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Nature Jun 2023A spinal cord injury interrupts the communication between the brain and the region of the spinal cord that produces walking, leading to paralysis. Here, we restored this...
A spinal cord injury interrupts the communication between the brain and the region of the spinal cord that produces walking, leading to paralysis. 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. This brain-spine interface (BSI) consists of fully implanted recording and stimulation systems that establish a direct link between cortical signals and the analogue modulation of epidural electrical stimulation targeting the spinal cord regions involved in the production of walking. A highly reliable BSI is calibrated within a few minutes. This reliability has remained stable over one year, including during independent use at home. 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. Moreover, neurorehabilitation supported by the BSI improved neurological recovery. The participant regained the ability to walk with crutches overground even when the BSI was switched off. This digital bridge establishes a framework to restore natural control of movement after paralysis.
Topics: Humans; Brain; Brain-Computer Interfaces; Electric Stimulation Therapy; Quadriplegia; Reproducibility of Results; Spinal Cord; Spinal Cord Injuries; Walking; Leg; Neurological Rehabilitation; Male
PubMed: 37225984
DOI: 10.1038/s41586-023-06094-5 -
The New England Journal of Medicine Jul 2021Technology to restore the ability to communicate in paralyzed persons who cannot speak has the potential to improve autonomy and quality of life. An approach that...
BACKGROUND
Technology to restore the ability to communicate in paralyzed persons who cannot speak has the potential to improve autonomy and quality of life. An approach that decodes words and sentences directly from the cerebral cortical activity of such patients may represent an advancement over existing methods for assisted communication.
METHODS
We implanted a subdural, high-density, multielectrode array over the area of the sensorimotor cortex that controls speech in a person with anarthria (the loss of the ability to articulate speech) and spastic quadriparesis caused by a brain-stem stroke. Over the course of 48 sessions, we recorded 22 hours of cortical activity while the participant attempted to say individual words from a vocabulary set of 50 words. We used deep-learning algorithms to create computational models for the detection and classification of words from patterns in the recorded cortical activity. We applied these computational models, as well as a natural-language model that yielded next-word probabilities given the preceding words in a sequence, to decode full sentences as the participant attempted to say them.
RESULTS
We decoded sentences from the participant's cortical activity in real time at a median rate of 15.2 words per minute, with a median word error rate of 25.6%. In post hoc analyses, we detected 98% of the attempts by the participant to produce individual words, and we classified words with 47.1% accuracy using cortical signals that were stable throughout the 81-week study period.
CONCLUSIONS
In a person with anarthria and spastic quadriparesis caused by a brain-stem stroke, words and sentences were decoded directly from cortical activity during attempted speech with the use of deep-learning models and a natural-language model. (Funded by Facebook and others; ClinicalTrials.gov number, NCT03698149.).
Topics: Adult; Brain Stem Infarctions; Brain-Computer Interfaces; Deep Learning; Dysarthria; Electrocorticography; Electrodes, Implanted; Humans; Male; Natural Language Processing; Neural Prostheses; Quadriplegia; Sensorimotor Cortex; Speech
PubMed: 34260835
DOI: 10.1056/NEJMoa2027540 -
Lancet (London, England) May 2017People with chronic tetraplegia, due to high-cervical spinal cord injury, can regain limb movements through coordinated electrical stimulation of peripheral muscles and... (Clinical Trial)
Clinical Trial Comparative Study
BACKGROUND
People with chronic tetraplegia, due to high-cervical spinal cord injury, can regain limb movements through coordinated electrical stimulation of peripheral muscles and nerves, known as functional electrical stimulation (FES). Users typically command FES systems through other preserved, but unrelated and limited in number, volitional movements (eg, facial muscle activity, head movements, shoulder shrugs). We report the findings of an individual with traumatic high-cervical spinal cord injury who coordinated reaching and grasping movements using his own paralysed arm and hand, reanimated through implanted FES, and commanded using his own cortical signals through an intracortical brain-computer interface (iBCI).
METHODS
We recruited a participant into the BrainGate2 clinical trial, an ongoing study that obtains safety information regarding an intracortical neural interface device, and investigates the feasibility of people with tetraplegia controlling assistive devices using their cortical signals. Surgical procedures were performed at University Hospitals Cleveland Medical Center (Cleveland, OH, USA). Study procedures and data analyses were performed at Case Western Reserve University (Cleveland, OH, USA) and the US Department of Veterans Affairs, Louis Stokes Cleveland Veterans Affairs Medical Center (Cleveland, OH, USA). The study participant was a 53-year-old man with a spinal cord injury (cervical level 4, American Spinal Injury Association Impairment Scale category A). He received two intracortical microelectrode arrays in the hand area of his motor cortex, and 4 months and 9 months later received a total of 36 implanted percutaneous electrodes in his right upper and lower arm to electrically stimulate his hand, elbow, and shoulder muscles. The participant used a motorised mobile arm support for gravitational assistance and to provide humeral abduction and adduction under cortical control. We assessed the participant's ability to cortically command his paralysed arm to perform simple single-joint arm and hand movements and functionally meaningful multi-joint movements. We compared iBCI control of his paralysed arm with that of a virtual three-dimensional arm. This study is registered with ClinicalTrials.gov, number NCT00912041.
