Automated Tools to Improve Spinal Cord Injury Outcomes with Epidural Stimulation

The Spinal Cord Injury (SCI) patient population suffers not only from severe restrictions of sensory and motor function, but also impacts on a range of autonomic nervous system functions. This can include orthostatic hypotension and reduced bladder function. The significant health issues in this population require technological developments in order to improve patient outcomes and restore key healthy functions. Spinal cord epidural stimulation (scES), a new approach, has the potential to regulate systolic blood pressure, improve bladder function, and restore sensory and motor activity in people with SCI through targeted modulation of neural populations in the spinal cord. Here, we present two innovative tools for improving efficacy of scES. The first is a technique for automatic segmentation and visualization to aid in individualized placement of epidural stimulation electrodes. The second is a system for closed loop control of stimulation parameters for epidural stimulation, capable of implementing real-time control algorithms based on sensory measurements to modify therapy parameters. This is implemented as an application on a tablet for future clinical and at home testing. Preliminary prototypes of each system are described and demonstrated, to motivate future closed-loop studies in a clinical setting. Taken together, these novel visualization and control tools can overcome critical barriers to improve outcomes for SCI patients using scES.