About this Research Topic
Severe spinal cord injury (SCI) dramatically impairs sensorimotor and autonomic functions, resulting in a drastic decrease in quality of life for affected individuals. Also, the economic impact of SCI is striking, with the greatest costs to those with the most severe injuries. To date, the paradigm for treating severe SCI is primarily focused on providing compensatory interventions aimed at improving function above the level of injury. However, the scientific evidence presently available challenges the belief that individuals with chronic and severe SCI have essentially no expectation for neurological and functional recovery.
Over the past century, the application of electrical stimulation to the spinal cord has developed into a clinical application for pain control. This development has also allowed parallel investigations demonstrating that spinal cord epidural stimulation (scES) can access the human lumbosacral spinal circuitry disconnected from supraspinal control and induce the generation of lower limb motor patterns. Moreover, animal studies showed that epidural electrical stimulation of specific segments of the dorsal surface of the spinal cord was effective for eliciting locomotor behavior even after a complete spinal transection. Subsequent investigations have demonstrated that intensive rehabilitation driven by scES can further enhance the recovery of locomotor performance.
In the last decade, the application of scES below the level of injury in individuals with complete SCI led to unprecedented proof of principle that recovery of motor function, even at a chronic stage, is potentially available. Furthermore, recent evidence suggests that scES has the potential to regulate autonomic functions in this population. While these scientific findings have brought hope for recovery of lost functions to millions of individuals worldwide living with a SCI, further efforts are needed to achieve an effective clinical translation of this spinal stimulation technology.
This Research Topic welcomes original and review articles focused on human, animal and computational models that are aimed at advancing the application of spinal cord epidural stimulation for motor and autonomic functions recovery after severe SCI by addressing some of the challenges currently faced in this field. These include, but are not limited to:
• Better understanding the mechanisms underlying the facilitation of motor and autonomic functions;
• Selection of stimulation parameters for task-specific recovery;
• Epidural stimulation technology;
• Characteristics of activity-based training with epidural stimulation;
• Neurophysiological and imaging markers associated with functional recovery;
• Integration of spinal cord epidural stimulation in the home and community environment.
Keywords: spinal cord injury, epidural stimulation, neuromodulation, recovery, function
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