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  4. Spatiotemporal spinal cord stimulation with real-time triggering exoskeleton restores walking capability: a case report

Spatiotemporal spinal cord stimulation with real-time triggering exoskeleton restores walking capability: a case report

Annals of Clinical and Translational Neurology, 2025 · DOI: 10.1002/acn3.52281 · Published: March 1, 2025

Spinal Cord InjuryNeurologyRehabilitation

Simple Explanation

This case report explores a novel approach to help a patient with a complete spinal cord injury regain some walking ability. The approach combines spinal cord stimulation (SCS) with a real-time triggered exoskeleton. SCS involves implanting electrodes near the spinal cord to deliver electrical impulses, while the exoskeleton is a robotic device that aids in movement and support. The exoskeleton is synchronized with the SCS, meaning it responds in real-time to the stimulation, providing support and resistance during movement to assist muscle training.

Study Duration
1 month
Participants
A 16-year-old female with complete T12 SCI
Evidence Level
Level 4; Case Report

Key Findings

  • 1
    After one month of treatment, the patient showed improved muscle strength in her legs, moving from ASIA A to ASIA C.
  • 2
    The patient was able to stand and walk with assistance after the treatment.
  • 3
    Percutaneous EMG results showed varying degrees of improvement in the motor conduction velocity of the left common peroneal and tibial nerves.

Research Summary

This case report presents a novel approach combining spatiotemporal spinal cord stimulation (SCS) with a real-time triggered exoskeleton (EXS-SCS) to restore walking capability in a patient with complete T12 SCI. The patient underwent SCS implantation followed by EXS-SCS therapy, resulting in improved muscle strength and the ability to stand and walk with assistance after one month. The study highlights the potential of coordinated peripheral and central stimulation for SCI rehabilitation, warranting further research to explore its efficacy and identify suitable patient populations.

Practical Implications

Rehabilitation Strategy

The study suggests a promising rehabilitation strategy for individuals with complete SCI, combining SCS and exoskeleton-assisted training.

Neural Circuit Activation

The integration of SCS enhances neuromuscular activation through the recruitment of myelinated sensory feedback circuits at the dorsal region of the spinal cord.

Personalized Treatment

Future research should focus on identifying the subset of patients who would benefit most from this EXS-SCS training regimen, considering factors such as the level of SCI and concomitant morbidities.

Study Limitations

  • 1
    Small sample size
  • 2
    Absence of a control cohort
  • 3
    Indistinct prognosis for long-term efficacy

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