Functional recovery following paralysis facilitated by epidural and transcutaneous spinal stimulation and Implications for the future

Impressive results are being obtained in multiple laboratories around the country using a variety of neural modulatory techniques. In this lecture I will focus on results, principally from my laboratory and from some of our collaborators. I will also focus on experiments using electrical stimulation applied epidurally via implanted electrode arrays on the dorsum of the spinal cord and transcutaneously with multiple electrodes applied to the skin overlying the spinal column. A small amount of data relating to pharmacological neuromodulation will also be addressed. Data will be presented, which provides compelling evidence of the similarity in the basic mechanisms of neuromodulation of spinal networks, but there are also important differences which will probably expand the scope of conditions and types of injuries that might be addressed with electrical neuromodulation. Based on a combination of studies using these techniques in studying animals and humans, I will present what I considered to be some the most important basic functional concepts that have emerged over the last decade        and how these concepts challenge long-held dogma associated with the basic biology of a spinal lesion, the persistence of plasticity of supraspinal and spinal networks well beyond a year post-injury. Finally, I will present data that suggest a basic neurophysiological phenomenon that seems to be an important component of how movement is controlled, but has largely been overlooked.