SPINAL CORD INJURY
The LION procedure to the pelvic nerves consist in the laparoscopic placement of electrodes to the pelvic nerves on both sides. The microelectrodes are placed in direct to the sciatic nerves (stabilization of the hips/bottom) and the femoral nerves (stabilization of the knees). Because the electrodes are placed of the deep protection of the pelvic bone, there is no need to fix them to the nerves that make the procedure safe and reversible.
No nerve-cutting is done, while the electrodes do not present any risk for damages of the nerves on long term. The electrodes are connected to a rechargeable pacemaker placed under the skin of the abdominal wall. The entire procedure take less than 1.5 hours.
Pelvic nerves stimulation is started on the first postoperative day, while physiotherapeutic training may be started first after a period of 2-3 weeks. For training of the quadriceps muscles (thighs), three programs are installed, one for each leg, and one for both legs together. Configuration of the pacemaker is done so that varying current of stimulation could be assessed by the patients themselves to obtain optimum efferent patterns for training, and later on for standing and stepping at home. After a period of muscles building from at last 6 months, training for standing and finally for stepping with walker and assistance by concomitant bilateral pelvic nerves stimulation is started. Such a training is extremely time-consuming, need strong motivation of the patient. To be able to walk for long distances (crutches are necessary because loss of body balance), it takes at last 3 years of intensive training.
Behind the psychological impact and the win in autonomy, benefits of locomotion include improvement of contractures, deep venous thrombosis, and edema, amelioration of spasticity. Standing up, in combination with gluteal muscle training (“gluteal pads effect) and the electrical-induced stimulant effect on skin circulation (especially at the bottom) that also better protects patients from decubitus lesions. Because there are today evidence of the role of the pelvic nerves in the skin circulation, pelvic nerves stimulation results not only in prevention for decubitus lesion, but also in potential treatment of them.
Therefore the LION procedure to the pelvic nerves is potentially useful in the rehabilitation of spinal cord injured peoples and may reduce risks for complications.
To improve control and harmony of neural connections, behind the training phase, the pelvic nerves are permanently stimulated with low-current electricity. Patients may also to mentally concentrate on performing the body function and not simply use the stimulation for training while concentrating on something else, but to think about his movements during training.
Concomitant stimulation of the sciatic nerves for contraction of the bottom muscles (stabilization of the pelvis) and stimulation of the femoral nerves for stabilization of the knees enable standing and stepping in paraplegics.
Electrical stimulation in spinal cord injured peoples can also be used to promote peripheral nerve regeneration in a desired direction using stimulation around the damaged spinal cord. Other experimental studies also indicated that electrical stimulation can lead to significant functional recovery but not due only to a true regeneration, but more to alternate nerves pathways. It exist today strong evidence that electrically-induced locomotors training with continuous low-stimulation of the pelvic nerves in paralyzed peoples may induce changes that affect the brain and the spinal cord and allows nerves below and above the level of the spinal cord injury to engage residual spinal pathways for cure.
However, there are no doubts that nerves to accomplish functions such regeneration, reconnection or reactivation, need a strong necessity to do. This is directly correlated with strong willpower of the patient. All these information’s create a “need for reconnection and regeneration” resulting in a potential neural plasticity and secondary improved functional abilities. Therefore motivation, re-education of SCI peoples and peripheral nerves stimulation are essential not only in rehabilitation of peoples with SCI, but also for cure of spinal cord injury.