1
|
Sun Y, Xiao Z, Chen B, Zhao Y, Dai J. Advances in Material-Assisted Electromagnetic Neural Stimulation. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2024; 36:e2400346. [PMID: 38594598 DOI: 10.1002/adma.202400346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 03/26/2024] [Indexed: 04/11/2024]
Abstract
Bioelectricity plays a crucial role in organisms, being closely connected to neural activity and physiological processes. Disruptions in the nervous system can lead to chaotic ionic currents at the injured site, causing disturbances in the local cellular microenvironment, impairing biological pathways, and resulting in a loss of neural functions. Electromagnetic stimulation has the ability to generate internal currents, which can be utilized to counter tissue damage and aid in the restoration of movement in paralyzed limbs. By incorporating implanted materials, electromagnetic stimulation can be targeted more accurately, thereby significantly improving the effectiveness and safety of such interventions. Currently, there have been significant advancements in the development of numerous promising electromagnetic stimulation strategies with diverse materials. This review provides a comprehensive summary of the fundamental theories, neural stimulation modulating materials, material application strategies, and pre-clinical therapeutic effects associated with electromagnetic stimulation for neural repair. It offers a thorough analysis of current techniques that employ materials to enhance electromagnetic stimulation, as well as potential therapeutic strategies for future applications.
Collapse
Affiliation(s)
- Yuting Sun
- State Key Laboratory of Molecular Developmental Biology, Institute of Genetics and developmental Biology, Chinese Academy of Sciences, Beijing, 100101, China
- University of Chinese Academy of Sciences, Beijing, 100049, China
| | - Zhifeng Xiao
- State Key Laboratory of Molecular Developmental Biology, Institute of Genetics and developmental Biology, Chinese Academy of Sciences, Beijing, 100101, China
| | - Bing Chen
- State Key Laboratory of Molecular Developmental Biology, Institute of Genetics and developmental Biology, Chinese Academy of Sciences, Beijing, 100101, China
| | - Yannan Zhao
- State Key Laboratory of Molecular Developmental Biology, Institute of Genetics and developmental Biology, Chinese Academy of Sciences, Beijing, 100101, China
| | - Jianwu Dai
- State Key Laboratory of Molecular Developmental Biology, Institute of Genetics and developmental Biology, Chinese Academy of Sciences, Beijing, 100101, China
- University of Chinese Academy of Sciences, Beijing, 100049, China
- Tianjin Key Laboratory of Biomedical Materials, Institute of Biomedical Engineering, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, 300192, China
| |
Collapse
|
2
|
Mondello SE, Young L, Dang V, Fischedick AE, Tolley NM, Wang T, Bravo MA, Lee D, Tucker B, Knoernschild M, Pedigo BD, Horner PJ, Moritz CT. Optogenetic spinal stimulation promotes new axonal growth and skilled forelimb recovery in rats with sub-chronic cervical spinal cord injury. J Neural Eng 2023; 20:056005. [PMID: 37524080 PMCID: PMC10496592 DOI: 10.1088/1741-2552/acec13] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 07/17/2023] [Accepted: 07/31/2023] [Indexed: 08/02/2023]
Abstract
Objective.Spinal cord injury (SCI) leads to debilitating sensorimotor deficits that greatly limit quality of life. This work aims to develop a mechanistic understanding of how to best promote functional recovery following SCI. Electrical spinal stimulation is one promising approach that is effective in both animal models and humans with SCI. Optogenetic stimulation is an alternative method of stimulating the spinal cord that allows for cell-type-specific stimulation. The present work investigates the effects of preferentially stimulating neurons within the spinal cord and not glial cells, termed 'neuron-specific' optogenetic spinal stimulation. We examined forelimb recovery, axonal growth, and vasculature after optogenetic or sham stimulation in rats with cervical SCI.Approach.Adult female rats received a moderate cervical hemicontusion followed by the injection of a neuron-specific optogenetic viral vector ipsilateral and caudal to the lesion site. Animals then began rehabilitation on the skilled forelimb reaching task. At four weeks post-injury, rats received a micro-light emitting diode (µLED) implant to optogenetically stimulate the caudal spinal cord. Stimulation began at six weeks post-injury and occurred in conjunction with activities to promote use of the forelimbs. Following six weeks of stimulation, rats were perfused, and tissue stained for GAP-43, laminin, Nissl bodies and myelin. Location of viral transduction and transduced cell types were also assessed.Main Results.Our results demonstrate that neuron-specific optogenetic spinal stimulation significantly enhances recovery of skilled forelimb reaching. We also found significantly more GAP-43 and laminin labeling in the optogenetically stimulated groups indicating stimulation promotes axonal growth and angiogenesis.Significance.These findings indicate that optogenetic stimulation is a robust neuromodulator that could enable future therapies and investigations into the role of specific cell types, pathways, and neuronal populations in supporting recovery after SCI.
