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Spinal implants let three people who were paralysed walk with support

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Three people who were completely paralysed from the waist down due to spinal cord injuries can now walk while using wheeled walking frames or crutches for support, thanks to implants that electrically stimulate nerves in their back and legs.

“All three patients immediately after the surgery were able to stand up and to step [with support],” says Jocelyne Bloch at Lausanne University Hospital in Switzerland, who carried out the surgery.

“On the first day, I was able to see my legs moving and it was very, very emotional,” says one of the recipients, an Italian man called Michel Roccati. After three to four months of training, he could walk outside using a walker.

Several groups have been investigating using implants to stimulate nerves of the spinal cord in people who have injured them, but most have focused on people with lesser injuries and more intact nerves. The idea is that the stimulation makes the remaining nerves more excitable and so amplifies the weak signals from the brain to the legs, although it takes months of training.

In the new study, the three men, who had all been injured for more than a year, had complete paralysis from the waist down. The instant results hinge on using purpose-built electrodes.

“This is a monumentally huge step forward,” says Ronaldo Ichiyama at the University of Leeds, UK. “However, we need to see this reported in more people before we get too excited.”

Roccati, who was paralysed in a motorbike crash in 2017, now uses the implanted device for 1 to 2 hours a day, including for going for walks on his own. He can also stand up for 2 hours, cycle and even swim, by choosing different stimulation programs. He finds walking or standing helps relieve pain caused by sitting in a wheelchair all day.

Users choose what kind of patterns of movement they need through a tablet computer. This links wirelessly to a device called a neurostimulator put into their abdomen, which connects to electrodes on their spine. The neurostimulator will have to be replaced after about nine years, although the electrodes should last the lifetime of the recipient.

Roccati feels some sensations when the implant starts working, as does another user, but the third person in this study, who had the most severe spinal cord injury, feels no sensations, says Grégoire Courtine at the Swiss Federal Institute of Technology in Lausanne (EPFL), who co-led the research with Bloch.

Roccati is also seeing small improvements in function even when the stimulation is turned off. This shows his spinal nerves weren’t completely severed, although he was classed as having complete paralysis of the legs. “He can induce movements, but not really move his leg voluntarily. It’s really dependent upon the stimulation turned on to have this recovery,” says Courtine.

Other previous work had used spinal implants designed for people who need relief from severe pain caused by spinal injury. But these implants aren’t powerful enough to reach all the different nerves needed for triggering the complex movement patterns required for stepping motions.

In the new approach, Courtine and his team worked with their technology spin-off company, Onward Medical, to develop larger electrodes that could target all the nerves needed. Each person has 16 electrodes implanted, although the team wants to put 32 into future recipients.

The computer software that controls the electrodes to achieve different patterns of movement is also an advance. The electrodes are tested during the surgery. “Sometimes you have an electrode not exactly at the perfect location, a patient will have the [nerves] a little bit distributed differently. So we have to tune the electrode and tune the timing,” says Bloch.

The group believes its approach could in theory help other paralysed people who have at least 6 centimetres of healthy spinal cord beneath the injury so there is room to implant all the electrodes. Onward Medical is planning a larger trial of the implants this year to test their effect on blood pressure, as spinal cord injuries can disrupt its regulation. They won’t be available outside trials for several years, says Bloch.

Journal reference: Nature Medicine, DOI: 10.1038/s41591-021-01663-5



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New Technology Restores Movement After Spinal Cord Paralysis

MONDAY, Feb. 7, 2022 (HealthDay News) -- A motorcycle crash left Michel Roccati with complete lower-body paralysis from a devastating spinal cord injury.

That was in 2017.

But now, the Italian native is walking again, courtesy of groundbreaking Swiss research that restores motor function within one day by means of carefully targeted electrical stimulation.

"At the beginning, I was unable to move the muscles of the legs, and I feel nothing," Roccati recalled recently.

