The social cost of spinal cord injuries (SCIs) causing high tetraplegia (C1 to C4) can be considered very high, due to the increasing general life expectancy and the quality of medical care. These traumatic events have devastating consequences from a physical, social, economic, and psychological point of view in patients’ lives, as they become more or completely dependent on activities of daily living. Attempts to restore lost physical functions, even partially successful, have proven to increase the mental quality of life of these patients.
The classical surgical strategy to improve finger flexion comprises tendon transfers, tenodesis, and arthrodesis (or a combination of these techniques) with predictable results. In the last few decades, nerve transfers showed their value in the restoration of upper extremity function after SCI, opening a wide chapter of surgical possibilities.
Spinal lesions cause interruption of signal transmission to upper and lower limbs; although control from the central nervous system (CNS) is lost, limbs are still functional per se. Several studies have been showing how a certain level of functionality could be restored and that the CNS cortical signals could be interpreted, if extracted correctly, to train patients to coordinate virtual or robotic limbs. This research aims at proposing a preclinical study to demonstrate how the correct interpretation and differentiation of brain cortical activity can be used to evoke different external outputs. This study represents the first step for a novel approach that aims at restoring the volitional use of the upper and lower limbs of patients with cervical lesions by combining the use of a wireless implantable cortical recorder and nerve stimulators trained to read cortical signals.