Employing Nerve Transfer to Restore Hand Function in People with Complete Spinal Cord Injury
Amir Faraji, MD, PhD

Dr. Faraji is leading the Methodist site of a multicenter clinical study to evaluate the outcomes a nerve transfer surgery on patients who have lost their arm and hand function from a complete spinal cord injury. In this procedure, a donor nerve originating from above the injury site in the spinal cord is transferred into a recipient nerve conduit in the arm that comes from below the injury. The patients in this study sustained a traumatic injury to the C4-C8 region of the spinal cord at most 36 months ago. Prior to the nerve transfer, the patients receive preoperative electromyography and nerve conduction evaluations to ensure that the donor and recipient nerves are viable for nerve transfer. Although the study is still underway, Faraji has collected promising evidence that the nerve transfer is successful in allowing meaningful hand movements. Further, the clinical study also keeps patients in occupational therapy so that the nerves are encouraged to grow toward their muscle target. Currently, Houston Methodist is the only site in the southern United States in this clinical trial.

Restoring Hand and Arm
Function Following Spinal Cord Injury

Marcia O’Malley, PhD
& Dimitry Sayenko, MD, PhD

Restoring hand and arm function is the highest treatment priority of individuals with cervical spinal cord injury (SCI). Traditional approaches of occupational or physical therapy do not provide sufficient specificity to target damaged neural networks and promote spared connections between the brain and periphery. Center investigators, led by O’Malley and Sayenko propose that the simultaneous activation of descending commands with a coordinated engagement of spinal networks is a critical objective in neurorehabilitation. This novel multi-disciplinary approach that combines spinal neuromodulation and robotics will allow the center to target, for the first time, upper limb (UL) neurorehabilitation at different levels of the neuroaxis, including descending control, supraspinal and spinal sensorimotor networks, and sensory inputs. These studies are designed to determine the effects of an intervention that combines transcutaneous electrical spinal cord stimulation (TSS) with rehabilitation training using an UL robotic exoskeleton on the neurophysiological and functional outcomes in individuals with incomplete cervical SCI.

Robot-Assisted Deep Brain Stimulations
Amir Faraji, MD, PhD

Faraji and his team combine medical imaging, state-of-art robotic surgical techniques and advanced neurophysiological testing to increase the benefits of deep brain stimulation in patients with Parkinson’s disease, dystonia, epilepsy, essential tremor, and neuropsychiatric disorders. The integration of these different technologies into a systematic and optimized workflow not only increases the accuracy of targeting the region of interest in the brain but also vastly reduces the time for neurosurgery. Robotic-assisted stereotaxy has been increasingly adopted for lead implantation in stereoelectroencephalography based on its efficiency, accuracy, and precision. Despite initially being developed for use in deep brain stimulation (DBS) surgery, it has not yet been widely adopted. Robotic-assisted DBS surgery increases precision and reduces the potential for human error associated with traditional frame-based surgery, in which several settings must be changed manually and multiple times. With robot-assisted surgery, Faraji and his team demonstrate improvement in lead placement error corresponded with accumulated experience using the ROSA system (Medtech, Zimmer Biomet). Additionally, they demonstrate good lead placement accuracy, and characterize learning curves.