Electrical Spinal Cord Stimulation: A New Frontier in Treating Spinal Cord Injuries?

A small trial from the University of Washington of noninvasive electrical stimulation showed lots of promise for people with spinal cord injuries. Some participants regained use of their hands.

Peer Reviewed

Hope can be marginal for people with a traumatic spinal cord injury, but an electrifying breakthrough in new research may provide a new avenue of treatment.

SCI electrostimulationCredit: Marcus Donner, Center for Neurotechnology, University of Washington

Nearly 18,000 people per year experience a traumatic spinal cord injury. Traumatic spinal cord injuries are often the result of a car accident, sports injury, or a situation involving diving, playing on a trampoline, or other activity gone awry.

Picking up a fork to eat, pouring a glass of water, or rolling up your sleeves are all daily activities that range from somewhat difficult to entirely impossible for someone with a traumatic spinal cord injury. Physical and occupational therapy has long been the treatment regimen for people who have experienced devastating spinal cord injury, with mild success in restoring motor functions. Many continue to experience partial or complete paralysis. 

That may all change with an innovative, nonsurgical spinal cord injury treatment involving electrical stimulation. 

Electrical spinal cord stimulation has been studied in recent years as a novel, effective spinal cord injury treatment. A new study from the University of Washington yielded new methods and promising initial data, but the findings may not change spinal cord injury treatment for all patients today.

About the Study

Researchers set out to improve hand and arm functions in people with spinal cord injury.

This research builds on the momentum of previous findings from the University of Lausanne in Switzerland, with one key difference. In the Swiss study, neurosurgeons implanted an electrical device inside the patient to deliver spinal cord stimulation. 

In Washington, the method of delivering electrical pulses didn’t require surgery. When researchers combined electrical stimulation with rigorous physical therapy training, participants experienced a true miracle.

The study recruited six participants who experienced chronic spinal cord injuries at least 18 months prior. Research began with evaluating a baseline of motor skill performance by participants, determining their level of capability. While some participants had limited mobility, others couldn’t wiggle their fingers.

The study involved sticking small patches on the participant’s skin around the back of the neck. The patches delivered electrical pulses, stimulating the nerve cells.

Participants received electrical stimulation three times per week for eight weeks. In addition to electrical stimulation, activity-based rehabilitation was conducted three times per week, with two hours per session. This activity involved repeating progressively more difficult  tasks, including pinching and gripping exercises, to analyze movement patterns.

From Paralysis to Hand Movement

Upon receiving electrical stimulation, some participants in the study experienced an immediate improvement in motor skills, including using their hands to pick up small objects. 

Before enrolling in the study, one participant had complete paralysis. After four weeks of physical training paired with electrical stimulation, he was able to move his fingers and thumbs for the first time since sustaining his devastating injury. While training alone did not yield improvements, his capabilities nearly doubled after four additional weeks of training paired with stimulation.

“It’s a hopeful time,” says Chet Moritz, PhD, senior author on the study. “We’ve seen exciting results across the seven people we’ve worked with so far. This treatment  may not work for everyone, but there are people seeing real benefits. It’s relatively simple to put these electrodes on the skin. The stimulation itself may not lead to recovery, but enables movement and more function   during therapy which in turn enables  recovery.”

The University of Washington researchers concluded that electrical stimulation in tandem with rigorous exercise training restored hand function. Rehab therapy alone wasn’t enough to trigger a response.

Fatma Inanici, MD, PhD, lead author on the study, clarifies: “[Electrical] stimulation, or any single treatment, is not enough by itself for recovery. Staying active after the injury is important. Stimulation is effective when combined with training. Passive treatment is not.”

Even more noteworthy is these results were achieved using small sticky patches that researchers placed over the skin along the participant’s spine. Because earlier research required surgery to implant a device and deliver results, the University of Washington researchers have truly opened up the landscape of spinal cord injury treatment with a noninvasive solution. 

SCI electrostim InaniciDr. Inanici observes a patient. Credit: Marcus Donner, Center for Neurotechnology, University of Washington

This study determined that “substantial and prolonged upper extremity function” was restored in participants -- giving them the ability to move freely -- without the need for neurosurgery to achieve such incredible results. 

Long-term Outlook of Electrostim for Spinal Cord Injuries

The researchers sought to determine how long the improvement in motor skills would last without further stimulation or physical therapy. The goal was to capture data over monthly follow-up visits over a three-month, and all participants maintained their improvements without further stimulation.  

Two participants’ volunteered to return after six months, and their gains in hand movement were sustained for this entire time  without further physical therapy or stimulation. The remaining participants were not eligible to return for this optional  six-month follow-up because they were already involved in other studies or received botulinum toxin (commonly known as Botox) injections during this time. As people with spinal cord injuries may experience spastic, uncontrolled muscle movements, research indicates that Botox injections may provide some pain relief, according to the Mayo Clinic. No participants in the Washington study experienced chronic pain.

Based on the limited research, more data is needed to determine if this therapy will work long-term. 

The good news? The University of Washington study has inspired the first large-scale, multi-center, international clinical trial. The trial, known as Up-LIFT, will evaluate the emerging ARC Therapy™ from ONWARD, a medical technology company.

“I’m hopeful this trial, with multiple centers across  North America and Europe, will lead to a successful outcome showing safety, most important, and that some people improve their function, ” says Dr. Moritz. At the status quo, “physical therapy and occupational therapy are helpful, but if electrical stimulation is available to people, they can use it in combination with physical therapy to enhance their recovery”.

More Research Needed

With a very small sample size of participants monitored over a brief period, it isn’t certain how effective this new therapy will be as a significant spinal cord injury treatment.

“We are not saying that this is a total cure, but it is a very promising new treatment that leads to regaining lost function. As a result, it increases the quality of life, improves independence, and reduces the need for a caregiver. These are meaningful gains for people with a spinal cord injury, and for society as a whole as it improves well-being and lessen the socioeconomic burden,” Dr. Inanici adds.

It is also important to evaluate those who have varying degrees of impaired function from their spinal cord injury. Segregating the severity of injury, how the injury was sustained, and the baseline function of many participants is crucial to determine consistency in the success of this treatment. 

Many questions arise that must be considered before this experimental therapeutic model can be applied as the new standard of care, such as:

  • Is it beneficial for patients to continue to receive stimulation treatments beyond two months of treatment? 
  • Are there any compromising side effects to electrical stimulation? 
  • How does this therapy impact patients with severe comorbidities? 
  • Can this therapy be used with patients that sustained an injury within the past year?

Once we have a better idea of how these questions will be answered by doctors and researchers, electrical stimulation may more frequently complement physical therapy. Until then, optimism remains high for those whose daily life has been devastated by a spinal cord injury.

“Stay motivated, stay active, and never give up hope,” says Dr. Inanici.

Updated on: 01/25/21
Continue Reading
When Your Spinal Cord Stimulator Needs to Come Out
Fatma Inanici, MD, PhD
Chet Moritz, PhD
Continue Reading:

When Your Spinal Cord Stimulator Needs to Come Out

Spinal cord stimulation is cutting-edge pain management, but does it always work? No, and sometimes your device needs to be removed. Here’s when—and why.
Read More