Abstract
Objective
To report on unexpected findings in 4 patients with chronic paraplegia who underwent
the laparoscopic implantation of neuroprosthesis procedure in the pelvic lumbosacral
nerves.
Design
Observational case series.
Setting
Tertiary referral unit specialized in advanced gynecological surgery and neuropelveology.
Participants
Three patients with incomplete American Spinal Injury Association (ASIA) Impairment
Scale (AIS) grade B (n=2) and AIS grade C (n=1) spinal cord injury (SCI) and 1 patient
with flaccid complete chronic SCI (AIS grade A) (n=1).
Intervention
Functional electrical stimulation (FES)-assisted locomotor training and continuous
low-frequency pelvic-lumbosacral neuromodulation.
Main Outcome Measures
Change in ASIA Lower Extremity Motor Scores, ASIA sensory scores for light touch and
pinprick sensation, and Walking Index for Spinal Cord Injury scores.
Results
All 4 patients developed progressive recovery of some sensory and voluntary motor
functions below the lesions. Three are currently capable of voluntary weight-bearing
standing and walking a few meters with a walker without FES. The first patient with
the longest follow-up is even capable of electrically assisted standing/walking with
2 crutches without braces or assistance for a distance of about 900 meters, and of
weight-bearing standing and walking for 30 meters with a walker without stimulation.
Conclusions
We report unexpected sensory and locomotor recovery in 4 people with paraplegia with
SCI. Our findings suggest that FES-assisted locomotor training with continuous low-frequency
pelvic nerve stimulation in patients with SCI may induce changes that affect the central
pattern generator and allow supra- and infraspinal inputs to engage residual spinal
pathways.
Keywords
List of abbreviations:
AIS (American Spinal Injury Association Impairment Scale), FES (functional electrical stimulation), SCI (spinal cord injury)To read this article in full you will need to make a payment
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References
- Surgical management of spasticity and spasms in spinal cord injury: an overview.J Am Paraplegia Soc. 1988; 11: 9-13
- Analysis of assisted-gait characteristics in persons with incomplete spinal cord injury.Spinal Cord. 1999; 37: 430-439
- Functional electrotherapy: stimulation of the peroneal nerve synchronized with the swing phase of the gait in hemiplegic patients.Arch Phys Med Rehabil. 1961; 42: 101-105
- New strategies of pelvic nerves stimulation for recovery of pelvic visceral functions and locomotion in paraplegics.Neurourol Urodyn. 2010; 29: 1433-1438
- Laparoscopic exposure and electrostimulation of the somatic and autonomous pelvic nerves: a new method for implantation of neuroprosthesis in paralysed patients?.J Gynecol Surg Endosc Imaging Allied Tech. 2004; 1: 87-90
- Guidelines for the conduct of clinical trials for spinal cord injury (SCI) as developed by the ICCP panel: clinical trial outcome measures.Spinal Cord. 2007; 45: 206-221
- Walking Index for Spinal Cord Injury (WISCI): criterion validation.Spinal Cord. 2005; 43: 43-71
- Synaptic regeneration and glial reactions in the transected spinal cord of the lamprey.J Neurocytol. 1981; 10: 57-79
- Transformation of nonfunctional spinal circuits into functional states after the loss of brain input.Nat Neurosci. 2009; 12: 1333-1342
- Restoration of walking function in an individual with chronic complete SCI.J Rehabil Med. 2010; 42: 795-798
- Recovery of assisted overground stepping in a patient with chronic motor complete spinal cord injury: a case report.NeuroRehabilitation. 2012; 31: 401-407
- Unexpected recovery after robotic locomotor training at physiologic steeping speed: a single-case design.Arch Phys Med Rehabil. 2012; 93: 1476-1485
- Neurotrophins enhance electric field-directed growth cone guidance and directed nerve branching.Dev Dyn. 2000; 217: 299-308
- Functional recovery after spinal cord hemisection in guinea pigs: the effects of applied electric fields.J Comp Neurol. 1990; 296: 634-653
- Oscillating field stimulation for complete spinal cord injury in humans: a phase 1 trial.J Neurosurg Spine. 2005; 2: 3-10
- Step training reinforces specific spinal locomotor circuitry in adult spinal rats.J Neurosci. 2008; 28: 7370-7375
- Characteristics and mechanisms of locomotion induced by intraspinal microstimulation and dorsal root stimulation in spinal cats.J Neurophysiol. 2007; 97: 1986-2000
- OEG implantation and step training enhance hindlimb-stepping ability in adult spinal transected rats.Brain. 2008; 131: 264-276
- Epidural stimulation induced modulation of spinal locomotor networks in adult spinal rats.J Neurosci. 2008; 28: 6022-6029
- Effect of epidural stimulation of the lumbosacral spinal cord on voluntary movement, standing, and assisted stepping after motor complete paraplegia: a case study.Lancet. 2011; 377: 1938-1947
- Leptin regulates bone formation via the sympathetic nervous system.Cell. 2002; 111: 305-317
- Sympathetic nervous system as transmitter of mechanical loading in bone.Joint Bone Spine. 2003; 70: 515-519
- Effects of electrical stimulation at different frequencies on regeneration of transacted peripheral nerve.Neurorehabil Neural Repair. 2008; 22: 367-373
- Increasing muscle mass in spinal cord injured persons with a functional electrical stimulation exercise program.Arch Phys Med Rehabil. 1999; 80: 1531-1536
- Treatment of venous ulcers with low frequency pulsed current (Dermapulse) effects on cutaneous microcirculation.Der Hautartzt. 1997; 18: 879-903
- Effect of high voltage pulsed galvanic stimulation on sacral transcutaneous oxygen tension levels in the spinal cord injured.Paraplegia. 1993; 31: 311-319
Article info
Publication history
Published online: November 21, 2013
Footnotes
No commercial party having a direct financial interest in the results of the research supporting this article has conferred or will confer a benefit on the authors or on any organization with which the authors are associated.
Identification
Copyright
© 2014 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
