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

作者：Enrico Rejc, Collin D. Bowersock, Tanvi Pisolkar, Isirame Omofuma, Tatiana Luna, Moiz Khan, Victor Santamaria, Beatrice Ugiliweneza, Claudia Angeli, Gail Forrest, Joel Stein, Sunil K. Agrawal, Susan J. Harkema · 发表于：Neurotrauma Reports · 年份：2024 · DOI：10.1089/neur.2024.0013 · 被引用次数：3 · 研究领域：Spinal Cord Injury Research、Spinal Dysraphism and Malformations、Nerve Injury and Rehabilitation

Activity-based training and lumbosacral spinal cord epidural stimulation (scES) have the potential to restore standing and walking with self-balance assistance after motor complete spinal cord injury (SCI). However, improvements in upright postural control have not previously been addressed in this population. Here, we implemented a novel robotic postural training with scES, performed with free hands, to restore upright postural control in individuals with chronic, cervical ( n = 5) or high-thoracic ( n = 1) motor complete SCI, who had previously undergone stand training with scES using a walker or a standing frame for self-balance assistance. Robotic postural training re-enabled and/or largely improved the participants' ability to control steady standing, self-initiated trunk movements and upper limb reaching movements while standing with free hands, receiving only external assistance for pelvic control. These improvements were associated with neuromuscular activation pattern adaptations above and below the lesion. These findings suggest that the human spinal cord below the level of injury can generate meaningful postural responses when its excitability is modulated by scES, and can learn to improve these responses. Upright postural control improvements can enhance functional motor recovery promoted by scES after severe SCI.