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Functional electrical stimulation (FES) is a technique that uses low-energy electrical pulses to artificially generate body movements in individuals who have been paralyzed due to injury to the central nervous system. More specifically, FES can be used to generate muscle contraction in otherwise paralyzed limbs to produce functions such as grasping, walking, bladder voiding and standing. This technology was originally used to develop neuroprostheses that were implemented to permanently substitute impaired functions in individuals with spinal cord injury (SCI), head injury, stroke and other neurological disorders. In other words, a person would use the device each time he or she wanted to generate a desired function. FES is sometimes also referred to as neuromuscular electrical stimulation (NMES).
A spinal cord injury (SCI) is damage to the spinal cord that causes temporary or permanent changes in its function. Symptoms may include loss of muscle function, sensation, or autonomic function in the parts of the body served by the spinal cord below the level of the injury. Injury can occur at any level of the spinal cord and can be complete, with a total loss of sensation and muscle function at lower sacral segments, or incomplete, meaning some nervous signals are able to travel past the injured area of the cord up to the Sacral S4-5 spinal cord segments. Depending on the location and severity of damage, the symptoms vary, from numbness to paralysis, including bowel or bladder incontinence. Long term outcomes also range widely, from full recovery to permanent tetraplegia or paraplegia. Complications can include muscle atrophy, loss of voluntary motor control, spasticity, pressure sores, infections, and breathing problems.
A spinal cord stimulator (SCS) or dorsal column stimulator (DCS) is a type of implantable neuromodulation device that is used to send electrical signals to select areas of the spinal cord for the treatment of certain pain conditions. SCS is a consideration for people who have a pain condition that has not responded to more conservative therapy. There are also spinal cord stimulators under research and development that could enable patients with spinal cord injury to walk again via epidural electrical stimulation (EES).
New Jersey Medical School (NJMS)—also known as Rutgers New Jersey Medical School—is a medical school of Rutgers University, a public research university in Newark, New Jersey. It has been part of the Rutgers Division of Biomedical and Health Sciences since the 2013 dissolution of the University of Medicine and Dentistry of New Jersey. Founded in 1954, NJMS is the oldest school of medicine in New Jersey.
The International Neuromodulation Society (INS) is a non-profit group of clinicians, scientists and engineers dedicated to the scientific development and awareness of neuromodulation – the alteration of nerve activity through the delivery of electromagnetic stimulation or chemical agents to targeted sites of the body. Neuromodulation is a burgeoning field – analysts forecast a double-digit annual growth rate through 2026. Founded in 1989 and based in San Francisco, CA, the INS educates and promotes the field through meetings, its bimonthly, peer-reviewed journal Neuromodulation: Technology at the Neural Interface and chapter websites.
The Kessler Foundation, established in 1985, is a public charity in the United States supporting people with disabilities. Kessler Foundation has its roots in the Kessler Institute, founded in 1949 to improve medical outcomes and employment of people disabled by brain or spinal injury. Kessler Foundation conducts rehabilitation research with the goal of increasing function for cognition, mobility, and long-term outcomes, including employment, for people with neurological disabilities caused by diseases and injuries of the brain and spinal cord.
Spinal locomotion results from intricate dynamic interactions between a central program in lower thoracolumbar spine and proprioceptive feedback from body in the absence of central control by brain as in complete spinal cord injury (SCI). Following SCI, the spinal circuitry below the lesion site does not become silent rather it continues to maintain active and functional neuronal properties although in a modified manner.
Neurostimulation is the purposeful modulation of the nervous system's activity using invasive or non-invasive means. Neurostimulation usually refers to the electromagnetic approaches to neuromodulation.
