Andreas Rowald, Salif Komi, Robin Demesmaeker, Edeny Baaklini, Sergio Daniel Hernandez-Charpak, Edoardo Paoles, Hazael Montanaro, Antonino Cassara, Fabio Becce, Bryn Lloyd, Taylor Newton, Jimmy Ravier, Nawal Kinany, Marina D’Ercole, Aurélie Paley, Nicolas Hankov, Camille Varescon, Laura McCracken, Molywan Vat, Miroslav Caban, Anne Watrin, Charlotte Jacquet, Léa Bole-Feysot, Cathal Harte, Henri Lorach, Andrea Galvez, Manon Tschopp, Natacha Herrmann, Moïra Wacker, Lionel Geernaert, Isabelle Fodor, Valentin Radevich, Katrien Van Den Keybus, Grégoire Eberle, Etienne Pralong, Maxime Roulet, Jean-Baptiste Ledoux, Eleonora Fornari, Stefano Mandija, Loan Mattera, Roberto Martuzzi, Bruno Nazarian, Stefan Benkler, Simone Callegari, Nathan Greiner, Benjamin Fuhrer, Martijn Froeling, Nik Buse, Tim Denison, Rik Buschman, Christian Wende, Damien Ganty, Jurriaan Bakker, Vincent Delattre, Hendrik Lambert, Karen Minassian, Cornelis A. T. van den Berg, Anne Kavounoudias, Silvestro Micera, Dimitri Van De Ville, Quentin Barraud, Erkan Kurt, Niels Kuster, Esra Neufeld, Marco Capogrosso, Leonie Asboth, Fabien B. Wagner, Jocelyne Bloch and Grégoire Courtine.
Abstract
Epidural electrical stimulation (EES) targeting the dorsal roots of lumbosacral segments restores walking in people with spinalcord injury (SCI). However, EES is delivered with multielectrode paddle leads that were originally designed to target thedorsal column of the spinal cord. Here, we hypothesized that an arrangement of electrodes targeting the ensemble of dorsalroots involved in leg and trunk movements would result in superior efficacy, restoring more diverse motor activities after themost severe SCI. To test this hypothesis, we established a computational framework that informed the optimal arrangementof electrodes on a new paddle lead and guided its neurosurgical positioning. We also developed software supporting the rapidconfiguration of activity-specific stimulation programs that reproduced the natural activation of motor neurons underlyingeach activity. We tested these neurotechnologies in three individuals with complete sensorimotor paralysis as part of an ongoingclinical trial (www.clinicaltrials.gov identifier NCT02936453). Within a single day, activity-specific stimulation programsenabled these three individuals to stand, walk, cycle, swim and control trunk movements. Neurorehabilitation mediated sufficientimprovement to restore these activities in community settings, opening a realistic path to support everyday mobility withEES in people with SCI.