Abstract
Spinal cord injury (SCI) induces severe deficiencies in sensory-motor and autonomic functions and has a significant negative impact on patients’ quality of life. There is currently no systematic rehabilitation technique assuring recovery of the neurological impairments caused by a complete SCI. Here, we report significant clinical improvement in a group of seven chronic SCI patients (six AIS A, one AIS B) following a 28-month, multi-step protocol that combined training with non-invasive brain-machine interfaces, visuo-tactile feedback and assisted locomotion. All patients recovered significant levels of nociceptive sensation below their original SCI (up to 16 dermatomes, average 11 dermatomes), voluntary motor functions (lower-limbs muscle contractions plus multi-joint movements) and partial sensory function for several modalities (proprioception, tactile, pressure, vibration). Patients also recovered partial intestinal, urinary and sexual functions. By the end of the protocol, all patients had their AIS classification upgraded (six from AIS A to C, one from B to C). These improvements translated into significant changes in the patients’ quality of life as measured by standardized psychological instruments. Reexamination of one patient that discontinued the protocol after 12 months of training showed that the 16-month break resulted in neurological stagnation and no reclassification. We suggest that our neurorehabilitation protocol, based uniquely on non-invasive technology (therefore necessitating no surgical operation), can become a promising therapy for patients diagnosed with severe paraplegia (AIS A, B), even at the chronic phase of their lesion.
Highlights
Spinal Cord Injuries (SCI) cause a wide array of disabilities with devastating motor, sensory, and autonomic deficits that impair the functional capacity of patients to perform routine living and working activities
The present study reports a systematic and unprecedented partial neurological recovery in patients diagnosed with chronic complete (AIS A) and motor complete (AIS B) paraplegia, following long-term non-invasive neurorehabilitation [33]
Based on a study that gathered clinical data from a group of eight SCI patients over a 28-month period, we found that the longer the patients trained under the protocol that combined a BMI, visuo-tactile feedback and active locomotion, the larger was the sensory-motor and visceral recovery observed below the SCI level
Summary
Spinal Cord Injuries (SCI) cause a wide array of disabilities with devastating motor, sensory, and autonomic deficits that impair the functional capacity of patients to perform routine living and working activities. In the US, the most common rank observed one year after the original SCI is AIS A (34%), which includes patients with complete neurological loss SCI (but not necessary anatomically complete lesions [7,8,9]) [10]. The majority of such AIS A cases involves lesions at the thoracic level (67%) [10]. These statistics indicate that the most commonly observed cases of chronic paraplegic SCI are represented by AIS A patients who have very little chance of spontaneous neurological recovery at the chronic phase of the injury
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