Spinal cord injuries can have life-changing consequences that affect mobility, sensation, and overall quality of life. However, advances in medical technologies such as epidural stimulation offer a new treatment option for spinal cord injury-related problems. This innovative technique has shown effective results in restoring voluntary movement, improving autonomic functions, and enhancing rehabilitation outcomes.
What is epidural stimulation?
Epidural stimulation is a neuromodulation treatment used to improve motor functions and physiological responses in spinal cord injuries. In this procedure, an electrical stimulator is placed on the dura, the protective covering of the spinal cord. The stimulator sends low-voltage electrical currents to the spinal cord, activating neural circuits that have become inactive due to the injury.
What are the causes and symptoms of spinal cord injuries?
Spinal cord injuries are conditions that result from damage to the spinal cord due to trauma or disease (e.g., multiple sclerosis, polio, transverse myelitis), spinal cord tumors, or infections, resulting in loss of motor, sensory, and autonomic functions. These injuries are classified by severity and location. Types of spinal cord injuries include:
- Complete: The individual loses all motor and sensory functions below the level of the injury.
- Partial: Some signals may still pass through the damaged area. This allows for partial movement and sensory perception.
Symptoms of spinal cord injury include:
- Loss of movement and sensory loss
- Paralysis (quadriplegia or paraplegia)
- Bowel and bladder dysfunction
- Chronic pain and spasticity
- Respiratory distress in high-level injuries
How does epidural stimulation work?
The working principle of the technique is as follows:
- Implantation: A small electrode array is surgically placed in the epidural region of the spinal cord.
- Electrical Stimulation: The device sends controlled electrical pulses to specific nerve pathways.
- Neural Activation: Electrical signals stimulate neurons below the injury site, bypassing damaged areas and enabling voluntary movement with training.
- External Control: Once the device is placed, it is programmed by specialists with special devices according to the patient’s needs to best support the patient’s motor functions.
How is epidural stimulation surgery performed?
Epidural stimulation is a procedure performed under local anesthesia. During the procedure, your skin is numbed and electrodes are placed under the skin and extended into the epidural space above the spinal cord. These electrodes are connected to a mobile phone-sized current generator that is carried outside your body. The procedure usually takes 1-2 hours. During the procedure, the surgeon places the electrodes in the epidural space under fluoroscopic guidance and positions them over specific nerves. The electrodes are connected to an external generator that is attached to a belt.
The procedure is usually painless. You may feel temporary discomfort at the insertion site. If 50% or more pain relief is achieved during the trial, surgery is planned to place a permanent device (stimulator) in the body. This surgery is performed under light general anesthesia and takes about 1-2 hours.
What are the benefits of epidural stimulation?
The treatment has provided physical independence for many individuals with spinal cord injuries. The main benefits include:
Improved Motor Functions:Many patients are able to regain some voluntary movement, especially with rehabilitation training.
Improved Autonomic Functions:Spinal cord injuries often affect autonomic functions such as blood pressure regulation, bladder control, and body temperature management. The treatment improves these functions, supporting cardiovascular health, bowel and bladder control, and temperature regulation.
Increased Sensory Perception:Some patients report returning sensation in areas where they previously had numbness or reduced sensory input.
Reduction in Pain:Chronic neuropathic pain is a common problem in spinal cord injuries. The treatment can help relieve pain symptoms.
Increased Quality of Life:Regaining movement and autonomic functions increases individuals’ independence, mental health, and overall life satisfaction.
What is the purpose of physical therapy and rehabilitation after epidural stimulation?
Although the procedure is an effective treatment, physical therapy and rehabilitation are of great importance to achieve maximum benefit. A structured rehabilitation program helps retrain the body and improve functions.
What are the stages of the physical therapy and rehabilitation program after epidural stimulation?
The physical therapy rehabilitation program is applied specifically for each patient. The stages generally applied are as follows:
Early Rehabilitation Phase
- Passive Movements: Passive movements are applied by therapists to prevent muscle atrophy (shrinkage) and increase circulation.
- Electrical Stimulation Training: The stimulator is activated with special devices by experts in controlled environments to evaluate responses and train nerve pathways.
- Posture Training: Patients;
Walking Training and Movement Exercises
- Body Weight Supported Treadmill Training:Used to re-teach walking patterns.
- Parallel Bar Training: Patients perform supported weight-bearing activities.
- Functional Electrical Stimulation (FES): Used with stimulation to improve muscle activation and coordination.
Strengthening and Conditioning
- Resistance Training: Used to strengthen remaining muscle functions exercises increase control and endurance.
- Trunk Exercises: Exercises targeting the abdominal and back muscles improve balance.
- Cardiovascular Conditioning: Low-impact exercises are applied to prevent circulation problems.
Psychological and Emotional Support
- Counseling and Support Groups: Mental health professionals help patients adapt to lifestyle changes.
- Mind-Body Techniques: Yoga, meditation and breathing exercises support stress management.
- Motivation and Goal Setting: Setting realistic rehabilitation goals motivates patients.
Rehabilitation is an ongoing process. Even after significant progress is made, patients are encouraged to continue maintenance exercises and regular checkups to ensure sustainable improvement.
Sources:
- Mayo Clinic
- National Institute of Neurological Disorders and Stroke (NINDS)
- World Federation of Neurology