People with chronic spine injuries have had their ability to walk restored using a combination of electrical stimulation and physical therapy.
Damage to their spine resulted in paralysis for all of them. The volunteers showed improvements five months later.
The exact nerve groups stimulated by the therapy have been identified by a recent study.
The section of the spine that runs through our lower back is home to the nerve cells that help us walk. When our spine is injured, we can't walk because the brain's signals are disrupted.
Unable to receive commands, these 'walking' neuron become nonfunctional, which could lead to a permanent paralysis of the legs.
It wasn't clear how electrical stimulation of the spine could reverse paralysis. A technology called epidural electrical stimulation was tested in nine individuals and an animal model by a group of scientists.
A neurotransmitter was implanted in the spine. Patients underwent a process of intensive neurorehabilitation that involved a robotic support system assisting them while they moved.
Four to five times a week, the patients underwent stimulation and rehabilitation. The volunteers were able to walk with the help of a walker.
The recovered patients showed a reduction in neural activity in the back of the neck. The team believes that the activity is being refined to a subset of neurons that are essential for walking.
"When you think about it, it should not be a surprise," Courtine said, " because in the brain, when you learn a task, that's exactly what you see."
In order to understand which cells were doing what, Kathe and his team used spatial transcriptomics and a combination of the two techniques.
There is a population of previously unknown neurons that can take over after an injury.
The cells that make up this tissue don't appear to be needed for walking in healthy animals, but they seem to be essential for recovering after a spine injury. Activity is dependent on their recruitment.
The hippocampus are uniquely positioned to transform information from the brain into executive commands. In their paper, Kathe and colleagues explain how these are broadcast to the neurons that make walking possible.
There's still a lot to be investigated, as this is only one part of a very complicated chain of messaging and receiving cells.
The researchers concluded that the participation of the Hoxa10 neurons is a fundamental requirement for the recovery of walking after a paralyzing injury.
This new understanding could lead to more treatment options and a better quality of life for people with other types of spine injuries as well.
The research was published in a journal.
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