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Epidural electrical stimulation (EES) potentially restores motor and autonomic functions in individuals with spinal cord injury (SCI), targeting the dorsal roots of the thoracic and lumbosacral segments, reactivating dormant neural networks below the injury. This thesis focuses on restoring trunk motor function in three individuals with complete chronic sensorimotor paralysis targeting the dorsal roots of the lowest thoracic spinal segment (T12). Results showed, EES immediately restored multiple motor functions (standing, walking, trunk stability/mobility). Following five months of EES-based rehabilitation, all participants improved their motor performance and regained volitional control over previously paralyzed muscles. Other focuses are extending spatial trunk muscle recruitment and respiratory function in two individuals with chronic sensorimotor complete paralysis (level C3 to T6). The results showed improved trunk stability, force and respiratory function, leading to increased physical independence and potential prevention of secondary complications. This technology-supported neurorehabilitation improved trunk and respiratory functions in para- and tetraplegic individuals.

A spinal cord injury interrupts the communication between the brain and the region of the spinal cord that produces walking, leading to paralysis(1,2). Here, we restored this communication with a digital bridge between the brain and spinal cord that enabled an individual with chronic tetraplegia to stand and walk naturally in community settings. This brain-spine interface (BSI) consists of fully implanted recording and stimulation systems that establish a direct link between cortical signals(3) and the analogue modulation of epidural electrical stimulation targeting the spinal cord regions involved in the production of walking(4-6). A highly reliable BSI is calibrated within a few minutes. This reliability has remained stable over one year, including during independent use at home. The participant reports that the BSI enables natural control over the movements of his legs to stand, walk, climb stairs and even traverse complex terrains. Moreover, neurorehabilitation supported by the BSI improved neurological recovery. The participant regained the ability to walk with crutches overground even when the BSI was switched off. This digital bridge establishes a framework to restore natural control of movement after paralysis.