Michel Roccati lost the ability to walk after a motorcycle accident in 2017, when he had a complete spinal cord injury. But today, equipped with an electrode device implanted on his spinal cord, Roccati can enjoy the simple things again: standing at a bar for drinks with friends, taking a shower without a chair and even strolling through the town with a walker.
“I am free,” said Roccati, who is from Italy. “I can walk wherever I want to.”
Roccati was one of three men between the ages of 29 and 41 to participate in the STIMO clinical trial, led by Dr. Jocelyne Bloch from Lausanne University Hospital and Grégoire Courtine of the Swiss Federal Institute of Technology. The results of the study were published Monday in the journal Nature Medicine.
The participants had 16-electrode devices implanted in the epidural space, an area between the vertebrae and the spinal cord membrane. The electrodes receive currents from a pacemaker implanted under the skin of the abdomen.
All the patients in the trial had a complete loss of voluntary movement below their injuries. Two also had a complete loss of sensation. But with the devices in place, the researchers could use a tablet computer to initiate unique sequences of electrical pulses, sent to the epidural electrodes via the pacemaker, to activate the participants’ muscles.
Other studies have anecdotally seen movement soon after surgery to implant similar devices, but this is the first study to report that all participants independently could take steps on a treadmill just a day after surgery, the researchers say.
“It’s a very emotional moment, because [patients] realize they can step,” Bloch said.
Researchers have been looking into electrical stimulation to the spinal cord for three decades. This study redesigned technology originally used to alleviate pain to target spinal nerve roots.
Previous studies out of the University of Louisville have shown that people who were completely paralyzed but still had sensation could walk again with several months of rehabilitation through electrical stimulation to the spinal cord. The STIMO trial found that within a week of their surgeries, all three participants could walk independently with the use of body-weight support from parallel bars and an overhead harness.
“For the first time, we have not only immediate effect — though training is still important — but also individuals with no sensation, no movement whatsoever, have been able to regain full standing and walking independently of the laboratory,” Courtine told CNN.
Dr. Nandan Lad, a neurosurgeon at Duke University, said this “very exciting work gives a new treatment option for tens of thousands of patients that have spinal cord injury and don’t really have other options.” Lad is leading a clinical trial in this area of research in the US and was not involved in the new study.
The Swiss team has been able to observe immediate results through important changes in the structure and implantation of their electrode device. The electrode array used in the STIMO trial, made by Onward Medical, is wider and longer than the array most commonly used in similar studies. According to Bloch, this new electrode array allows access to a broader area of the spinal cord to stimulate both trunk and leg muscles.
The investigators developed an algorithm to optimally place the electrode array, running tests during the surgery to measure muscle activity after delivering pulses. The precise neurosurgical placement of the electrodes is key to the study’s ability to stimulate the necessary muscle groups in the legs so quickly, Lad said.
The STIMO trial also introduces a new method for initiating and sustaining movement. To begin stimulation, previous studies have relied on participants’ intent to move and the brain signals that follow. In the new study, a timed sequence of stimulations is generated using motor responses to different jolts of electricity. These pre-established sequences trigger movement and attempt to mimic the natural pattern of muscle activation needed to walk.
Susan Harkema, a professor in the Department of Neurological Surgery who led the Louisville studies, said it’s encouraging to know that two types of stimulation can generate movement patterns through human spinal circuitry, indicating that some function is retained, even with complete injuries.
“But I don’t think we have enough evidence yet to know the best way to stimulate for the best outcomes,” Harkema told CNN.
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