2023-05-24 17:00:58
In 2011, the Dutch Gert-Jan Oskam He had a serious cycling accident in China. His spinal cord was severely damaged, with an incomplete injury that after much rehabilitation allowed him to barely move his arms.
From the beginning, his objective was to try to recover as much mobility as possible, so when they told him about a group of leading researchers who, from Lausanne (Switzerland) They were trying to find ways to help spinal cord injury patients, so I didn’t hesitate to knock on his door.
He was one of five participants who took part in the trial I esteem, a neurorehabilitation program that, through epidural electrical stimulation of the spinal cord, demonstrated that it was possible to recover some motor capacity. Thanks to the program Oskam, who is now 40 years old, was able to walk again with the help of a walker.
After three years, the Dutchman had reached the limit of possible recovery, so he had no doubts when the multidisciplinary team led by Grgoire Courtinefrom the Federal Polytechnic School of Lausanne (EPFL), and neurosurgeon Jocelyne Blochfrom the University Hospital of Lausanne, asked him to participate in a new trial, called STIMO-BSI, which wanted to go a step further in the approach.
The results of this strategy, which makes it possible to establish a direct link between brain y mdula espinal and provides a voluntary control and more natural of motor capacity, have supposed a qualitative leap in Oskam’s quality of life, as he pointed out at a press conference. You can perform tasks such as standing up, walking, climbing stairs, and adapting your gait to different terrains. The implantation of the device has also allowed him to improve neural recovery, so that he is now able to walk with crutches even when the implants are turned off. “These improvements are very useful in my day to day. They help me a lot”, underlined. Details of the case are published this week in the magazine Nature.
What is the digital bridge that allows motor function to be recovered?
What the researchers have developed is a kind of ‘digital bridge’ that, to a certain extent, it allows restoring the line of communication that exists between the brain and the area of the spinal cord that allows walking and that, in the case of Oskam, was damaged by the accident.
Through implants in the brain, the system is capable of capturing cortical signals, the ‘orders’ that the brain sends when we want to stand up or take a step. These signals, duly decoded using artificial intelligence methods, are sent to a stimulation system implanted in the epidural region, where the generating center of the gait pattern is located, which allows the muscles involved to start working according to the instructions. instructions received.
“It allows me much greater control. Now I control the stimulation with my thoughts,” Oskam told reporters, a point Courtine also underlined.
Although it has given very good results, by itself the epidural electrical stimulation of the spinal cord that the team had previously used has some drawbacks, such as the fact that the patient must use a knob or a button to initiate the stimulation or that it is difficult to adapt movements to changes in the terrain or to the needs of each task.
It allows me much more control. Now I control the stimulation with my thoughts
This new direct connection between the brain and the spinal cord, on the other hand, allows for more natural movements, adapted to each moment, since they occur in real time. In addition, it also allows a greater range of motion, for example, in hip flexion or knee extension, said the researchers, who want to extend the trial to more patients and explore the usefulness of the device in other cases, such as paralysis of the arms. the upper extremities.
“It is very interesting work that follows the line that this team began more than 10 years ago,” says Joan Vidalrehabilitator doctor, teaching director of the Guttmann Institute in Barcelona and principal researcher of the research line ‘Neurorepair and advanced therapies‘ of said center.
Both the use of cortical receptors and epidural stimulation are techniques that have been used previously. The novelty lies in the fact that this system combines them, providing voluntary control, “which is very interesting”, emphasizes the specialist.
For Vidal, one aspect of the work that should be highlighted is that it shows that after the implantation of the device and through rehabilitation, there is some functional recovery, the patient is able to walk again with crutches even when the implants are not connected.
“The central nervous system has a plastic capacity, to generate new connections. And this once again shows that through neuromodulacin combined with neurorehabilitation, those new neural networks that allow a certain recovery can be favored”, he points out.
After turning off the systems it seems that the patient is a little better, there is some functional recovery
It is pronounced, in the same line Antonio Olivierohead of the Laboratory for Functional Exploration and Neuromodulation of the Nervous System at the National Hospital for Paraplegics in Toledo: “One of the pieces of information that most strikes me is that not only is there this possibility of walking when the stimulator and the interface are working, but also after turning off these systems it seems that the system is a little better, there is a certain functional recovery and this allows us to think of these devices not only as substitutes for the anatomical and functional lesion but also as important rehabilitation tools”, he indicates.
In the future, the use of this type of device could also be considered in other types of motor disorders, such as those that occur after a stroke, both specialists agree.
“In the last 10 years, a lot of progress has been made. We are closer to understanding which are the lines of research where we must go deeper, where we must invest, but there is still a long way to go,” remarks Vidal, who asks caution not to generate false expectations in patients. “This research has been carried out on a single patient,” she stresses. The progress made is still limited and these types of devices still need more research before they can be approved by regulatory agencies, she recalls.
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