Epidural Spinal-Cord Stimulation Facilitates Recovery of Functional Walking Following Incomplete Spinal-Cord Injury

Michael R. Carhart, Jiping He, Richard Herman, S. D'Luzansky, Wayne T. Willis

Research output: Contribution to journalArticle

90 Scopus citations

Abstract

We investigated a novel treatment paradigm for developing functional ambulation in wheelchair-dependent individuals with chronic, incomplete spinal-cord injury. By coordinating epidural stimulation of the dorsal structures of the spinal cord with partial weight bearing treadmill therapy, we observed improvement in treadmill and over-ground ambulation in an individual with chronic incomplete tetraplegia. The application of partial weight-bearing therapy alone was not sufficient to achieve functional ambulation over ground, though treadmill ambulation improved significantly. Combining epidural spinal-cord stimulation (ESCS, T10-T12 vertebral levels) with partial weight-bearing therapy resulted in further improvement during treadmill ambulation. Moreover, the combination of therapies facilitated the transfer of the learned gait into over ground ambulation. Performance improvements were elicited by applying continuous, charge-balanced, monophasic pulse trains at a frequency of 40-60 Hz, a pulse duration of 800 μs, and an amplitude determined by the midpoint (50%) between the sensory and motor threshold values. The participant initially reported a reduction in sense of effort for over ground walking from 8/10 to 3/10 (Borg scale), and was able to double his walking speed. After several weeks of over ground training, he reached maximum walking speeds of 0.35 m/s, and was able to ambulate over 325 m. We propose that ESCS facilitated locomotor recovery in this patient by augmenting the use-dependent plasticity created by partial weight bearing therapy. Confirmation of these promising results in a controlled study of groups of spinal-cord-injured subjects is warranted.

Original languageEnglish (US)
Pages (from-to)32-42
Number of pages11
JournalIEEE Transactions on Neural Systems and Rehabilitation Engineering
Volume12
Issue number1
DOIs
StatePublished - Mar 1 2004

Keywords

  • Electrical stimulation
  • Gait rehabilitation
  • Muscle coordination
  • Spinal-cord injury

ASJC Scopus subject areas

  • Internal Medicine
  • Neuroscience(all)
  • Biomedical Engineering

Fingerprint Dive into the research topics of 'Epidural Spinal-Cord Stimulation Facilitates Recovery of Functional Walking Following Incomplete Spinal-Cord Injury'. Together they form a unique fingerprint.

  • Cite this