Exoskeleton gait training with spinal cord neuromodulation

Front. Hum. Neurosci., 2023 · DOI: 10.3389/fnhum.2023.1194702 · Published: May 11, 2023

Spinal Cord Injury Neurology Rehabilitation

Simple Explanation

Spinal cord electrical stimulation (SCES) can help restore movement in people with walking problems. However, it works best when combined with training, like exoskeleton gait training (EGT). This helps the spinal cord learn and adapt. To make treatments better, it's important to check the spinal cord's condition. This helps create personalized SCES and EGT plans that fit each person's needs. Combining SCES and EGT can improve walking, feeling, and functions like blood pressure and bladder control in paralyzed people.

Study Duration

Not specified

Participants

Individuals with gait deficits and spinal cord injuries

Evidence Level

Mini Review

Key Findings

1
SCES can be utilized to restore gait in patients who have suffered from the eﬀects of spinal cord injuries (SCI).
2
Combining SCES and EGT to activate the locomotor network can have a synergistic rehabilitative effect on restoring walking abilities, somatic sensation, and cardiovascular and bladder function in paralyzed individuals.
3
Walking in an exoskeleton while SCES is applied allows coupling of continuous sensory feedback with activity-dependent plasticity of spinal neuronal networks, which represents a great therapeutic potential.

Research Summary

Neuromodulating the locomotor network through spinal cord electrical stimulation (SCES) is effective for restoring function in individuals with gait deficits. The existing literature suggests that combining SCES and EGT to activate the locomotor network can have a synergistic rehabilitative effect on restoring walking abilities, somatic sensation, and cardiovascular and bladder function in paralyzed individuals. Combining SCES with EGT is an eﬃcient approach to rehabilitation of patients paralyzed after SCI. This method enacts sensorimotor functions while increasing the activity in spinal networks.

Practical Implications

Personalized Therapies

Assessing individual spinal cord function is crucial for developing personalized SCES and EGT therapies.

Enhanced Rehabilitation

Combining SCES and EGT can lead to synergistic improvements in walking ability, somatic sensation, and autonomic functions.

Improved Gait Performance

EGT enables more autonomous gait performance, postural control, full limb loading and whole-body coordination, and may facilitate a long-term training of adaptive gait to support everyday mobility in people with SCI.

Study Limitations

1
SCES alone has limited effectiveness without concurrent locomotor function training
2
Only a limited number of recent studies have investigated the potential beneﬁts of combining EGT and SCES treatments in individuals with SCI
3
The eﬀects were limited, should be validated in a larger population of patients with SCI, and could vary due to various clinical and methodological factors.

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