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Thread: Q&A: Epidural Stimulation and Bladder, Bowel, & Sexual Function

  1. #51
    Luckily the project being discussed in this thread should be expedited in translation through a larger number of individuals with SCI to the next phase of the SPARC initiative. Hopefully that will help alleviate problems with locating necessary funding.

    On September 20th, the "FUNCTIONAL MAPPING WITH LUMBOSACRAL EPIDURAL STIMULATION FOR RESTORATION OF BLADDER FUNCTION AFTER SPINAL CORD INJURY" (an OCA2 project) I posted earlier in post (#38) was awarded SPARC funds of $1,239,591. Keep in mind, the experiments will be utilizing the Medtronic Specify 5-6-5 for mapping the cord.

    I had the new SPARC initiative information and videos posted on the U2FP SCI report a year ago last May for those that missed it. It's very interesting and helpful in understanding the bladder and sexual function project that's underway. LINK
    __________________________________________________ _________________________________________________

    In addition, the NIH (RO1) award of $311,250. on July 28th, 2017 for the project posted in (#37) was for "EFFECTS OF ACTIVITY DEPENDENT PLASTICITY ON RECOVERY OF BLADDER AND SEXUAL FUNCTION AFTER HUMAN SPINAL CORD INJURY".
    Last edited by GRAMMY; 01-02-2018 at 11:22 AM. Reason: Added 3 red links to public information

  2. #52

  3. #53
    Quote Originally Posted by GRAMMY View Post
    Thanks for that.

    I see its a 6 year study for 36 people. I'd love to know how they justify stretching it out.

  4. #54
    Quote Originally Posted by niallel View Post
    Thanks for that.

    I see its a 6 year study for 36 people. I'd love to know how they justify stretching it out.
    I would imagine it has to do with all the lab personnel and equipment space availability along with surgery scheduling.

  5. #55
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    I hope they're working with UCLA and Caltech on the very latest stimulation modes (waveforms and electrode layouts). It would also be interesting to have a second group who only use transcutaneous.
    T3 complete since Sept 2015.

  6. #56
    Quote Originally Posted by Mize View Post
    I hope they're working with UCLA and Caltech on the very latest stimulation modes (waveforms and electrode layouts). It would also be interesting to have a second group who only use transcutaneous.
    I don't believe that's the case. I've listed the projects previously for the other labs in Kentucky being discussed. They're working with the "Medtronic Specify 5-6-5" implants.

    Here's the two abstracts for 2017 at the University of California Los Angeles lab.

    5U01EB015521-05 Former Number: 5U01EB015521-04Contact PI / Project Leader:EDGERTON, REGGIE
    Total Funding: $1,207,800.

    DESCRIPTION (provided by applicant): We have demonstrated that the physiological state of the lumbosacral spinal circuitry of spinal rats and cats can be modulated with spinal cord epidural stimulation (EDS) and/or administration of pharmacological agents to generate weight-bearing standing and stepping over a range of speeds, loads, and directions. We have translated some of these results to humans by implanting 3 motor complete spinal cord injured (SCI) subjects about three years post-injury with an epidural electrode array over the lumbosacral spinal cord. In less than one month post-electrode implant, the subjects could stand independently, and after up to 7 months of daily EDS and motor training, voluntary control of both legs was evident in the presence of EDS, whereas complete paralysis remained in absence of EDS. We propose to employ a similar stimulation strategy for the recovery of upper limb function. We will include extensive testing of spinal rats to guide our strategy to test for upper extremity improvement in human SCI subjects. We will use off-the-shelf FDA approved pharmacological and stimulation modalities to: 1) Determine the optimal stimulation parameters, i.e., electrode placement and stimulation intensity, frequency and duration, for facilitating forelimb fine motor function in rats with a cervical SCI. Using existing FDA-approved epidural electrodes, we will demonstrate in patients with a cervical SCI that cervical EDS can facilitate arm-hand function. 2) Identify an effective mode of administration, define the dose- response pharmacokinetics, and determine the effectiveness of a monoaminergic agonist to facilitate upper limb function after a cervical SCI. We will assess the effectiveness of existing FDA-approved pharmacological agents (i.e., buspirone and as an alternative, bromocriptine), and determine their effectiveness in improving forelimb control in subjects with a cervical SCI. 3) Define the dose-response properties of monoaminergic agonists when combined with EDS in facilitating forelimb function in rats after a cervical SCI. We will demonstrate the efficacy of ES in combination with a pharmacological intervention in facilitating arm and hand function in humans after a cervical SCI. 4) Determine whether motor training of spinal rats will further enhance the recovery of motor function when combined with pharmacological and/or EDS interventions. 5) Develop a protocol for machine learning to enable rapid selection of the optimal pharmacological and EDS parameters for motor recovery in rats and in human subjects. If successful, this could represent the beginning of a paradigm shift in the use of minimally invasive strategies combined with rehabilitative approaches to realize significant improvement in upper limb function after paralysis.

