High density epidural stimulation for facilitation of locomotion, posture, voluntary movement, and recovery of autonomic, sexual, vasomotor, and cognitive function after neurological injury
First Claim
1. A method comprising:
- positioning a human patient in a training device, the patient having a neurologically derived paralysis in a portion of the patient'"'"'s body, the training device being configured to assist with physical training that is configured to induce neurological signals in the portion of the patient'"'"'s body having the paralysis, the patient having a spinal cord with at least one selected spinal circuit that has a first stimulation threshold representing a minimum amount of stimulation required to activate the at least one selected spinal circuit, and a second stimulation threshold representing an amount of stimulation above which the at least one selected spinal circuit is fully activated and adding the induced neurological signals has no additional effect on the at least one selected spinal circuit, the induced neurological signals being below the first stimulation threshold and insufficient to activate the at least one selected spinal circuit; and
applying electrical stimulation to a portion of a spinal cord of the patient, the electrical stimulation being below the second stimulation threshold such that the at least one selected spinal circuit is at least partially activatable by the addition of at least one of (a) a second portion of the induced neurological signals, and (b) supraspinal signals.
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Accused Products
Abstract
Methods of enabling locomotor control, postural control, voluntary control of body movements (e.g., in non-weight bearing conditions), and/or autonomic functions in a human subject having spinal cord injury, brain injury, or neurological neuromotor disease. In certain embodiments, the methods involve stimulating the spinal cord of the subject using an epidurally placed electrode array, subjecting the subject to physical training thereby generating proprioceptive and/or supraspinal signals, and optionally administering pharmacological agents to the subject. The combination of stimulation, physical training, and optional pharmacological agents modulate in real time electrophysiological properties of spinal circuits in the subject so they are activated by supraspinal information and/or proprioceptive information derived from the region of the subject where locomotor activity is to be facilitated.
217 Citations
51 Claims
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1. A method comprising:
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positioning a human patient in a training device, the patient having a neurologically derived paralysis in a portion of the patient'"'"'s body, the training device being configured to assist with physical training that is configured to induce neurological signals in the portion of the patient'"'"'s body having the paralysis, the patient having a spinal cord with at least one selected spinal circuit that has a first stimulation threshold representing a minimum amount of stimulation required to activate the at least one selected spinal circuit, and a second stimulation threshold representing an amount of stimulation above which the at least one selected spinal circuit is fully activated and adding the induced neurological signals has no additional effect on the at least one selected spinal circuit, the induced neurological signals being below the first stimulation threshold and insufficient to activate the at least one selected spinal circuit; and applying electrical stimulation to a portion of a spinal cord of the patient, the electrical stimulation being below the second stimulation threshold such that the at least one selected spinal circuit is at least partially activatable by the addition of at least one of (a) a second portion of the induced neurological signals, and (b) supraspinal signals. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29)
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30. A method of enabling one or more functions selected from a group consisting of postural and/or locomotor activity, voluntary movement of leg position when not bearing weight, voluntary voiding of the bladder and/or bowel, return of sexual function, autonomic control of cardiovascular function, body temperature control, and normalized metabolic processes, in a human subject having a neurologically derived paralysis, the method comprising:
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stimulating the spinal cord of the subject using an electrode array; and while subjecting the subject to physical training that exposes the subject to relevant postural proprioceptive signals, locomotor proprioceptive signals, and supraspinal signals; wherein at least one of the stimulation and physical training modulates in real time the electrophysiological properties of spinal circuits in the subject so the spinal circuits are activated by at least one of supraspinal information and proprioceptive information derived from the region of the subject where the selected one or more functions are facilitated. - View Dependent Claims (31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46)
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47. A method for use with a human patient having a spinal cord, and a neurologically derived paralysis in a portion of the patient'"'"'s body, the method comprising:
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implanting an electrode array on the patient'"'"'s spinal cord; positioning the patient in a training device configured to assist with physical training that is configured to induce neurological signals in the portion of the patient'"'"'s body having the paralysis, the patient'"'"'s spinal cord having at least one selected spinal circuit that has a first stimulation threshold representing a minimum amount of stimulation required to activate the at least one selected spinal circuit, and a second stimulation threshold representing an amount of stimulation above which the at least one selected spinal circuit is fully activated and adding the induced neurological signals has no additional effect on the at least one selected spinal circuit, the induced neurological signals being below the first stimulation threshold and insufficient to activate the at least one selected spinal circuit; and applying electrical stimulation to a portion of a spinal cord of the patient, the electrical stimulation being below the second stimulation threshold such that the at least one selected spinal circuit is at least partially activatable by the addition of at least one of (a) a second portion of the induced neurological signals, and (b) supraspinal signals. - View Dependent Claims (48)
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49. A system for use with a human patient having a spinal cord with a dura, and a neurologically derived paralysis in a portion of the patient'"'"'s body, the system comprising:
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a training device configured to assist with physically training of the patient, when undertaken, the physical training inducing neurological signals in the portion of the patient'"'"'s body having the paralysis; an implantable electrode array configured to be implanted on the dura of the patient'"'"'s spinal cord; and a stimulation generator connected to the implantable electrode array, the stimulation generator being configured to apply electrical stimulation to the implantable electrode array, electrophysiological properties of at least one spinal circuit in the patient'"'"'s spinal cord being modulated by the electrical stimulation and at least one of a first portion of the induced neurological signals and supraspinal signals such that the at least one spinal circuit is at least partially activatable by at least one of (a) the supraspinal signals and (b) a second portion of the induced neurological signals. - View Dependent Claims (50)
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51. A system for use with a patient having a neurologically derived paralysis in a portion of the patient'"'"'s body, the system comprising:
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means for physically training the patient to induce neurological signals in the portion of the patient'"'"'s body having the paralysis; and means for applying electrical stimulation to a portion of a spinal cord of the patient, electrophysiological properties of at least one spinal circuit in the patient'"'"'s spinal cord being modulated by the electrical stimulation and at least one of a first portion of the induced neurological signals and supraspinal signals such that the at least one spinal circuit is at least partially activatable by at least one of (a) the supraspinal signals and (b) a second portion of the induced neurological signals.
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Specification