Defining the capacity of the lumbosacral network for neuromodulation in humans with spinal cord injury
Funded in: 2019, 2020, 2021
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Problem: Spinal neural circuits for stepping are in different functional states in the face of heterogeneous spinal cord injuries
Target: Use electrical stimulation of sensory nerve fibers entering the spinal cord
Goal: Stimulate sensory inputs to the spinal cord to enhance stepping function
Spinal cord injury (SCI) separates the neural networks in the spinal cord responsible for leg movements from normal brain control. However, below the level of injury, sensory feedback to the spinal cord is uninjured, which still gives us access to the nervous system for stepping.
Attempts have been made to stimulate sensory inputs to the spinal cord to enhance stepping function in people with SCI, but these have had variable results. One reason for this may be that the spinal neural circuits for stepping may be in different functional states in the face of heterogeneous spinal cord injuries. Our goal is to understand the neurophysiological profile of different spinal cord injuries to augment stepping in different individuals or groups of individuals.
The scientists propose to use electrical stimulation of sensory nerve fibers entering the spinal cord (transcutaneous spinal stimulation) to study spinal reflexes under several test conditions during robotic-assisted stepping. They will apply different neuromodulation stimulation patterns and record leg muscle responses in 60 patients over three years in their laboratory.
They anticipate discovering a spectrum of neurophysiological profiles that can be explained by the pattern and severity of SCI, which will predict the responsiveness of different individuals to neuromodulation with different parameters of transcutaneous spinal stimulation. This could serve to improve the magnitude of the effect of neuromodulation in patients for this novel neurorehabilitation approach.