Epidural Stimulation and Resistance Training (REST-SCI) for Overground Locomotion After Spinal Cord Injury:...

Area of Science:

• Neuromodulation
• Rehabilitation Medicine
• Neuroscience

Background:

• Spinal cord injury (SCI) severely impairs motor function and autonomic control.
• Spinal cord epidural stimulation (SCES) is an emerging technique to enhance central pattern generator activity.
• Restoring volitional motor control and improving quality of life post-SCI remain significant challenges.

Purpose of the Study:

• To evaluate the combined effects of exoskeleton-assisted walking (EAW), epidural stimulation (ES), and resistance training (RT) on motor control in individuals with motor-complete SCI.
• To assess the impact of EAW + ES + RT versus EAW + delayed ES on autonomic cardiovascular profile, body composition, and bladder function.
• To compare outcomes between an intervention group (EAW + ES + RT) and a control group (EAW + delayed ES + no RT).

Main Methods:

• Randomized controlled trial with 20 participants (motor-complete SCI, AIS A/B, injury below C5).
• Intervention: EAW + ES + RT for over 12 months; Control: EAW + delayed ES + no RT.
• Assessments included volitional motor control, H-reflexes, ambulation (WISCI 2), body composition, metabolic profile, and urodynamic testing.

Main Results:

• The combination of ES and EAW demonstrated potential for restoring locomotion.
• Resistance training may further enhance the motor function outcomes achieved with ES.
• Improvements were observed in motor control, cardiovascular, metabolic, and bladder parameters.

Conclusions:

• Percutaneous SCES is a feasible and safe rehabilitation strategy for motor function restoration in SCI.
• Combining SCES with task-specific training like EAW and RT can augment functional recovery.
• This multimodal approach offers a promising avenue for improving life quality in individuals with SCI.