Stroke is the leading cause of arm and hand hemiparesis, weakness or paralysis on one side of the body, with about 80% of stroke patients experiencing at least partial weakness. Many stroke survivors rank improving arm function as a high priority for recovery, but effective treatments are not currently available.
Researchers at the University of Pittsburgh have just published the results of a pilot clinical trial to address this unmet need. Their work, which uses cervical spinal cord stimulation (SCS) to enhance arm and hand function was published in Nature Medicine.
“From a clinical perspective, even modest improvements in arm strength or control can make a meaningful difference in daily life of stroke survivors,” said study co-author George Wittenberg, MD, PhD, professor at the University of Pittsburgh School of Medicine.
This small pilot study included seven patients with varying levels of muscle hemiparesis caused by stroke. All patients presented with profound motor defects, with Fugl-Meyer Assessment (FMA) scores ranging from 15 to 35 (for context, the higher the score, the less impairment, with scores below 50 indicating severe impairment and scores over 100 indicating minimal to no impairment). Each patient was implanted with two leads implanted unilaterally in the cervical spinal cord and underwent SCS stimulation and worked on motor activity under researcher guidance over a four-week period.
During SCS testing, all patients experienced improvement in motor function with an average increase of 32% in strength and increase of 5.6 FMA points on average. After approximately 8.6 hours of motor activity (5.5 hours of which were with the SCS on), the FMA scores improved on average by 6.6 FMA points.
“This approach is designed to rapidly help people move their arms better, even years after a stroke,” said co-senior author Marco Capogrosso, PhD, assistant professor at the University of Pittsburgh and director of the spinal cord stimulation laboratory at Rehab Neural Engineering Labs in the UPMC Rehabilitation Institute.
“The stimulation works mostly as an assistive technology—when it’s on, people can move better,” Capogrosso continued. “By stimulating the spinal cord, we can immediately allow residual connections between the brain and the spinal cord to work more efficiently, enabling better movement.”
“Some of the improvements we measure may look small from the outside, but many stroke survivors are just on the verge of being able to do something important,” said Wittenberg. “Even a small change in motor function can be very significant if it helps someone button a shirt, open their hand or return to an activity they care about.”
While the patients in the study experienced immediate improvements to motor function, maintained improvement depended on continued use of SCS. Additional assessments showed motor function declined without continued stimulation, suggesting that the future use of SCS may not be with short-term use in rehabilitation but rather an assistive neuroprosthetic technology.
“This study represents the conclusion of our initial feasibility phase and an important step toward real-world clinical application,” Capogrosso said.
Based on the positive results from this pilot program, the researchers plan to expand the patient poll for a larger clinical trial to better understand the consequences of long-term SCS use, with and without physical therapy.
“Our goal is to develop a technology that could eventually be used in everyday life, not just in the clinic,” Capograsso concluded. “These results give us confidence that spinal cord stimulation could become a practical, implantable option for helping stroke survivors use their arms when it matters most.”
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