AT-REACH

Bilateral loss of upper-limb functions after complete cervical Spinal Cord Injury (SCI) dramatically impacts people ability to live independently. When rehabilitation and/or surgery fail to reinforce limb mobility, there is no available solution to restore autonomous functional movements of the upper-limbs. Although, considerable progress has been made in the field of Spinal Cord Stimulation (SCS) for rehabilitation of motor functions in recent years, the most significant results are still achieved through long-lasting clinical trials combining SCS with task-specific physical exercises. Alongside these studies, recent clinical trials reported promising outcomes after performing peripheral nerve stimulation (PNS) with implanted electrodes which immediately restores functional – albeit coarse – movements of the upper limb. The AT-REACH proposal is paving the way to the next generation of clinical protocols by investigating the added-value of pairing PNS with SCS. The combination of immediate functional recovery (implanted PNS) with long-lasting boosts of neuronal plasticity (SCS) should support the progressive refinement of elicited movements and lead to the restoration of a larger range of functions (drinking, eating, etc.) in individuals with cervical SCI. Although simplistic on paper, the foundations of such an approach rely on a careful and audacious analysis of the most recent literature and require the validation of intermediate hypotheses able to provide new insights on motor control and movement neuroscience. The AT-REACH multimodal approach will call for research beyond state-of-the-art and test these hypotheses via the conception of biomimetic computational models supported by animal experiments in order to 1- elucidate SCS mechanisms of action and 2- improve knowledge on spinal cord neural networks in intact and neurologically impaired conditions. Major breakthroughs are expected at the crossroads of engineering, neuroscience and rehabilitation medicine.