Brain-controlled modulation of spinal circuits improves recovery from spinal cord injury

• Published in: Nature communications Vol. 9; no. 1; pp. 3015 - 14
• Main Authors: Bonizzato, Marco, Pidpruzhnykova, Galyna, DiGiovanna, Jack, Shkorbatova, Polina, Pavlova, Natalia, Micera, Silvestro, Courtine, Grégoire
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01.08.2018; Nature Publishing Group; Nature Portfolio
• Subjects: 631/378; 631/378/2632; Animals; Brain; Brain - physiopathology; Brain injury; Cortex; Disorders; Electric Stimulation Therapy; Electromyography; Extremities - physiopathology; Female; Gait; Humanities and Social Sciences; Leg; Locomotion; Motors; Movement disorders; multidisciplinary; Muscles - physiopathology; Nerve Net - physiopathology; Neurological diseases; Neuromodulation; Paralysis; Rats; Rats, Inbred Lew; Recovery; Recovery of Function - physiology; Rehabilitation; Reproducibility of Results; Science; Science (multidisciplinary); Spinal cord; Spinal Cord - physiopathology; Spinal cord injuries; Spinal Cord Injuries - physiopathology; Spine; Stimulation; Walking
• ISSN: 2041-1723; 2041-1723
• DOI: 10.1038/s41467-018-05282-6

The delivery of brain-controlled neuromodulation therapies during motor rehabilitation may augment recovery from neurological disorders. To test this hypothesis, we conceived a brain-controlled neuromodulation therapy that combines the technical and practical features necessary to be deployed daily during gait rehabilitation. Rats received a severe spinal cord contusion that led to leg paralysis. We engineered a proportional brain–spine interface whereby cortical ensemble activity constantly determines the amplitude of spinal cord stimulation protocols promoting leg flexion during swing. After minimal calibration time and without prior training, this neural bypass enables paralyzed rats to walk overground and adjust foot clearance in order to climb a staircase. Compared to continuous spinal cord stimulation, brain-controlled stimulation accelerates and enhances the long-term recovery of locomotion. These results demonstrate the relevance of brain-controlled neuromodulation therapies to augment recovery from motor disorders, establishing important proofs-of-concept that warrant clinical studies. Brain–spine interfaces have been used to enable leg movement following spinal cord injury, but movement is either involuntary or not adjustable. Here, the authors show in rats that a proportional stimulation interface permits voluntary movement and augments recovery in conjunction with rehabilitation.