Abstract
Objective
The purpose of this study was to report on long-term effects of low-frequency stimulation
of the pelvic somatic nerves in patients with chronic spinal cord injuries who underwent
laparoscopic implantation of neuroprosthesis (LION) in the pelvic lumbosacral nerves.
Design
Observational case report.
Setting
Tertiary referral unit specialized in advanced gynecologic surgery and neuropelveology.
Participants
Patients (N=29) with chronic SCI who underwent a LION procedure to the pelvic lower
motor neurons for the recovery of standing and walking motion. Our study is not composed
of preselected patients but includes patients across the entire range of SCIs: patients
with paraplegia, patients with tetraplegia (except for high tetraplegia), patients
with complete and incomplete SCIs, and even patients with flaccid or spastic paralysis.
Intervention
Patients underwent in-body functional electrical stimulation–assisted locomotor training
and continuous low-frequency pelvic lumbosacral nerve neuromodulation.
Main Outcome Measures
Evolution of American Spinal Injury Association (ASIA) sensory score, ASIA Lower Extremity
Motor Score, and Walking Index.
Results
All patients with incomplete SCI regained some voluntary control of previously paralyzed
muscles after a few months of stimulation training. With a follow-up of 9 years, 20
patients (71.4%) were able to demonstrate an electrically assisted voluntary extension
of the knee. Twenty-six patients could get to their feet when the pacemaker was switched
on (92.8%). Five patients could walk <10 m (17.85%) at the bar. Nineteen patients
(Abbreviated Injury Score [AIS] A: n=8; AIS B: n=9; AIS C: n=2) could walk >10 m (67.8%),
8 of them only at the bar (28.5%) and 11 of them with the aid of crutches or a walker
and without braces (40%).
Conclusions
The major finding of our study is that 17 of 25 patients with complete motor chronic
SCI (68%) developed enough recovery of supraspinal control of leg movements that voluntary
walking became feasible, even though a minimal amount of stimulation may be required.
Keywords
List of abbreviations:
AIS (Abbreviated Injury Score), ASIA (American Spinal Injury Association), FES (functional electrical stimulation), LION (laparoscopic implantation of neuroprosthesis), SCI (spinal cord injury), WISCI (Walking Index for Spinal Cord Injury)To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Archives of Physical Medicine and RehabilitationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- 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
- 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: 1938-1941
- An implantable neuroprosthesis for standing and walking in paraplegia: 5-year patient follow-up.J Neural Eng. 2006; 3: 268-270
- Laparoscopic exposure and electro stimulation of the somatic and autonomous pelvic nerves: a new method for implantation of neuroprothesis in paralyzed patients?.Gynecol Surg. 2004; 1: 87-90
- New strategies of pelvic nerves stimulation for recovery of pelvic visceral functions and locomotion in paraplegics.Neurourol Urodyn. 2010; 29: 1433-1438
- Recovery of sensory and supraspinal control of leg movement in people with chronic paraplegia: a case series.Arch Phys Med Rehabil. 2014; 95: 610-614
- The LION procedure to the pelvic nerves for recovery of locomotion in 18 spinal cord injured peoples - a case series.Surg Technol Int. 2016; 29: 19-25
- Recovery of supraspinal control of leg movement in a chronic complete flaccid paraplegic man after continuous low-frequency pelvic nerve stimulation and FES-assisted training.Spinal Cord Ser Cases. 2017; 3: 16034
- Restoring voluntary control of locomotion after paralyzing spinal cord injury.Science. 2012; 336: 1182
- Targeted neurotechnology restores walking in humans with spinal cord injury.Nature. 2018; 563 (65-1)
- International standards for neurological classification of spinal cord injury.J Spinal Cord Med. 2011; 34: 535-546
- Walking index for spinal cord injury (WISCI): criterion validation.Spinal Cord. 2005; 43: 43-71
- Unexpected recovery after robotic locomotor training at physiologic stepping speed: a single-case design.Arch Phys Med Rehabil. 2012; 93: 1476-1484
- Descending systems contributing to locomotor recovery after mild or moderate SCI in rats: experimental evidence and a review of literature.Restor Neurol Neurosci. 2002; 20: 189-218
- Restoration of walking function in an individual with chronic complete (AIS A) spinal cord injury.J Rehabil Med. 2010; 42: 795-798
- Multimodal treatment for spinal cord injury: a sword of neuroregeneration upon neuromodulation.Neural Regen Res. 2020; 15: 1437-1450
- Network structure of the human musculoskeletal system shapes neural interaction on multiple timescales.Sci Adv. 2018; 4: 1-26
- Structural and functional reorganization of propriospinal connections promotes functional recovery after spinal cord injury.Neural Regen Res. 2015; 10: 509-513
Tamus Z, Ádám N, Balazs S, Kiss I, István B. Can the near field of lightning impulse in down conductors cause harmful health effects? Paper presented at: 30th International Conference on Lightning Protection-ICLP. September 8, 2010; Cagliari, Italy.
- Action-potential-encoded second-harmonic generation as an ultrafast local probe for nonintrusive membrane diagnostics.Phys Rev. 2010; 81031926
- How does a lightning rod work?.Dover Publications, New York1986
Article Info
Publication History
Published online: October 13, 2020
Footnotes
Disclosures: Dr Possover has a patent issued to No. US,8,019,423 (February 2007).
Identification
Copyright
© 2020 by the American Congress of Rehabilitation Medicine
