Robotic Postural Training With Epidural Stimulation for the Recovery of Upright Postural Control in Individuals With Motor Complete Spinal Cord Injury: A Pilot Study

Neurotrauma Reports, 2024 · DOI: 10.1089/neur.2024.0013 · Published: January 1, 2024

Spinal Cord Injury Assistive Technology Neurology

Simple Explanation

This study explores using robotic postural training with epidural stimulation (scES) to help people with complete spinal cord injuries regain upright posture control. Participants with chronic, motor complete SCI underwent robotic postural training with scES, focusing on controlling steady standing, trunk movements, and upper limb reaching without upper limb assistance. The results suggest that the spinal cord can generate postural responses when stimulated, leading to improved upright control and potentially enhancing motor recovery after severe SCI.

Study Duration

Not specified

Participants

6 individuals with chronic cervical or high-thoracic motor complete SCI

Evidence Level

Pilot Study

Key Findings

1
Robotic postural training with scES re-enabled or improved upright postural control in participants with chronic, motor complete SCI.
2
Participants showed improved ability to control steady standing, self-initiated trunk movements, and upper limb reaching while standing with free hands.
3
Improvements were associated with neuromuscular activation pattern adaptations above and below the lesion, suggesting the spinal cord can learn and improve postural responses.

Research Summary

This pilot study investigated the effects of robotic postural training combined with spinal cord epidural stimulation (scES) on upright postural control in individuals with motor complete spinal cord injury (SCI). The intervention involved 80 sessions of robotic postural training using a robotic upright stand trainer (RobUST) in six participants with chronic cervical or high-thoracic motor complete SCI, who had previously undergone stand training with scES using assistive devices. The study found that robotic postural training with Stand-scES re-enabled and/or largely improved upright postural control without any self-assistance provided by the upper limbs, suggesting that the spinal cord can generate and learn to improve postural responses when its excitability is modulated by scES.

Practical Implications

Enhanced Functional Motor Recovery

Improvements in upright postural control can enhance functional motor recovery promoted by scES after severe SCI, potentially increasing independence and interaction with the environment.

Home and Community Implementation

With the implementation of scES in the home and community environment at the horizon for the SCI population, the observed functional gains might further support the safe and effective practice of standing.

Further Motor Task Improvements

Observed postural control gains may translate to improvements in the control of other motor tasks such as walking and sitting.

Study Limitations

1
Small sample size
2
Lack of a control group
3
Independent effects of RobUST postural training and scES alone need to be specifically evaluated

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