    __________________________________________________ __________________________________________________ __________________________________________________ ___________

    Project Number:5U01EB007615-09 Former Number: 2R01EB007615-06A1Contact PI / Project Leader:EDGERTON, REGGIE
    NIBIB Funding: $457,885.

    DESCRIPTION (provided by applicant): In the first 5-year period of our BRP we had two major objectives: 1) to determine whether we could improve motor function of the lower limbs by neuromodulating the spinal lumbosacral circuitry with epidural stimulation and 2) to begin to develop and improve the technologies associated with electrode arrays and chronic implantable stimulation devices to maximize the neuromodulatory potential. These new technologies have the potential to fine tune the epidural stimulation parameters, to help in understanding some of the underlying mechanisms of epidural stimulation., to examine synergistic effects of epidural stimulation, pharmacological modulation, and examine activity-dependent interventions that might affect the level of recovery of motor function after complete paralysis. We have demonstrated that an adult rat with a complete, mid-thoracic spinal cord transection can regain full weight-bearing stepping over a range of speeds, loads, and even directions when the spinal cord is stimulated tonically to increase the excitability of the lumbosacral locomotor circuitry. Furthermore, we learned that load-bearing sensory information can serve as the controller of these complex motor tasks and that the performance of these tasks can be improved even further with combinations of epidural stimulation, pharmacological, and motor training interventions. We have shown that four humans with a motor complete spinal injury have regained independent standing, assisted stepping, and even a significant level of voluntary control of the lower limbs in the presence of epidural stimulation, with one subject now even having some volitional control without stimulation. Improvement in bladder control, blood pressure, temperature regulation, and even sexual function has been realized. Thus, our present challenge is to develop the capability to selectively activate combinations of neural networks that can enable standing, and probably stepping, by improving the technologies needed to make this intervention available in the clinic and in the home of individuals with complete motor paralysis using a chronic epidural electrode implant. Specifically, we will further improve the electrode array stimulation technology needed for fine-tune control in rats and humans and transform the present hardwired technology for rats to a wireless capability to stimulate and record evoked potentials along the brain-spinal cord-muscle axis in the rat. To advance the clinical potential, we will continue to develop, refine and validate our machine-learning strategies which automatically optimize stimulation parameters for standing, stepping, and voluntary control. We will develop an improved interface between the devices implanted in our present subjects and the control devices for defining the specific stimulation parameters needed for a given subject to perform a motor task in the clinic or at home.

  7. #57
    Senior Member lynnifer's Avatar
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    Windsor ON Canada
    Roses are red. Tacos are enjoyable. Don't blame immigrants, because you're unemployable.

    T-11 Flaccid Paraplegic due to TM July 1985 @ age 12

  8. #58

  9. #59
    Senior Member lunasicc42's Avatar
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    Lutz, Fl USA*********C456
    this post is just about my own situation actually but as I suspected; epidural stimulation isn't for me as it stands because of my Syrinx. I contacted one of the epidural stimulation trials by e-mail and I was informed that having a Syrinx indeed does disqualify me from participating in any of the stimulation studies... DAMN THIS SYRINX AAAARGH

    I need detethering so bad but I have been informed that no one will detether me due to the risk unless I actively start to lose function because of it. A restorative treatment and detethering will be needed to be done in tandem for me
    "That's not smog! It's SMUG!! " - randy marsh, southpark

    "what???? , you don't 'all' wear a poop sac?.... DAMNIT BONNIE, YOU LIED TO ME ABOUT THE POOP SAC!!!! "

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  10. #60
    As far as I'm concerned from all I've seen they are milking this thing for all it's worth. Without mentioning names there was a video of one of the original guys in the trial from 2010 climbing stairs bumping up on his butt. He is every bit as much of a T5 Paraplegic as me even though CR foundation has boosted about all kinds of benefits, I just don't see it. I'm sorry I ever donated money towards this, I think it was all a waste. It's not the answer towards any meaningful cure. I think the only near term answer is robotics and I hope robots will help me in my old age, I'll be turning 60 in May so starting to get up there and after 37 years of T4 complete spinal cord injury it takes its toll on the body. I'd hoped maybe this Epidural stim would help me out personally with A/D I get, if anything will kill me that will be it. But I never hear back from anyone. It's a useless cause in my opinion, money would be better spent on med research or other technologies that could actually help us, I know they will keep doing what they are doing though, no way to change that. So many of these never go anywhere or help anyone.
    "Life is about how you
    respond to not only the
    challenges you're dealt but
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    soul dies".~Liz Fordred

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