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Thread: Carhart, et al. (2004). Epidural spinal-cord stimulation facilitates recovery of functional walking

  1. #1

    Carhart, et al. (2004). Epidural spinal-cord stimulation facilitates recovery of functional walking

    • Carhart MR, He J, Herman R, D'Luzansky S and Willis WT (2004). Epidural spinal-cord stimulation facilitates recovery of functional walking following incomplete spinal-cord injury. IEEE Trans Neural Syst Rehabil Eng. 12: 32-42. Harrington Department of Bioengineering, Arizona State University, Tempe, AZ 85287, USA. 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 micros, 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.

  2. #2
    Senior Member TimN's Avatar
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    Dr Young could you put this in a more simplified form? I'm not sure if I'm understanding everything to be honest. Is this only for ambulatory incompletes? Is it definitely going to clinical trials or being proposed? Thanks in advance.
    Tim

  3. #3
    TimN, this is a clinical trial. Herman had earlier reported that he was able to use epidural stimulation of the spinal cord to activate and facilitate walking in a quadriplegic person who was a very limited household walker, converting the person to one who can walk a kilometer without much energy expenditure.

    This study now reports that the use of epidural stimulation will accelerate recovery of locomotor function during weight-supported treadmill ambulatory training. This is very important since weight-support ambulatory training is not working for everybody and also takes a long time. Anything that increases training efficiency would make a big difference for the acceptance of ambulation training.

    So, in this particular case, a person who was training on a treadmill alone did not recover independent locomotion. However, when the treadmill training was combined with epidural lumbar stimulation of the locomotor pattern generator, the person not only showed better walking on treadmill but transferred his learned gait to overground walking such that after several weeks of training with overground walking, he was able to ambulate over 325 meters. That is nearly three and a half football fields and double his walking speed, as well as reduction of effort in doing so.

    Wise.

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    what happened after 325 metres? did he fall over? or exhausted?

  5. #5
    Chris2, I don't know. Maybe the investigator got tired and told him to stop. Wise.

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