Targeted neurotechnology restores walking in humans with spinal cord injury

Fabien B. Wagner, Jean-Baptiste Mignardot, Camille G. Le Goff-Mignardot, Robin Demesmaeker, Salif Komi, Marco Capogrosso, Andreas Rowald, Ismael Seáñez, Miroslav Caban, Elvira Pirondini, Molywan Vat, Laura A. McCracken, Roman Heimgartner, Isabelle Fodor, Anne Watrin, Perrine Seguin, Edoardo Paoles, Katrien Van Den Keybus, Grégoire Eberle, Brigitte Schurch, Etienne Pralong, Fabio Becce, John Prior, Nicholas Buse, Rik Buschman, Esra Neufeld, Niels Kuster, Stefano Carda, Joachim von Zitzewitz, Vincent Delattre, Tim Denison, Hendrik Lambert, Karen Minassian, Jocelyne Bloch, Grégoire Courtine
Nature. 2018-10-31; 563(7729): 65-71
DOI: 10.1038/s41586-018-0649-2

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Wagner FB(1)(2), Mignardot JB(1)(2), Le Goff-Mignardot CG(1)(2), Demesmaeker R(1)(2), Komi S(1)(2), Capogrosso M(3), Rowald A(1)(2), Seáñez I(1)(2), Caban M(4)(5), Pirondini E(1)(2)(6), Vat M(7), McCracken LA(1)(2), Heimgartner R(1)(2), Fodor I(2), Watrin A(4), Seguin P(1)(2), Paoles E(4), Van Den Keybus K(2), Eberle G(2), Schurch B(2), Pralong E(7), Becce F(8), Prior J(9), Buse N(10), Buschman
R(10), Neufeld E(11), Kuster N(11)(12), Carda S(2), von Zitzewitz J(4), Delattre V(4), Denison T(10)(13), Lambert H(4), Minassian K(1)(2), Bloch J(2)(7)(14), Courtine G(15)(16)(17)(18).

Author information:
(1)Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, Swiss Federal Institute of Technology (EPFL), Lausanne, Switzerland.
(2)Department of Clinical Neuroscience, Lausanne University Hospital (CHUV), Lausanne, Switzerland.
(3)Platform of Translational Neuroscience, Department of Neuroscience and Movement Science, University of Fribourg, Fribourg, Switzerland.
(4)GTXmedical, Lausanne, Switzerland.
(5)Institute of Bioengineering, Swiss Federal Institute of Technology (EPFL), Lausanne, Switzerland.
(6)Department of Radiology and Medical Informatics, University of Geneva, Geneva, Switzerland.
(7)Department of Neurosurgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland.
(8)Department of Diagnostic and Interventional Radiology, Lausanne University Hospital (CHUV), Lausanne, Switzerland.
(9)Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital (CHUV), Lausanne, Switzerland.
(10)Medtronic, Minneapolis, MN, USA.
(11)Foundation for Research on Information Technologies in Society (IT’IS), Zurich, Switzerland.
(12)Department for Information Technology and Electrical Engineering, Swiss Federal Institute of Technology (ETHZ), Zurich, Switzerland.
(13)Department of Engineering Science, University of Oxford, Oxford, UK.
(14)Faculty of Biology and Medicine, University of Lausanne (UNIL), Lausanne, Switzerland.
(15)Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, Swiss Federal Institute of Technology (EPFL), Lausanne, Switzerland.
(16)Department of Clinical Neuroscience, Lausanne University Hospital (CHUV), Lausanne, Switzerland.
(17)Department of Neurosurgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland.
(18)Faculty of Biology and Medicine, University of Lausanne (UNIL), Lausanne, Switzerland.

Comment in
Nat Neurosci. 2018 Dec;21(12):1647-1648.
Nature. 2018 Nov;563(7729):6.
Nat Rev Neurosci. 2019 Jan;20(1):1.

Spinal cord injury leads to severe locomotor deficits or even complete leg paralysis. Here we introduce targeted spinal cord stimulation neurotechnologies that enabled voluntary control of walking in individuals who had sustained a spinal cord injury more than four years ago and presented with permanent motor deficits or complete paralysis despite extensive rehabilitation. Using an implanted pulse generator with real-time triggering capabilities, we delivered trains of spatially selective stimulation to the lumbosacral spinal cord with timing that coincided with the intended movement. Within one week, this spatiotemporal stimulation had re-established adaptive control of paralysed muscles during overground walking. Locomotor performance improved during rehabilitation. After a few months, participants regained voluntary control over
previously paralysed muscles without stimulation and could walk or cycle in ecological settings during spatiotemporal stimulation. These results establish a technological framework for improving neurological recovery and supporting the activities of daily living after spinal cord injury.


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