Developments in spinal cord implants and what it could mean for SCI patients

A spinal cord implant developed by a team of Swiss researchers has made headlines this week as it has enabled a paralysed man, Michel Roccati, who has a completely severed spinal cord, to be able to walk again. The same technology also improved the health of another paralysed patient, enabling him to become a father.

Epidural electrical stimulation

Researchers, Andreas Rowald et al, published an article (Activity-dependent spinal cord neuromodulation rapidly restores trunk and leg motor functions after complete paralysis) in the journal Nature Medicine on 7 February following a study regarding epidural electrical stimulation (EES).

The interesting thing about this study is that the results showed the restoration of function in cases of complete paralysis within the first day of stimulation.  Dr Hariharan, a consultant at the Northern General Hospital in Sheffield, who is independent of the research team, backs the research and said: "I have not heard of any study where they have put in an implant [into a patient with a complete spinal cord cut] and demonstrated muscle movements and improving balance, enough to stand and walk."  He does however add that further clinical trials are required before it can be confirmed as an effective treatment.

The patients had complete sensorimotor paralysis and, on the device being engaged, they were able to step independently on a treadmill on the first day.  It cannot be questioned that this is an impressive result, with the article recording that the participants could produce up to 300 independent steps as early as the first day.  The patients were able to walk, stand, cycle, swim and control trunk movements through the activity specific-stimulation programs.  After a five month neurorehabilitation programme, including EES, the participants progressively regained full weight-bearing capacities, with substantial increase in the mass of leg and trunk muscles. 

How does it work?

The device works by stimulating the region of the spinal cord related to the muscles for the trunk and legs.  Soft leads are placed underneath a patient’s vertebrae, directly on the spinal cord, and are controlled by AI software.   The AI software activates neurons through a pacemaker that is inserted into the patient’s abdomen.  The device is activated through two small remote controls placed on the patient’s walker and connected wirelessly to a tablet.  The tablet forwards signals to the pacemaker and, when the buttons are pressed, this facilitates the patient to walk.  The restoration of the patient’s motor activities is by way of computer algorithms that mimic the natural activation of motor neurons underlying activity.

Whilst this is an encouraging development for SCI patients, the researchers have been clear that this is not a cure but they see it as a critical step to improve the quality of life for those with spinal cord injuries.

What does this mean for future claims?

This is certainly something for insurers to keep on their radar.  We may see funding requests and claims for this type of treatment in personal injury cases of the future although, with research in the early stages and further clinical studies required, this may remain some way off yet.  Whether this technology will ultimately be akin to current exoskeletons, i.e. not suitable for everyday use in the community, also remains to be seen.  However, improved core strength and weight bearing capacities will likely have a knock on effect in terms of life expectancy and increase periods of good health more generally.  It could also potentially have an impact on patient care needs, such as modulate the level of care required or defer increased care needs for a longer period of time. 

Implant technology is not the only SCI treatment being researched; perhaps we will see implant technology eventually used in conjunction with nerve regeneration treatment, such as stem cell treatment which is also in the early stages of research.

The full article on this research can be located here.