Electrical spinal cord stimulation must preserve proprioception to enable locomotion in humans with spinal cord injury.
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Version: Author's accepted manuscript
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State: Public
Version: Author's accepted manuscript
License: Not specified
Serval ID
serval:BIB_F80544F3A538
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Electrical spinal cord stimulation must preserve proprioception to enable locomotion in humans with spinal cord injury.
Journal
Nature neuroscience
ISSN
1546-1726 (Electronic)
ISSN-L
1097-6256
Publication state
Published
Issued date
12/2018
Peer-reviewed
Oui
Volume
21
Number
12
Pages
1728-1741
Language
english
Notes
Publication types: Journal Article ; Research Support, Non-U.S. Gov't
Publication Status: ppublish
Publication Status: ppublish
Abstract
Epidural electrical stimulation (EES) of the spinal cord restores locomotion in animal models of spinal cord injury but is less effective in humans. Here we hypothesized that this interspecies discrepancy is due to interference between EES and proprioceptive information in humans. Computational simulations and preclinical and clinical experiments reveal that EES blocks a significant amount of proprioceptive input in humans, but not in rats. This transient deafferentation prevents modulation of reciprocal inhibitory networks involved in locomotion and reduces or abolishes the conscious perception of leg position. Consequently, continuous EES can only facilitate locomotion within a narrow range of stimulation parameters and is unable to provide meaningful locomotor improvements in humans without rehabilitation. Simulations showed that burst stimulation and spatiotemporal stimulation profiles mitigate the cancellation of proprioceptive information, enabling robust control over motor neuron activity. This demonstrates the importance of stimulation protocols that preserve proprioceptive information to facilitate walking with EES.
Keywords
Animals, Biomechanical Phenomena/physiology, Computer Simulation, Feedback, Physiological/physiology, Female, Humans, Locomotion/physiology, Models, Biological, Muscle, Skeletal/physiopathology, Proprioception/physiology, Rats, Spinal Cord/physiopathology, Spinal Cord Injuries/physiopathology, Spinal Cord Injuries/therapy, Spinal Cord Stimulation/methods, Walking/physiology
Pubmed
Web of science
Create date
07/11/2018 12:07
Last modification date
30/04/2021 6:16