Integrating these functions will enhance research collaboration, improve patient care and increase treatment capacity by 50%, allowing up to 24 children per day to receive life-changing therapies.

The expansion is also made possible thanks to federal support and philanthropic generosity. Congressman Morgan McGarvey and Honorable former Congressman John Yarmuth championed a Health Resources and Services Administration (HRSA) grant that provided $2 million toward the project. Their leadership helped secure critical funding to support this vital expansion in pediatric care. In addition, the university recognizes with deep gratitude a bequest realized from the estate of Jane Burian in memory of Dr. Frank J. Burian and Henrietta S. Burian, whose legacy will have a lasting impact on the lives of children and families served by the center.

For over a decade, UofL’s pediatric neurorecovery program, led by Dr. Andrea Behrman, has transformed the lives of children recovering from spinal cord injuries, growing from serving one child per day to 16, with more than 21 daily visits for occupational and physical therapy. However, the program has long outgrown its existing facilities, which are scattered across multiple floors and repurposed spaces within Frazier Rehab Institute.

“Our mission is to not only provide the best care for children affected by spinal cord injuries but to push the boundaries of what is possible for their recovery,” said Behrman, director of the center and professor in the UofL Department of Neurological Surgery. “Thanks to the unwavering support of Kosair for Kids, we will now have a facility designed specifically for this groundbreaking work, enabling us to reach more children and provide even better outcomes.”

Additionally, the center will serve as a hub for training the next generation of therapists, researchers and physicians specializing in restorative pediatric neurorecovery.

“Kosair for Kids has proudly supported this center since its inception,” said Barry Dunn, president and CEO of Kosair for Kids. “We have witnessed Kosair Kids regain movement and hope, ability and joy. This expanded partnership with UofL delivers on the Kosair for Kids promise to help every child live life to the fullest. This is what it means to bring hope and healing to our community.”

The center’s research is part of the work of the , funded by the Kentucky Spinal Cord and Head Injury Research Trust. Jim Shaughnessy, director of the Kentucky Spinal Cord and Head Injury Research Board, emphasized the impact of the new space on the center’s broader mission:

“This expansion is a critical step forward in our mission to drive innovative, research-based care for children with spinal cord injuries,” said Shaughnessy. “By bringing research and therapy together under one roof, we are accelerating the path from discovery to recovery and creating a model that can be replicated worldwide.”

Highlights of the center’s new location:

• Integrated therapy and research spaces to ensure seamless collaboration between clinicians and scientists.
• Dedicated teen therapy areas and specialized equipment to accommodate all pediatric age groups.
• Private consultation rooms for families to meet with health care professionals.
• A family-friendly common space for caregivers to rest, network with other families, or work remotely during therapy sessions.
• Advanced rehabilitation technology tailored to pediatric neurorecovery needs.

Gifts to the assist families whose insurance does not fully cover the cost of therapy, allowing more children with spinal cord injuries have full access to activity-based therapies to make their lives better. ��

See .��

The four Phase 2 winners in the NIH’s competition each will receive $1 million, technical assistance and other resources to accelerate the development for neuromodulation therapies — those aimed at stimulating the nervous system to improve function and treat a range of conditions. At UofL, researchers are using these therapies to help patients with paralysis restore functions they may otherwise never have again.

“This technology holds enormous potential for people living with paralysis resulting from spinal cord injury,” said Susan Harkema, a UofL professor, researcher and lead on the Neuromod Prize project. “Our research so far, and the progress we will make supported by this new funding, could dramatically improve all aspects of their daily lives, from movement to cardiovascular function.”

The project team includes UofL researchers Harkema and Charles Hubscher, working in collaboration with Johns Hopkins University Applied Physics Laboratory (APL), Medtronic and long-time clinical translational research partner, the Kessler Foundation. Together, they will develop a novel communication and analysis system, called StimXS, that integrates sensor information to both stabilize blood pressure and improve respiratory and bladder function.

