Spinal plasticity in robot-mediated therapy for the lower limbs
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JNER
JOURNAL OF NEUROENGINEERING AND REHABILITATION
REVIEW
Open Access
Spinal plasticity in robot-mediated therapy for the lower limbs Andrew JT Stevenson1* , Natalie Mrachacz-Kersting1, Edwin van Asseldonk2, Duncan L. Turner3 and Erika G. Spaich1
Abstract Robot-mediated therapy can help improve walking ability in patients following injuries to the central nervous system. However, the efficacy of this treatment varies between patients, and evidence for the mechanisms underlying functional improvements in humans is poor, particularly in terms of neural changes in the spinal cord. Here, we review the recent literature on spinal plasticity induced by robotic-based training in humans and propose recommendations for the measurement of spinal plasticity using robotic devices. Evidence for spinal plasticity in humans following robotic training is limited to the lower limbs. Body weight-supported (BWS) robotic-assisted step training of patients with spinal cord injury (SCI) or stroke patients has been shown to lead to changes in the amplitude and phase modulation of spinal reflex pathways elicited by electrical stimulation or joint rotations. Of particular importance is the finding that, among other changes to the spinal reflex circuitries, BWS robotic-assisted step training in SCI patients resulted in the re-emergence of a physiological phase modulation of the soleus H-reflex during walking. Stretch reflexes elicited by joint rotations constitute a tool of interest to probe spinal circuitry since the technology necessary to produce these perturbations could be integrated as a natural part of robotic devices. Presently, ad-hoc devices with an actuator capable of producing perturbations powerful enough to elicit the reflex are available but are not part of robotic devices used for training purposes. A further development of robotic devices that include the technology to elicit stretch reflexes would allow for the spinal circuitry to be routinely tested as a part of the training and evaluation protocols.
Introduction Robot-mediated therapy is utilized to restore motor function in patients with central nervous system damage. One application for robotic devices is aimed at improving walking ability in patients, particularly following either spinal cord injury (SCI) or brain injury. Robotic devices allow for the body weight of patients to be supported and enable mobilization of the joints when patients cannot achieve this without aid. Robotic exoskeleton devices have been employed in numerous studies and have a positive effect in improving walking ability in SCI and stroke patients [1–5]. Until recently, however, few studies have investigated the underlying neural mechanisms for the functional improvements observed following robot-mediated therapy in humans, particularly within the spinal neural circuitry. * Correspondence: [email protected] 1 Center for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, Aalborg University, Fredrik Bajers Vej 7 D-3, Aalborg DK 9220, Denmark Full list of author inf
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