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Targeted neurotechnology restores walking in humans with spinal cord injury
Open accessAbstract
Spinal cord injury leads to severe locomotor deficits or even complete leg paralysis. Here we introduce targeted spinal cord stimulation neurotechnologies that enabled voluntary control of walking in individuals who had sustained a spinal cord injury more than four years ago and presented with permanent motor deficits or complete paralysis despite extensive rehabilitation. Using an implanted pulse generator with real-time triggering capabilities, we delivered trains of spatially selective stimulation to the lumbosacral spinal cord with timing that coincided with the intended movement. Within one week, this spatiotemporal stimulation had re-established adaptive control of paralysed muscles during overground walking. Locomotor performance improved during rehabilitation. After a few months, participants regained voluntary control over previously paralysed muscles without stimulation and could walk or cycle in ecological settings during spatiotemporal stimulation. These results establish a technological framework for improving neurological recovery and supporting the activities of daily living after spinal cord injury.
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“He had previously participated in the STIMO clinical trial (clinicaltrials.gov, NCT02936453), which involved a five-month neurorehabilitation programme supported by targeted epidural electrical stimulation of the spinal cord4,5.”
From Walking naturally after spinal cord injury using a brain–spine interface (2023) · cites this paper as [4]
In the citing paper
“In turn, recruiting these dorsal root entry zones with preprogrammed spatiotemporal sequences replicates the physiological activation of leg motor pools underlying standing and walking4,5,11,13,14.”
From Walking naturally after spinal cord injury using a brain–spine interface (2023) · cites this paper as [4]
In the citing paper
“This programme enabled him to regain the ability to step with the help of a front-wheel walker.”
From Walking naturally after spinal cord injury using a brain–spine interface (2023) · cites this paper as [4]
In the citing paper
“Walking involves well-defined sequences of muscle activation patterns that support weight acceptance, propulsion and swing of the left and right lower limbs. These sequences coincide with the activation of motor pools located within well-segregated regions of the lumbosacral spinal cord4,27.”
From Walking naturally after spinal cord injury using a brain–spine interface (2023) · cites this paper as [4]
In the citing paper
“First, the physiological principles underlying targeted epidural electrical stimulation of the spinal cord have now been validated in nine out nine treated individuals with incomplete4 and complete5 injuries6.”
From Walking naturally after spinal cord injury using a brain–spine interface (2023) · cites this paper as [4]
In the citing paper
“This chain of software and hardware enabled real-time control of stimulation protocols with a latency inferior to 150 ms (ref. 4).”
From Walking naturally after spinal cord injury using a brain–spine interface (2023) · cites this paper as [4]
In the citing paper
“We implemented a grid search model to explore the different electrode configurations and frequencies to select the configurations of cathodes and anodes to achieve maximum selectivity in the recruitment of the targeted muscle groups4.”
From Walking naturally after spinal cord injury using a brain–spine interface (2023) · cites this paper as [4]
In the citing paper
“Application of EES during neurorehabilitation (EESREHAB) further improved recovery of walking, even when the stimulation was turned off1,21.”
From The neurons that restore walking after paralysis (2022) · cites this paper as [1]
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Metadata
- Authors
- Wagner, F. B., Mignardot, J.-B., Le Goff-Mignardot, C. G., Demesmaeker, R., Komi, S., Capogrosso, M., Rowald, A., Seáñez, I., Caban, M., Pirondini, E., Vat, M., McCracken, L. A., Heimgartner, R., Fodor, I., Watrin, A., Seguin, P., Paoles, E., Van Den Keybus, K., Eberle, G., Schurch, B., Pralong, E., Becce, F., Prior, J., Buse, N., Buschman, R., Neufeld, E., Kuster, N., Carda, S., von Zitzewitz, J., Delattre, V., Denison, T., Lambert, H., Minassian, K., Bloch, J., & Courtine, G.
- Affiliations
- Centre Hospitalier Universitaire Vaudois (CH)
- University of Fribourg (CH)
- École Polytechnique Fédérale de Lausanne (CH)
- University of Geneva (CH)
- Medtronic (United States) (US)
- Foundation for Research on Information Technologies in Society (CH)
- ETH Zurich (CH)
- Corresponding author
- Courtine, Grégoire
- ORCID
- Wagner, Fabien B.
- Mignardot, Jean-Baptiste
- Demesmaeker, Robin
- Komi, Salif
- Capogrosso, Marco
- Rowald, Andreas
- Seáñez, Ismael
- Caban, Miroslav
- Pirondini, Elvira
- McCracken, Laura A.
- Heimgartner, Roman
- Fodor, Isabelle
- Eberle, Grégoire
- Schurch, Brigitte
- Becce, Fabio
- Prior, John
- Buse, Nicholas
- Buschman, Rik
- Neufeld, Esra
- Kuster, Niels
- Carda, Stefano
- Minassian, Karen
- Bloch, Jocelyne
- Courtine, Grégoire
- Venue
- Nature
- Published
- 2018-10-31
- Volume
- 563
- Issue
- 7729
- Pages
- 65-71
- ISSN
- 0028-0836 (ISSN-L)
- 1476-4687
- OpenAlex
- W2898429451
- Cited by
- 1,087
- References
- 46
- Citations by year
- 2026: 110 · 2025: 160 · 2024: 117 · 2023: 153 · 2022: 152 · 2021: 176 · 2020: 125 · 2019: 81 · 2018: 10
- FWCI
- 74.13
- Type
- journal article
- Language
- en
- Open access
- green
- infoscience.epfl.ch
- Licence
- Locations
- Nature (publishedVersion)
- PubMed (publishedVersion)
- HAL (submittedVersion)
- RePEc: Research Papers in Economics (submittedVersion)
- Ghent University Academic Bibliography (Ghent University) (submittedVersion)
- Infoscience (Ecole Polytechnique Fédérale de Lausanne) (submittedVersion, cc-by-nc-nd)
- IRIS (submittedVersion)
- SERVAL (Université de Lausanne) (submittedVersion)
- Topics
- Health Sciences › Medicine › Clinical Neurology › Spinal Cord Injury Research
- Health Sciences › Medicine › Rehabilitation › Stroke Rehabilitation and Recovery
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Treatment
- Keywords
- spinal cord injury, spinal cord stimulation, neurotechnology, lumbosacral spinal cord, implanted pulse generator, voluntary motor control, paralysis, locomotor rehabilitation, neurological recovery, activities of daily living
- MeSH terms
- Activities of Daily Living, Computer Simulation, Electromyography, Electric Stimulation Therapy, Epidural Space, Humans, Leg, Locomotion, Male, Motor Neurons, Paralysis, Spinal Cord, Spinal Cord Injuries, Walking, Muscle, Skeletal, Biomedical Technology
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