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Published20 February 2023
DOI https://doi.org/10.1038/s41591-022-02202-6
Marc P. Powell, Nikhil Verma, Erynn Sorensen, Erick Carranza, Amy Boos, Daryl P. Fields, Souvik Roy, Scott Ensel, Beatrice Barra, Jeffrey Balzer, Jeff Goldsmith, Robert M. Friedlander, George F. Wittenberg, Lee E. Fisher, John W. Krakauer, Peter C. Gerszten, Elvira Pirondini, Douglas J. Weber & Marco Capogrosso
Abstract
Cerebral strokes can disrupt descending commands from motor cortical areas to the spinal cord, which can result in permanent motor deficits of the arm and hand. However, below the lesion, the spinal circuits that control movement remain intact and could be targeted by neurotechnologies to restore movement. Here we report results from two participants in a first-in-human study using electrical stimulation of cervical spinal circuits to facilitate arm and hand motor control in chronic post-stroke hemiparesis (NCT04512690). Participants were implanted for 29 d with two linear leads in the dorsolateral epidural space targeting spinal roots C3 to T1 to increase excitation of arm and hand motoneurons. We found that continuous stimulation through selected contacts improved strength (for example, grip force +40% SCS01; +108% SCS02), kinematics (for example, +30% to +40% speed) and functional movements, thereby enabling participants to perform movements that they could not perform without spinal cord stimulation. Both participants retained some of these improvements even without stimulation and no serious adverse events were reported. While we cannot conclusively evaluate safety and efficacy from two participants, our data provide promising, albeit preliminary, evidence that spinal cord stimulation could be an assistive as well as a restorative approach for upper-limb recovery after stroke.
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https://www.nature.com/articles/s41591-022-02202-6#citeas
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University of Pittsburgh
School of Medicine Neurological Surgery
Spinal Cord Stimulation Improves Arm Mobility After Stroke
Pittsburgh, February 20, 2023 -- A neurotechnology that stimulates the spinal cord instantly improves arm and hand mobility, enabling people affected by moderate to severe stroke to conduct their normal daily activities more easily, report researchers from the University of Pittsburgh and Carnegie Mellon University today in Nature Medicine.
[Read the study Epidural stimulation of the cervical spinal cord for post-stroke upper-limb paresis on Nature Medicinewebsite.]
A pair of thin metal electrodes resembling strands of spaghetti implanted along the neck engage intact neural circuits, allowing stroke patients to fully open and close their fist, lift their arm above their head or use a fork and knife to cut a piece of steak for the first time in years.
“We discovered that electrical stimulation of specific spinal cord regions enables patients to move their arm in ways that they are not able to do without the stimulation. Perhaps even more interesting, we found that after a few weeks of use, some of these improvements endure when the stimulation is switched off, indicating exciting avenues for the future of stroke therapies,” said corresponding and co-senior author Marco Capogrosso, PhD, assistant professor of neurological surgery at Pitt. ...