This builds on past work by UofL researchers, who have used neuromodulation to target and improve a range of health effects resulting from spinal cord injury, including cardiac, respiratory and bladder function and even — something previously thought to be impossible. To target these functions, the researchers use an implantable stimulation device that can send electrical signals to select areas of the spinal cord.

“With this new Phase 2 Neuromod funding, we can take a major step toward advancing this technology for broad use in patients,” said Hubscher, professor and co-director of the KSCIRC. “We’ve seen great results in the lab, but the true impact of this technology will be when it’s in a clinical setting and helping the people who need it most.”

This work has also been supported by several public and private sponsors, such as the Christopher and Dana Reeve Foundation, the Craig H. Neilsen Foundation, the Helmsley Charitable Trust and . As part of the Neuromod Prize, Phase 2 winners will be exclusively invited to participate in Phase 3, which will have a total potential prize pool of $5 million. ��

“This is truly game-changing research with the power to improve lives,” said Jon Klein, UofL’s interim executive vice president for research and innovation. “I applaud the research team for their success in driving this important work forward and am excited to see them translate this for broad use in patients.”

The Neuromod Prize is part of the��, which is making critical progress to help accelerate the development of neuromodulation therapies, close fundamental knowledge gaps, and offer tools that enable open science and innovation through the .

“On the 10-year anniversary of the program, it was time to honor and thank the two individuals whose driving vision and support launched what has become the Kosair Charities Center for Pediatric NeuroRecovery by naming these awards in their honor,” said Andrea Behrman, director of the center. “Further, we are proud to present these awards to individuals whose support and contribution have had a significant positive impact on the lives of children with spinal cord injuries and their families.”

The Susan J. Harkema Pediatric NeuroRecovery Research Award honors Harkema’s “enduring generosity in sharing her vision to advance recovery for adults with spinal cord injury to children with SCI, the contributions of her research as the foundation and catalyst for recovery and her unwavering support of the Pediatric NeuroRecovery Program,” Behrman said.

The first recipient of the Susan J. Harkema Pediatric NeuroRecovery Research Award is Yury Gerasimenko, professor in UofL’s . Known as the father of neuromodulation, Gerasimenko extended his spinal stimulation technology and work using neuromodulation to advance motor recovery of postural control, arm and hand function and walking in children with SCI. ��

“His work embodies the characteristics of generosity in sharing his knowledge to advance recovery in children with SCI. We are grateful for his contributions of research and unwavering support of the Pediatric NeuroRecovery Program,” Behrman said.

The second recipient of the Susan J. Harkema Research Award is Goutam Singh, assistant professor at Spalding University and visiting scientist in the Kentucky Spinal Cord Injury Research Center, for his research in pediatric SCI relative to respiratory function, trunk control and neuromodulation.

The A. Keith Inman Pediatric NeuroRecovery Community Service Award recognizes the contributions of Inman, who served as president of Kosair Charities from 2017-2021 and previously as vice president for advancement at UofL. The award honors those who support children and adolescents with spinal cord injury and their families through the gift of their own time and community-based support.

The first recipients of the A. Keith Inman Pediatric NeuroRecovery Community Service Award are Amy Brown and Jennifer Nachreiner of RISE AGAIN, a not-for-profit organization that supports those with spinal cord illness or injury to reach beyond expectations. As parents of children with spinal cord injury, Brown and Nachreiner have first-hand knowledge of the challenges facing parents and families of children with spinal cord injury.

The second recipient is Alyssa Lemons, who established and maintains a Facebook group “” as a resource for parents and caregivers of children and adolescents with spinal cord injury.

On behalf of the awardees, $10,000 ($2,500 for each award) was donated to the Shelley A. Trimble Pediatric NeuroRecovery Fund at the University of Louisville. The Trimble fund provides assistance for children with SCI and their families to fill the gaps in insurance, funding for clinical services at UofL Health – Frazier Rehab Institute and travel and lodging for children and families participating in research at the Center for Pediatric NeuroRecovery.