A powered exoskeleton, also known as power armor, powered armor, powered suit, cybernetic suit, cybernetic armor, exosuit, hardsuit, exoframe or augmented mobility, is a mobile machine that is wearable over all or part of the human body, providing ergonomic structural support and powered by a system of electric motors, pneumatics, levers, hydraulics or a combination of cybernetic technologies, while allowing for sufficient limb movement with increased strength and endurance. The exoskeleton is designed to provide better mechanical load tolerance, and its control system aims to sense and synchronize with the user's intended motion and relay the signal to motors which manage the gears. The exoskeleton also protects the user's shoulder, waist, back and thigh against overload, and stabilizes movements when lifting and holding heavy items.
When treating a person with a spinal cord injury, repairing the damage created by injury is the ultimate goal. By using a variety of treatments, greater improvements are achieved, and, therefore, treatment should not be limited to one method. Furthermore, increasing activity will increase his/her chances of recovery.
The Center for Neurotechnology (CNT) is an Engineering Research Center funded by the National Science Foundation to create devices to restore the body's capabilities for sensation and movement. The National Science Foundation has awarded the CNT $~30 million since 2011.
Restorative neurology is a branch of neurology dedicated to improving functions of the impaired nervous system through selective structural or functional modification of abnormal neurocontrol according to underlying mechanisms and clinically unrecognized residual functions. When impaired, the body naturally reconstructs new neurological pathways and redirects activity. The field of restorative neurology works to accentuate these new pathways and primarily focuses on the theory of the plasticity of an impaired nervous system. Its main goal is to take a broken down and disordered nervous system and return it to a state of normal function. Certain treatment strategies are used to augment instead of fully replace any performance of surviving and also improving the potential of motor neuron functions. This rehabilitation of motor neurons allows patients a therapeutic approach to recovery opposed to physical structural reconstruction. It is applied in a wide range of disorders of the nervous system, including upper motor neuron dysfunctions like spinal cord injury, cerebral palsy, multiple sclerosis and acquired brain injury including stroke, and neuromuscular diseases as well as for control of pain and spasticity. Instead of applying a reconstructive neurobiological approach, i.e. structural modifications, restorative neurology relies on improving residual function. While subspecialties like neurosurgery and pharmacology exist and are useful in diagnosing and treating conditions of the nervous system, restorative neurology takes a pathophysiological approach. Instead of heavily relying on neurochemistry or perhaps an anatomical discipline, restorative neurology encompasses many fields and blends them together.
Neuromodulation is "the alteration of nerve activity through targeted delivery of a stimulus, such as electrical stimulation or chemical agents, to specific neurological sites in the body". It is carried out to normalize – or modulate – nervous tissue function. Neuromodulation is an evolving therapy that can involve a range of electromagnetic stimuli such as a magnetic field (rTMS), an electric current, or a drug instilled directly in the subdural space. Emerging applications involve targeted introduction of genes or gene regulators and light (optogenetics), and by 2014, these had been at minimum demonstrated in mammalian models, or first-in-human data had been acquired. The most clinical experience has been with electrical stimulation.
A lumbar anterior root stimulator is a type of neuroprosthesis used in patients with a spinal cord injury or to treat some forms of chronic spinal pain. More specifically, the root stimulator can be used in patients who have lost proper bowel function due to damaged neurons related to gastrointestinal control and potentially allow paraplegics to exercise otherwise paralyzed leg muscles.
Although spinal cord injury (SCI) often causes sexual dysfunction, many people with SCI are able to have satisfying sex lives. Physical limitations acquired from SCI affect sexual function and sexuality in broader areas, which in turn has important effects on quality of life. Damage to the spinal cord impairs its ability to transmit messages between the brain and parts of the body below the level of the lesion. This results in lost or reduced sensation and muscle motion, and affects orgasm, erection, ejaculation, and vaginal lubrication. More indirect causes of sexual dysfunction include pain, weakness, and side effects of medications. Psycho-social causes include depression and altered self-image. Many people with SCI have satisfying sex lives, and many experience sexual arousal and orgasm. People with SCI may employ a variety of adaptations to help carry on their sex lives healthily, by focusing on different areas of the body and types of sexual acts. Neural plasticity may account for increases in sensitivity in parts of the body that have not lost sensation, so people often find newly sensitive erotic areas of the skin in erogenous zones or near borders between areas of preserved and lost sensation.
