Article

OBJECTIVE: To report on unexpected findings in 4 patients with chronic paraplegia
who underwent the laparoscopic implantation of neuroprosthesis procedure in the
pelvic lumbosacral nerves. DESIGN: Observational case series. SETTING: Tertiary
referral unit specialized in advanced gynecological surgery and neuropelveology.
PARTICIPANTS: Three patients with incomplete American Spinal Injury Association
(ASIA) Impairment Scale (AIS) grade B (n=2) and AIS grade C (n=1) spinal cord
injury (SCI) and 1 patient with flaccid complete chronic SCI (AIS grade A) (n=1).
INTERVENTION: Functional electrical stimulation (FES)-assisted locomotor training
and continuous low-frequency pelvic-lumbosacral neuromodulation. MAIN OUTCOME
MEASURES: Change in ASIA Lower Extremity Motor Scores, ASIA sensory scores for
light touch and pinprick sensation, and Walking Index for Spinal Cord Injury
scores. RESULTS: All 4 patients developed progressive recovery of some sensory
and voluntary motor functions below the lesions. Three are currently capable of
voluntary weight-bearing standing and walking a few meters with a walker without
FES. The first patient with the longest follow-up is even capable of electrically
assisted standing/walking with 2 crutches without braces or assistance for a
distance of about 900 meters, and of weight-bearing standing and walking for 30
meters with a walker without stimulation. CONCLUSIONS: We report unexpected
sensory and locomotor recovery in 4 people with paraplegia with SCI. Our findings
suggest that FES-assisted locomotor training with continuous low-frequency pelvic
nerve stimulation in patients with SCI may induce changes that affect the central
pattern generator and allow supra- and infraspinal inputs to engage residual
spinal pathways.
CI - Copyright (c) 2014 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.

Langue : ANGLAIS