The electrode array is then used to deliver continuous electrical pulses to the sensory afferents in the dorsal columns. Epidural SCS therapy requires the implantation of a silicone-based multi-electrode array in the epidural space between the spinal cord and the vertebral bone. Spinal cord stimulation: from pain management to the first anecdotical observations of improvements in motor functionĮpidural spinal cord stimulation has been a clinically approved technology for the treatment of neuropathic pain since the 1970s (Krames et al. In this work, we review the clinical evidence of long-term recovery induced by SCS after SCI and the experimental evidence on markers of neural plasticity that have been observed in animal and human studies. Albeit only in a small number of patients, because of the size and consistency of the effects, these observations have been regarded as a giant step for SCI research (Moritz 2018) and a potential paradigm shift in rehabilitation strategies (Smith et al. In 2018, three independent groups demonstrated, for the first time, that participants with chronic motor-complete SCI could achieve overground walking with SCS (Angeli et al. Recent studies combining spinal cord stimulation (SCS) with activity-based training have reported lasting improvements in motor function that were historically thought impossible in the chronic stage of spinal cord injury (SCI). Future experiments in humans and animal models of paralysis will be critical to understand the potential and limits for functional improvements in people with different types, levels, timeframes, and severities of SCI. Experiments in animal models of SCI investigating the potential mechanisms underpinning this neurorecovery suggest a synaptic reorganization of cortico-reticulo-spinal circuits that correlate with improvements in voluntary motor control. Interestingly, individuals with SCI classified as AIS B and C regained motor function in paralyzed joints even without stimulation, but not individuals with motor and sensory complete SCI (AIS A). While all reported participants were able to move previously paralyzed limbs from day 1, recovery of more complex motor functions was gradual, and the timeframe for first observations was proportional to the task complexity. We discuss how this led to the standardization of implant position which resulted in consistent observations by independent clinical studies that SCS in combination with physical training promotes improvements in motor performance and neurorecovery. the understanding that SCS activates dormant spinal circuits below the lesion by recruiting large-to-medium diameter sensory afferents within the posterior roots. In this work, we first provide an overview of the critical scientific advancements that have led to the current uses of SCS in neurorehabilitation: e.g. Specifically, recent studies combining SCS with activity-based training have reported unprecedented improvements in motor function in people with chronic SCI that persist even without stimulation. Electrical spinal cord stimulation (SCS) has been gaining momentum as a potential therapy for motor paralysis in consequence of spinal cord injury (SCI).
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