The Pediatric NeuroRecovery Summit was a two-day educational forum tapping a broad array of expertise on recent scientific research and innovations that may effectively advance the recovery of children with spinal cord injury. More than 35 invited researchers, physicians, therapists, psychologists and SCI community members from across the United States, the United Kingdom and France attended to network and to address progress in recovery in children with spinal cord injury and outreach to educate health care professionals and families concerning the potential for recovery that now exists for these children.

Speakers included Karen Adolph of New York University, Federico Canavese of Universite de Lille, France, Gerasimenko, Singh, Katie Lucas of UofL, and Kyle Brothers and Margaret Calvery of UofL and Norton Children’s, along with parents of children with SCI.

The summit is held every two years in conjunction with the .

On one level, it was a dream come true, but he had to think carefully about it before accepting.

Before he enrolled, he took stock of his goals. Did he have expectations about what he might gain? Was he doing it only for himself? Finally, he was about to get married and it would require relocating to Louisville from his home in New York City for an extended period of time.

Ultimately, he decided his participation could benefit other older SCI patients and those longer post-injury – he was 55 years old and 39 years post injury. The possibility that he could benefit personally was a bonus – but an exciting one.

“My wife said I would be regretting it for the rest of my life if I didn’t do it,” Stifel said. “I admit I was like a kid in a candy shop – I wanted that candy! But I knew I would have to work extra hard.”

From philanthropist to participant

Stifel was 17 years old in 1982 when an auto accident left him paralyzed, unable to walk or use his hands. With support from his family and community, he got on with life, graduating from high school, then college with a degree in finance and pursuing a career on Wall Street.

Hoping to change the trajectory of spinal cord injury research, dubbed the “graveyard of neuroscience,” Stifel and his father started a foundation to raise money and fund research that would give hope for recovery to people with spinal cord injuries. That foundation eventually merged with the American Paralysis Association and later with what now is known as the Christopher and Dana Reeve Foundation, supporting research and advocacy for individuals with spinal cord injury (SCI).

As a board member of the foundation throughout its history, Stifel followed the work of SCI researchers, particularly UofL professor Susan Harkema and . He was impressed with the progress they made using implanted epidural stimulators, from Rob Summers, the first individual implanted with a stimulator for SCI research, to additional participants who experienced voluntary movement, improved cardiovascular function, the ability to stand and improved bowel, bladder and sexual function. Some even took steps because of the implant and specialized therapy developed by the UofL team.

Stifel, now in his 50s, was gratified to see this progress and support the work through the foundation, including “The Big Idea,” a 36-participant study of the benefits of epidural stimulation funded by the Reeve Foundation and led by Harkema. The previous participants were younger and had a shorter length of time since their injury. Although he had been to Louisville to participate in other studies, Stifel believed that because it had been nearly 40 years since his injury, it was unlikely he would be able to participate in the epidural stimulation studies.

Then in 2018, Stifel got a call to participate in The Big Idea. Since his deficits were stable, which gave the researchers a solid starting point to document any gains or changes he might experience, he qualified.

When he arrived in Louisville for the study in 2020, he knew that nothing was guaranteed.

“I understood that you need to go in with zero expectations,” Stifel said. “You can only have expectations if the therapy is proven, but it is still being tested. My goal was to be involved and represent others who are injured as long as me. I wanted to help the research progress.”

Blood pressure regulation and stand training

Stifel’s overall health had remained relatively stable in the years since his injury, without many of the comorbidities people with severe SCI often experience. The one side effect he did have was chronic low blood pressure.

“My blood pressure was typically 80/50, which can be debilitating,” he said. “I became used to it, but it is not a healthy way to live. When I was giving a presentation or having a conversation, I would find myself distracted.”

