Introduction: Epidural spinal cord stimulation (ESCS) is a common procedure in neurosurgical practice for the treatment of chronic pain. In the last two decades, animal and human model research studies have used ESCS to modulate spinal afferent and interneuronal circuits aiming to improve motor outcomes following stroke, spinal cord injury (SCI), and other neurological movement disorders by using patterns of tonic stimulation. ESCS for recovery of motor control has been successfully applied to lower-limb rehabilitation, with numerous studies demonstrating various degrees of locomotor recovery. However, the upper limbs are crucial for essential activities of daily living and maintaining quality of life, severely affecting those with cervical SCI. Despite this, there have been far fewer studies investigating the use of ESCS for upper-limb motor recovery. Cervical spinal cord transcutaneous stimulation has been reported in anecdotal and pivotal SCI studies. However, transcutaneous stimulation has less specificity than ESCS and requires setup each time it is applied.
Methods: Here, we describe the clinical experience of a C4-level participant implanted with a brain-computer interface (BCI) system that enabled motor intent detection to control a unilateral ESCS device. To test if ESCS could produce substantially improved arm function in a combined BCI-ESCS paradigm, a recent surgical procedure involved placing percutaneous leads into the right epidural space caudal to the site of injury, specifically targeting sensorimotor circuits responsible for upper-limb control.
Results: Over one month, the participant demonstrated improvements in clinical assessments related to grasping and reaching abilities. Moreover, the participant reported a positive overall experience throughout the month-long intervention.
Conclusion : Modulating descending control of the upper limbs through spinal cord stimulation after SCI in combination with BCI establishes a precedent to employ ESCS in future upper-limb rehabilitation studies following upper-level cervical SCI.
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