# Spinal Cord Stimulation:  A Novel Method to Restore Breathing in Spinal Cord Injury

> **NIH NIH R01** · CASE WESTERN RESERVE UNIVERSITY · 2020 · $605,899

## Abstract

7. Project Summary/Abstract
 Due to cervical spinal cord injury, many patients are dependent upon lifelong mechanical ventilatory support.
While electrical stimulation techniques have been useful in liberating some patients from mechanical
ventilation, the vast majority is still dependent on these devices. Due to their significant disadvantages,
additional pacing options are badly needed. We have demonstrated in an animal model of spinal cord injury
that inspiratory muscle activation can be achieved with upper thoracic high frequency (~300 Hz) spinal cord
stimulation (HF-SCS) with low stimulus amplitudes. This unique and exciting innovative method involves
stimulation of spinal cord circuitry, resulting in a more physiologic pattern of inspiratory muscle activation.
However, critically important aspects of this method require characterization and analysis prior to clinical
application, particularly in view of the fact that this method represents a life support system. In Objective 1, we
plan to evaluate the possible involvement of long descending inspiratory bulbospinal fibers on the efficacy of
HF-SCS, in a sub-acute animal model of spinal cord injury. Since the spinal cord undergoes significant
plasticity beyond this period, we will also evaluate the efficacy of HF-SCS in a chronic cervical hemi-sected rat
model over a period of 8 weeks. In Objective 2, we will examine the mechanism of HF-SCS with the
development of a validated computational model, which will be used to predict optimal stimulus paradigms and
optimal electrode designs; these will subsequently tested in our animal model. In Objective 3, various stimulus
paradigms derived from computational model predictions will be validated. An optimal pattern of stimulation
should result in the physiologic participation of each of the inspiratory muscle groups, normal gas exchange
and have low electrical charge requirements. In Objective 4, we will determine the degree to which HF-SCS
results in physiologic activation of the inspiratory muscles by assessing motor unit recruitment order. In
Objective 5, we will assess the degree to which opposing expiratory muscles are activated during HF-SCS. In
addition, a more detailed analysis of potential non-inspiratory muscle activation will be determined by
evaluating the metabolic cost of breathing during HF-SCS. In summary, the results of these studies should
resolve the important basic science and practical issues concerning HF-SCS in advance of clinical trials. If
successful, HF-SCS may provide a more natural and effective method of inspiratory muscle activation and is
likely to reduce the number of tetraplegics dependent upon mechanical ventilation and thereby significantly
improve their life quality.

## Key facts

- **NIH application ID:** 9903471
- **Project number:** 5R01NS105785-03
- **Recipient organization:** CASE WESTERN RESERVE UNIVERSITY
- **Principal Investigator:** Anthony F. DiMarco
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $605,899
- **Award type:** 5
- **Project period:** 2018-04-01 → 2023-03-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9903471

## Citation

> US National Institutes of Health, RePORTER application 9903471, Spinal Cord Stimulation:  A Novel Method to Restore Breathing in Spinal Cord Injury (5R01NS105785-03). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/9903471. Licensed CC0.

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