Once enrolled in the study, Stifel underwent preliminary assessments followed by the surgery to implant the electrode on his spine and the epidural stimulator in his abdomen. Then the researchers did a series of mapping sessions in which the stimulator was tested for each of the areas being studied: voluntary leg movement, trunk control and cardiovascular function.

Stifel was randomized into a cardiovascular arm of the study, which required that he monitor his blood pressure every 15 minutes for six hours a day, keeping his systolic blood pressure between 110 and 120. If it dropped below that, he was to adjust the stimulator to regain that level.

Those sessions brought significant improvement for Stifel.

“I didn’t realize how poorly I felt until it was fixed. I guess you have to feel bad to realize what good feels like,” he said. “When my blood pressure maintains a healthy level, it is like a breath of fresh air. My ability to engage, be proactive and live life is so much easier.”

Now, even when he turns off the stimulator, his blood pressure remains above its previous levels for several hours.

Stifel’s study protocol also included 160 two-hour stand training sessions in the lab at . Every weekday, he would stand upright in a standing frame with trainers supporting his back, chest and each knee. These sessions were to help Stifel gain strength and independence.

“At the end of the sessions, I could consistently stand for 10-to-16 minutes without knee support,” Stifel said. “The epidural stimulator is more intense and effective than anything else I have experienced.”

Moving the needle

Stifel’s time since injury is the longest of any of the participants in the UofL studies so far.

“I am more of an outlier on the low end, but at 56 years old and nearly 40 years post injury, I think I did great,” he said.

Even Harkema was somewhat surprised that Stifel regained voluntary movement as soon as his early sessions led by Claudia Angeli, assistant professor of bioengineering and director of the epidural stimulation program at KSCIRC.

“I admit we had low expectations of Henry being able to move voluntarily after almost four decades of no movement,” said Harkema, professor of neurological surgery and associate director for KSCIRC.��“Even though it supported our theory of the sophistication of the human spinal circuitry, I was stunned when Dr. Angeli was able to find stimulation configurations for him to sit independently and move his toes, ankles, knees and hips in the first sessions. Importantly, this shows that under the right conditions, recovery can happen even decades after injury.”

Now that he has completed his initial part of the study, Stifel is taking part in another study arm in which he will complete another 80 sessions focusing on trunk control and voluntary leg movement.

Once he completes the additional studies, Stifel plans to incorporate training with the stimulator in his daily exercise routine. Although he is not steady enough to stand on his own at home, he will continue that training along with blood pressure regulating, core exercising and any other positive outcomes that might come from this new phase of the study.

“I don’t want to do this study and then shelve it. We accomplished a lot and I want to be able to do more.” Stifel said. “I feel like I won the senior golf tournament, but I still want to beat the kids that have won the Masters. It’s human nature to want more.”

He also is happy to have contributed personally to the overall body of research.

“I think I have helped them move the research needle,” Stifel said. “There have been so many exciting discoveries. Spinal cord injury research has moved from the graveyard of neurological research to interventions that are impacting lives today. This field of research is quickly moving from the traditional fundraising path to one of venture philanthropy and gaining the interest of true capital. Lives are being changed thanks to epidural stimulation, transcutaneous stimulation and the other work being done here and elsewhere.

“This is an amazing research study within the walls of an amazing university. I hope the Louisville community is aware of it and proud of the accomplishments coming from it. It is an amazing time for this field of research.”

Visit Henry Stifel’s blog about his journey with epidural stimulation research at .

To support spinal cord injury research at the University of Louisville, visit .

Despite these significant results, use of epidural stimulation outside a research lab setting to restore function for people with spinal cord injury thus far has been hampered by several limitations, including the use of a technology that was designed for patients with chronic, intractable pain – not those with spinal cord injury.

Applying this therapy for spinal cord injury is a big step closer to use outside the research lab thanks to a $7.8 million grant from the National Institute of Neurological Disorders and Stroke, one of the National Institutes of Health. The grant will fund work at UofL’s ��in collaboration with medical device manufacturer Medtronic to develop and test software applications specifically designed for spinal cord injury that work in concert with Medtronic’s commercially-available device, Intellis, which is indicated as a spinal cord stimulator for chronic pain. The five-year project, funded through the , is focused on incorporating technology to improve control of locomotor and bladder function using epidural stimulation.