Now he can stand, walk and do stairs. In fact, "everything I have in mind to train I can do with the stimulation," Roccati said at a press briefing hosted by Nature Medicine, which recently published the findings.

According to the World Health Organization, every year from 250,000 to a half-million people around the world suffer a seriously disabling spinal cord injury, most often the result of a fall, violence or, like Roccati, a traffic accident. Compared to people without this injury, they are two to five times more likely to die prematurely.

Roccati is one of three patients enrolled in the Swiss effort, all men between 29 and 41 years old. Each had experienced a complete spinal cord injury at least a year prior to the study's launch.

"This means that they could not move the legs, and they did not have any sensation over the legs," said study co-author Dr. Jocelyne Bloch, a neurosurgeon and chief of the functional neurosurgery unit at Lausanne University Hospital in Switzerland.

Speaking at the briefing, Bloch noted that in 2020 the three men underwent surgery at NeuroRestore in Lausanne to implant a pacemaker in the abdomen and electrodes directly onto the spinal cord.

Those electrodes are themselves an important innovation, explained study colleague and neuroscientist Grégoire Courtine.

Constructed to be permanent, they are "precisely positioned to target all the regions of the spinal cord that are relevant to activate trunk and leg muscles," said Courtine, who is with the Swiss Federal Institute of Technology in Lausanne.

The electrodes were then paired with new software that facilitated a highly personalized mapping of each patient's spinal cord, Courtine said in the briefing.

The software also provides a simple tablet-based interface that allows patients and physical therapists to easily set up semi-automated stimulation programs that enable a variety of movements.

Patients can operate these programs themselves, via a tablet and small remote controls that can communicate wirelessly to the patient's pacemaker.

For Roccati, all this meant that following a 10-day post-surgery recovery period, rehab began -- and "I was able to walk after one day," he said. The remote controls are attached to his walker.

"Thanks to this technology, all three patients, immediately after surgery, were able to stand up and walk," said Bloch during the briefing. Pedaling, swimming, and torso movement were also enabled. None reported any pain or side effects triggered by the stimulation.

Still, Bloch noted that motor control "was not perfect at the very beginning." And Courtine emphasized that regaining movement post-surgery is a process, "not a miracle," with patients initially needing a lot of physical support. Also, "the recovery of sensation is very different from one patient to the other," he added.

"But what it does is enable an immediate ability to train," Courtine noted. And because the technology is small and portable, that training can take place out in the real world.

Every day, with the stimulation turned on, "Michel is able to stand for two hours, and he walks almost 1 kilometer (.6 of a mile) straight, without stopping," in addition to climbing up and down stairs, said Courtine. "When the stimulation is turned off, he had some recovery, but to a very limited extent."

Bloch said the technology would almost certainly work equally well among female paralysis patients.

And while future research may expand what's possible, Bloch acknowledged one key limitation: "We need at least 6 centimeters of healthy spinal cord under the lesion. That's where we implant our electrodes."

Claudia Angeli, director of the University of Louisville's Spinal Cord Injury Research Center in Kentucky, agreed the Swiss team's work is "encouraging," but said other approaches also show merit.

"This group is using a very specific stimulation" signaling method, while alternative efforts attempt to enable motor control via direct stimulation of brain signals, she said.

Such alternative approaches "have shown similar results," Angeli noted. "There has not been a direct comparison of the two methods, but both are showing promise for recovery following spinal cord injury."

Meanwhile, the Swiss team has a trial in the works in the United States. The researchers noted that the U.S. Food and Drug Administration has approved a "breakthrough devices" designation to expedite the process whereby the technology could become commercially available. This designation would also ensure coverage through the Medicare Coverage of Innovative Technology program if larger clinical trials are successful, the researchers said.

As for Roccati, after nine months of Lausanne-based rehab, he now lives independently in Italy. "I continued rehab at home, working alone, with all the devices," he said. "And I see improvements every day."


Michel Roccati stands up and walks in Lausanne. Image credit: EPFL/Alain Herzog 2021




Edited by Gregorius
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