The strategy applies electrostimulation transcutaneously in the area of the spinal cord injury while the patient performs rehabilitation exercises.
A non-invasive technique, based on external electrostimulation of the spinal cord, has managed to improve the function of arms and hands in 43 quadriplegic patients due to spinal cord injury.
This is demonstrated by a clinical trial designed to test the safety and explore the effectiveness of the strategy, the conclusions of which are published in the latest issue of the journal. Nature Medicine.
When severe, spinal injuries make proper communication between the brain and spinal cord impossible, preventing different neurological functions depending on the damaged area. For example, a neck injuryat the level of the cervical spine, hinders proper function of the arms and hands, as well as the lower extremities.
A team led by the scientist Gregoire Courtinefrom the Federal Polytechnic School of Lausanne (EPFL, Switzerland) and well known for his research to restore motor function in patients with paraplegia and tetraplegia, wanted to evaluate the possibilities of a new approach to help patients with these types of injuries. .
Almost exactly a year ago, Courtine presented the development of a kind of ‘digital bridge’ that allowed communication between the brain and the spinal cord to be restored, a strategy that made it possible for the quadriplegic Gert-Jan Oskam recovers and controls the pace to a certain extent. The approach was based on the placement of implants both in the brain and in the area of the spinal cord injury.
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A quadriplegic manages to walk and control his gait with thought thanks to a ‘digital bridge’ between the brain and the spinal cord
A quadriplegic manages to walk and control his gait with thought thanks to a ‘digital bridge’ between the brain and the spinal cord
The strategy that is now presented in Nature MedicineHowever, it is based on a non-invasive strategy and is aimed at improving the functionality of arms and hands in patients with chronic tetraplegia due to spinal cord injury. The technique, called ARC-EX, performs transcutaneous electrical stimulation while the patient performs rehabilitation exercises. This approach, its creators point out, allows nerve cells to be modulated and, to a certain extent, circumvent the lack of communication due to spinal cord injury.
To prove its safety and test its effectiveness, the researchers launched a multicenter, open-label trial in 65 quadriplegic patients (60 completed the trial) who had suffered a spinal cord injury at the level of the cervical. All of them had suffered the injury for at least a year and in some cases the damage was much earlier. In fact, one of the patients had been living with tetraplegia for more than 30 years.
All patients underwent a rehabilitation program over a period of two months. Then, for another two months, electrostimulation with ARC-EX was added to the same program.
The evaluation revealed that in 43 of the 60 patients there was a improves both the strength and functionality of arms and hands. No serious side effects were recorded.
“We saw that when we applied the stimulation, movement was immediately facilitated,” Courtine said at a press conference to present the results of the work. But, in addition, he highlighted, “we also observed the growth of new connections between the nerves”, greater sensitivity, a greater ability to make pincer and force movements, in addition to a “significant improvement in the quality of life of the patients.” Those affected, she noted, reported a decrease in the frequency and severity of muscle spasms, a reduction in pain and an improvement in the quality of sleep, as well as an improvement in their levels of independence to carry out activities of daily living.
Patients’ testimony
This was highlighted by patients present at the press conference, such as the British Melanie Reidwith tetraplegia for 14 years due to a horse riding accident.
Before undergoing the test, his left hand was practically useless, he noted. “And now I can use it. I can make scroll on a tablet or a phone with my left hand and I can get back into a ponytail again, which was something I couldn’t do.
Also Sherown Campbell, from Colorado, USA, noted that after the test he was able to type much faster and “I could participate more at home, cooking and doing things with my children, like tying balloons at birthday parties,” he said.
In their work, the team highlights that the findings of the study indicate that the technique is safe and effective and suggest that it can serve as a new approach to improve the neurological recovery of arms and hands in patients with chronic spinal cord injury. The technique already has requested approval from the FDAthe body that regulates medicines and medical devices in the US and hopes to do the same in Europe in the coming months.
For Helena Bascuñanapresident of the Spanish Society of Rehabilitation and Physical Medicine (SERMEF), which last week held its 62nd National Congress, this “innovative technique is very promising from the start” because “similar things had been done with intramedullary stimulation but this represents a change important because the stimulation it performs is transcutaneous, non-invasive, which makes patient treatment much easier.
In his opinion, the most relevant thing about this study is that “it was done in chronic patients in whom classic rehabilitation no longer has much to offer.”
“A patient with a spinal cord injury between the c2 and c8 vertebrae has a very severe disabling condition; she has a very significant disability in the mobility of her hands,” recalls Bascuñana. In these cases, a small improvement, such as moving the fingers a little if the patient could only flex the elbow, can mean a very significant change in their daily life, she points out.
Antonio Oliverohead of the Functional Exploration and Neuromodulation Group at the National Paraplegic Hospital of Toledo and neurologist at the Los Madroños Hospital (Madrid), shows “moderate optimism” about the approach.
The fact that it is a non-invasive and a priori easy-to-implement technique could facilitate rapid transfer to the clinic, says the specialist. However, “they would first have to carry out a specific efficacy trial with a comparator,” says Oliviero. “For example, use different stimulation frequencies to see if lower stimulation produces ineffectiveness and also probably compare the rehabilitation they do with standard rehabilitation to demonstrate that the application protocol is essential,” he says.
For your part Hatice Kumruneurologist and member of the Neurorehabilitation team at the Guttmann Institute of Barcelona, points out that the intervention is “very promising for its use in rehabilitation for the future”, both in cases of spinal cord injury and in other neurological pathologies, such as Parkinson’s.
All the specialists consulted agree in emphasizing that stimulation must always be accompanied by rehabilitation strategies and in no case allows the recovery of complete functionality of the upper extremities.