“We have seen excellent results with epidural stimulation in the lab, but these enhancements to the technology system will make it much easier to implement this therapy out in the community. Integrating multiple systems will allow people with chronic spinal cord injuries to benefit from stimulation on a daily basis by reducing the need to monitor and manually revise stimulation settings,” said Claudia Angeli, assistant professor of bioengineering in the UofL and director of the Epidural Stimulation Program at KSCIRC. Angeli and Maxwell Boakye, neurosurgeon and clinical director of KSCIRC, will lead the project.

Medtronic epidural stimulators first were used for spinal cord injury in 2009 under an Investigational Device Exemption with the FDA during research at UofL led by Susan Harkema, professor of neurological surgery and associate scientific director for KSCIRC. The epidural stimulation therapy involves implanting a neurostimulator under the patients’ skin and implanting electrodes in the epidural space of the lower spinal cord, which together deliver mild electrical impulses to the spine.��

While epidural stimulation has been proven to provide effective relief for chronic pain, there are limitations in functionality when treating individuals with spinal cord injury. For example, the stimulation settings that allow individuals with spinal cord injury to stand are different from settings that allow them to walk, while a third configuration is required to help with bladder function and so forth. The devices that researchers use today must be programmed manually for each individual function.

The goal of the new project is to develop integrated, closed-loop programming for multiple systems, specifically locomotion and bladder function, using wireless sensors to monitor the user’s condition and adjust stimulator settings as needed. Working with Medtronic, the UofL researchers will develop learning programs for the closed-loop system and integrate the programming with commercially available epidural stimulators, as an investigational use.

“This device will be customized for the needs of individuals with spinal cord injury, which will require less manual interaction and lead to more positive outcomes in both locomotion and bladder function, dramatically improving the future of neuromodulation for spinal cord injury,” said Boakye, chief of spinal neurosurgery at the , neurosurgeon with and lead neurosurgeon for implantation of the device.

During the first phase of the study, the researchers will develop learning algorithms and the closed-loop system, working with the Medtronic’s Intellis Spinal Cord Stimulation platform. This phase calls for eight individuals to receive implanted stimulators and either locomotor or bladder interventions to develop learning algorithms, which later will be integrated in closed-loop controls. Those data and technical tools then will be applied to a second group of eight individuals who have not received prior training.

“By monitoring multiple systems and enabling the controller to adjust stimulation without direct input from the user, these improvements will make this device a powerful tool for improving the lives of people with spinal cord injury,” said April Herrity, an investigator on the project.

The 2018 breakthrough was the result of years of research by the UofL team, which found that applying electrical stimulation to the lower spinal cord, combined with physical therapy, allows unexpected degrees of recovery in people with complete spinal cord injury. Research participants are able to move voluntarily, stand and take steps, in addition to experiencing improvements in blood pressure regulation, bowel and bladder function and other common health issues associated with spinal cord injury.

“One of the main obstacles to making this therapy available to patients has been the need for programming specific for spinal cord injury,” said Harkema, also an investigator on this project. “This new work will promote the safe, long-term use of the therapy in the home and community, allowing people with spinal cord injury to benefit from the discoveries we have made over the past two decades.”

“Medtronic is excited to be collaborating with the University of Louisville on research related to the use of spinal cord stimulation to improve function for individuals with spinal cord injury,” said Charlie Covert, vice president and general manager of Pain Therapies, part of the Neuromodulation Operating Unit at Medtronic. “Collaboration is vital to innovation in this space in order to meet the needs of this important patient population.”

