title: Long-Term Training with a Brain-Machine Interface-Based Gait Protocol Induces Partial Neurological Recovery in Paraplegic Patients.
abstract: Brain-machine interfaces (BMIs) provide a new assistive strategy aimed at restoring mobility in severely paralyzed patients. Yet, no study in animals or in human subjects has indicated that long-term BMI training could induce any type of clinical recovery. Eight chronic (3-13 years) spinal cord injury (SCI) paraplegics were subjected to long-term training (12 months) with a multi-stage BMI-based gait neurorehabilitation paradigm aimed at restoring locomotion. This paradigm combined intense immersive virtual reality training, enriched visual-tactile feedback, and walking with two EEG-controlled robotic actuators, including a custom-designed lower limb exoskeleton capable of delivering tactile feedback to subjects. Following 12 months of training with this paradigm, all eight patients experienced neurological improvements in somatic sensation (pain localization, fine/crude touch, and proprioceptive sensing) in multiple dermatomes. Patients also regained voluntary motor control in key muscles below the SCI level, as measured by EMGs, resulting in marked improvement in their walking index. As a result, 50% of these patients were upgraded to an incomplete paraplegia classification. Neurological recovery was paralleled by the reemergence of lower limb motor imagery at cortical level. We hypothesize that this unprecedented neurological recovery results from both cortical and spinal cord plasticity triggered by long-term BMI usage.
authors: Neurorehabilitation Laboratory, Associação Alberto Santos Dumont para Apoio à Pesquisa (AASDAP), Sâo Paulo, Brazil.|Associação de Assistência à Criança Deficiente (AACD), São Paulo, Brazil.
authors: Ana R C
authors: AR
authors: Donati
authors: Neurorehabilitation Laboratory, Associação Alberto Santos Dumont para Apoio à Pesquisa (AASDAP), Sâo Paulo, Brazil.
authors: Solaiman
authors: S
authors: Shokur
authors: Edmond and Lily Safra International Institute of Neuroscience, Santos Dumont Institute, Macaiba, Brazil.|Alberto Santos Dumont Education and Research Institute, Sao Paulo, Brazil.
authors: Edgard
authors: E
authors: Morya
authors: Neurorehabilitation Laboratory, Associação Alberto Santos Dumont para Apoio à Pesquisa (AASDAP), Sâo Paulo, Brazil.|Associação de Assistência à Criança Deficiente (AACD), São Paulo, Brazil.
authors: Debora S F
authors: DS
authors: Campos
authors: Edmond and Lily Safra International Institute of Neuroscience, Santos Dumont Institute, Macaiba, Brazil.|Alberto Santos Dumont Education and Research Institute, Sao Paulo, Brazil.
authors: Renan C
authors: RC
authors: Moioli
authors: Neurorehabilitation Laboratory, Associação Alberto Santos Dumont para Apoio à Pesquisa (AASDAP), Sâo Paulo, Brazil.|Associação de Assistência à Criança Deficiente (AACD), São Paulo, Brazil.
authors: Claudia M
authors: CM
authors: Gitti
authors: Neurorehabilitation Laboratory, Associação Alberto Santos Dumont para Apoio à Pesquisa (AASDAP), Sâo Paulo, Brazil.|Associação de Assistência à Criança Deficiente (AACD), São Paulo, Brazil.
authors: Patricia B
authors: PB
authors: Augusto
authors: Neurorehabilitation Laboratory, Associação Alberto Santos Dumont para Apoio à Pesquisa (AASDAP), Sâo Paulo, Brazil.|Associação de Assistência à Criança Deficiente (AACD), São Paulo, Brazil.
authors: Sandra
authors: S
authors: Tripodi
authors: Neurorehabilitation Laboratory, Associação Alberto Santos Dumont para Apoio à Pesquisa (AASDAP), Sâo Paulo, Brazil.|Associação de Assistência à Criança Deficiente (AACD), São Paulo, Brazil.
authors: Cristhiane G
authors: CG
authors: Pires
authors: Neurorehabilitation Laboratory, Associação Alberto Santos Dumont para Apoio à Pesquisa (AASDAP), Sâo Paulo, Brazil.|Associação de Assistência à Criança Deficiente (AACD), São Paulo, Brazil.
authors: Gislaine A
authors: GA
authors: Pereira
authors: Edmond and Lily Safra International Institute of Neuroscience, Santos Dumont Institute, Macaiba, Brazil.|Alberto Santos Dumont Education and Research Institute, Sao Paulo, Brazil.
authors: Fabricio L
authors: FL
authors: Brasil
authors: STI IMT, Ecole Polytechnique Federal de Lausanne, Lausanne, Switzerland.
authors: Simone
authors: S
authors: Gallo
authors: Neurorehabilitation Laboratory, Associação Alberto Santos Dumont para Apoio à Pesquisa (AASDAP), Sâo Paulo, Brazil.|Department of Biomedical Engineering, Duke University, Durham, NC, USA.
authors: Anthony A
authors: AA
authors: Lin
authors: Neurorehabilitation Laboratory, Associação Alberto Santos Dumont para Apoio à Pesquisa (AASDAP), Sâo Paulo, Brazil.
authors: Angelo K
authors: AK
authors: Takigami
authors: Edmond and Lily Safra International Institute of Neuroscience, Santos Dumont Institute, Macaiba, Brazil.
authors: Maria A
authors: MA
authors: Aratanha
authors: Mechanical and Aerospace Engineering, University of California, Davis, CA, USA.
authors: Sanjay
authors: S
authors: Joshi
authors: STI IMT, Ecole Polytechnique Federal de Lausanne, Lausanne, Switzerland.
authors: Hannes
authors: H
authors: Bleuler
authors: Institute for Cognitive Systems, Technical University of Munich (TUM), Munich, Germany, Germany.
authors: Gordon
authors: G
authors: Cheng
authors: Department of Biomedical Engineering, Duke University, Durham, NC, USA.|Colorado State University, Fort Collins, CO, USA.
authors: Alan
authors: A
authors: Rudolph
authors: Neurorehabilitation Laboratory, Associação Alberto Santos Dumont para Apoio à Pesquisa (AASDAP), Sâo Paulo, Brazil.|Edmond and Lily Safra International Institute of Neuroscience, Santos Dumont Institute, Macaiba, Brazil.|Department of Biomedical Engineering, Duke University, Durham, NC, USA.|Department of Neurobiology, Duke University, Durham, NC, USA.|Department of Psychology and Neuroscience, Duke University, Durham, NC, USA.|Center for Neuroengineering, Duke University, Durham, NC, USA.
authors: Miguel A L
authors: MA
authors: Nicolelis
mesh_terms: D000293:Adolescent; D000328:Adult; D062207:Brain-Computer Interfaces; D004569:Electroencephalography; D056228:Feedback, Sensory; D005260:Female; D005684:Gait / Q000502:physiology*; D006801:Humans; D033183:Interdisciplinary Communication; D008124:Locomotion; D035002:Lower Extremity; D008297:Male; D000066530:Neurological Rehabilitation / Q000379:methods*; D010264:Paraplegia / Q000503:physiopathology / Q000534:rehabilitation*; D012371:Robotics; D013119:Spinal Cord Injuries / Q000503:physiopathology / Q000534:rehabilitation*; D016138:Walking / Q000502:physiology*; D055815:Young Adult