Research studies
to establish the most
suitable methods.

The Paralysis Center uses a sophisticated technique of EMG evaluation that counts the number and shape of motor units within a muscle and measures their changes over time.

Using this information, we map out how these findings translate into ultimate strength and functional recovery in each particular muscle group. This is the best tool for anticipating the rate and degree of recovery following a nerve injury.

The results of this study will help define who will require surgery and who will ultimately go on to full recovery on their own and how to determine which category you are in as early as possible.

For patients with spinal cord injury (SCI), regaining bladder and bowel function is of great importance. In conjunction with Dr. Michael Ruggieri and Dr. Mary Barbe at Temple University, our team has been studying the potential for restoring the ability to urinate using a nerve transfer surgery.

When the neural connection between the spinal cord and the bladder has been disrupted, patients with flaccid bladder paralysis cannot use functional electrical stimulation (FES) to induce bladder emptying. These patients require new neural pathways to regain control of bladder function. The goal of these studies is to provide the final burden of proof for human trials of somatic nerve transfer to reinnervate the urinary bladder. We have successfully completed the first patient and will be enrolling additional patients this year.

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Nerve Transfer For Bladder Function

The recovery of hand and arm function is of critical importance for decreasing long-term care costs and increasing quality of life for individuals with tetraplegia due to SCI.

Together with Dr. Edmund Hollis at Burke Neurological Institute and Weill Cornell Medicine, Dr. Brown is studying the role of innovative therapy programs in achieving optimal function following nerve transfers.

The use of nerve transfer after SCI is relatively novel and many patients exhibit a remarkable recovery of motor function in the months that follow. However, in others, the extent of recovery is likely limited, in part, by the variability in rehabilitation and the ability of the motor cortex to incorporate the new peripheral circuitry resulting from this procedure.

More information about this study can be found here.

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Diagram of Cortical Motor Networks

Nerve transfers have evolved into a powerful intervention to restore function following SCI. However, destruction of the lower motor neurons of the spine and subsequent degeneration of their axons and target muscle remain an impediment to reconstructive strategies. Skeletal muscle requires innervation from these motor neurons to survive and only remain salvageable for a short time. Overcoming this degeneration would dramatically augment the functional gains realized by long distance nerve repairs in the distal upper extremity.

In collaboration with stem cell expert, Dr. Stan Bazarek, at Case Western University we are investigating an innovative approach of transplanting stem cell-derived spinal motor neurons into the distal nerve to innervate and sustain muscle integrity while the native, regenerating axons make the long distance journey to the target muscle. These transplanted cells may also serve to directly drive muscle contraction upon electrical or optogenetic stimulation from an external source such as a brain computer interface.

Induced pluripotent stem cells (IPSCs) are used in this study. These cells can be directed to become any cell in the human body. Unlike embryonic stem cells, there is no destruction of human embryos as they are derived from adult tissue such as a skin sample. Furthermore, adult-derivation enables the potential for autologous cell transplantation, obviating the need for immunosuppression.

Nerve injuries and lower motor neuron degeneration can lead to progressive muscle atrophy, fibrosis, and irreversible loss of function, often limiting the success of delayed nerve reconstruction. Because skeletal muscle depends on continuous neural input to maintain its structural and functional integrity, identifying viable muscle before irreversible degeneration occurs remains one of the major challenges in reconstructive neurosurgery.

Led by Dr. Armando Armas-Salazar in collaboration with Dr. Matthias J. Krenn and Prof. Winfried Mayr, this research program investigates the use of long-pulse muscle activation (LPMA) as both a diagnostic and therapeutic strategy for chronically denervated muscle following peripheral nerve and spinal cord injuries.

The team is developing translational approaches to directly evaluate residual muscle excitability and contractile capacity in muscles that may appear nonfunctional on conventional electrodiagnostic studies. By combining electrophysiology, imaging, biomechanical analysis, and functional assessments in both preclinical and human studies, the program aims to establish objective biomarkers of muscle viability that can guide surgical timing, patient selection, and reconstructive decision-making.

In parallel, the group is investigating whether long-pulse stimulation can preserve muscle structure and mitigate degeneration during prolonged denervation, potentially extending the therapeutic window for nerve repair and improving long-term functional recovery after paralysis.