Keynote Title: The Application of Biomedical Instrumentation for Sensory-Motor Recovery and Functional Assessment in Spinal Cord Injured Individuals
Keynote Lecturer: Dr. Alberto Cliquet Jr.
Keynote Chair: Dr. Sergio Cerutti
Presented on: 26-01-2011
Abstract: Spinal cord injury (SCI) is known to be a permanent neurological impairment. Patients are classified by functional ASIA (American Spinal Injury Association) degrees, grade A being a complete lesion. About one year after injury, the sensitive and motor levels are stable and 90% of patients with ASIA A show no functional recovery. Improvement of the remaining 10% is enough to reclassify them as ASIA B. Artificial Neuromuscular Electrical Stimulation (NMES) is being applied to those patients, aiming at osteoporosis regression, cardio-pulmonary function improvement and artificial gait training, as well as towards triggering the human central pattern generator (CPG). Recent work has also shown complete paraplegics becoming incomplete ones and, as an example, a comprehensive clinical case is presented:
A 45 year old male patient, T8 level ASIA A secondary to a sequela of neurocysticercosis in the spinal cord was submitted to NMES (yielding flexion and extension of the hip, knee and ankle joints) gait training for about 3 years. Magnetic resonance imaging (MRI) shows a diffuse arachnoidytis leading to an almost complete destruction of cord tissue from T3 to T10, with a central cystic (syringomyelia), leaving a thin layer of surrounding neural tissue. Five years after the lesion, the subject referred sensation below injury level; a month later, he started with voluntary ankle dorsiflexion movements (the same pattern originally generated by NMES). Voluntary gait, as well as sphincter control are now possible, the patient being reclassified as T12 ASIA D! Somatory-sensitive evoked potential (SSEP) after tibial nerve stimulation revealed contralateral cortical activity in the correspondent inferior limb area, thus characterizing the sensory recovery. Until recently, SCI has been taken as a neurological irreversible damage. Technology and rehabilitation protocols can provide a longer life to such patients and minimize their clinical complications. In this context, a novel paradigm has emerged: is neurological regeneration possible? Are humans able to have their long dormant primitive gait patterns evoked through NMES triggered locomotion? Relevant results from other patients undergoing our protocols (references) using biomedical instrumentation and control strategies towards artificial and voluntary gait, as well as data from MRI, SSEP, etc. give further hope for paraplegics and tetraplegics.
Presented at the following Conferences: BIOSTEC, International Joint Conference on Biomedical Engineering Systems and Technologies
Conference Website: biostec.org/