BioMechanics Lab

Journal Club

NOVEL NON-INVASIVE
STRATEGY FOR SPINAL
NEUROMODULATION TO
CONTROL HUMAN LOCOMOTION
FRONT. HUM. NEUROSCI., 13 JANUARY 2021

Moshonkina, T., Grishin, A., Bogacheva, I., Gorodnichev, R.,

Ovechkin, A., Siu, R., Edgerton, V. R., & Gerasimenko, Y. (2021).

Luis David Torres Mailleux 5/13/2022

BioMechanics Lab

Human
Movement

Recovery following an Improve ourselves in

injury healthy and impaired
 Edgerton Lab

min 1

Science of Movement Electrical stimulation of the spinal cord

How and why we move like we do: Circuitry in the spinal Tested on animals, we can change the physiological
cord can generate patterns and reactions without properties of the spinal circuitry to get it ready to walk or to
information from the brain stand
Mapping of Rat Spinal Networks
Hypothesis: Activate spinal networks in rats with paralysis to activate the lower body muscles
Method: Implant fabrication, Control box, head connector, Implantations, Stimulation, Data collection
Results: Different generations of ER, MR and LRs
Discussions: Selective activation of spinal circuits can be used to facilitate standing and stepping in rats after a
complete spinal cord transection

Spinal cord excitability enables voluntary movements

Hypothesis: Neuromodulating the spinal circuitry, enables completely paralysed individuals to regain
control of paralysed muscles.
Method: locomotor training sessions, Implantation, epidural stimulation, data collection.
Results Individuals were able to execute intentional movements
Discussions: Chronically complete paralysed individuals can process conceptual, auditory, and visual
input to regain specific voluntary control of paralysed muscles.

Non-invasive Strategy
Paper to be discussed today
1st Part - Hypothesis
Testing on animals

Previously successful activation of limbs.

Wanted to better understand the
mechanisms of motor regulation.
Chronic implants activate spinal networks in
rats with paralysis to activate the lower
body muscles.
1P - Methods

All procedures described are in accordance with the National Institute of Health Guide for the Care
and Use of Laboratory Animals.

Implant fabrication

Pulse control box

Implantation

Testing
 1P - Results
All stimulation combinations
did not generate all three
responses

Rostral end - Early

Responses

Middle - Early and Middle

responses

Caudal end - Early responses

P1 - Discussion
Guess what they did

Graphic(ish) image
warning
2nd Part - Hypothesis
Upgrading to Humans

Neuromodulating the spinal

circuitry, enables completely
paralysed individuals to regain
control of paralysed muscles.
P2 - Methods

Training 26.9 (± 4)
Years
sessions

All individuals were unable to stand or walk independently or voluntarily move their lower
extremities despite standard-of-care rehabilitation and additional intensive locomotor training

16-electrode array was

Implantation implanted at vertebrae
T11–T12

To target primary activation No accurate voltage info

Epidural areas, key in movement. 0.5 - 2.5V / 25 Hz or 30 Hz.
Stimulation
A computer monitor displayed a real time
sine wave with frequency of 0.25 Hz.
2P - Results (previous to the stimulation)

Four individuals diagnosed with clinically motor

complete paralysis and implanted with a lumbrosacral
spinal cord stimulator at least 2.2 years post injury

No motor activity was present when attempting to

move without epidural stimulation following a verbal
command or visual cue

There is not currently an effective treatment that

would result in regaining voluntary motor function for
these individuals.
 2P - Results (after stimulation) G- Stim
B- force

The individuals were able to consistently

activate the muscles for the specified action
with temporally synchronized force generation

Daily training using epidural stimulation and

home-based voluntary training resulted in the
generation of voluntary efforts with higher
forces and lower stimulation voltages.

Patient B13 showed a similar trend of lower

threshold for force generation even achieving
movement with no stimulation.
 2P - Discussion

min 1.30
3rd Part - Hypothesis
Upgrading to Non - invasive

Altering spinal cord excitability

enables voluntary movements.

Neuromodulation makes rats

regain step functions

Voluntary movements of the

lower limb can be recovered in
humans with complete paralysis

There is recovery, pain and other

burdens to patients.
 Developed a novel method of non-invasive
01
transcutaneous spinal cord stimulation (scTS).
overlying the cervical, lower thoracic, lumbosacral, and
coccygeal vertebrae using high frequency electrical pulses.

02 3 x 3 multielectrode transcutaneous array

Specifically configured multisite stimulation can produce

3P- a more robust response

Methods 03 Non-injured subject on a “gravity-neutral” position

New strategy of spinal neuromodulation
using the continuous stimulation

04 Significantly higher response with multi-site

stimulation at 2 levels than at one level
(T11-ABC) + (L1-ABC) better than only (T11)
 3P - Findings
Electrodes were placed at T11 and L1
Vertebrae

Two interconnected 5 × 9 cm2 selfadhesive electrodes

Two 2.5-cm-diameter round gel adhesive electrodes

1.0-ms pulses at a frequency of 15 and 30Hz, each pulse

filled with a carrier frequency of 5 kHz.

6 non-injured subjects (23.7 ± 2.3 years),

 3P - Results
Stimulation induced an increase in the amplitude of movements in the hip joint and the
lifting of the knee

Specifically configured multisite

scTS is able to selectively
facilitate the activation of the
motor pools of the lower
extremities and control their
activity to regulate the phases of
the stepping cycle.

Tonic always on, rythmic alternate

[tibialis ant. (TA) and medial

gastrocnemius (MG)] and
proximal [vastus lat. (VL) and
biceps femoris (BF)]
General Discussion

It is possible to regain Right now the best Non-invasive activation of

voluntary control of lower method involves spinal spinal structures at
limbs surgery for implants specific segments is
possible.

Visual and hearing aid is Rostral lumbar segments Main issue for scTS is that
helpful for patients are the key controllers of different sites of the
hindlimb locomotor spinal cord can provide
rhythmicity spatiotemporal specificity
of the locomotor network
Personal toughts

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BioMechanics Lab

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