Effect of epidural stimulation of the lumbosacral spinal cord on voluntary movement, standing, and assisted stepping after motor complete paraplegia: a case study
Open accessAbstract
Background Repeated periods of stimulation of the spinal cord and training increased the ability to control movement in animal models of spinal cord injury. We hypothesised that tonic epidural spinal cord stimulation can modulate spinal circuitry in human beings into a physiological state that enables sensory input from standing and stepping movements to serve as a source of neural control to undertake these tasks.Methods A 23-year-old man who had paraplegia from a C7-T1 subluxation as a result of a motor vehicle accident in July 2006, presented with complete loss of clinically detectable voluntary motor function and partial preservation of sensation below the T1 cord segment. After 170 locomotor training sessions over 26 months, a 16-electrode array was surgically placed on the dura (L1-S1 cord segments) in December 2009, to allow for chronic electrical stimulation. Spinal cord stimulation was done during sessions that lasted up to 250 min. We did 29 experiments and tested several stimulation combinations and parameters with the aim of the patient achieving standing and stepping.Findings Epidural stimulation enabled the man to achieve full weight-bearing standing with assistance provided only for balance for 4·25 min. The patient achieved this standing during stimulation using parameters identified as specific for standing while providing bilateral load-bearing proprioceptive input. We also noted locomotor-like patterns when stimulation parameters were optimised for stepping. Additionally, 7 months after implantation, the patient recovered supraspinal control of some leg movements, but only during epidural stimulation.Interpretation Task-specific training with epidural stimulation might reactivate previously silent spared neural circuits or promote plasticity. These interventions could be a viable clinical approach for functional recovery after severe paralysis.Funding National Institutes of Health and Christopher and Dana Reeve Foundation.
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This recovery has been documented in various independent studies, including in participants with complete sensorimotor paralysis.
“This recovery has been documented in various independent studies, including in participants with complete sensorimotor paralysis5,6,30–34.”
From Walking naturally after spinal cord injury using a brain–spine interface (2023) · cites this paper as [30]
The Discussion reports regained voluntary leg movement with epidural stimulation, supporting the recovery claim. But the Methods describe this participant as motor complete with partially preserved sensation (AIS B), not as having complete sensorimotor paralysis. This is a single-participant case study; the citation is one of several attached to the broader sentence. (LLM, conf=0.90)
Experimental — accuracy not yet measuredThe delivery of epidural electrical stimulation over the lumbar spinal cord has enabled many individuals with spinal cord injury to regain adaptive control over the activity of otherwise paralysed muscles.
“The delivery of epidural electrical stimulation over the lumbar spinal cord has enabled many individuals with spinal cord injury to regain adaptive control over the activity of otherwise paralysed muscles.”
From Walking naturally after spinal cord injury using a brain–spine interface (2023) · cites this paper as [30]
The Findings and Discussion report that epidural stimulation enabled voluntary control of certain leg movements in one person with a motor-complete spinal cord injury, and only while stimulation was active. This case study does not support the claim that many individuals regained such control. (LLM, conf=0.90)
Experimental — accuracy not yet measured
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- [19]Gerasimenko Y Daniel O Regnaux J Combeaud M Bussel B Dengler R Kossev A Mechanisms of locomotor activity generation under epidural spinal cord stimulation Washington, DC IOS Press 2001 164 71
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- Authors
- Harkema, S., Gerasimenko, Y., Hodes, J., Burdick, J., Angeli, C., Chen, Y., Ferreira, C., Willhite, A., Rejc, E., Grossman, R. G., & Edgerton, V. R.
- Affiliations
- University of Louisville (US)
- University of California, Los Angeles (US)
- California Institute of Technology (US)
- University of Udine (IT)
- Houston Methodist (US)
- Corresponding author
- Edgerton, V Reggie
- ORCID
- Venue
- The Lancet
- Publisher
- Elsevier BV
- Published
- 2011-06
- Volume
- 377
- Issue
- 9781
- Pages
- 1938-1947
- ISSN
- 0099-5355 (ISSN-L)
- 0140-6736
- PMC
- PMC3154251
- OpenAlex
- W2142004558
- Cited by
- 1,229
- References
- 37
- Citations by year
- 2026: 80 · 2025: 78 · 2024: 64 · 2023: 87 · 2022: 109 · 2021: 103 · 2020: 120 · 2019: 67 · 2018: 84 · 2017: 74 · 2016: 91 · 2015: 72 · 2014: 73 · 2013: 57 · 2012: 52
- FWCI
- 44.20
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Licence
- Locations
- The Lancet (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- CaltechAUTHORS (California Institute of Technology) (submittedVersion)
- Institutional Research Information System (University of Udine) (submittedVersion)
- Funders
- Dana Foundation
- Christopher and Dana Reeve Foundation
- National Institutes of Health
- National Institute of Neurological Disorders and Stroke (R01NS062009)
- National Institute of Biomedical Imaging and Bioengineering (R01EB007615)
- Topics
- Health Sciences › Medicine › Pathology and Forensic Medicine › Spinal Cord Injury Research
- Health Sciences › Medicine › Rehabilitation › Stroke Rehabilitation and Recovery
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Treatment
- Keywords
- epidural spinal cord stimulation, spinal cord injury, locomotor recovery, standing, weight bearing, proprioception, neuroplasticity, locomotor training, supraspinal control, chronic electrical stimulation, spinal circuitry
- MeSH terms
- Electrodes, Implanted, Electromyography, Electric Stimulation Therapy, Humans, Leg, Lumbosacral Region, Male, Movement, Paraplegia, Posture, Spinal Cord, Spinal Cord Injuries, Weight-Bearing, Muscle, Skeletal, Young Adult
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