Weight Bearing Over-ground Stepping in an Exoskeleton with Non-invasive Spinal Cord Neuromodulation after Motor Complete Paraplegia

• Published in: Frontiers in neuroscience Vol. 11; p. 333
• Main Authors: Gad, Parag, Gerasimenko, Yury, Zdunowski, Sharon, Turner, Amanda, Sayenko, Dimitry, Lu, Daniel C, Edgerton, V Reggie
• Format: Journal Article
• Language: English
• Published: Switzerland Frontiers Research Foundation 08.06.2017; Frontiers Media S.A
• Subjects: Autonomic nervous system; Buspirone; Coordination; Exoskeleton; locomotion rehabilitation; Medical equipment; Muscles; neural prostheses for locomotion; Neuromodulation; Neuroscience; Neurosciences; non-invasive neuromodulation; Paralysis; Paraplegia; Physiology; Robotics; Spinal cord; Spinal cord injuries; spinal cord injury; spinal cord stimulation; Spine; Thermoregulation; Los Angeles California; United States > US; California; spinal cord injury; neural prostheses for locomotion; exoskeleton; non-invasive neuromodulation; spinal cord stimulation; locomotion rehabilitation
• ISSN: 1662-4548; 1662-453X; 1662-453X
• DOI: 10.3389/fnins.2017.00333

We asked whether coordinated voluntary movement of the lower limbs could be regained in an individual having been completely paralyzed (>4 year) and completely absent of vision (>15 year) using two novel strategies-transcutaneous electrical spinal cord stimulation at selected sites over the spine as well as pharmacological neuromodulation by buspirone. We also asked whether these neuromodulatory strategies could facilitate stepping assisted by an exoskeleton (EKSO, EKSO Bionics, CA) that is designed so that the subject can voluntarily complement the work being performed by the exoskeleton. We found that spinal cord stimulation and drug enhanced the level of effort that the subject could generate while stepping in the exoskeleton. In addition, stimulation improved the coordination patterns of the lower limb muscles resulting in a more continuous, smooth stepping motion in the exoskeleton along with changes in autonomic functions including cardiovascular and thermoregulation. Based on these data from this case study it appears that there is considerable potential for positive synergistic effects after complete paralysis by combining the over-ground step training in an exoskeleton, combined with transcutaneous electrical spinal cord stimulation either without or with pharmacological modulation.