Research: Breakthrough device helps paralyzed people walk

Michel Roccati (from Italy) was unable to walk after a motorcycle accident in 2017 left the man with a complete spinal cord injury. However, thanks to an electrode device implanted in the spinal cord, Roccati is now able to do seemingly simple things again: stand at a bar with friends, shower without a chair and even go for a walk. around town on a walker.

Specifically, Roccati is one of three men between the ages of 29 and 41 participating in the STIMO clinical trial led by Dr Jocelyne Bloch at the University Hospital Lausanne and Grégoire Courtine of the Swiss Federal Institute of Technology. The results of the study were published February 7 in the journal Nature Medicine.

The participants had 16 electrodes implanted in the epidural space, the area between the vertebrae and the membranes of the spinal cord. Electrodes that receive electrical current from a pacemaker are implanted under the skin of the abdomen.

All patients in the trial had complete loss of self-mobility in the area below the injury site. The two of them lost their senses completely. But with devices in place, the researchers can use tablets to initiate sequences of electrical impulses, sent to epidural electrodes via a pacemaker, to activate the muscles of these people. Participants. This is the first study in which all participants were able to walk on their own just one day after surgery.

Researchers have been looking at electrical stimulation to the spinal cord for the past three decades. This study redesigned technology originally used for pain relief to target spinal nerve roots.

Previously, researchers at the University of Louisville showed that people with complete paralysis but still able to walk after several months of rehabilitation through electrical stimulation to the spinal cord. The STIMO trial showed that within a week of surgery, all three participants were able to walk on their own with the help of some equipment.

Dr Nandan Lad, a neurosurgeon at Duke University, said the work could provide new treatment options for tens of thousands of patients with spinal cord injuries and no other options.

The team was able to observe immediate results through significant changes in the structure and implantation of the electrode device. The electrode system used in the STIMO trial, manufactured by Onward Medical, was wider and longer than the system commonly used in similar studies. According to Dr. Jocelyne Bloch, this new electrode system allows access to a wider area of ​​the spinal cord to stimulate both the trunk and leg muscles.

The researchers developed an algorithm for optimal placement of the electrodes, running tests during surgery to measure muscle activity after stimulation. Placing the electrodes in the correct position is the key to stimulating the necessary muscle groups in the legs quickly.

However, with the STIMO device, people with spinal cord injuries can fully walk only when receiving stimulation. While the device is off, they will not be able to move on their own. The electrodes may not need to be replaced for a lifetime, but pacemakers need to be replaced every 9 years.

But with exercise, patients can increase endurance and perform more activities. After surgery, three study participants received physical therapy for 1 or 2 hours, 4 times a week. After 3 or 4 months of continuous training, a participant was able to stand for 2 hours straight. A person can walk 500 meters on their own. One can even step up stairs. The tablets in the study were equipped with specific programs coded for certain types of activities, such as standing, walking, and swimming.

The team now plans to work with Onward Medical to make the device more user-friendly for everyday use, such as integrating the program into a mobile phone or smartwatch. Next, the team is looking to scale up a larger clinical trial in the US. They estimate that it will take another three to four years to bring the technology to market.