An intracortical neuroprosthesis immediately alleviates walking deficits and improves recovery of leg control after spinal cord injury

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Science Translational Medicine  24 Mar 2021:
Vol. 13, Issue 586, eabb4422
DOI: 10.1126/scitranslmed.abb4422

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Motor recovery begins in the cortex

Clinical rehabilitation after spinal cord injury (SCI) can be enhanced with prosthetic devices. To maximize effectiveness, the ideal device should target supraspinal circuits responsible for the voluntary movement control. However, most of the current approaches only target subspinal circuits, peripheral nerves, and muscles. Here, Bonizzato and Martinez developed an intracortical neuroprosthetic device able to deliver electrical stimulation at motor cortex level, on-demand, in phase coherence with locomotion in rats. The neuroprosthesis promoted activity-dependent changes in cortico-spinal transmission and improved control of locomotion in animals after SCI, suggesting that targeting cortical circuits could be effective in promoting motor recovery in patients with SCI.


Most rehabilitation interventions after spinal cord injury (SCI) only target the sublesional spinal networks, peripheral nerves, and muscles. However, mammalian locomotion is not a mere act of rhythmic pattern generation. Recovery of cortical control is essential for voluntary movement and modulation of gait. We developed an intracortical neuroprosthetic intervention to SCI, with the goal to condition cortical locomotor control. Neurostimulation delivered in phase coherence with ongoing locomotion immediately alleviated primary SCI deficits, such as leg dragging, in rats with incomplete SCI. Cortical neurostimulation achieved high fidelity and markedly proportional online control of leg trajectories in both healthy and SCI rats. Long-term neuroprosthetic training lastingly improved cortical control of locomotion, whereas short training held transient improvements. We performed longitudinal awake cortical motor mapping, unveiling that recovery of cortico-spinal transmission tightly parallels return of locomotor function in rats. These results advocate directly targeting the motor cortex in clinical neuroprosthetic approaches.

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