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Robotic Postural Training With Epidural Stimulation for the Recovery of Upright Postural Control in Individuals With
Enrico Rejc1,2,3, Collin Bowersock3,4, Tanvi Pisolkar3
1Tim and Caroline Reynolds Center for Spinal Stimulation, Kessler Foundation, West Orange, New Jersey, USA.
Neurotrauma Reports
|March 22, 2024
Summary
Robotic postural training combined with spinal cord epidural stimulation (scES) improved upright postural control in individuals with spinal cord injury (SCI). This approach enabled better standing and movement with free hands, suggesting the spinal cord can learn to improve postural responses.
Area of Science:
- Neuroscience
- Rehabilitation Medicine
- Biomedical Engineering
Background:
- Activity-based training and spinal cord epidural stimulation (scES) show promise for restoring function after spinal cord injury (SCI).
- Upright postural control has not been a primary focus in previous scES studies for individuals with motor complete SCI.
- Previous interventions often required external balance assistance, limiting functional recovery.
Purpose of the Study:
- To investigate the efficacy of a novel robotic postural training combined with scES for restoring upright postural control in individuals with chronic motor complete SCI.
- To assess improvements in steady standing, trunk movements, and upper limb reaching with free hands during robotic postural training with scES.
- To explore the neuromuscular adaptations associated with improved postural control.
Main Methods:
- A novel robotic postural training system was implemented with scES in individuals with chronic cervical or high-thoracic motor complete SCI.
- Participants had prior experience with stand training using scES and assistive devices.
- The training involved free-hand standing with robotic assistance primarily for pelvic control.
Main Results:
- Robotic postural training with scES significantly improved or re-enabled participants' ability to control steady standing.
- Participants demonstrated enhanced self-initiated trunk movements and upper limb reaching capabilities while standing with free hands.
- Neuromuscular activation patterns above and below the SCI lesion showed adaptive changes correlating with postural improvements.
Conclusions:
- The human spinal cord below the level of injury can generate and learn to improve postural responses when modulated by scES.
- Robotic postural training with scES offers a promising avenue for enhancing upright postural control in individuals with severe SCI.
- Improvements in postural control can contribute to greater functional motor recovery after SCI.
