Brain-controlled neuroprosthetic interventions to restore locomotion after contusion spinal cord injury in the rat

Spinal cord injury (SCI), second only to stroke, is the leading cause of paralysis. Therapies based on electrical stimulation of the spinal cord and other locomotor areas of the Nervous System improve motor control in people with neurotrauma. Neuromodulation of the sensorimotor systems can indeed reactivate circuitries that are left dormant after SCI and turn them into an active locomotor state. These results have been found in animal models and translated to clinical fruition. Recent medical research has demonstrated that the involvement of volition and motor intent is a decisive factor for success of rehabilitation therapies that involve functional electrical stimulation of spinal cord and muscles. A key brain area that encodes information related to the conscious processing and execution of movement is the primary sensory-motor cortex. In this thesis I present two novel neuroprosthetic systems for neuromodulation based on cortical population activity in rats with SCI. We tested the hypotheses that neurons in the motor cortex could provide a reliable input for closed-loop neuroprosthetic systems designed to electrically stimulate different locomotor areas of the nervous system in a locomotor-phase-specific manner and thus enhance the locomotor output. During the experiments, we connected cortical correlates of intended movements with patterns of stimulation delivered either at the midbrain or at the sublesional spinal cord. Our brain-controlled functional stimulation reduced locomotor deficits caused by spinal cord injury and restored voluntary control of foot movement. These findings and the control policies we developed could be applied to clinical trials to improve the results of neurorehabilitation, for the benefit of people living with SCI.