Spinal cord injury research seeks new ways to cure or treat spinal cord injury in order to lessen the debilitating effects of the injury in the short or long term. There is no cure for SCI, and current treatments are mostly focused on spinal cord injury rehabilitation and management of the secondary effects of the condition. Two major areas of research include neuroprotection, ways to prevent damage to cells caused by biological processes that take place in the body after the injury, and neuroregeneration, regrowing or replacing damaged neural circuits.
Jocelyne Bloch is a Swiss neuroscientist and a neurosurgeon at Lausanne University Hospital and at EPFL.
Sandra M. Garraway is a Canadian-American neuroscientist and assistant professor of physiology in the Department of Physiology at Emory University School of Medicine in Atlanta, Georgia. Garraway is the director of the Emory Multiplex Immunoassay Core (EMIC) where she assists researchers from both academia and industry to perform, analyze, and interpret their multiplexed immunoassays. Garraway studies the neural mechanisms of spinal nociceptive pain after spinal cord injury and as a postdoctoral researcher she discovered roles for both BDNF and ERK2 in pain sensitization and developed novel siRNA technology to inhibit ERK2 as a treatment for pain.
Grégoire Courtine is a French neuroscientist and a professor at the École Polytechnique Fédérale de Lausanne (EPFL), where he is the co-director of the Defitech center for interventional neurotherapies (.NeuroRestore). His research focuses on the field of neurotechnology, with the aim to restore locomotor functions in patients with central nervous system disorders such as spinal cord injuries.
Chet T. Moritz is an American neural engineer, neuroscientist, physiologist, and academic researcher. He is an Associate Professor of Electrical and Computer Engineering, and holds joint appointments in the School of Medicine departments of Rehabilitation Medicine, and Physiology & Biophysics at the University of Washington.
References
- 1 2 "Rutgers New Jersey Medical School". njms-web.njms.rutgers.edu. Retrieved 2019-01-29.
- 1 2 3 4 "Gail Forrest, PhD". Kessler Foundation. Retrieved 2023-02-21.
- ↑ "New collaborative work wins Neuromod Prize to accelerate the development of neuromodulation therapies". News-Medical.net. 2022-07-22. Retrieved 2022-10-21.
- ↑ "Department of Health | New Jersey Commission on Spinal Cord Research | 2002 Research Directory". www.state.nj.us. Retrieved 2019-01-29.
- ↑ Ramanujam, A.; Husain, S. R.; Momeni, K.; Garbarini, E.; Augustine, J.; Forrest, G. F. (November 2017). "Effects of longitudinal powered exoskeleton training on overground walking for SCI: A case study". 2017 International Symposium on Wearable Robotics and Rehabilitation (WeRob). pp. 1–2. doi:10.1109/WEROB.2017.8383822. ISBN 978-1-5386-4377-8. S2CID 49193867.
- ↑ Saleh, S.; Ramanujam, A.; Momeni, K.; Hoxha, A.; Husain, S. R.; Allexandre, D.; Yue, G.; Forrest, G. F. (November 2017). "Cortical control of walking with and without powered exoskeleton assistance: An EEG pilot study". 2017 International Symposium on Wearable Robotics and Rehabilitation (WeRob). pp. 1–2. doi:10.1109/WEROB.2017.8383865. ISBN 978-1-5386-4377-8. S2CID 49190831.
- ↑ "Epidural Stimulation Program – Victory Over Paralysis" . Retrieved 2022-10-21.
- ↑ "Research team wins NIH prize for plan to accelerate advances in spinal stimulation through autonomic neuromodulation". EurekAlert!. Retrieved 2022-10-21.
- ↑ "Kessler Foundation receives major funding from the Craig H. Neilsen Foundation to advance research in spinal cord injury and fellowship education". EurekAlert!. Retrieved 2022-10-21.