High density epidural stimulation for facilitation of locomotion, posture, voluntary movement, and recovery of autonomic, sexual, vasomotor, and cognitive function after neurological injury
A system and methods are disclosed for enabling or improving control of cardiovascular and/or vasomotor autonomic functions in a patient having a neurologically derived paralysis or a nervous system disorder.
1 . A method of enabling or improving, in a patient having a neurologically derived paralysis, control autonomic functions including at least one of a cardiovascular autonomic function or a vasomotor autonomic function, the method comprising:
receiving, in a processor, data related to the one or more autonomic functions in the patient during postural training to induce postural proprioceptive signals in the patient;
detecting, via the processor, the one or more autonomic functions in the patient during the postural training based on the received data;
selecting, using the processor, electrical stimulation parameters among a plurality of electrical stimulation parameters based on the detected one or more autonomic functions; and
applying, via an electrode array that is communicatively coupled to the processor, electrical stimulation using the selected electrical stimulation parameters to a portion of a spinal cord of the patient, the electrode array electrically coupled to the portion of the spinal cord,
wherein at least one of the electrical stimulation or the postural training is configured to modulate in real time electrophysiological properties of a spinal circuit in the patient so the spinal circuit is activated by postural proprioceptive signals that are derived from a region of the patient where the one or more autonomic functions are enabled or improved.
2 . The method of claim 1 , wherein selecting the electrical stimulation parameters includes using, via the processor, a machine learning algorithm including a regression model that relates the one or more autonomic functions of the patient to the selected electrical stimulation parameters, the machine learning algorithm configured to use the regression model to select the electrical stimulation parameters for increasing functional performance of the patient during the postural training.
3 . The method of claim 1 , wherein the spinal circuit includes a first stimulation threshold representing a minimum amount of stimulation required to activate the spinal circuit and a second stimulation threshold representing an amount of stimulation above which the spinal circuit is fully activated, and
wherein the electrical stimulation applied to the portion of the spinal cord of the patient is below the second stimulation threshold such that addition of the postural training activates the spinal circuit by the postural proprioceptive signals that are derived from the region of the patient where the one or more autonomic functions occur.
4 . The method of claim 1 , wherein the postural training comprises at least one of stabilizing sitting posture or stabilizing standing posture.
5 . The method of claim 1 , wherein the electrode array comprises one or more electrodes stimulated in a monopolar configuration or bipolar configuration.
6 . The method of claim 1 , wherein the electrical stimulation comprises at least one of tonic stimulation or intermittent stimulation.
7 . The method of claim 1 , wherein the postural training comprises inducing a postural change at the region of the patient.
8 . The method according to claim 7 , wherein the postural change in the patient comprises at least one of standing up or sitting down.
9 . The method of claim 1 , further comprising causing one or more neuropharmaceutical agents to be administered to the patient before, during, or after the postural training, the one or more neuropharmaceutical agents including at least one of a serotonergic drug, a dopaminergic drug, a noradrenergic drug, a GABAergic drug, a glycinergic drug, or a combination thereof.
10 . The method of claim 1 , wherein the electrical stimulation parameters define at least one of stimulating voltage amplitudes, stimulating currents, stimulating frequencies, or stimulating waveform shapes for the electrical stimulation.
11 . The method of claim 1 , wherein receiving the data further comprises detecting, with a sensor, the one or more autonomic functions in the patient during the postural training.
12 . A system for enabling or improving, in a patient having a neurologically derived paralysis, control autonomic functions including at least one of a cardiovascular autonomic function or a vasomotor autonomic function, the system comprising:
an electrode array electrically coupled to a portion of a spinal cord of the patient; and
a processor communicatively coupled to the electrode array, the processor configured to:
receive data related to the one or more autonomic functions in the patient during postural training using a training device, the training device configured to induce postural proprioceptive signals in the patient,
detect the one or more autonomic functions in the patient during the postural training based on the received data,
select electrical stimulation parameters among a plurality of electrical stimulation parameters based on the detected one or more autonomic functions, and
cause the electrode array to apply electrical stimulation using the selected stimulation parameters to the portion of the spinal cord of the patient,
wherein at least one of the electrical stimulation or the postural training is configured to modulate electrophysiological properties of a spinal circuit in the patient so the spinal circuit is activated by the postural proprioceptive signals that are derived from a region of the patient where the one or more autonomic functions are enabled or improved.
