercises and so on.     
https://gscrochetdesigns.blogspot.com. one can see my crochet creations  
https://gseasyrecipes.blogspot.com. feel free to view for easy, simple and healthy recipes    
https://kneereplacement-stickclub.blogspot.com. for info on knee replacement     

An Electronic Implant to Return Motor Function

There’s renewed hope that paraplegic and quadriplegic patients will one day be able to return motor and sensory function to their affected limbs, thanks to a brand-new invention by doctors in the US.

 

The stimulator they have come up with bypasses spinal injuries by forcing the body to use alternative neural pathways in order to transmit signals to the body’s extremities. In fact, the most recent test that the doctors conducted saw a quadriplegic’s finger motion improve by 300% while simultaneously improving grip strength, giving the patient the ability to perform everyday tasks once again.

Last June, the doctors implanted the stimulator into the body of a 28-year-old quadriplegic named Brian Gomez. The operation was conducted at Ronald Reagan University in California, USA. Gomez suffered his injuries during a dirt biking accident when he was 23 years old.

He broke his neck at his C-5 vertebra, which is at the middle of the neck next to the thyroid cartilage. This means that he lost all motor functions at his extremities, but retained head-to-toe sensation. Due to the nature of the injury he suffered, he was considered to be the perfect candidate for the experimental treatment.

Gomez assisted the researchers by giving them feedback on the sensations he was feeling from the stimulator so that they could be adjusted accordingly. The stimulator contains a series of 32 electrodes that can send pulses around the injured area, and that’s why it was implanted into the patient’s neck – to bypass the injury.
A great analogy for how the stimulator works is what occurs when there’s an accident on a freeway. While it’s almost inevitable that traffic will come to a standstill, there are numerous side streets and detours that can be taken to bypass the scene of the accident and reach the final destination.

 Neural signals are like traveling vehicles, the scene of the accident is the injury, and the alternate routes are the new pathways that the stimulator helps the spinal cord to find.

 

In addition to the stimulator and its electrodes, the researchers also implanted a battery pack into the patient so that the electrical stimulation they were providing to him could be fine-tuned into certain patterns, thus providing more or less stimulation to certain areas as needed.

The concept behind this is to stimulate neural pathways that the brain might be ignoring. Over time, these pathways open up and allow messages to pass through them. In essence, the whole process is like retraining the body to use the undamaged “side streets” so that the neural messages can arrive, thus returning functionality to the body’s extremities.

This particular study marks the very first time that doctors have tried electrode technology on someone suffering from quadriplegia stemming from a neck injury. It’s also the first time that such technology has been implanted under the skin to attempt to treat such an injury.

Despite the excitement resulting from this genuine medical breakthrough, it must be emphasized that the researchers’ intention was never to return affected limbs back to 100% functionality. In fact, the main goal was for hands to be able to impart enough force in order for the patient to be able to do tasks such as brushing his teeth, tying his shoelaces, or simply eating food with a fork.

Although the breakthrough is undoubtedly fascinating, researchers are exercising caution with regard to expectations, and this is because the stimulator has only been tested on a single patient to date. More data needs to be gathered, followed by a peer review and publication of the researchers’ definitive results. 

Nevertheless, it’s a hugely exciting time for paraplegics and quadriplegics who now have hope of returning some motor function to their extremities.

this is only for your information, kindly take the advice of your doctor for medicines, exercises and so on.

https://gscrochetdesigns.blogspot.com. one can see my crochet creations

https://gseasyrecipes.blogspot.com. feel free to view for easy, simple and healthy recipes 

https://kneereplacement-stickclub.blogspot.com. for info on knee replacement