Andrea Behrman, PhD, of the UofL Department of Neurological Surgery and the (KSCIRC), pioneered the use of locomotor training in children at UofL since 2012. Until now, however, Behrman’s team has used treadmills and harnesses designed for adults that have been adapted for children. The oversized equipment is cumbersome for children and working on cut-down adult-sized devices has resulted in unnecessary strain for the trainers and therapists who work with them.

So, Behrman enlisted Tommy Roussel, PhD, of the at UofL, to engineer a treadmill and harness system specifically for young children. Using engineering expertise, user feedback and a patent held by Susan Harkema, PhD, professor of neurosurgery and a pioneer in spinal cord injury research in adults at UofL, a new treadmill was designed from the ground up just for children.��

“It was kind of like putting a kid on an adult bicycle or watching kids play basketball with a 10-foot goal,” Roussel said. “So we have redesigned the system with the same operational capacity, but with kids in mind.”

The new pediatric treadmill has multiple advantages for both children and trainers:

• Suspension tower is located behind the child on the treadmill so therapists can more easily and directly engage with the child
• Narrower tread, focusing the child’s steps and bringing trainers closer to the child’s legs and feet
• Trainers’ seats are more appropriately positioned closer to the child and are adjustable to accommodate trainers of different heights
• Treadmill tower swivels to allow the child to be hoisted from a wheelchair and onto the treadmill
• Smaller, more adaptable harness that is more comfortable and easier to adjust to the child’s changing capability

“The treadmill is a tool for us, but we want it to be a smart tool. By making it better, we are going to do our jobs better and the child is going to participate better,” Behrman said. “We changed it to make the child more accessible to the trainer with good body posture and position for all this repetitive activity.”

Thanks to funding and support from the , the team was able to develop the initial prototype. Behrman and Roussel then collaborated with other specialized manufacturers, further refining the treadmill and harnesses. Once they had a customized treadmill, the team worked to commercialize the device and harness system to make it available to therapists in other centers.

“We starting thinking, ‘How can we make it better?’” Roussel said. “If we are going to move to manufacturing this, how can we make it more modular and with fewer parts that need to be assembled? That’s where the magic and the fun happened.”

The treadmill design was licensed to and units are in place or on their way to facilities in Pittsburgh, Houston and New York, as well as in Louisville at Frazier Rehab Institute.

“In the last several years, we have been able to achieve things that have not historically happened in terms of rehabilitation outcomes for these children,” Behrman said.��“Children once unable to sit on their own, for example, can now do so due to locomotor training. Such improvements open up other possibilities to play and engage, and help a child get back on the developmental track.��This new treadmill system gives physical therapists and trainers a device that is state-of-the-art in design and utility and revolutionizes the way we deliver locomotor training specifically for children.”

Check out video of the new treadmill system:

Donors and developers include: Christopher and Dana Reeve Foundation, Kosair Charitie, WHAS Crusade for Children, Independent Pilots Association Foundation, Ty Adams, Jena Allen, Laura Argetsinger, Andrea Behrman, Yangsheng Chen, Ran Cheng, Susan J. Harkema, Dena Howland, Winston Rauch, Tommy Roussel, Shelley Trimble, Winston Industries, Haffendorfer Machine Inc., Tuff Tread Treadmills, Rich and Norrie Oelkers and the Bonita Bay Tennis Club, Goose Kearse, Rachel Marsilia, MacKenzie Roberts and Misty Mountain Threadworks.

“My whole life has opened up for me again!” Putnam said.

A C4 spinal cord injury in 2009 left Putnam paralyzed from the neck down and suffering from chronic low blood pressure. She relied on medication and tight corsets to maintain her blood pressure, but she still passed out five or six times a day.

Her new lease on life is the result of spinal cord epidural stimulation (scES) she received as a participant in research at the University of Louisville’s (KSCIRC) to aid recovery for individuals with spinal cord injury. Research published today in describes the improvements Putnam and three other research participants experienced in blood pressure and heart rate regulation during and after scES. All four participants had chronic, complete cervical spinal cord injury, persistent low resting blood pressure and blood pressure decrease when sitting up prior to receiving scES.

