Motor recovery after activity-based training with spinal cord epidural stimulation in a chronic motor complete paraplegic
Open accessAbstract
The prognosis for recovery of motor function in motor complete spinal cord injured (SCI) individuals is poor. Our research team has demonstrated that lumbosacral spinal cord epidural stimulation (scES) and activity-based training can progressively promote the recovery of volitional leg movements and standing in individuals with chronic clinically complete SCI. However, scES was required to perform these motor tasks. Herein, we show the progressive recovery of voluntary leg movement and standing without scES in an individual with chronic, motor complete SCI throughout 3.7 years of activity-based interventions utilizing scES configurations customized for the different motor tasks that were specifically trained (standing, stepping, volitional leg movement). In particular, this report details the ongoing neural adaptations that allowed a functional progression from no volitional muscle activation to a refined, task-specific activation pattern and movement generation during volitional attempts without scES. Similarly, we observed the re-emergence of muscle activation patterns sufficient for standing with independent knee and hip extension. These findings highlight the recovery potential of the human nervous system after chronic clinically motor complete SCI.
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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 [31]
The Discussion reports motor recovery in this participant and describes recovery reported in other studies. But Materials and Methods (Research participant; no page supplied) classifies this participant as AIS B, with sensation preserved below the injury, not complete sensorimotor paralysis. The Discussion mentions AIS A lesions but does not establish the claimed recovery in participants with those lesions. (LLM, conf=0.87)
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 [31]
The Abstract (page unavailable) says the research team had demonstrated recovery of volitional leg movements and standing in individuals with chronic, clinically complete spinal cord injury using lumbosacral epidural stimulation and activity-based training. This paper’s own results concern one participant, however, and do not establish that stimulation enabled this control in “many” individuals or independently of training. (LLM, conf=0.85)
Experimental — accuracy not yet measuredApplication of EES during neurorehabilitation (EESREHAB) further improved recovery of walking, even when the stimulation was turned off.
“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 [21]
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Self-citation
- Authors
- Rejc, E., Angeli, C. A., Atkinson, D., & Harkema, S. J.
- Affiliations
- University of Louisville (US)
- Corresponding author
- Harkema, Susan J.
- Venue
- Scientific Reports
- Published
- 2017-10-26
- Volume
- 7
- Issue
- 1
- Pages
- 13476-13476
- ISSN
- 2045-2322 (ISSN-L)
- PMC
- PMC5658385
- OpenAlex
- W2762911039
- Cited by
- 180
- References
- 45
- Citations by year
- 2026: 18 · 2025: 23 · 2024: 14 · 2023: 17 · 2022: 22 · 2021: 24 · 2020: 24 · 2019: 19 · 2018: 19
- FWCI
- 13.31
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Scientific Reports (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Institutional Research Information System (University of Udine) (submittedVersion)
- Funders
- Christopher and Dana Reeve Foundation
- Leona M. and Harry B. Helmsley Charitable Trust (R01EB007615)
- Medtronic
- National Institutes of Health
- National Institute of General Medical Sciences (P30GM103507, GM103507)
- 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
- spinal cord injury, epidural stimulation, activity-based training, motor recovery, standing, neuroplasticity, muscle activation patterns, chronic spinal cord injury
- MeSH terms
- Neurological Rehabilitation, Adult, Electrodes, Implanted, Epidural Space, Humans, Leg, Male, Movement, Muscle Contraction, Paraplegia, Spinal Cord Injuries, Muscle, Skeletal, Spinal Cord Stimulation
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