Here, we suggest that a digital bridge 13, 15, 16, 17, 18, 19 between the brain and spinal cord would enable volitional control over the timing and amplitude of muscle activity, restoring more natural and adaptive control of standing and walking in people with paralysis due to spinal cord injury. Moreover, the participants showed limited ability to adapt leg movements to changing terrain and volitional demands. Consequently, the control of walking was not perceived as completely natural. However, this recovery required wearable motion sensors to detect motor intentions from residual movements or compensatory strategies to initiate the preprogrammed stimulation sequences 5. These stimulation sequences restored standing and basic walking in people with paralysis due to a spinal cord injury. In turn, recruiting these dorsal root entry zones with preprogrammed spatiotemporal sequences replicates the physiological activation of leg motor pools underlying standing and walking 4, 5, 11, 13, 14. We previously showed that epidural electrical stimulation targeting the individual dorsal root entry zones of the lumbosacral spinal cord enables the modulation of specific leg motor pools 9, 10, 11, 12. Although the majority of spinal cord injuries do not directly damage these neurons, the disruption of descending pathways interrupts the brain-derived commands that are necessary for these neurons to produce walking 8. To walk, the brain delivers executive commands to the neurons located in the lumbosacral spinal cord 7. This digital bridge establishes a framework to restore natural control of movement after paralysis. The participant regained the ability to walk with crutches overground even when the BSI was switched off. Moreover, neurorehabilitation supported by the BSI improved neurological recovery. The participant reports that the BSI enables natural control over the movements of his legs to stand, walk, climb stairs and even traverse complex terrains. This reliability has remained stable over one year, including during independent use at home. A highly reliable BSI is calibrated within a few minutes. This brain–spine interface (BSI) consists of fully implanted recording and stimulation systems that establish a direct link between cortical signals 3 and the analogue modulation of epidural electrical stimulation targeting the spinal cord regions involved in the production of walking 4, 5, 6. Here, we restored this communication with a digital bridge between the brain and spinal cord that enabled an individual with chronic tetraplegia to stand and walk naturally in community settings. Nature volume 618, pages 126–133 ( 2023) Cite this articleĪ spinal cord injury interrupts the communication between the brain and the region of the spinal cord that produces walking, leading to paralysis 1, 2. These results suggest that impedance can be used for detecting paddle position and lead migration, and therefore for guiding SCS programming.Walking naturally after spinal cord injury using a brain–spine interface In addition, among all the lead positions studied, medial-lateral movement resulted in the most substantial changes to SC activation regions. We found that SCS lead impedance was highly sensitive to the distance between the lead and cerebrospinal fluid (CSF) layer. We used a two-stage computational model, including a finite element method model of field potentials in the spinal cord during stimulation, coupled to a biophysical cable model of mammalian, myelinated nerve fibers to calculate tissue impedance and nerve fiber activation within the DC. Jude Medical PENTA™ paddle in the dorsal-ventral or medial-lateral directions on dorsal column (DC) stimulation thresholds and neural activation regions. The objective of this work was to investigate the feasibility of using SCS lead impedance for determining the location of a SCS lead and for detecting lead migration, as well as the impact of axial movement and rotation of the St. The effectiveness of spinal cord stimulation (SCS) for chronic pain treatment depends on selection of appropriate stimulation settings, which can be especially challenging following posture change or SCS lead migration.
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