Neuroprosthetic systems to promote recovery and plasticity of the injured spinal cord
Funded in: 2013, 2014, 2015
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Problem: After SCI spinal neural circuits are damaged leading to severely impaired function
Target: Training and stimulation of spared neural circuits
Goal: Promotion of use-dependent plasticity of spared neural systems to improve functional recovery.
Locomotion is controlled by the supraspinal centers, like the motor region of the brain and the cerebellum, but is profoundly and durably modulated by the spinal locomotor circuits through the sensory information coming from the body periphery. After a spinal cord injury these circuits are severely damaged, but it is known that the spinal cord has the capacity of remodeling its circuits. How this occurs is still an open question.
In previous research in rodents Dr. Courtine demonstrated that a combination of three interventions, termed electrochemical neuroprosthesis, could transform lumbosacral circuits from non-functional to highly functional states in rats with severe spinal cord injury (SCI) and enable locomotion. The combination included
- Activity related learning of the damaged spinal cord by locomotor training
- Epidural electrical spinal cord stimulation
- and monoaminergic drugs that have stimulating effects on the spinal cord
There are also reports in the literature by other groups suggesting that electrical spinal cord stimulation in paraplegic patients can improve leg movement.
In this project Dr. Courtine will explore this combination of interventions as an important step in the translation to clinical use. Activity related learning is already used in clinical rehabilitation, as for example treadmill training, aiming to promote spinal plasticity. The rational for the use of electrical stimulation and the monoaminergic drug is the excitatory effect on the nervous system.
Various technical and biomedical issues remain to be addressed to ensure the safe and efficacious translation of this therapy to a viable clinical intervention. The project aims to develop an electrochemical neuroprosthesis to facilitate locomotion and to demonstrate its safety and efficacy for gait training enabled. This study is an important step in the efforts to translate the findings from rats to human. The goal is to improve functional recovery and promote use-dependent plasticity of spared neural systems.