Medical Design Briefs - April 2022 - 47

uses electrical stimulation to reactivate spinal neurons - could
work effectively in patients.
Fast forward three years, and a new milestone has just been
reached. The research team led by both Courtine, a professor
at EPFL, and Bloch, a professor and neurosurgeon at CHUV,
has enhanced their system with more sophisticated implants
controlled by artificial intelligence software. These implants
can stimulate the region of the spinal cord that activates the
trunk and leg muscles. Thanks to this new technology, three
patients with complete spinal cord injury were able to walk
again outside the lab.
" Our stimulation algorithms are still based on imitating
nature, " says Courtine. " And our new, soft implanted leads
are designed to be placed underneath the vertebrae, directly
on the spinal cord. They can modulate the neurons regulating
specific muscle groups. By controlling these implants,
we can activate the spinal cord like the brain would do naturally
to have the patient stand, walk, swim, or ride a bike,
for example. "
n Activating Motor Sequences at the Push of a
Button
On a cold, snowy day last December, Michel Roccati - an
Italian man who became paralyzed after a motorcycle accident
four years earlier - braved the icy wind to try out the system
outdoors, in central Lausanne. He had recently undergone the
surgical procedure in which Bloch placed the new, implanted
lead on his spinal cord.
Scientists from the Courtine and Bloch's NeuroRestore
research center were with him, helping to prepare the
demonstration. They attached two small remote controls to
Michel's walker and connected them wirelessly to a tablet
that forwards the signals to a pacemaker in Michel's
abdomen. The pacemaker in turn relays the signals to the
implanted spinal lead that stimulates specific neurons, causing
Michel to move. When he was ready, Michel grasped the
walker and set off. He pressed the button on the right side of
the walker with the firm intention of taking a step forward
with his left leg. His left foot rose like magic and fell to the
ground a few centimeters ahead. He then did the same thing
with the button on his left side, and his right foot moved forward.
He was walking!
" The first few steps were incredible - a dream come true! "
he says. " I've been through some pretty intense training in the
past few months, and I've set myself a series of goals. For
instance, I can now go up and down stairs, and I hope to be
able to walk one kilometer by this spring. "
Two other patients have also successfully tested the new system,
which is described in an article appearing in Nature
Medicine.1
" Our breakthrough here is the longer, wider implanted
leads with electrodes arranged in a way that corresponds exactly
to the spinal nerve roots, " says Bloch. " That gives us precise
control over the neurons regulating specific muscles. "
Ultimately, it allows for greater selectivity and accuracy in controlling
the motor sequences for a given activity.
n One Day Is All It Takes
Extensive training is obviously necessary for patients to get
comfortable using the device. But the pace and scope of rehabilitation
is amazing. " All three patients were able to stand,
walk, pedal, swim, and control their torso movements in just
Medical Design Briefs, April 2022
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Medical Design Briefs - April 2022

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