Altering spinal cord excitability enables voluntary movements after chronic complete paralysis in humans

Brain. 2014 May;137(Pt 5):1394-409. doi: 10.1093/brain/awu038. Epub 2014 Apr 8.


Previously, we reported that one individual who had a motor complete, but sensory incomplete spinal cord injury regained voluntary movement after 7 months of epidural stimulation and stand training. We presumed that the residual sensory pathways were critical in this recovery. However, we now report in three more individuals voluntary movement occurred with epidural stimulation immediately after implant even in two who were diagnosed with a motor and sensory complete lesion. We demonstrate that neuromodulating the spinal circuitry with epidural stimulation, enables completely paralysed individuals to process conceptual, auditory and visual input to regain relatively fine voluntary control of paralysed muscles. We show that neuromodulation of the sub-threshold motor state of excitability of the lumbosacral spinal networks was the key to recovery of intentional movement in four of four individuals diagnosed as having complete paralysis of the legs. We have uncovered a fundamentally new intervention strategy that can dramatically affect recovery of voluntary movement in individuals with complete paralysis even years after injury.

Keywords: epidural stimulation; human spinal cord injury; voluntary movement.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Chronic Disease
  • Electric Stimulation Therapy / methods*
  • Electromyography
  • Evoked Potentials, Motor / physiology
  • Exercise Test
  • Humans
  • Locomotion / physiology*
  • Male
  • Movement / physiology
  • Muscle, Skeletal / physiopathology
  • Paralysis* / pathology
  • Paralysis* / rehabilitation
  • Paralysis* / therapy
  • Physical Therapy Modalities*
  • Spinal Cord / physiology*
  • Treatment Outcome
  • Young Adult