FINDINGS
The intracortical implant occurred on Dec 1, 2014, and we are continuing to study the participant. The last session included in this report was Nov 7, 2016. The point-to-point target acquisition sessions began on Oct 8, 2015 (311 days after implant). The participant successfully cortically commanded single-joint and coordinated multi-joint arm movements for point-to-point target acquisitions (80-100% accuracy), using first a virtual arm and second his own arm animated by FES. Using his paralysed arm, the participant volitionally performed self-paced reaches to drink a mug of coffee (successfully completing 11 of 12 attempts within a single session 463 days after implant) and feed himself (717 days after implant).
INTERPRETATION
To our knowledge, this is the first report of a combined implanted FES+iBCI neuroprosthesis for restoring both reaching and grasping movements to people with chronic tetraplegia due to spinal cord injury, and represents a major advance, with a clear translational path, for clinically viable neuroprostheses for restoration of reaching and grasping after paralysis.
FUNDING
National Institutes of Health, Department of Veterans Affairs.
Topics: Brain; Brain-Computer Interfaces; Electric Stimulation Therapy; Electrodes, Implanted; Feasibility Studies; Hand; Hand Strength; Humans; Male; Microelectrodes; Middle Aged; Motor Cortex; Movement; Muscle, Skeletal; Quadriplegia; Self-Help Devices; Spinal Cord Injuries; United States; United States Department of Veterans Affairs; User-Computer Interface
PubMed: 28363483
DOI: 10.1016/S0140-6736(17)30601-3 -
Medicine Nov 2022Spastic quadriplegia is most severe form of Infantile Cerebral Palsy. Patients are unable to use their legs, arms and body and show language disorder and profound...
RATIONALE
Spastic quadriplegia is most severe form of Infantile Cerebral Palsy. Patients are unable to use their legs, arms and body and show language disorder and profound intellectual disability. The treatment of patients diagnosed with spastic quadriplegia is complex and multidisciplinary. In this case report we described the positive effect of multisensory environment (MSEs) rehabilitation, and the strategies and technologies used to provide child who have to severe spastic quadriplegia and intellectual disability, palsy with playful and fun activities designed according to his abilities.
PATIENT CONCERN
A 7-years-old boy diagnosed with spastic quadriplegia and severe intellectual disability began rehabilitation by MSEs.
DIAGNOSES
Spastic quadriplegia is most severe form of Infantile Cerebral Palsy. Patients are unable to use their legs, arms and body and show language disorder and profound intellectual disability.
INTERVENTIONS
Multisensory room is a large environment containing various elements where child can interact spontaneously and independently.
OUTCOMES
The comparison scores between T0-T1 showed a reduction in self-harm and motor stereotypies (hand flapping). Sustained attention was improved and we observed a better therapeutic compliance by means of greater involvement in gaming activities.
CONCLUSION
The stimuli within the MSEs provided the child opportunities to express himself with facilities more suited to his potential. Future research should project designed randomized controlled trials to examine the efficacy of multisensory on reduction disability.
Topics: Humans; Child; Male; Cerebral Palsy; Intellectual Disability; Quadriplegia; Language Disorders
PubMed: 36401482
DOI: 10.1097/MD.0000000000031404 -
Annals of Physical and Rehabilitation... Nov 2022Scientific evidence indicates the presence of secondary conditions (such as pressure injuries) after spinal cord injury (SCI). Treatment methods focusing on the... (Review)
Review
BACKGROUND
Scientific evidence indicates the presence of secondary conditions (such as pressure injuries) after spinal cord injury (SCI). Treatment methods focusing on the management of paraplegia and tetraplegia include systematic preventive follow-up. These advances have significantly improved the functional and vital prognosis of people with SCI, but some people may not have access to these specialized organizations or may not adhere closely to this medicalized vision. We used a narrative approach to explore the perceptions of people with SCI to better understand their adherence to follow-up.
OBJECTIVES
We aimed to determine the "common denominators" that lead to adherence or non-adherence to long-term follow-up after SCI.
METHODS
People with SCI who had completed their first rehabilitation period for > 1 year were included with regard to 2 variables: 1) an actual medical follow-up or not and 2) a history of pressure injury or not. A review of the literature was used as preparation for semi-directive interviews, which were prospectively analysed by using qualitative analysis software. Thematic saturation was reached at 28 interviews, and 32 interviews were ultimately completed.
RESULT
Three main areas concerning participants' perceptions emerged: people's readiness, appropriation and modulation of the systematic follow-up. We developed a broad conceptual framework representing follow-up and the promotion of the long-term health of people with SCI from their perspectives.
