A stroke paralyzed her arm. This implant let her use again
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“This is very exciting,” says Jason Carmel, a motor systems neuroscientist at Columbia University who was not involved with the study. “It opens up a potential treatment avenue that we’ve never had before for people with chronic stroke.”
Stroke is the leading cause of disability in adults. Globally, one in four people over the age of 25 will experience one during their lifetime, and three quarters of them have permanent motor deficits in their arms and hands.
A stroke occurs when the blood supply to the brain is blocked or when a blood vessel bursts. Depending on the severity of the brain damage and where it occurs, a stroke can cause certain impairments, such as paralysis, weakness, or problems with speaking, thinking, or memory.
People with paralysis of stroke cannot move a specific muscle or muscle group at will. When the part of the brain that controls movement is damaged, it interferes with the transmission of messages between the brain and muscles. Patients often recover within the first few months after a stroke. Beyond six months there is little chance of further improvement. This is the chronic stage of stroke where the effects are usually permanent.
Both Rendulic and the other patient were in this phase, and the researchers wanted to see if they could use a gentle electrical current delivered to precisely defined points in the spinal cord to restore function to the arm and hand muscles. The spinal cord is the long nerve tube in the back that carries messages from the brain to the rest of the body.
Spinal cord stimulation is already being used to treat pain, and in 2018 separate research teams published a series of papers showing that it enabled a handful of patients paralyzed by spinal cord injuries to stand independently and walk with assistive devices for the first time in years. However, spinal cord stimulation for upper extremity recovery is largely unexplored.
In the latest study, surgeons implanted a pair of thin metal electrodes, shaped like spaghetti noodles, along the top region of the spinal cord in the neck to target nerve populations that control arm and hand muscles. The electrode cables were routed outside the skin and connected to a stimulation system in the laboratory.
The day the researchers turned on the electrical stimulation, Rendulic was able to fully open and close her left hand — something she couldn’t do before. “We were all in tears,” she says. “I opened my hand in a way I hadn’t in almost a decade.”
Over four weeks, Rendulic and the other patient performed a series of laboratory tests. (The second patient, a 47-year-old woman with more severe deficits, had suffered a stroke three years earlier.) They performed tasks such as moving blocks, picking up marbles, grasping a soup can, and picking a lock. While Rendulic showed more improvement than the other patient, the stimulation increased strength, range of motion, and function of the arm and hand in both women. When the device was on, Rendulic said she felt a slight vibration in her arm, but it didn’t hurt.
