Abstract
Design: This paper describes a treatment paradigm to facilitate functional gait in a quadriplegic, ASIA C spinal cord injured (SCI), wheelchair-dependent subject who presented with some large fiber sensation, sub-functional motor strength in all lower limb muscles, and moderate spasticity. The study utilizes partial weight bearing therapy (PWBT) followed by epidural spinal cord stimulation (ESCS) with the assumption that both treatments would be necessary to elicit a well organized, near effortless functional gait with a walker. Function is defined in terms of accomplishing task-specific activities in the home and community.
Objectives: To demonstrate the feasibility and benefits of combined PWBT and ESCS therapies aimed at promoting functional gait in a wheelchair-dependent ASIA C SCI subject.
Setting: The Clinical Neurobiology and Bioengineering Research Laboratories at Good Samaritan Regional Medical Center, Phoenix, Arizona, USA, and the Department of Bioengineering, Arizona State University, Tempe, Arizona, USA.
Methods: The study began with the application of PWBT. The subject walked on the treadmill until a plateau in gait rhythm generation was reached. Subsequently, ESCS, applied to the lumbar enlargement, was utilized to facilitate PWBT and, later, over-ground walking for a standard distance of 15 m. Gait performance was analyzed by measuring average speed, stepping symmetry, sense of effort, physical work capacity, and whole body metabolic activity.
Results: PWBT led to improved stereotypic stepping patterns associated with markedly reduced spasticity, but was insufficient for over-ground walking in terms of safety, energy cost, and fatigue. ESCS with PWBT generated immediate improvement in the subject's gait rhythm when appropriate stimulation parameters were used. When compared to the non-stimulated condition, over-ground walking with ESCS across a 15 m distance was featured by a reduction in time and energy cost of walking, sense of effort, and a feeling of ‘lightness’ in the legs. After a few months of training, performance in speed, endurance, and metabolic responses gradually converged with/without ESCS at this short distance, suggesting a learned response to these conditions. However, at longer distances (eg, 50–250 m), performance with ESCS was considerably superior. The subject was able to perform multiple functional tasks within the home and community with ESCS.
Conclusion: We propose that ESCS augments the use-dependent plasticity created by PWBT and may be a valuable adjunct to post-SCI treadmill training in ASIA C subjects. We also conclude that ESCS elicits greater activation of an oxidative motor unit pool, thereby reducing the subject's sense of effort and energetic cost of walking.
Similar content being viewed by others
Log in or create a free account to read this content
Gain free access to this article, as well as selected content from this journal and more on nature.com
or
References
Lapointe R, Lajoie Y, Serresse O, Barbeau H . Functional community ambulation requirements in incomplete spinal cord injured subjects Spinal Cord 2001 39: 327–335
Wolpaw JR, Tennissen AN . Activity-dependent spinal cord plasticity in health and disease Annu Rev Neurosci 2001 24: 807–843
Barbeau H, Ladouceur M, Norman KE, Pepin A, Leroux A . Walking after spinal cord injury: evaluation, treatment, and functional recovery Arch Phys Med Rehabil 1999 80: 225–235
Muir GD, Steeves JD . Sensorimotor stimulation to improve locomotor recovery after spinal cord injury TINS 1997 20: 72–77
Cook AW, Weinstein SP . Chronic dorsal column stimulation for the treatment of movement disorders NY State J Med 1973 73: 2868–2872
Davis R, Gray E, Kudzma J . Beneficial augmentation following dorsal column stimulation in some neurological diseases Appl Neurophysiol 1981 44: 37–49
Iwahara T, Atsuta Y, Garcia-Rill E, Skinner RD . Spinal cord stimulation-induced locomotion in the adult cat Brain Res Bull 1992 28: 99–105
Dimitrijevic MR, Gerasimenko Y, Pinter MM . Evidence for a spinal central pattern generator in humans In: Kiehn O, Harris-Warrick RM, Jordan LM, Hultborn H, Kudo N (eds) Neuronal Mechanisms for Generating Locomotor Activity. Ann N Y Acad Sci. Vol. 860: New York: New York Academy of Sciences 1998 pp 360–376
Robertson RJ, Goss FL, Metz KF . Perception of physical exertion during dynamic exercise Percept Mot Skills 1998 86: 183–191
Frayn KN . Calculation of substrate oxidation rate in vivo from gas exchange J Appl Physiol 1983 55: 628–634
Burke RE, Edgerton VR . Motor unit properties and selective involvement in movement Exerc Sport Sci Rev 1975 3: 31–81
Granit R . Constant errors in the execution and appreciation of movement Brain 1972 95: 649–660
Acknowledgements
We gratefully acknowledge the funding supports from the GSRMC and ASU. We also recognize the assistance of the physical therapy staff at GSRMC, Qingjun Wang, Gary Yamaguchi, James Sweeney and Jeffrey Thrasher to this project. We appreciate Amir Seif-Naraghi for his valuable insight in this project, Medronic for contributing the stimulation device, and the Whitaker Foundation's partial support.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Herman, R., He, J., D'Luzansky, S. et al. Spinal cord stimulation facilitates functional walking in a chronic, incomplete spinal cord injured. Spinal Cord 40, 65–68 (2002). https://doi.org/10.1038/sj.sc.3101263
Published:
Issue date:
DOI: https://doi.org/10.1038/sj.sc.3101263
Keywords
This article is cited by
-
Neuroprosthetics: from sensorimotor to cognitive disorders
Communications Biology (2023)
-
Activity-dependent spinal cord neuromodulation rapidly restores trunk and leg motor functions after complete paralysis
Nature Medicine (2022)
-
Motor improvements enabled by spinal cord stimulation combined with physical training after spinal cord injury: review of experimental evidence in animals and humans
Bioelectronic Medicine (2021)
-
Transcutaneous Spinal Neuromodulation Reorganizes Neural Networks in Patients with Cerebral Palsy
Neurotherapeutics (2021)
-
Functional magnetic resonance imaging (fMRI) of the sensorimotor cortex in spinal cord injury patient after intensive rehabilitation
Research on Biomedical Engineering (2020)
