Neuroprosthetic technologies to augment the impact of neurorehabilitation after spinal cord injury

摘要

ABSTRACT Spinal cord injury leads to a range of disabilities, including limitations in locomotor activity, that seriously diminish the patients' autonomy and quality of life. Electrochemical neuromodulation therapies, robot-assisted rehabilitation and willpower-based training paradigms restored supraspinal control of locomotion in rodent models of severe spinal cord injury. This treatment promoted extensive and ubiquitous remodeling of spared circuits and residual neural pathways. In four chronic paraplegic individuals, electrical neuromodulation of the spinal cord resulted in the immediate recovery of voluntary leg movements, suggesting that the therapeutic concepts developed in rodent models may also apply to humans. Here, we briefly review previous work, summarize current developments, and highlight impediments to translate these interventions into medical practice to improve functional recovery of spinal-cord-injured individuals. The World Health Organization (WHO) estimates that as many as 500,000 people suffer from a spinal cord injury (SCI) each year. SCI leads to a myriad of detrimental changes in vital physiological and sensorimotor functions, including locomotor impairments that significantly diminish the patients' quality of life. In most cases of SCI, the spinal neuronal networks that coordinate leg movements are located below the injury. Previous research has shown that even when isolated from supraspinal centers, the spinal cord of rats, cats and humans can still produce motor patterns to stand and walk [1-8]. However, spinal cord damage interrupts the descending sources of modulation and activation that are essential for the operation of spinal locomotor circuits. Consequently, these networks are in a non-functional state [9]. In the majority of SCIs, however, some nerve fibers still connect the brain and brainstem to the spinal cord below the injury [7,10].