“From a quality of life perspective, orthostatic hypotension, or low blood pressure when sitting up, is truly life limiting,” said Glenn A. Hirsch, MD, a cardiologist with the UofL School of Medicine and co-author of the study.

Spinal cord epidural stimulation uses an implanted electrode array to deliver electrical signals to the lumbar spine. For this study, research participants received stimulation using specific configurations selected to target cardiovascular function, monitoring blood pressure and cardiovascular function throughout, for an average of 89 daily, two-hour sessions. Earlier research showed the benefits of scES in controlling cardiovascular function during stimulation, but this data reveals participants’ blood pressure and heart rate remained stabilized between sessions, showing an enduring effect.

“What was most surprising was that only having it on for a few hours a day, we were noticing participants having normal blood pressure through longer periods of each day,” Hirsch said. “We are noticing it now across the research participants who had that problem, that there is a prolonged stabilizing effect even after the stimulator is turned off.”

Since receiving scES for her cardiovascular symptoms, Putnam said she enjoys increased independence and alertness, and she no longer needs medication to increase her blood pressure.

“I am an active member in my own life instead of merely existing. I am really living! I can prepare and cook my own meals. I can feed myself and carry on a conversation. Without the disruption of passing out or gasping for breaths in the middle of a task or having to stop and be back in my chair for two hours at a time, I can accomplish so much more. Now I can live my best life with energy to focus on my future.” Putnam said.

Research at UofL using scES, led by Susan Harkema, PhD, associate director of KSCIRC and professor of neurosurgery at UofL, began with the goal of restoring motor function. However, researchers and participants soon noticed stimulation led to improvements in cardiovascular and autonomic systems as well.

“In our motor system studies, we observed that we could actually regulate blood pressure without activating the motor system. That launched us into another area of research,” Harkema said. “Many people don’t realize that walking in many cases is not really the aspect that makes their daily lives most difficult because they have cardiovascular dysfunction and problems with respiratory, bowel, bladder, and sexual function. All of those things are disrupted so every day is incredibly difficult for people with spinal cord injury.”

In ongoing research to explore further the life-enhancing effects of epidural stimulation, the UofL researchers are conducting a six-year study with 36 participants with chronic, complete spinal cord injuries.

Today’s published research, “Epidural Spinal Cord Stimulation Training and Sustained Recovery of Cardiovascular Function in Individuals with Chronic Cervical Spinal Cord Injury,” was supported by the Craig H. Neilsen Foundation, The Leona M. and Harry B. Helmsley Charitable Trust, University of Louisville Hospital, Christopher & Dana Reeve Foundation and Medtronic Plc.

Check out Stefanie’s story in her own words here:��

“People with severe spinal cord injury – especially when it occurs in a higher level in the spine – have problems with blood pressure regulation to the point that it becomes the main factor affecting quality of life for them,” said Glenn Hirsch, MD, professor of cardiology at the University of Louisville. “Some cannot even sit up without passing out. They are forced to use medications, compression stockings or abdominal binders to maintain an adequate blood pressure.”

Working with human research participants, Hirsch and researchers at the ��at UofL, have found that spinal cord epidural stimulation can safely and effectively elevate blood pressure in individuals with SCI along with chronic hypotension. The research was reported this month in Frontiers in Human Neuroscience ().

Led by Susan Harkema, PhD, associate director of KSCIRC and professor of neurosurgery, the research included four research participants with chronic, motor complete, cervical SCI who suffered from persistent low resting blood pressure. The participants were implanted with an electrode array for epidural stimulation, and individual configurations for stimulation were identified for each participant. During five two-hour sessions, the participants’ blood pressure was elevated to normal ranges. Their blood pressure returned to low levels when stimulation ceased, and was again elevated to normal ranges with stimulation.

Stefanie Putnam was one of the research participants. Following a severe spinal cord injury in 2009, Putnam’s blood pressure was so low she was unable to engage in the simplest of activities without losing consciousness.

