Medical breakthrough: paralyzed people will be able to walk again thanks to an implant

Scientists have developed a device to stimulate the spinal cord, with the help of which paralyzed people can walk again on the second day after surgery. CNN.

Photo: Shutterstock

Michel Roccati lost the ability to walk after a motorcycle accident in 2017, when his spinal cord was completely damaged. But today, equipped with an electrode implanted in his spinal cord, Roccati can once again enjoy the simple things: stand at a bar for drinks with friends, take a shower without a chair, and even walk around the city with a walker.

“I’m free,” said Roccati from Italy. “I can walk wherever I want.”

Roccati was one of three men aged 29 to 41 who took part in the STIMO clinical trial led by Dr. Jocelyn Bloch from the University Hospital of Lausanne and Grégoire Curtin from the Swiss Federal Institute of Technology. The results of the study were published February 7 in the journal Nature Medicine.

Participants were implanted with 16-electrode devices in the epidural space, the area between the vertebrae and the lining of the spinal cord. The electrodes receive currents from a stimulator implanted under the skin of the abdomen.

All patients in the study had a complete loss of voluntary movements below the injury. Two also had complete loss of sensation. But with these devices, the researchers could use a tablet computer to initiate unique sequences of electrical pulses sent to epidural electrodes through the implant to activate the participants' muscles.

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Other studies have occasionally seen movement shortly after surgery to implant similar devices, but this is the first study to report that all participants were independently able to take steps on a treadmill as little as a day after surgery, the researchers say.

“It's a very emotional moment because patients realize they can take steps,” Bloch said.

Researchers have been studying electrical stimulation of the spinal cord for three decades. This study redesigned technology originally used to relieve pain that affected spinal nerve roots.

Previous research from the University of Louisville showed that people who were completely paralyzed but still had sensation were able to walk again after several months of rehabilitation with electrical spinal cord stimulation. The STIMO trial showed that within a week after surgery, all three participants were able to walk independently using body weight support from the parallel bars and suspension straps.

“For the first time, we have an immediate effect – although rehab is still important. People without sensitivity, paralyzed, were able to stand upright, were able to walk independently of the laboratory, ”said Cortin.

Dr. Nandan Lad, a neurosurgeon at Duke University, said this "very exciting work provides a new treatment option for tens of thousands of spinal cord injury patients who don't really have any other options." Lad leads a clinical trial in this area of ​​research in the US and was not involved in the new study.

The Swiss team was able to observe immediate results thanks to important changes in the structure and implantation of their electrode device. The electrode array used in the STIMO test, made by Onward Medical, is wider and longer than the array most commonly used in similar studies. This new set of electrodes allows access to a wider area of ​​the spinal cord to stimulate muscles in the trunk and legs, Bloch says.

The researchers developed an algorithm for optimal placement of the array of electrodes by conducting tests during surgery to measure muscle activity after the pulses were applied. Precise neurosurgical placement of the electrodes is key to the device's ability to stimulate the right muscle groups in the legs so quickly, Lad says.

The STIMO test also introduces a new method for initiating and sustaining movement. To initiate stimulation, previous studies relied on participants' intention to move and subsequent brain signals. In the new study, a synchronized sequence of stimulations is generated using motor responses to various electrical discharges. These pre-set sequences trigger movement and attempt to mimic the natural muscle activation pattern required for walking.

Susan Harkema, a professor in the Department of Neurological Surgery who led the Louisville research, said it was reassuring that the two types of stimulation could generate movement patterns through the circuitry of the human spine, indicating that some function is preserved even with complete injuries.

"But I don't think we have enough evidence to determine the best way to stimulate for the best results," Harkema said.

With the STIMO implant, people with a completely damaged spinal cord can only regain movement in their legs during stimulation. While the device is turned off, movement will not be possible. The electrodes can stay in place for life, but the implant needs to be replaced every nine years.

But with exercise, patients can develop greater endurance and perform a wider range of activities. After surgery, study participants received one or two hours of physical therapy four times a week. In three to four months of consecutive training, one participant could stand for two hours at a time. Another could walk 500 meters on his own. One participant even climbed the stairs again.

The tablet used in the study is equipped with special programs coded for specific activities, including standing, walking and swimming.

“The more they train, the more they achieve, so they need motivation to stand for a long time,” Bloch said of the progress of the participants.

Cortin and Bloch now plan to work with Onward Medical to make the device more convenient for everyday use, such as integrating the program with mobile phones or smartwatches. The team then plans to scale up to a larger U.S. clinical trial. They estimate that it will take another three to four years for the technology to become commercially available.

At a press briefing last week, the researchers announced that the U.S. Food and Drug Administration had called the device a "medical breakthrough" to speed up the technology adoption process.

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It will also provide Medicare Coverage of Innovative Technology coverage if the larger clinical trials are successful.

“I think this study should be a call for all of us to understand that there is hope for a cure for these patients,” said Dr. Nicholas Theodore, director of the Johns Hopkins Center for Spine Neurosurgery, who was not involved in the study. “I think now there will be hope.” associated with an engineering solution, not a cellular repair strategy."

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