High density epidural stimulation for facilitation of locomotion, posture, voluntary movement, and recovery of autonomic, sexual, vasomotor, and cognitive function after neurological injury

摘要

Methods of enabling locomotor control, postural control, voluntary control of body movements (e.g., in non-weight bearing conditions), and/or autonomic functions in a human subject having spinal cord injury, brain injury, or neurological neuromotor disease. In certain embodiments, the methods involve stimulating the spinal cord of the subject using an epidurally placed electrode array, subjecting the subject to physical training thereby generating proprioceptive and/or supraspinal signals, and optionally administering pharmacological agents to the subject. The combination of stimulation, physical training, and optional pharmacological agents modulate in real time electrophysiological properties of spinal circuits in the subject so they are activated by supraspinal information and/or proprioceptive information derived from the region of the subject where locomotor activity is to be facilitated.

主权项

1. A method comprising:
positioning a human patient in a training device, the patient having a neurologically derived paralysis in a portion of the patient's body, the training device being configured to assist with physical training that is configured to induce neurological signals in the portion of the patient's body having the paralysis, the patient having a spinal cord with at least one selected spinal circuit that has a first stimulation threshold representing a minimum amount of stimulation required to activate the at least one selected spinal circuit, and a second stimulation threshold representing an amount of stimulation above which the at least one selected spinal circuit is fully activated and adding the induced neurological signals has no additional effect on the at least one selected spinal circuit, the induced neurological signals being below the first stimulation threshold and insufficient to activate the at least one selected spinal circuit; and applying electrical stimulation to a portion of a spinal cord of the patient, the electrical stimulation being below the second stimulation threshold such that the at least one selected spinal circuit is at least partially activatable by the addition of at least one of (a) a second portion of the induced neurological signals, and (b) supraspinal signals.