Collapse
Affiliation(s)
- Sarah E Mondello
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA 98195, United States of America
- Center for Neurotechnology, Seattle, WA 98195, United States of America
| | - Lisa Young
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA 98195, United States of America
| | - Viet Dang
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA 98195, United States of America
| | - Amanda E Fischedick
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA 98195, United States of America
| | - Nicholas M Tolley
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA 98195, United States of America
- Center for Neurotechnology, Seattle, WA 98195, United States of America
| | - Tian Wang
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA 98195, United States of America
| | - Madison A Bravo
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA 98195, United States of America
- Center for Neurotechnology, Seattle, WA 98195, United States of America
| | - Dalton Lee
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA 98195, United States of America
| | - Belinda Tucker
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA 98195, United States of America
| | - Megan Knoernschild
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA 98195, United States of America
| | - Benjamin D Pedigo
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA 98195, United States of America
- Center for Neurotechnology, Seattle, WA 98195, United States of America
| | - Philip J Horner
- Center for Neuroregeneration, Department of Neurological Surgery, Houston Methodist Research Institute, Houston, TX 77030, United States of America
| | - Chet T Moritz
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA 98195, United States of America
- Center for Neurotechnology, Seattle, WA 98195, United States of America
- Department of Electrical and Computer Engineering, University of Washington, Seattle, WA 98195, United States of America
- Department of Physiology and Biophysics, University of Washington, Seattle, WA 98195, United States of America
| |
Collapse
|
3
|
Powell MP, Verma N, Sorensen E, Carranza E, Boos A, Fields DP, Roy S, Ensel S, Barra B, Balzer J, Goldsmith J, Friedlander RM, Wittenberg GF, Fisher LE, Krakauer JW, Gerszten PC, Pirondini E, Weber DJ, Capogrosso M. Epidural stimulation of the cervical spinal cord for post-stroke upper-limb paresis. Nat Med 2023; 29:689-699. [PMID: 36807682 DOI: 10.1038/s41591-022-02202-6] [Citation(s) in RCA: 42] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 12/22/2022] [Indexed: 02/22/2023]
Abstract
Cerebral strokes can disrupt descending commands from motor cortical areas to the spinal cord, which can result in permanent motor deficits of the arm and hand. However, below the lesion, the spinal circuits that control movement remain intact and could be targeted by neurotechnologies to restore movement. Here we report results from two participants in a first-in-human study using electrical stimulation of cervical spinal circuits to facilitate arm and hand motor control in chronic post-stroke hemiparesis ( NCT04512690 ). Participants were implanted for 29 d with two linear leads in the dorsolateral epidural space targeting spinal roots C3 to T1 to increase excitation of arm and hand motoneurons. We found that continuous stimulation through selected contacts improved strength (for example, grip force +40% SCS01; +108% SCS02), kinematics (for example, +30% to +40% speed) and functional movements, thereby enabling participants to perform movements that they could not perform without spinal cord stimulation. Both participants retained some of these improvements even without stimulation and no serious adverse events were reported. While we cannot conclusively evaluate safety and efficacy from two participants, our data provide promising, albeit preliminary, evidence that spinal cord stimulation could be an assistive as well as a restorative approach for upper-limb recovery after stroke.