CONCLUSIONS
The medical environment should ensure that people with SCI are ready to actively consider the implementation of prevention strategies and should take into account their ability to establish their own truth, to integrate various life stages after SCI and to negotiate systematic follow-up. The implementation of data about functioning should be conducted using the concept of the Learning Health System.
Topics: Humans; Spinal Cord Injuries; Qualitative Research; Paraplegia; Quadriplegia; Software
PubMed: 35031498
DOI: 10.1016/j.rehab.2022.101629 -
Journal of Medicine and Life 2016Cerebral palsy is the most common cause of developing neuro-motor disability in children, in many cases, the triggering cause remaining unknown. Quadriplegia is the most...
Cerebral palsy is the most common cause of developing neuro-motor disability in children, in many cases, the triggering cause remaining unknown. Quadriplegia is the most severe spastic cerebral palsy, characterized by severe mental retardation and bi-pyramidal syndrome. The purpose of this paper was to demonstrate the importance of knowing the risk factors and the psychosomatic ones, determining to what extent they influence the functional evolution in patients diagnosed with spastic quadriplegia. 23 children diagnosed with spastic quadriplegia were included in the study, being aged between 1 year and half and 12 years. Patients were assessed at baseline (T1), at one year (T2) and after two years at the end of the study (T3). Patients received a comprehensive rehabilitation program for the motor and sensory deficits throughout the study. Initially, a comprehensive evaluation (etiopathogenic, clinical and functional) that started from a thorough medical history of children (the older ones), was conducted but chose parents to identify the risk factors, and a complete physical exam. At each assessment, joint and muscle balance was conducted. To assess functionality, the gross motor function classification systems (GMFCS) and manual ability (MACS) were used. Many risk factors that were classified according to the timeline in prenatal factors, perinatal and postnatal, were identified from a thorough history. A direct correlation was noticed between the decrease of coarse functionality and manual ability, both initially and in dynamic and low APGAR scores, low gestational age, low birth weight and a higher body mass index of the mother. A direct link was observed between the gross motor function and the manual ability. A significant improvement in the MACS score was noticed in patients with a better GMFCS score.
Topics: Child; Child, Preschool; Demography; Female; Fetal Weight; Gestational Age; Humans; Infant; Male; Maternal Age; Motor Skills; Quadriplegia; Risk Factors
PubMed: 27453749
DOI: No ID Found -
BMJ (Clinical Research Ed.) Feb 2005
Review
Topics: Cerebrovascular Disorders; Communication Aids for Disabled; Consciousness Disorders; Dysarthria; Humans; Prognosis; Quadriplegia; Quality of Life; Syndrome
PubMed: 15718541
DOI: 10.1136/bmj.330.7488.406 -
Ugeskrift For Laeger Feb 2020This review summarises the present, limited, knowledge of os odontoideum (OO). The prevalence is unknown, and the aetiology is widely debated, though irrelevant to... (Review)
Review
This review summarises the present, limited, knowledge of os odontoideum (OO). The prevalence is unknown, and the aetiology is widely debated, though irrelevant to management of the disease. Surgery of symptomatic patients is advocated, as there is more uncertainty about the treatment of asymptomatic patients. Diagnosis is obtained with plain X-ray. However, nowadays MRI and CT scanning are recommended for further clarification and judgement of the severity. Knowledge of OO is important to minimise misjudgement and consequently inappropriate treatment. It is recommended, that patients are examined by highly specialised spine doctors before further cervical manipulation due to the high risk of instability with potentially severe consequences.
Topics: Axis, Cervical Vertebra; Humans; Magnetic Resonance Imaging; Odontoid Process; Quadriplegia; Tomography, X-Ray Computed
PubMed: 32138818
DOI: No ID Found -
Revue Medicale de Liege 2008The Locked-In Syndrome (LIS) is classically caused by an anterior pontine vascular lesion and characterized by quadriplegia and anarthria with preserved consciousness... (Review)
Review
The Locked-In Syndrome (LIS) is classically caused by an anterior pontine vascular lesion and characterized by quadriplegia and anarthria with preserved consciousness and intellectual functioning. We here review the definition, etiologies, diagnosis and prognosis of LIS patients and briefly discuss the few studies on their quality of life and the challenging end-of-life decisions that can be encountered. Some clinicians may consider that LIS is worse than being in a vegetative or in a minimally conscious state. However, preliminary data from chronic LIS survivors show a surprisingly preserved self-scored quality of life and requests of treatment withdrawal or euthanasia, though not absent, are infrequent.
Topics: Humans; Prognosis; Quadriplegia; Quality of Life
PubMed: 18669218
DOI: No ID Found -
Journal of General Internal Medicine Nov 2014
Topics: Adolescent; Communication Aids for Disabled; Humans; Male; Physician-Patient Relations; Quadriplegia
PubMed: 24859916
DOI: 10.1007/s11606-014-2869-y