Brain-Spine Interface (BSI)
Brain-spine interfaces (BSI) use brain activity, combined with implantable electrical spinal cord stimulation (ESCS), to mimic the command transfers from the brain itself to the spinal cord (Lakshmipriya & Gopinath 2024). In BSI technology, a command originating in the brain is linked to neurons with motor intent, decoded into commands with movement patterns, and then transmitted to an implanted electrode along the spinal cord. This electrode activates the spinal circuits by generating electrical pulses, helping to initiate movement based on the person’s intent. This system is designed to enable voluntary control over leg movements to walk, stand, and climb stairs.
Discussion
We found one published case report by Lorach et al. (2023) that is a part of an ongoing clinical feasibility study STIMO-BSI (‘Brain-controlled Spinal Cord Stimulation in Patients with Spinal Cord Injury’), which investigates the safety and preliminary efficacy of brain-controlled spinal cord stimulation after SCI (clinicaltrials.gov, NCT04632290). This one participant was implanted with a spinal cord stimulation system (ESCS), then completed a five-month intensive neurorehabilitation program, followed by a two-year period of independent use at home (Lorach et al. 2023). The results showed that the reliability of the brain–spine interface (BSI) remained stable over one year (including during independent use at home), that the BSI enabled natural control over the movements of the legs of the participant to stand, walk, climb stairs and even traverse complex terrains (Lorach et al. 2023).
Although these results are promising, they need to be replicated in larger studies and the digital bridge will require several developments, which will require time and resources.
Conclusions
There is level 5 evidence (from 1 case report study: Lorach et al. 2023) that a BSI coupled with ESCS and months of rehabilitation/walking training enabled natural control over standing and walking in one participant with chronic, incomplete tetraplegia.
