Intraspinal microstimulation (ISMS) is a form of neuromodulation that involves inserting ultrafine wires into the ventral horn of the lumbar spinal cord to target the locomotor networks that reside there. By stimulating through these wires with low levels of current we are able to activate the locomotor networks and create walking-like movements. Eventually we hope to use this technique to restore functional walking following spinal cord injury. There are currently 3 different projects going on in this discipline.

One project involves comparing epidural spinal cord stimulation, another method of neuromodulation, and ISMS. This will involve looking at the sites and mechanisms of activation, determine the reorganization that takes place in the spinal cord, and assess the neuroplastic changes that occur and how they affect walking. For another project, a strain relief mechanism will be designed that ensures the mechanical stability of ISMS implants. This will be done by fabricating micro-coiled cables with appropriate size, stretchablity and electrochemical properties. This will allow for ISMS to be translated to human application. The third project aims to design intelligent control strategies to restore personalized walking. For this purpose, a locomotor cat model is developed and being used to test the feasibility of the controllers. The strategies will eventually be tested in animals with chronic spinal cord injury.

2) Arm and Leg Cycling Paired with Transcutaneous Spinal Cord Stimulation to Improve Walking after Spinal Cord Injury

The overall goal of this research is to develop a novel, cost-effective, and widely translatable therapy to reduce paralysis and improve walking function for individuals after a spinal cord injury (SCI). Traditionally, rehabilitation interventions primarily focus on leg training for restoring walking. However, previous research has highlighted the importance of including the arms in the rehabilitation of walking after both spinal cord injury (SCI) and stroke, respectively. However, there may be possible to enhance these effects even further by strengthening interlimb connectivity with a functional electrical stimulation (FES) assisted arm and leg cycling training paradigm paired with transcutaneous spinal cord stimulation (tSCS).

Therefore, the purpose of the proposed project is to determine, for the first time, whether long-term application of non-invasive spinal stimulation can improve over-ground walking when paired with A&L cycling for individuals with iSCI. We believe that the addition of spinal stimulation will further improve the connectivity of neural networks between the brain and spinal cord, better improve connectivity of spinal cord networks, and better improve the recovery of walking than is currently possible with available rehabilitation strategies. If successful, this exciting training strategy can be directly translated to the clinic. Importantly, unlike currently available rehabilitation exercises for improving walking, our training strategy is not taxing on the therapists, which means that more people with SCI and other neural impairments can be treated without increasing healthcare system costs..

3) Reduction of Spasticity after Spinal Cord Injury and Stroke

Spasticity is a very debilitating side-effect of spinal cord injury and stroke. It can lead to uncontrolled spasms and compromise the efficiency of residual voluntary function. This project focuses on obtaining a better understanding of the mechanisms of spasticity using computer modeling, and developing surface electrical stimulation and training paradigms that would reduce spasticity in individuals with spinal cord injury and stroke.

4) Restoration of Arm Function

A staggering 1.3% of the population has some type of neurological deficit, many of whom have diminished arm function. In an effort to alleviate the significant health care costs associated with the treatment of these ailments, , we are working towards rehabilitative interventions to improve arm function. Such interventions include both robot-assisted rehabilitation and FES training. Furthermore, daily activities often necessitate engagement of both arms, and concurrently demand cognitive and sensory processing as a necessary part of motor decisions. Spinal cord injury (SCI) disrupts the bridge between the brain and body, and results in the loss of control over various body functions, leading to substantial reduction in independence and quality of life. Therefore, the choice of a rehabilitation intervention needs to be based on an understanding of the neural correlates of arm movements. Thus, we are also working toward identifying the influence of more complex movements on motor processes associated with the planning and execution of arm movements using Kinarm exoskleton.

5) Early Detection and Prevention of Pressure Injuries

People who are dependent on a wheelchair for daily mobility or are confined to a bed due to illness are at high risk of developing pressure ulcers (commonly known as bed sores). Pressure ulcers can develop at the surface of the skin due to multiple factors including abrasions, moisture and poor nutrition, and can progress inwards if not properly attended. Pressure ulcers can also develop from the inside-out. These ulcers develop at deep bone-muscle interfaces directly due to pressure, which causes tissue deformation and ischemia, and can cause massive tissue damage prior to exhibiting clear skin signs. The goals of this project are threefold: developing tools that would allow for early detection of inside-out pressure ulcers, preventing the development of pressure ulcers using a smart garment developed in our laboratory called Smart-e-Pants, and reversing the progression of existing deep tissue pressure injuries.

6) Prevention of Deep Vein Thrombosis (DVT)

Deep vein thrombosis (DVT) is a clot in the deep veins of the legs that can dislodge and travel to the lungs where it causes a pulmonary embolism. Pulmonary embolisms lead to death in 30% of the patients and long-term disability in the remaining patients affected by the condition. People admitted to hospitals are at 100 times the risk of developing a DVT than people in the community. The goal of this project is to develop a novel intervention that prevents the formation of a DVT; and thus reduces the incidence of pulmonary embolisms in hospitals.