Collapse
Affiliation(s)
- Marc P Powell
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA
- Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA
| | - Nikhil Verma
- Department of Mechanical Engineering, Carnegie Mellon University, Pittsburgh, PA, USA
- NeuroMechatronics Lab, Carnegie Mellon University, Pittsburgh, PA, USA
| | - Erynn Sorensen
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA
- Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Erick Carranza
- Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA
| | - Amy Boos
- Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Daryl P Fields
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA
- Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA
| | - Souvik Roy
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA
- Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA
| | - Scott Ensel
- Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA
| | - Beatrice Barra
- Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jeffrey Balzer
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jeff Goldsmith
- Department of Biostatistics, Columbia University, New York, NY, USA
| | - Robert M Friedlander
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - George F Wittenberg
- Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA
- Veterans Affairs HS, Pittsburgh, PA, USA
| | - Lee E Fisher
- Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Biomedical Engineering, Carnegie Mellon University, Pittsburgh, PA, USA
| | - John W Krakauer
- Department of Neurology, Johns Hopkins University, Baltimore, MD, USA
- Department of Neuroscience, Johns Hopkins University, Baltimore, MD, USA
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD, USA
- The Santa Fe Institute, Santa Fe, NM, USA
| | - Peter C Gerszten
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Elvira Pirondini
- Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA
| | - Douglas J Weber
- Department of Mechanical Engineering, Carnegie Mellon University, Pittsburgh, PA, USA
- NeuroMechatronics Lab, Carnegie Mellon University, Pittsburgh, PA, USA
- The Neuroscience Institute, Carnegie Mellon University, Pittsburgh, PA, USA
| | - Marco Capogrosso
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA.
- Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA.
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA.
| |
Collapse
|
4
|
Obara K, Kaneshige M, Suzuki M, Yokoyama O, Tazoe T, Nishimura Y. Corticospinal interface to restore voluntary control of joint torque in a paralyzed forearm following spinal cord injury in non-human primates. Front Neurosci 2023; 17:1127095. [PMID: 36960166 PMCID: PMC10028188 DOI: 10.3389/fnins.2023.1127095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 01/23/2023] [Indexed: 03/09/2023] Open
Abstract
The corticospinal tract plays a major role in the control of voluntary limb movements, and its damage impedes voluntary limb control. We investigated the feasibility of closed-loop brain-controlled subdural spinal stimulation through a corticospinal interface for the modulation of wrist torque in the paralyzed forearm of monkeys with spinal cord injury at C4/C5. Subdural spinal stimulation of the preserved cervical enlargement activated multiple muscles on the paralyzed forearm and wrist torque in the range from flexion to ulnar-flexion. The magnitude of the evoked torque could be modulated by changing current intensity. We then employed the corticospinal interface designed to detect the firing rate of an arbitrarily selected "linked neuron" in the forearm territory of the primary motor cortex (M1) and convert it in real time to activity-contingent electrical stimulation of a spinal site caudal to the lesion. Linked neurons showed task-related activity that modulated the magnitude of the evoked torque and the activation of multiple muscles depending on the required torque. Unlinked neurons, which were independent of spinal stimulation and located in the vicinity of the linked neurons, exhibited task-related or -unrelated activity. Thus, monkeys were able to modulate the wrist torque of the paralyzed forearm by modulating the firing rate of M1 neurons including unlinked and linked neurons via the corticospinal interface. These results suggest that the corticospinal interface can replace the function of the corticospinal tract after spinal cord injury.
Collapse
Affiliation(s)
- Kei Obara
- Neural Prosthetics Project, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
- Division of Neural Engineering, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | - Miki Kaneshige
- Neural Prosthetics Project, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Michiaki Suzuki
- Neural Prosthetics Project, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Osamu Yokoyama
- Neural Prosthetics Project, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Toshiki Tazoe
- Neural Prosthetics Project, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Yukio Nishimura
- Neural Prosthetics Project, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
- Division of Neural Engineering, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
- *Correspondence: Yukio Nishimura,
| |
Collapse
|
5
|
McIntosh JR, Joiner EF, Goldberg JL, Murray LM, Yasin B, Mendiratta A, Karceski SC, Thuet E, Modik O, Shelkov E, Lombardi JM, Sardar ZM, Lehman RA, Mandigo C, Riew KD, Harel NY, Virk MS, Carmel JB. Intraoperative electrical stimulation of the human dorsal spinal cord reveals a map of arm and hand muscle responses. J Neurophysiol 2023; 129:66-82. [PMID: 36417309 PMCID: PMC9799146 DOI: 10.1152/jn.00235.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Although epidural stimulation of the lumbar spinal cord has emerged as a powerful modality for recovery of movement, how it should be targeted to the cervical spinal cord to activate arm and hand muscles is not well understood, particularly in humans. We sought to map muscle responses to posterior epidural cervical spinal cord stimulation in humans. We hypothesized that lateral stimulation over the dorsal root entry zone would be most effective and responses would be strongest in the muscles innervated by the stimulated segment. Twenty-six people undergoing clinically indicated cervical spine surgery consented to mapping of motor responses. During surgery, stimulation was performed in midline and lateral positions at multiple exposed segments; six arm and three leg muscles were recorded on each side of the body. Across all segments and muscles tested, lateral stimulation produced stronger muscle responses than midline despite similar latency and shape of responses. Muscles innervated at a cervical segment had the largest responses from stimulation at that segment, but responses were also observed in muscles innervated at other cervical segments and in leg muscles. The cervical responses were clustered in rostral (C4-C6) and caudal (C7-T1) cervical segments. Strong responses to lateral stimulation are likely due to the proximity of stimulation to afferent axons. Small changes in response sizes to stimulation of adjacent cervical segments argue for local circuit integration, and distant muscle responses suggest activation of long propriospinal connections. This map can help guide cervical stimulation to improve arm and hand function.NEW & NOTEWORTHY A map of muscle responses to cervical epidural stimulation during clinically indicated surgery revealed strongest activation when stimulating laterally compared to midline and revealed differences to be weaker than expected across different segments. In contrast, waveform shapes and latencies were most similar when stimulating midline and laterally, indicating activation of overlapping circuitry. Thus, a map of the cervical spinal cord reveals organization and may help guide stimulation to activate arm and hand muscles strongly and selectively.
Collapse
Affiliation(s)
- James R. McIntosh
- 1Department of Orthopedic Surgery, https://ror.org/00hj8s172Columbia University, New York, New York,4Department of Neurological Surgery, Weill Cornell Medicine-New York Presbyterian, Och Spine Hospital, New York, New York
| | - Evan F. Joiner
- 2Department of Neurological Surgery, Columbia University, New York, New York
| | - Jacob L. Goldberg
- 4Department of Neurological Surgery, Weill Cornell Medicine-New York Presbyterian, Och Spine Hospital, New York, New York
| | - Lynda M. Murray
- 8Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, New York,9James J. Peters Veterans Affairs Medical Center, Bronx, New York
| | - Bushra Yasin
- 1Department of Orthopedic Surgery, https://ror.org/00hj8s172Columbia University, New York, New York,4Department of Neurological Surgery, Weill Cornell Medicine-New York Presbyterian, Och Spine Hospital, New York, New York
| | - Anil Mendiratta
- 3Department of Neurology, Columbia University, New York, New York
| | - Steven C. Karceski
- 5Department of Neurology, Weill Cornell Medicine-New York Presbyterian, Och Spine Hospital, New York, New York
| | - Earl Thuet
- 6New York Presbyterian, Och Spine Hospital, New York, New York
| | - Oleg Modik
- 5Department of Neurology, Weill Cornell Medicine-New York Presbyterian, Och Spine Hospital, New York, New York
| | - Evgeny Shelkov
- 5Department of Neurology, Weill Cornell Medicine-New York Presbyterian, Och Spine Hospital, New York, New York
| | - Joseph M. Lombardi
- 1Department of Orthopedic Surgery, https://ror.org/00hj8s172Columbia University, New York, New York,6New York Presbyterian, Och Spine Hospital, New York, New York
| | - Zeeshan M. Sardar
- 1Department of Orthopedic Surgery, https://ror.org/00hj8s172Columbia University, New York, New York,6New York Presbyterian, Och Spine Hospital, New York, New York
| | - Ronald A. Lehman
- 1Department of Orthopedic Surgery, https://ror.org/00hj8s172Columbia University, New York, New York,6New York Presbyterian, Och Spine Hospital, New York, New York
| | - Christopher Mandigo
- 2Department of Neurological Surgery, Columbia University, New York, New York,6New York Presbyterian, Och Spine Hospital, New York, New York
| | - K. Daniel Riew
- 1Department of Orthopedic Surgery, https://ror.org/00hj8s172Columbia University, New York, New York,4Department of Neurological Surgery, Weill Cornell Medicine-New York Presbyterian, Och Spine Hospital, New York, New York,6New York Presbyterian, Och Spine Hospital, New York, New York
| | - Noam Y. Harel
- 7Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York,8Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, New York,9James J. Peters Veterans Affairs Medical Center, Bronx, New York
| | - Michael S. Virk
- 4Department of Neurological Surgery, Weill Cornell Medicine-New York Presbyterian, Och Spine Hospital, New York, New York
| | - Jason B. Carmel
- 1Department of Orthopedic Surgery, https://ror.org/00hj8s172Columbia University, New York, New York,3Department of Neurology, Columbia University, New York, New York,4Department of Neurological Surgery, Weill Cornell Medicine-New York Presbyterian, Och Spine Hospital, New York, New York
| |
Collapse
|
6
|
Oh J, Steele AG, Varghese B, Martin CA, Scheffler MS, Markley RL, Lo YK, Sayenko DG. Cervical transcutaneous spinal stimulation for spinal motor mapping. iScience 2022; 25:105037. [PMID: 36147963 PMCID: PMC9485062 DOI: 10.1016/j.isci.2022.105037] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 07/29/2022] [Accepted: 08/25/2022] [Indexed: 12/02/2022] Open
Abstract
Transcutaneous spinal stimulation (TSS) is a promising approach to restore upper-limb (UL) functions after spinal cord injury (SCI) in humans. We sought to demonstrate the selectivity of recruitment of individual UL motor pools during cervical TSS using different electrode placements. We demonstrated that TSS delivered over the rostrocaudal and mediolateral axes of the cervical spine resulted in a preferential activation of proximal, distal, and ipsilateral UL muscles. This was revealed by changes in motor threshold intensity, maximum amplitude, and the amount of post-activation depression of the evoked responses. We propose that an arrangement of electrodes targeting specific UL motor pools may result in superior efficacy, restoring more diverse motor activities after neurological injuries and disorders, including severe SCI. Cervical spinal motor maps are created by transcutaneous spinal stimulation Upper limb muscle-specific stimulation coincides with segmental motor pool locations Lateral stimulation can be advantageous depending on rostral or caudal sites Site-specific stimulation can help determine therapeutic outcomes after SCI
Collapse
|
7
|
Barra B, Conti S, Perich MG, Zhuang K, Schiavone G, Fallegger F, Galan K, James ND, Barraud Q, Delacombaz M, Kaeser M, Rouiller EM, Milekovic T, Lacour S, Bloch J, Courtine G, Capogrosso M. Epidural electrical stimulation of the cervical dorsal roots restores voluntary upper limb control in paralyzed monkeys. Nat Neurosci 2022; 25:924-934. [PMID: 35773543 DOI: 10.1038/s41593-022-01106-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 05/19/2022] [Indexed: 11/09/2022]
Abstract
Regaining arm control is a top priority for people with paralysis. Unfortunately, the complexity of the neural mechanisms underlying arm control has limited the effectiveness of neurotechnology approaches. Here, we exploited the neural function of surviving spinal circuits to restore voluntary arm and hand control in three monkeys with spinal cord injury, using spinal cord stimulation. Our neural interface leverages the functional organization of the dorsal roots to convey artificial excitation via electrical stimulation to relevant spinal segments at appropriate movement phases. Stimulation bursts targeting specific spinal segments produced sustained arm movements, enabling monkeys with arm paralysis to perform an unconstrained reach-and-grasp task. Stimulation specifically improved strength, task performances and movement quality. Electrophysiology suggested that residual descending inputs were necessary to produce coordinated movements. The efficacy and reliability of our approach hold realistic promises of clinical translation.
Collapse
Affiliation(s)
- Beatrice Barra
- Platform of Translational Neuroscience, Department of Neuroscience and Movement Sciences, Faculty of Sciences and Medicine, University of Fribourg, Fribourg, Switzerland.,Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA
| | - Sara Conti
- Platform of Translational Neuroscience, Department of Neuroscience and Movement Sciences, Faculty of Sciences and Medicine, University of Fribourg, Fribourg, Switzerland
| | - Matthew G Perich
- Department of Fundamental Neuroscience, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Katie Zhuang
- Platform of Translational Neuroscience, Department of Neuroscience and Movement Sciences, Faculty of Sciences and Medicine, University of Fribourg, Fribourg, Switzerland
| | - Giuseppe Schiavone
- Bertarelli Foundation Chair in Neuroprosthetic Technology, Laboratory for Soft Bioelectronic Interfaces, Institute of Microengineering, Institute of Bioengineering, Centre for Neuroprosthetics, École Polytechnique Fédérale de Lausanne, Geneva, Switzerland
| | - Florian Fallegger
- Bertarelli Foundation Chair in Neuroprosthetic Technology, Laboratory for Soft Bioelectronic Interfaces, Institute of Microengineering, Institute of Bioengineering, Centre for Neuroprosthetics, École Polytechnique Fédérale de Lausanne, Geneva, Switzerland
| | - Katia Galan
- Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland.,Defitech Center for Interventional Neurotherapies (NeuroRestore), University Hospital Lausanne (CHUV), University of Lausanne (UNIL) and École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Nicholas D James
- Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Quentin Barraud
- Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland.,Defitech Center for Interventional Neurotherapies (NeuroRestore), University Hospital Lausanne (CHUV), University of Lausanne (UNIL) and École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Maude Delacombaz
- Platform of Translational Neuroscience, Department of Neuroscience and Movement Sciences, Faculty of Sciences and Medicine, University of Fribourg, Fribourg, Switzerland.,Defitech Center for Interventional Neurotherapies (NeuroRestore), University Hospital Lausanne (CHUV), University of Lausanne (UNIL) and École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Mélanie Kaeser
- Platform of Translational Neuroscience, Department of Neuroscience and Movement Sciences, Faculty of Sciences and Medicine, University of Fribourg, Fribourg, Switzerland
| | - Eric M Rouiller
- Platform of Translational Neuroscience, Department of Neuroscience and Movement Sciences, Faculty of Sciences and Medicine, University of Fribourg, Fribourg, Switzerland
| | - Tomislav Milekovic
- Department of Fundamental Neuroscience, Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Defitech Center for Interventional Neurotherapies (NeuroRestore), University Hospital Lausanne (CHUV), University of Lausanne (UNIL) and École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Stephanie Lacour