“It prevented me from participating in activities, from talking on the phone, from sitting at a table and eating food. I had trouble breathing, trouble swallowing, trouble carrying on a conversation,” Putnam said. “I was passing out periodically – six or more times a day. Then I would have to tilt back in the chair for two hours.”

To help sustain her blood pressure, Putnam took medication, wore an extremely tight corset and drank a large amount of caffeine.

“I would still pass out,” she said.

With epidural stimulation, Putnam said she immediately felt the effects.

“I went from feeling like I was glued to the floor to elevated – as though gravity was not weighing me down. I feel alive,” she said.

Because of the undesirable side effects of pharmaceutical and non-pharmaceutical interventions, Hirsch said epidural stimulation for chronic low blood pressure in SCI could have significant benefits.

“People with severe SCI who have problems with resting hypotension have limited options. This intervention appears to reliably and reproducibly maintain blood pressure,” Hirsch said.

This work builds on previous research at KSCIRC showing benefits of spinal cord epidural stimulation, along with activity-based training, in which individuals with SCI have achieved voluntary movement, standing and stepping, and improved bladder, bowel and sexual function.

Harkema, the publication’s first author, said the blood pressure research is promising, but must be tested over time and with a larger cohort of study participants.

“We need to see if it will have an impact over months or years,” Harkema said. “It will be very important to determine if these results are sustainable.”

To that end, UofL is screening participants for a six-year study that will further explore the life-enhancing effects of epidural stimulation on people with spinal cord injury. That study will measure the extent to which epidural stimulation will improve cardiovascular function as well as facilitate the ability to stand and voluntarily control leg movements below the injury level in 36 participants with chronic, complete spinal cord injuries. Individuals interested in being considered for this study can add their information to the university’s Victory Over Paralysis database, which is available online. ��

The published research is supported by the Craig H. Neilsen Foundation, The Leona M. and Harry B. Helmsley Charitable Trust, University of Louisville Hospital, Christopher & Dana Reeve Foundation and Medtronic Plc.

The study, funded by the Christopher & Dana Reeve Foundation through its campaign, will measure the extent to which epidural stimulation will improve cardiovascular function as well as facilitate the ability to stand and voluntarily control leg movements below the injury level in 36 chronic, complete participants.

Researchers led by principal investigator Susan Harkema, PhD, associate director of the University of Louisville’s and professor of neurosurgery, are seeking to demonstrate – using a significant sample size – the safety and efficacy of epidural stimulation as a treatment for SCI, as well as potentially expedite its availability to individuals who can benefit from it.

This research builds on pilot studies funded by the Craig H. Neilsen Foundation showing promising results for using epidural stimulation to improve cardiovascular function in people with SCI. In addition, it continues groundbreaking epidural stimulation research funded by the Reeve Foundation, the Leona M. and Harry B. Helmsley Charitable Trust, the National Institutes of Health and the Kessler Foundation published in 2014 in the scientific journal Brain. In that study, four young men diagnosed with chronic complete spinal cord injury were implanted with a device called an epidural stimulator on their spine. The men regained the ability to stand, bear their weight, and flex their toes, legs and hips. They have also experienced improved autonomic functions, including bladder, bowel and sexual function.

“The discovery that sparked The Big Idea signaled an unprecedented breakthrough in our pursuit to enhance the independence, health and quality of life for people with paralysis,” said Peter Wilderotter, president and CEO of the Reeve Foundation. “With participant enrollment set to begin, we are closer than ever to bringing a therapy that will effectively transform the lives of individuals living with spinal cord injury and give hope to those who were told that recovery was impossible. As Christopher Reeve said, ‘nothing is impossible’ and The Big Idea will prove that.”

The University of Louisville is currently screening potential candidates for the six-year study. Each participant will be enrolled for two years. Those interested in being considered can add their information to the University’s Victory Over Paralysis database, .��