Six years after losing motor-function below the level of injury, Andrew Meas, research participant at the University of Louisville with a complete spinal cord injury, has regained the ability to move his legs and stand voluntarily.
He was unable to walk, stand, or voluntarily move his legs, even after 21 months of rehabilitation and training following the accident. Just over four years after the accident, researchers from the Kentucky Spinal Cord Injury Research Center at the University of Louisville paired his rehabilitation with something called spinal cord epidural stimulation. |1|
A study published on October 26th in Scientific Reports |2| describes the recovery of motor function in Andrew who previously had received long-term activity-based training along with spinal cord epidural stimulation (scES).
Senior author Susan Harkema, Ph.D., professor and associate director of the Kentucky Spinal Cord Injury Research Center (KSCIRC) at the University of Louisville, and her colleagues report that over the course of 34.5 months following the original training, the participant recovered substantial voluntary lower-limb motor control and the ability to stand independently without the use of scES.
Previous research at KSCIRC involving four participants with chronic clinically motor-complete spinal cord injury found that activity-based training with the use of scES (electrical signals delivered to motor neurons in the spine by an implanted device) allowed the participants to stand and to perform relatively fine voluntary lower limb movements when the scES device was activated. Andrew Meas was one of the four participants in that study.
Spinal cord epidural simulation is pretty invasive. A small device was implanted over Andrew’s spinal column, simulating the lumbosacral enlargement with electrical signals during the physical training. An electrode lead was tunnelled to a pouch under the skin of the patient’s abdomen, which contained the pulse generator.
The original training protocol included one-hour activity-based training sessions per day, with the help of scES. During these sessions, they trained on standing activity for several months, followed by several months of training on stepping.
After completing a nine-month training program in the lab, Meas continued the stand training at home. A year of independent training passes, Andrew then returned to the lab to train for another three months in a newly revised activity-based training schedule. The revised training called for two daily one-hour training sessions, and included both stand and step training each day, all with the aid of epidural stimulation (scES).
After all that training, Meas was able to voluntarily extend his knees, and his hip flexion was improved. In addition, using his upper body and minimal additional assistance to reach a standing position, he was able to remain in a standing position without assistance and even stand on one leg, without the use of epidural stimulation.
“We are enormously excited about this development in Dr. Harkema’s work, as it not only validates the promise of effective treatments for spinal cord injury, but further demonstrates the spinal cord’s ability to recover after severe trauma,” said Peter Wilderotter, president & CEO of the Christopher & Dana Reeve Foundation, which offered funding for the research. “As we continue to support and fund Dr. Harkema’s research, it is awe-inspiring to see another breakthrough on the path to cures for paralysis, and how much this particular treatment has improved quality of life and health for Drew.”
The researchers on Meas’s case believe that his remarkable recovery can be attributed to the combination of the activity he went through and scES-based training, which has remodeled the neuronal connections along the spinal cord. They also believe that the amount of sheer effort Meas put into the training contributed as well.
“The voluntary component of him trying constantly with spinal stimulation on and while performing motor tasks can lead to unexpected recovery,” said first researcher, Enrico Rejc.