Spinal Cord Injury

The patient controls the individual settings as well as the different stimulation programs by means of a remote control unit and can therefore independently determine the intensity with which the exercises are to be conducted.

A direct stimulation of the muscle would trigger sudden, jerky movements, since an "all or nothing" muscle contraction is produced. Nerve stimulation, on the other hand, has an indirect effect on the muscles and leads to more harmonious movements, is more gentle on the tendons and joints and prevents premature muscle fatigue. This type of movement requires sufficient strength in the forearms to stabilize the upper body. Since the introduction of this new technology, researchers have found that nerve stimulation also has the potential to promote nerve growth and subsequently the reconnection of nerve fibres.

Muscles move through electrical stimulation of the nerves

In the LION procedure (Laparoscopic Implantation Of Neuroprothesis or LION Procedure) on the pelvic nerves, electrodes are placed laparoscopically on both sides of the pelvic nerves: With the help of a tiny camera, the electrodes are inserted minimally invasively. The microelectrodes are placed directly on the sciatic nerve (stabilization of the hip/buttocks) and on the femoral nerve (stabilization of the knee). Since the electrodes are positioned deeply and are protected by the pelvic bone, they do not need to be attached directly to the nerves, making the procedure safe as well as reversible. There is no nerve incision, as the electrodes do not pose any risk of damage to the nerves in the long term.

The electrodes are connected to a rechargeable pacemaker, which is placed under the skin on the abdominal wall. The entire procedure takes less than 1.5 hours. The electrical stimulation is controlled by the patient using a remote device.

Getting up and walking requires intensive training

Pelvic nerve stimulation can be started the day after the operation; physiotherapy training should not be started until at least two to three weeks later. The quadriceps muscles (thighs) are trained with three programmes, one for each leg and one for both legs. Using the Pacemaker, the patient can determine the intensity and duration of the stimulation himself in order to achieve optimal and effective results - during training and then later at home. After a muscle building phase of at least six months, getting up and finally walking can be trained with a walker, supported by bilateral pelvic nerve stimulation. This time-consuming training requires a high level of motivation on the part of the patient. In order to be able to cover a more extended distance - due to the loss of balance of the body with crutches - intensive training over at least three years is essential.

In order to improve the neural connections for a controlled and harmonious movement of the legs, the pelvic nerves are permanently stimulated after the training phase with a low intensity current. During training, the patient should mentally focus on performing the bodily functions, even if the movements are induced by the stimulation. Simultaneous stimulation of the sciatic nerve to contract the gluteal muscles (stabilisation of the pelvis) and the femoral nerve to stabilise the knees, enables the paraplegic to stand up and walk.

Positive effects of nerve stimulation during rehabilitation

The LION procedure on the pelvic nerves is extremely beneficial in the rehabilitation of patients with spinal cord injuries and can significantly reduce the risk of complications. After all,  besides the positive psychological effect of gaining independence, the advantages of locomotion also include improved contraction, relief of deep vein thrombosis and oedema and improvement of muscular spasticity.

Standing up in connection with gluteal muscle training ("gluteal pad effect") and electrically induced stimulation of the skin circulation, especially on the buttocks, better protects the patient from decubitus lesions. Since we already have indications of the role of the pelvic nerves in skin circulation, pelvic nerve stimulation not only serves to prevent decubitus lesions but can also be used in their treatment.

Electrical stimulation in paraplegics can also be used for peripheral nerve regeneration by applying the stimulation to the desired area around the damaged spinal cord. Other experimental studies show that electrical stimulation can lead to a significant recovery of functions, not only through regeneration in the proper sense, but also through alternative nerve-conductor pathways. There is strong evidence today that electrically induced exercise with continuously low pelvic nerve stimulation can lead to changes in the brain and spinal cord in paraplegics that allow nerves below and above spinal cord injury to turn on remaining spinal cord pathways for healing.

Undoubtedly, nerves need a very strong stimulus to become effective for regeneration, reconnection or reactivation. The patient's own strong will is crucial here. All this information creates a "need for reconnection and regeneration", which leads to potential neural plasticity and thus to improved functional abilities. The patient's motivation and daily training with the help of peripheral nerve stimulation are extremely important - both in the rehabilitation of paraplegics and in the healing of spinal cord injuries.