Recovery of Volitional Motor Control and Overground Walking in Participants With Chronic Clinically Motor Complete Spinal Cord Injury: Restoration of Rehabilitative Function With Epidural Spinal Stimulation (RESTORES) Trial—A Preliminary Study

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Recovery of Volitional Motor Control and Overground Walking in Participants With Chronic Clinically Motor Complete Spinal Cord Injury: Restoration of Rehabilitative Function With Epidural Spinal Stimulation (RESTORES) Trial—A Preliminary Study
Title:
Recovery of Volitional Motor Control and Overground Walking in Participants With Chronic Clinically Motor Complete Spinal Cord Injury: Restoration of Rehabilitative Function With Epidural Spinal Stimulation (RESTORES) Trial—A Preliminary Study
Journal Title:
Journal of Neurotrauma
Publication Date:
20 December 2023
Citation:
Wan, K. R., Ng, Z. Y. V., Wee, S. K., Fatimah, M., Lui, W., Phua, M. W., So, Q. Y. R., Maszczyk, T. K., Premchand, B., Saffari, S. E., Ker, R. X. J., & Ng, W. H. (2024). Recovery of Volitional Motor Control and Overground Walking in Participants With Chronic Clinically Motor Complete Spinal Cord Injury: Restoration of Rehabilitative Function With Epidural Spinal Stimulation (RESTORES) Trial—A Preliminary Study. Journal of Neurotrauma. https://doi.org/10.1089/neu.2023.0265
Abstract:
Spinal cord injury (SCI) is damage to any part of the spinal cord resulting in paralysis, bowel and/or bladder incontinence, loss of sensation and other bodily functions. Current treatments for chronic SCI are focused on managing symptoms and preventing further damage to the spinal cord with limited neuro-restorative interventions. Recent research and independent clinical trials of spinal cord stimulation (SCS) or intensive neuro-rehabilitation including neuro-robotics in participants with SCI have suggested potential malleability of the neuronal networks for neurological recovery. We hypothesize that epidural electrical stimulation (EES) delivered via SCS in conjunction with mental imagery practice and robotic neuro-rehabilitation can synergistically improve volitional motor function below the level of injury in participants with chronic clinically motor-complete SCI. In our pilot clinical RESTORES trial (RESToration Of Rehabilitative function with Epidural spinal Stimulation) we investigate the feasibility of this combined multi-modal approach in restoring volitional motor control and achieving independent overground locomotion in participants with chronic motor complete thoracic SCI. Secondary aims are to assess the safety of this combination therapy including the off-label SCS usage as well as improving functional outcome measures. To our knowledge, this is the first clinical trial that investigates the combined impact of this multi-modal EES and rehabilitation strategy in participants with chronic motor complete SCI. Two participants with chronic motor-complete thoracic SCI were recruited for this pilot trial. Both participants have successfully regained volitional motor control below their level of SCI injury and achieved independent overground walking within a month of post-operative stimulation and rehabilitation. There were no adverse events noted in our trial and there was an improvement in postoperative truncal stability score. Results from this pilot study demonstrates the feasibility of combining EES, mental imagery practice and robotic rehabilitation in improving volitional motor control below level of SCI injury and restoring independent overground walking for participants with chronic motor-complete SCI. Our team believes that this provides very exciting promise in a field currently devoid of disease-modifying therapies.
License type:
Publisher Copyright
Funding Info:
This research / project is supported by the National Medical Research Council of Singapore - New Investigator Grant (NIG)
Grant Reference no. : MOH-001083-00
Description:
This is the accepted version of the following article: Wan, K. R., Ng, Z. Y. V., Wee, S. K., Fatimah, M., Lui, W., Phua, M. W., So, Q. Y. R., Maszczyk, T. K., Premchand, B., Saffari, S. E., Ker, R. X. J., & Ng, W. H. (2024). Recovery of Volitional Motor Control and Overground Walking in Participants With Chronic Clinically Motor Complete Spinal Cord Injury: Restoration of Rehabilitative Function With Epidural Spinal Stimulation (RESTORES) Trial—A Preliminary Study. Journal of Neurotrauma. https://doi.org/10.1089/neu.2023.0265, which has now been formally published in final form at Journal of Neurotrauma at doi.org/10.1089/neu.2023.0265. This original submission version of the article may be used for non-commercial purposes in accordance with the Mary Ann Liebert, Inc., publishers’ self-archiving terms and conditions.
ISSN:
1557-9042
0897-7151
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