Keynote address III: Recovery of function in major spinal cord injury using learning-guided spinal stimulation

Abstract

Approximately 5,000,000 worldwide suffer from a serious spinal cord injury (SCI). Not only do the injured lose the ability to stand and walk (and sometimes move their arms), they suffer from additional injury-induced complications including loss of bladder and bowel control, decreased cardiovascular and pulmonary health, inability to regulate body temperature, and loss of muscle strength and bone density. The totality of the injury and its secondary dysfunctions makes daily activities of living a challenge. Because the median age of SCI in the U.S. is 32 years, SCI individuals amass an additional $1.4–$4.2 million in healthcare costs over their lifetimes. A team of researchers at Caltech, UCLA, and Univ. of Louisville have been developing new technologies and new therapies for motor complete SCI patients — those who have lost motor control below the level of their injury. The centerpiece of this approach is a multi-electrode array that is implanted over the lumbosacral spinal cord either in in the epidural space between the dura and the interior of the vertebral canal, or on the skin over this area. When this technology is coupled with locomotor training and drug therapy (when possible), SCI patients receiving this therapy can stand independently and make some voluntary movements (after being in a wheel chair for over 3 years). More importantly, they can expect to make useful gains in cardiovascular health, muscle tone, as well as improved autonomic function such as bladder, bowel, blood pressure, and temperature regulation. After first reviewing our clinical successes, this talk will focus on current research on new machine algorithms for automated tuning of the stimuli parameters.