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Thread: E-stim combined Brain & Spinal

  1. #1
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    E-stim combined Brain & Spinal

    Sorry. I don't understand why the efforts of Dr. Jason Carmel (Burke Rehab) to combine Brain & Spinal Stim have been left out of the estim conversation. I don't understand the science but it seems important enough to merit some comment from those who do.
    His work is funded by the Travis Foundation and the NYS dedicated funds that we fought successfully to get restored. He spoke at a recent open house at Rutgers. His work is aimed at upper body-hand and arm for complete quads. He has a personal connection. His twin brother is SCI and a leader in New Yorkers to Cure Paralysis, the group that led the fight for fund restoration.
    I posted an earlier post with the reference but it apparently slipped by so I am trying a new thread.
    Finbar

  2. #2
    Perhaps Wise can comment: http://www.travisroyfoundation.org/r...archers/2405-2


    Quote Originally Posted by Finbar View Post
    Sorry. I don't understand why the efforts of Dr. Jason Carmel (Burke Rehab) to combine Brain & Spinal Stim have been left out of the estim conversation. I don't understand the science but it seems important enough to merit some comment from those who do.
    His work is funded by the Travis Foundation and the NYS dedicated funds that we fought successfully to get restored. He spoke at a recent open house at Rutgers. His work is aimed at upper body-hand and arm for complete quads. He has a personal connection. His twin brother is SCI and a leader in New Yorkers to Cure Paralysis, the group that led the fight for fund restoration.
    I posted an earlier post with the reference but it apparently slipped by so I am trying a new thread.
    Finbar

  3. #3
    The money award for the 3 year research study was announced just a few months ago. Hopefully they will have success with this combo.

    April 11, 2014
    The Travis Roy Foundation has awarded a research grant of $374,266 to Jason Carmel, M.D., Ph.D., director of the Motor Recovery Laboratory at the Burke Medical Research Institute. The three-year grant will support research in Dr. Carmel's lab to investigate the effects of combined brain and spinal cord stimulation on recovery of arm and hand function.

    Previous research in Dr. Carmel's lab, also supported by the Travis Roy Foundation, has found that electrical brain stimulation can strengthen residual brain-spinal cord connections after injury. In rats, brain stimulation was shown to help restore movement after both acute and chronic injury.

    In the new 3 year study, researchers will characterize the physiological, behavioral, and anatomical effects of cervical spinal cord stimulation alone and in combination with brain stimulation. They believe that the two treatments will act synergistically by strengthening brain signals reaching the spinal cord and increasing the responsiveness of the spinal cord to these signals. According to Dr. Carmel, this will be the first study to 1) combine brain and spinal cord stimulation and 2) use spinal stimulation to target recovery of arm and hand function, a top priority of people with quadriplegia.


    Jack M. Parent, MD, of the University of Michigan, and a member of the American Neurological Association's Scientific Program Advisory Committee, interviews poster presenter Jason B. Carmel, MD, PhD, Weill Cornell Medical School, about his Rehabilitation and Regeneration poster presentation at the ANA's 2012 Annual Meeting. Dr. Carmel's poster is titled "Recovery of Motor Function after Complete Unilateral Injury of the Corticospinal Tract Using Electrical Stimulation of Motor Cortex on the Uninjured Hemisphere in Rats."
    Last edited by GRAMMY; 11-11-2014 at 10:10 PM.

  4. #4
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    Estm coordination. I just finished reading all 127 posts on the Ep-Future Trials thread. There was nothing like this flurry of promising activity 14 years ago at the time of our injury. So I came away encouraged but somewhat blurry.
    I would find it useful if someone (Grammy?) could put the whole epistim project together in a coherent statement as to where it is now. The efffort is international in scope. Is there any cooperation-conversation between the various researchers.?g Is it possible to bring things together. Is there any fear of unnecessary duplication? What about Kennedy-Krieger? I know they focus on direct stim of muscles-but are they irrelevant here?Can we do anything to encourage cooperation. Or is this a competitive race? Where should we direct funding? ,
    Finbar

  5. #5
    Here's a poster abstract from SFN 2014 LINK

    Paired motor cortex and cervical spinal cord stimulation augments corticospinal motor responses and promotes learning in the spinal cord of rats

    A. M. MISHRA1, D. GUPTA1, J. B. CARMEL1,2;
    1Motor Recovery Laboratory, Burke Med. Res., White Plains, NY; 2Brain and Mind Res. Inst. and Departments of Neurol. and Pediatrics, Weill Med. Col. of Cornell Univ., New York, NY

    Abstract:

    Spinal epidural stimulation has emerged as a powerful tool to raise the excitability of spinal cord circuits and to strengthen voluntary movement after injury. We sought to augment excitability of the corticospinal tract by pairing stimulation of its origin in motor cortex with stimulation of its terminations in the cervical spinal cord. All of the experiments were conducted in intact, anesthetized adult rats. We assayed excitability of the motor system by stimulating motor cortex with trains of 3 biphasic pulses at 333 Hz using and recording EMG in the contralateral biceps muscle. We created recruitment curves by stimulating cortex at increasing intensity and compared curve under different conditions. We used silver ball electrodes on the dorsum of the cervical spinal cord to deliver epidural stimulation. We conducted 3 experiments. In the first experiment, we measured the effects of tonic 40Hz spinal epidural stimulation on EMG responses. We hypothesized that, like lumber epidural stimulation, tonic cervical spinal cord stimulation would augment EMG responses in a manner dependent on the intensity, polarity, and stimulation location. Indeed, tonic stimulation directed at the cervical enlargement produced robust augmentation of EMG with both cathodal and biphasic stimulation that increased with intensity. In the second experiment, we hypothesized that a single pulse of spinal stimulation at discrete intervals after cortex stimulation would augment EMG responses. Latency was a crucial determinant, with 11ms being optimal. This timing coincides with the timing of the cord dorsum potential recorded in the cervical cord after motor cortex stimulation, suggesting synergistic effects of corticospinal and large diameter afferent stimulation. Finally, we asked whether repeatedly pairing of cortex and spinal cord stimulation at the optimal latency would induce learning in the spinal cord. We created a baseline response curve and also measured the spinal stimulation necessary to provoke EMG responses. We then delivered motor cortex stimulation followed 11ms later by a single biphasic spinal cord pulse and repeated this every 2 seconds for 5 minutes for a total of150 paired stimuli. We recorded a response curve and spinal thresholds immediately after the pairings and every 10 minutes thereafter. Paired stimulation caused a dramatic (>100%) increase in motor responses and the spinal threshold also decreased. Thus, we demonstrate plasticity in the intact CST by repetitive pairing of brain and spinal cord stimulation that occurs at the level of spinal cord.
    Last edited by GRAMMY; 11-19-2014 at 10:21 PM.

  6. #6
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    Grammy,
    I think I get the gist of this but some of us could use some interpretation. How significant is this? Is it a breakthrough? How close would this put to human trials? Can it help others working with epistim?
    Finbar

  7. #7
    @Finbar,

    This line of study is very much in it's infancy and they've pretty much just started working with this concept in principal. It will probably be a couple years before all the studies have concluded and we get published peer reviewed papers on all of their findings. This first abstract from SFN looks interesting. With approval of the proper devices they would want to use, it wouldn't be too hard or long to get something like this into a CT.

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