![]() Moreover, the participants showed limited ability to adapt leg movements to changing terrain and volitional demands. Consequently, the control of walking was not perceived as completely natural. However, this recovery required wearable motion sensors to detect motor intentions from residual movements or compensatory strategies to initiate the preprogrammed stimulation sequences 5. These stimulation sequences restored standing and basic walking in people with paralysis due to a spinal cord injury. In turn, recruiting these dorsal root entry zones with preprogrammed spatiotemporal sequences replicates the physiological activation of leg motor pools underlying standing and walking 4, 5, 11, 13, 14. We previously showed that epidural electrical stimulation targeting the individual dorsal root entry zones of the lumbosacral spinal cord enables the modulation of specific leg motor pools 9, 10, 11, 12. Although the majority of spinal cord injuries do not directly damage these neurons, the disruption of descending pathways interrupts the brain-derived commands that are necessary for these neurons to produce walking 8. ![]() To walk, the brain delivers executive commands to the neurons located in the lumbosacral spinal cord 7. This digital bridge establishes a framework to restore natural control of movement after paralysis. The participant regained the ability to walk with crutches overground even when the BSI was switched off. Moreover, neurorehabilitation supported by the BSI improved neurological recovery. The participant reports that the BSI enables natural control over the movements of his legs to stand, walk, climb stairs and even traverse complex terrains. ![]() This reliability has remained stable over one year, including during independent use at home. ![]() A highly reliable BSI is calibrated within a few minutes. This brain–spine interface (BSI) consists of fully implanted recording and stimulation systems that establish a direct link between cortical signals 3 and the analogue modulation of epidural electrical stimulation targeting the spinal cord regions involved in the production of walking 4, 5, 6. Here, we restored this communication with a digital bridge between the brain and spinal cord that enabled an individual with chronic tetraplegia to stand and walk naturally in community settings. Nature volume 618, pages 126–133 ( 2023) Cite this articleĪ spinal cord injury interrupts the communication between the brain and the region of the spinal cord that produces walking, leading to paralysis 1, 2. Walking naturally after spinal cord injury using a brain–spine interface ![]()
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