13 . The system of claim 12 , wherein the processor is configured to use a machine learning algorithm including a regression model that relates the one or more autonomic functions of the patient to the selected electrical stimulation parameters, the machine learning algorithm configured to use the regression model to select the electrical stimulation parameters for increasing functional performance of the patient during the postural training.
14 . The system of claim 12 , wherein the spinal circuit includes a first stimulation threshold representing a minimum amount of stimulation required to activate the spinal circuit and a second stimulation threshold representing an amount of stimulation above which the spinal circuit is fully activated, and
wherein the electrical stimulation applied to the portion of the spinal cord of the patient is configured to be below the second stimulation threshold such that addition of the postural training activates the spinal circuit by the postural proprioceptive signals that are derived from the region of the patient where the one or more autonomic functions occur.
15 . The system of claim 12 , wherein the electrode array comprises one or more electrodes stimulated in a monopolar configuration or bipolar configuration.
16 . The system of claim 12 , wherein the electrical stimulation comprises at least one of tonic stimulation or intermittent stimulation.
17 . The system of claim 12 , wherein the electrical stimulation parameters define at least one of stimulating voltage amplitudes, stimulating currents, stimulating frequencies, or stimulating waveform shapes for the electrical stimulation.
18 . The system of claim 12 , further comprising a sensor communicatively coupled to a sensor, the sensor configured to detect the data corresponding to the one or more autonomic functions in the patient during the postural training.
19 . The system of claim 12 , wherein the processor is configured to cause the electrode array to apply the electrical stimulation before, during, or after one or more neuropharmaceutical agents is administered to the patient, the one or more neuropharmaceutical agents including at least one of a serotonergic drug, a dopaminergic drug, a noradrenergic drug, a GABAergic drug, a glycinergic drug, or a combination thereof.
20 . The system of claim 12 , wherein the postural training comprises at least one of standing up, sitting down, laying down, stabilizing sitting posture, or stabilizing standing posture.
21 . A method of enabling or improving, in a patient having a nervous system disorder, one or more autonomic function selected from the group consisting of cardiovascular function, body temperature, metabolic processes, sexual function, bladder function, vasomotor function, or cognitive function, the method comprising:
inducing, with a stimulator including a processor connected to at least one electrode, spinal interneuronal excitability to a sub-threshold level within at least one spinal circuit by:
applying, via at least one of the at least one electrode, an electrical stimulation according to selected electrical stimulation parameters to excite neurons in dorsal roots of the patient to the sub-threshold level,
wherein the electrical stimulation activates in real time dorsal root afferent fibers in the patient to stimulate a neural circuit regulating the one or more autonomic function, and
wherein the at least one autonomic function is enabled or improved.
22 . A system for enabling or improving, in a patient having a nervous system disorder, at least one autonomic function selected from a group consisting of cardiovascular function, body temperature, metabolic processes, bladder function, sexual function, vasomotor function, or cognitive function, the system comprising:
at least one electrode; and
a stimulator including a processor communicatively coupled to the at least one electrode, the stimulator comprising at least one processor and a memory, the stimulator configured to:
select electrical stimulation parameters from a memory to induce, with the stimulator connected to the at least one electrode, spinal interneuronal excitability to a sub-threshold level within at least one spinal circuit, and
cause the at least one electrode to apply electrical stimulation according to the selected stimulation parameters to excite neurons in dorsal roots of the patient to the sub-threshold level,
wherein parameters of the electrical stimulation are configured to activate in real time dorsal root afferent fibers in the patient to stimulate a neural circuit regulating the at least one autonomic function,
wherein the one or more autonomic function is enabled or improved.