A sensory information compliant spinal cord stimulation system for the rehabilitation of motor functions

A spinal cord stimulation, spinal cord technology, used in the recovery of motor function, the system of stimulating the spinal cord, and the field of sports injuries, can solve the problems of reducing the efficacy of the stimulation system, destroying the sensory information of the recruited fibers, etc., to achieve the effect of reducing the number of

Pending Publication Date: 2019-08-13
ECOLE POLYTECHNIQUE FEDERALE DE LAUSANNE (EPFL)
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  • Summary
  • Abstract
  • Description
  • Claims
  • Application Information

AI Technical Summary

Problems solved by technology

[0024] However, it has now been found that in humans, stimulation pulses interacting with sensory fibers at frequencies above 30 Hz significantly disrupt sensory information in recruited fibers, reducing the efficacy of this stimulation system

Method used

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  • A sensory information compliant spinal cord stimulation system for the rehabilitation of motor functions
  • A sensory information compliant spinal cord stimulation system for the rehabilitation of motor functions
  • A sensory information compliant spinal cord stimulation system for the rehabilitation of motor functions

Examples

Experimental program
Comparison scheme
Effect test

Embodiment 1

[0217] Assessing destructive interference in human spinal cord stimulation

[0218]Each pulse of electrical spinal cord stimulation elicits an action potential in recruited fibers that propagate anterogradely (ie, run along its axis in its natural normal direction) and retrogradely (in the opposite direction). For the duration of the transit time of a retrograde action potential to the periphery, the orthodromic activity in the same axon that naturally arises in the periphery during locomotion will be abolished, a phenomenon known as retrograde collision. For this reason, part of the natural sensory information that flows into the spinal cord during motor execution may collide with the retrograde action potential elicited along the nerve by stimulation and thus be counteracted by the stimulation. We hereafter refer to this interaction of electrical stimulation and sensory feedback information as destructive interference.

[0219] The probability of these reverse collisions oc...

Embodiment 2

[0225] Comparison between stimulation paradigms according to the present application and conventional stimulation protocols

[0226] Conventional spinal cord stimulation protocols for promoting walking function are derived from animal models, using frequencies from 20 to 50 Hz (Angeli et al., 2014; Danner et al., 2015) and amplitudes sufficient to elicit leg muscle activation with each stimulation pulse. As we have previously shown, with these stimulation frequencies, sensory information in electrically recruited fibers collides with evoked counteractivity. Considering that about 40% of Ia fibers need to be recruited to elicit a motor response via reflex circuits, it is clear that these types of stimulation protocols greatly reduce the amount of sensory feedback information that actually reaches the spinal cord. This sensory information is thought to be the source of motor control necessary to drive recovery of locomotion. For this reason, we hypothesized that a stimulation r...

Embodiment 3

[0237] Effects of high-frequency SCS on rodents

[0238] The disclosed stimulation paradigm relies on two independent mechanisms.

[0239] First, each Ia fiber has excitatory synaptic connections with all motor neurons of the muscle of the same name. For this reason, the recruitment of even a small number of fibers transmits stimulation to the entire motor pool.

[0240] Second, excitatory postsynaptic potentials (EPSPs) elicited by Ia fibers on motor neurons are characterized by a half-amplitude duration of approximately 4 ms (Burke R.E, 1968). This suggests that high-frequency recruitment of a small number of afferent fibers will trigger strong depolarization of motor neurons as continuous EPSPs will wrap up over time.

[0241] However, the maximum rate at which EPSPs sum up depends on the afferent refractory period, which may be too long to effectively depolarize motor neurons. Furthermore, rapid repetitive recruitment of Ia fibers will lead to homosynaptic depression of...

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Abstract

The present invention refers to a system for stimulation of the spinal cord for the rehabilitation of motor function in subjects with spinal cord injury or other motor disorders. Said system comprisesa programmable implantable pulse generator (IPG), operatively connected to deliver current pulses to one or more multi-electrode arrays, wherein said IPG is adapted to deliver to said multi-electrodearray a stimulation characterized by a frequency comprised between 20 and 1200 Hz and an amplitude comprised between 0.1 motor threshold amplitude and 1.5 motor threshold amplitude. The use of such system for facilitating locomotor functions or upper limb movements in a subject with neuromotor impairments is also within the scope of the invention.

Description

technical field [0001] This application relates to the field of spinal nerve prostheses, especially for sports injuries. [0002] In particular, it relates to systems for stimulating the spinal cord, more particularly for the recovery of motor function in subjects with spinal cord injuries or other motor impairments, such as after stroke. Background technique [0003] Severe spinal cord injury (SCI) disrupts communication between the center of the spine and the spinal circuits underlying the lesion, often including those responsible for generating motion. Disruption of the descending pathway removes the source of conditioning and stimulation necessary to place spinal circuits in a state capable of producing movement (termed a "functional state"). For this reason, while largely anatomically intact, the spinal circuits underlying the lesion remain in a state that does not allow standing and walking (termed "dormant state"). [0004] In humans, functionally SCI can be complet...

Claims

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Application Information

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Patent Type & Authority Applications(China)
IPC IPC(8): A61N1/05A61N1/36
CPCA61N1/0551A61N1/36067A61N1/36157A61N1/36171A61N1/36062A61H3/00A61H2201/10A61N1/36003A61N1/3616A63B22/02
Inventor 艾玛努埃莱·芙曼托马可·卡波格罗索西尔维斯特·米塞拉葛瑞哥尔·库尔坦凯伦·米娜西安
Owner ECOLE POLYTECHNIQUE FEDERALE DE LAUSANNE (EPFL)
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