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Epidural Stimulation Study Allows Three More Paralyzed People to Take Steps

In September, a breakthough in epidural stimulation research made global headlines.  The New England Journal of Medicine published work from The Spinal Cord Injury Research Center at the University of Louisville, which announced that four paralyzed people regained the ability to walk after being implanted with a stimulation device and undergoing months of physical training.
Now, a new study published in Nature and Nature Neuroscience has revealed similar results in three more spinal cord injured subjects.
Epidural stimulation involves surgery that implants a set of electrodes directly on to a person’s injured spinal cord.  A power pack is also implanted underneath the person’s skin.  When the device is turned on, the spinal cord is stimulated and messages are sent to the body that bypass the injury.  (Above photo credit: The Guardian)
Dr. Susan Harkema, Director of the Christopher and Dana Reeve Foundation NeuroRecovery Network (NRN), was first behind epidural stimulation 8 years ago that restored function in multiple people with motor complete spinal cord injury.   Over the last several years her research has expanded and major milestones have been met.  First, epidural stimulation provided the ability to stand.  Then, bits of voluntary and task-specific movement were discovered.   Finally, unassisted STEPS took place.
All of these successes were performed in labs, and were combined with an incredible amount of time and repetition, but the results are fascinating, and the knowledge is still in its infancy.
NeuroHope joined the Reeve Foundation NRN earlier this year.  As a result, we are now one of a select number of sites in the world that is using what has been discovered about the unique electrical parameters in the implants, and investigating if it can be translated to Neuromuscular Electrical Stimulation (NMES) over the skin.  NMES is similar to Functional Electrical Stimulation (FES), but uses pre-programmed, task specific activities set at exclusive FDA-approved parameters that are aimed at targeting both the muscle and the circuitry of the spinal cord itself.
It is not yet known if NMES has the ability to promote neurorecovery, but we are proud to begin data collection for the NRN and thankful for the opportunity to offer it in a plan of care for our clients.

NeuroHope at the NeuroRecovery Network Summit

The NeuroRecovery Network (NRN) held its annual summit at Frazier Rehabilitation Institute in Louisville, Kentucky last week.  NeuroHope is laying the groundwork to join the network later this year, and our staff was invited to attend and learn about the innovative therapy interventions that are being researched and implemented at NRN sites across the country and overseas.

The NRN is a collaboration of clinical sites tied to rehabilitation hospitals (Craig Hospital, Frazier Rehab Institute, Kessler Institute for Rehabilitation, Magee Rehabilitation Hospital, Ohio State University Medical Center) and independent sites aimed to continue aggressive therapy and wellness for patients after they leave the hospital system (Next Step, Courage Kenny, Journey Forward, NeuroKinex).

The inspiration to begin this unique network of sites began through the work of Dr. Susan Harkema and Dr. Andrea Behrman, whose research led to a better understanding of neuroplasticity, which is the ability of nerve cells in the central nervous system to develop new connections and learn new functions.  Their work provided new evidence about the role the spinal cord plays in stepping, standing, and interpreting sensory information to re-learn tasks.

The Christopher and Dana Reeve Foundation (CDRF) helped fund the original research, and in the years since, the Foundation has been devoted to translating results to the clinic to help patients recovering from and living with spinal cord injury.

The NRN revolves around providing Activity-based therapy, a specific technique that activates the nervous system below the injury level and focuses on strengthening muscle weakness and neurologic recovery.  In addition to specific manual techniques, a principle Activity-based intervention is Locomotor Training.  Locomotor Training allows injured individuals to repetitively practice standing and stepping using body weight support.  In a therapy session, the participant is suspended in a harness over a treadmill at a high speed while specially trained therapists move the legs and ankles using specific sensory cues to simulate walking.  As the person gains function, improvements in sitting, standing, core strength, circulation, and bone-density may occur.

Dr. Harkema is also a pioneer in implementing epidural stimulation in her work, which made global headlines in 2011 and 2014 for restoring movement in four spinal cord injured individuals.  Since then, the NRN has incorporated new methods of NeuroMuscular Electrical Stimulation (NMES) at their sites to target upper extremity function, increase movement, and improve neuroplasticity.  NMES uses parameters beyond typical electrical stimulation to excite the central nervous system and activate weakened muscles.

Drs. Harkema and Behrman delivered lectures at this year’s summit and worked with NRN staff members from sites around the country as they practiced evaluation and activity-based therapy techniques.

We were honored to be invited to the summit and learn from some of the best minds in the world of neuroscience.  NeuroHope will soon be one of just 13 sites in the world where these innovative techniques are available.

Learn more about the NRN below: