Efforts to bring epidural stimulation into mainstream use – which could enable people with spinal cord injury to walk again – have moved a step closer through new funding for the project.
In 2018, the University of Louisville made news worldwide when two people diagnosed with spinal cord injuries recovered the ability to walk through the experimental use of epidural stimulation.
However, since that time, the use of the breakthrough therapy outside of a research lab setting have so far not come to fruition.
However, the prospect has moved a step closer with a $7.8million grant from the National Institute of Neurological Disorders and Stroke, one of the National Institutes of Health (NIH).
The grant will fund work at UofL’s Kentucky Spinal Cord Injury Research Center (KSCIRC) in collaboration with medical device manufacturer Medtronic, to develop and test software applications specifically designed for spinal cord injury that work in concert with Medtronic’s commercially-available device, Intellis, which is indicated as a spinal cord stimulator for chronic pain.
The five-year project, funded through the NIH BRAIN Initiative, is focused on incorporating technology to improve control of locomotor and bladder function using epidural stimulation.
“We have seen excellent results with epidural stimulation in the lab, but these enhancements to the technology system will make it much easier to implement this therapy out in the community,” says Professor Claudia Angeli, director of the Epidural Stimulation Program at KSCIRC.
“Integrating multiple systems will allow people with chronic spinal cord injuries to benefit from stimulation on a daily basis by reducing the need to monitor and manually revise stimulation settings.”
The epidural stimulation therapy involves implanting a neurostimulator under the patients’ skin and implanting electrodes in the epidural space of the lower spinal cord, which together deliver mild electrical impulses to the spine.
While epidural stimulation has been proven to provide effective relief for chronic pain, there are limitations in functionality when treating individuals with spinal cord injury.
For example, the stimulation settings that allow individuals with spinal cord injury to stand are different from settings that allow them to walk, while a third configuration is required to help with bladder function and other conditions.
The devices that researchers use today must be programmed manually for each individual function.
The goal of the new project is to develop integrated, closed-loop programming for multiple systems, specifically locomotion and bladder function, using wireless sensors to monitor the user’s condition and adjust stimulator settings as needed.
Working with Medtronic, the UofL researchers will develop learning programs for the closed-loop system and integrate the programming with commercially available epidural stimulators, as an investigational use.
The 2018 breakthrough was the result of years of research by the UofL team, which found that applying electrical stimulation to the lower spinal cord, combined with physical therapy, allows unexpected degrees of recovery in people with complete spinal cord injury.
Research participants are able to move voluntarily, stand and take steps, in addition to experiencing improvements in blood pressure regulation, bowel and bladder function and other common health issues associated with spinal cord injury.
“One of the main obstacles to making this therapy available to patients has been the need for programming specific for spinal cord injury,” adds Professor Susan Harkema, professor of neurological surgery and associate scientific director for KSCIRC.
“This new work will promote the safe, long-term use of the therapy in the home and community, allowing people with spinal cord injury to benefit from the discoveries we have made over the past two decades.”
