Robotic Postural Training With Epidural Stimulation for the Recovery of Upright Postural Control in Individuals With Motor Complete Spinal Cord Injury: A Pilot Study

Authors

Enrico Rejc, Tim and Caroline Reynolds Center for Spinal Stimulation, Kessler Foundation, West Orange, New Jersey, USA.
Collin Bowersock, Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky, USA.
Tanvi Pisolkar, Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky, USA.
Isirame Omofuma, Department of Mechanical Engineering, Columbia University, New York, New York, USA.
Tatiana Luna, Department of Mechanical Engineering, Columbia University, New York, New York, USA.
Moiz Khan, Department of Radiology at BWH, Harvard Medical School, Boston, Massachusetts, USA.
Victor Santamaria, Department of Physical Therapy, New York Medical College, Valhalla, New York, USA.
Beatrice Ugiliweneza, Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky, USA.
Claudia A. Angeli, Tim and Caroline Reynolds Center for Spinal Stimulation, Kessler Foundation, West Orange, New Jersey, USA.
Gail F. Forrest, Tim and Caroline Reynolds Center for Spinal Stimulation, Kessler Foundation, West Orange, New Jersey, USA.
Joel Stein, Department of Rehabilitation and Regenerative Medicine, Columbia University, New York, New York, USA.
Sunil Agrawal, Department of Mechanical Engineering, Columbia University, New York, New York, USA.
Susan J. Harkema, Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky, USA.

Author Type(s)

Faculty

Journal Title

Neurotrauma Reports

First Page

277

Last Page

292

Document Type

Article

Publication Date

1-1-2024

Department

Rehabilitation Sciences

Abstract

Activity-based training and lumbosacral spinal cord epidural stimulation (scES) have the potential to restore standing and walking with self-balance assistance after motor complete spinal cord injury (SCI). However, improvements in upright postural control have not previously been addressed in this population. Here, we implemented a novel robotic postural training with scES, performed with free hands, to restore upright postural control in individuals with chronic, cervical ( = 5) or high-thoracic ( = 1) motor complete SCI, who had previously undergone stand training with scES using a walker or a standing frame for self-balance assistance. Robotic postural training re-enabled and/or largely improved the participants' ability to control steady standing, self-initiated trunk movements and upper limb reaching movements while standing with free hands, receiving only external assistance for pelvic control. These improvements were associated with neuromuscular activation pattern adaptations above and below the lesion. These findings suggest that the human spinal cord below the level of injury can generate meaningful postural responses when its excitability is modulated by scES, and can learn to improve these responses. Upright postural control improvements can enhance functional motor recovery promoted by scES after severe SCI.

Recommended Citation

Rejc, E., Bowersock, C., Pisolkar, T., Omofuma, I., Luna, T., Khan, M., Santamaria, V., Ugiliweneza, B., Angeli, C. A., Forrest, G. F., Stein, J., Agrawal, S., & Harkema, S. J. (2024). Robotic Postural Training With Epidural Stimulation for the Recovery of Upright Postural Control in Individuals With Motor Complete Spinal Cord Injury: A Pilot Study. Neurotrauma Reports, 5 (1), 277-292. https://doi.org/10.1089/neur.2024.0013