- Bertarelli Foundation Chair in Neuroprosthetic Technology, Laboratory for Soft Bioelectronic Interfaces, Institute of Microengineering, Institute of Bioengineering, Centre for Neuroprosthetics, École Polytechnique Fédérale de Lausanne, Geneva, Switzerland
| | - Jocelyne Bloch
- Defitech Center for Interventional Neurotherapies (NeuroRestore), University Hospital Lausanne (CHUV), University of Lausanne (UNIL) and École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland.,Department of Neurosurgery, CHUV, Lausanne, Switzerland
| | - Grégoire Courtine
- Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland.,Defitech Center for Interventional Neurotherapies (NeuroRestore), University Hospital Lausanne (CHUV), University of Lausanne (UNIL) and École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland.,Department of Neurosurgery, CHUV, Lausanne, Switzerland
| | - Marco Capogrosso
- Platform of Translational Neuroscience, Department of Neuroscience and Movement Sciences, Faculty of Sciences and Medicine, University of Fribourg, Fribourg, Switzerland. .,Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA. .,Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA.
| |
Collapse
|
8
|
Tringides CM, Mooney DJ. Materials for Implantable Surface Electrode Arrays: Current Status and Future Directions. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2022; 34:e2107207. [PMID: 34716730 DOI: 10.1002/adma.202107207] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 10/26/2021] [Indexed: 06/13/2023]
Abstract
Surface electrode arrays are mainly fabricated from rigid or elastic materials, and precisely manipulated ductile metal films, which offer limited stretchability. However, the living tissues to which they are applied are nonlinear viscoelastic materials, which can undergo significant mechanical deformation in dynamic biological environments. Further, the same arrays and compositions are often repurposed for vastly different tissues rather than optimizing the materials and mechanical properties of the implant for the target application. By first characterizing the desired biological environment, and then designing a technology for a particular organ, surface electrode arrays may be more conformable, and offer better interfaces to tissues while causing less damage. Here, the various materials used in each component of a surface electrode array are first reviewed, and then electrically active implants in three specific biological systems, the nervous system, the muscular system, and skin, are described. Finally, the fabrication of next-generation surface arrays that overcome current limitations is discussed.
Collapse
Affiliation(s)
- Christina M Tringides
- Harvard Program in Biophysics, Harvard University, Cambridge, MA, 02138, USA
- Harvard-MIT Division in Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Cambridge, MA, 02138, USA
| | - David J Mooney
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Cambridge, MA, 02138, USA
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, 02138, USA
| |
Collapse
|
9
|
Kaneshige M, Obara K, Suzuki M, Tazoe T, Nishimura Y. Tuning of motor outputs produced by spinal stimulation during voluntary control of torque directions in monkeys. eLife 2022; 11:78346. [PMID: 36512395 PMCID: PMC9747157 DOI: 10.7554/elife.78346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 11/25/2022] [Indexed: 12/14/2022] Open
Abstract
Spinal stimulation is a promising method to restore motor function after impairment of descending pathways. While paresis, a weakness of voluntary movements driven by surviving descending pathways, can benefit from spinal stimulation, the effects of descending commands on motor outputs produced by spinal stimulation are unclear. Here, we show that descending commands amplify and shape the stimulus-induced muscle responses and torque outputs. During the wrist torque tracking task, spinal stimulation, at a current intensity in the range of balanced excitation and inhibition, over the cervical enlargement facilitated and/or suppressed activities of forelimb muscles. Magnitudes of these effects were dependent on directions of voluntarily produced torque and positively correlated with levels of voluntary muscle activity. Furthermore, the directions of evoked wrist torque corresponded to the directions of voluntarily produced torque. These results suggest that spinal stimulation is beneficial in cases of partial lesion of descending pathways by compensating for reduced descending commands through activation of excitatory and inhibitory synaptic connections to motoneurons.
