Researchers Use Electrical Stimulation and Physical Therapy to Aid Movement in Man with Paralysis

Mayo Clinic researchers in Rochester, Minn., used electrical stimulation on the spinal cord and intense physical therapy to help a man intentionally move his paralyzed legs, stand and make steplike motions for the first time in three years.

The case, the result of collaboration with UCLA researchers, was published this week in Mayo Clinic Proceedings. Researchers say these results offer further evidence that a combination of this technology and rehabilitation may help people with spinal cord injuries regain control over previously paralyzed movements, such as steplike actions, balance control and standing.

“We’re really excited because our results went beyond our expectations,” said neurosurgeon Kendall Lee, M.D., Ph.D., principal investigator and director of Mayo Clinic’s Neural Engineering Laboratory. “These are initial findings, but the patient is continuing to make progress.”

The 26-year-old patient sustained a T-6 complete spinal cord injury three years ago. The injury left him unable to move or feel anything below the middle of his torso.

The Mayo study started with the patient going through 22 weeks of physical therapy. He had three training sessions a week to prepare his muscles for attempting tasks during spinal cord stimulation. He was tested for changes regularly. Some results led researchers to characterize his injury further as discomplete, suggesting dormant connections across his injury may remain.

Following physical therapy, he underwent surgery to implant an electrode in the epidural space near the spinal cord below the injured area. The electrode is connected to a computer-controlled device under the skin in the patient’s abdomen. This device, for which Mayo Clinic received permission from the U.S. Food and Drug Administration for off-label use, sends electrical current to the spinal cord, enabling the patient to create movement.

After a three-week recovery period from surgery, the patient resumed physical therapy with stimulation settings adjusted to enable movements. In the first two weeks, he intentionally was able to:

• Control his muscles while lying on his side, resulting in leg movements
• Make steplike motions while lying on his side and standing with partial support
• Stand independently using his arms on support bars for balance

Intentional, or volitional, movement means the patient’s brain is sending a signal to motor neurons in his spinal cord to move his legs purposefully.

"This study supports the growing evidence that when a small amount of electrical stimulation is added to the spinal cord, it can increase the ability of the spinal cord to carry information from the brain to the muscles," said Edelle Field-Fote, PT, Ph.D., FAPTA, director of spinal cord injury research at Shepherd Center in Atlanta.

The earliest published record of this type of research dates back to the 1980s. Shepherd Center research scientist William (Barry) McKay made significant contributions to this work during its early development. Now, Shepherd Center researcher Stephen Estes, Ph.D., is performing similar studies using more clinically available types of electrical stimulation that do not require surgical implantation.

"The goal of the study is to determine whether this more accessible, non-invasive type of stimulation, combined with physical therapy, can improve the ability to voluntarily move the legs and reduce spasticity in people with spinal cord injury," Dr. Field-Fote explained.

More information on Shepherd Center research is available here.

More information on the Mayo Clinic research is available here.