The restoration of standing and walking after neural injury or disease has the benefits of improving muscle and skin properties, joint health and bone density, and cardiovascular and pulmonary function. The ability to walk again is also one of the main desires of people with neural injury or disease. Intraspinal microstimulation (ISMS) is a novel electrical stimulation technique pioneered in our laboratory for restoring mobility. The approach uses very fine, hair-like wires to stimulate the 'control center' for standing and walking in the spinal cord. The microwires are implanted in a relatively small region of the cord (about 5 cm) and patterned stimulation through these wires can generate coordinated muscle contractions in the legs. These contractions produce balanced standing and walking. This is a large project focused on assessing the long-term functionality and benefits of ISMS, its effects on spinal cord and muscle health, and its clinical translation.

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2) Arm and Leg Cycling for Improving Walking after Incomplete Spinal Cord Injury

While walking, humans swing their arms in opposition to the legs, an action that increases the metabolic efficiency and improves balance during walking. This inter-limb modulation involves neuronal pathways between the arm and leg control regions in the spinal cord. Despite the importance of this connectivity to walking, current rehabilitation protocols do not involve the arms for improving locomotion. The goal of this project is to evaluate a new rehabilitation intervention that actively involves the arms and legs for the improvement of walking after neural injury or disease. We proposed that a functional electrical stimulation (FES)-assisted arm and leg cycling paradigm would provide larger improvements in over-ground walking capacity than those produced by paradigms focused on training the legs alone. In studies involving people with incomplete spinal cord injury, we indeed showed that FES-assisted arm and leg cycling may better increase walking speed and endurance, improve balance and improve the quality of walking than interventions focusing on leg rehabilitation alone. This work is currently in the process of implementation in the clinic and future studies will extend to involve people with other neural injuries and diseases.

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, as well as provide individuals with a greater level of independence, we are working towards rehabilitative interventions to improve arm function. Such interventions include both operant conditioning and FES training.

5) Early Detection and Prevention of Pressure Ulcers

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.