Collapse
Affiliation(s)
- Miki Kaneshige
- Neural Prosthetics Project, Tokyo Metropolitan Institute of Medical ScienceTokyoJapan,The Japan Society for the Promotion of ScienceTokyoJapan
| | - Kei Obara
- Neural Prosthetics Project, Tokyo Metropolitan Institute of Medical ScienceTokyoJapan,Division of Neural Engineering, Graduate School of Medical and Dental Sciences, Niigata UniversityNiigataJapan
| | - Michiaki Suzuki
- Neural Prosthetics Project, Tokyo Metropolitan Institute of Medical ScienceTokyoJapan
| | - Toshiki Tazoe
- Neural Prosthetics Project, Tokyo Metropolitan Institute of Medical ScienceTokyoJapan
| | - Yukio Nishimura
- Neural Prosthetics Project, Tokyo Metropolitan Institute of Medical ScienceTokyoJapan
| |
Collapse
|
10
|
Guiho T, Baker SN, Jackson A. Epidural and transcutaneous spinal cord stimulation facilitates descending inputs to upper-limb motoneurons in monkeys. J Neural Eng 2021; 18. [PMID: 33540399 PMCID: PMC8208633 DOI: 10.1088/1741-2552/abe358] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 02/04/2021] [Indexed: 12/12/2022]
Abstract
Objective. There is renewed interest in epidural and transcutaneous spinal cord stimulation (SCS) as a therapy following spinal cord injury, both to reanimate paralyzed muscles as well as to potentiate weakened volitional control of movements. However, most work to date has focussed on lumbar SCS for restoration of locomotor function. Therefore, we examined upper-limb muscle responses and modulation of supraspinal-evoked movements by different frequencies of cervical SCS delivered to various epidural and transcutaneous sites in anaesthetized, neurologically intact monkeys. Approach. Epidural SCS was delivered via a novel multielectrode cuff placed around both dorsal and ventral surfaces of the cervical spinal cord, while transcutaneous SCS was delivered using a high carrier frequency through surface electrodes. Main results. Ventral epidural SCS elicited robust movements at lower current intensities than dorsal sites, with evoked motor unit potentials that reliably followed even high-frequency trains. By contrast, the muscle responses to dorsal SCS required higher current intensities and were attenuated throughout the train. However, dorsal epidural SCS and, to a lesser extent, transcutaneous SCS were effective at facilitating supraspinal-evoked responses, especially at intermediate stimulation frequencies. The time- and frequency-dependence of dorsal SCS effects could be explained by a simple model in which transynaptic excitation of motoneurons was gated by prior stimuli through presynaptic mechanisms. Significance. Our results suggest that multicontact electrodes allowing access to both dorsal and ventral epidural sites may be beneficial for combined therapeutic purposes, and that the interaction of direct, synaptic and presynaptic effects should be considered when optimising SCS-assisted rehabilitation.
Collapse
Affiliation(s)
- Thomas Guiho
- Biosciences Institute, Newcastle University Faculty of Medical Sciences, Framlington Place, Newcastle upon Tyne, Tyane and wear, NE2 4HH, UNITED KINGDOM OF GREAT BRITAIN AND NORTHERN IRELAND
| | - Stuart N Baker
- Biosciences Institute, Newcastle University Faculty of Medical Sciences, Framlington Place, Newcastle upon Tyne, Tyne and wear, NE2 4HH, UNITED KINGDOM OF GREAT BRITAIN AND NORTHERN IRELAND
| | - Andrew Jackson
- Biosciences Institute, Newcastle University Faculty of Medical Sciences, Framlington Place, Newcastle upon Tyne, Tyne and wear, NE2 4HH, UNITED KINGDOM OF GREAT BRITAIN AND NORTHERN IRELAND
| |
Collapse
|
11
|
Greiner N, Barra B, Schiavone G, Lorach H, James N, Conti S, Kaeser M, Fallegger F, Borgognon S, Lacour S, Bloch J, Courtine G, Capogrosso M. Recruitment of upper-limb motoneurons with epidural electrical stimulation of the cervical spinal cord. Nat Commun 2021; 12:435. [PMID: 33469022 PMCID: PMC7815834 DOI: 10.1038/s41467-020-20703-1] [Citation(s) in RCA: 67] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Accepted: 12/16/2020] [Indexed: 12/21/2022] Open
Abstract
Epidural electrical stimulation (EES) of lumbosacral sensorimotor circuits improves leg motor control in animals and humans with spinal cord injury (SCI). Upper-limb motor control involves similar circuits, located in the cervical spinal cord, suggesting that EES could also improve arm and hand movements after quadriplegia. However, the ability of cervical EES to selectively modulate specific upper-limb motor nuclei remains unclear. Here, we combined a computational model of the cervical spinal cord with experiments in macaque monkeys to explore the mechanisms of upper-limb motoneuron recruitment with EES and characterize the selectivity of cervical interfaces. We show that lateral electrodes produce a segmental recruitment of arm motoneurons mediated by the direct activation of sensory afferents, and that muscle responses to EES are modulated during movement. Intraoperative recordings suggested similar properties in humans at rest. These modelling and experimental results can be applied for the development of neurotechnologies designed for the improvement of arm and hand control in humans with quadriplegia. The efficacy of epidural electrical stimulation (EES) to engage arm muscles and improve movement after spinal cord injury is still unclear. Here, the authors investigated how EES can recruit upper-limb motor neurons by combining computational modelling with experiments in non-human primates.
Collapse
Affiliation(s)
- Nathan Greiner
- Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, École Polytechnique Fédérale de Lausanne (EPFL), Geneva, Switzerland. .,Department of Neuroscience and Movement Science, Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland.
| | - Beatrice Barra
- Department of Neuroscience and Movement Science, Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland
| | - Giuseppe Schiavone
- Bertarelli Foundation Chair in Neuroprosthetic Technology, Laboratory for Soft Bioelectronics Interface, Institute of Microengineering, Institute of Bioengineering, Centre for Neuroprosthetics, Ecole Polytechnique Fédérale de Lausanne, Geneva, Switzerland
| | - Henri Lorach
- Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, École Polytechnique Fédérale de Lausanne (EPFL), Geneva, Switzerland.,Defitech Center for Interventional Neurotherapies (NeuroRestore), Lausanne, Switzerland
| | - Nicholas James
- Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, École Polytechnique Fédérale de Lausanne (EPFL), Geneva, Switzerland
| | - Sara Conti
- Department of Neuroscience and Movement Science, Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland
| | - Melanie Kaeser
- Department of Neuroscience and Movement Science, Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland
| | - Florian Fallegger
- Bertarelli Foundation Chair in Neuroprosthetic Technology, Laboratory for Soft Bioelectronics Interface, Institute of Microengineering, Institute of Bioengineering, Centre for Neuroprosthetics, Ecole Polytechnique Fédérale de Lausanne, Geneva, Switzerland
| | - Simon Borgognon
- Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, École Polytechnique Fédérale de Lausanne (EPFL), Geneva, Switzerland.,Department of Neuroscience and Movement Science, Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland
| | - Stéphanie Lacour
- Bertarelli Foundation Chair in Neuroprosthetic Technology, Laboratory for Soft Bioelectronics Interface, Institute of Microengineering, Institute of Bioengineering, Centre for Neuroprosthetics, Ecole Polytechnique Fédérale de Lausanne, Geneva, Switzerland
| | - Jocelyne Bloch
- Defitech Center for Interventional Neurotherapies (NeuroRestore), Lausanne, Switzerland.,Department of Neurosurgery, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
| | - Grégoire Courtine
- Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, École Polytechnique Fédérale de Lausanne (EPFL), Geneva, Switzerland.,Defitech Center for Interventional Neurotherapies (NeuroRestore), Lausanne, Switzerland.,Department of Neurosurgery, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
| | - Marco Capogrosso
- Department of Neuroscience and Movement Science, Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland. .,Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA. .,Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA.
| |
Collapse
|