Exoskeleton gait training with spinal cord neuromodulation

Yury Ivanenko; Elena Y Shapkova; Daria A Petrova; Daria F Kleeva; Mikhail A Lebedev

doi:10.3389/fnhum.2023.1194702

Exoskeleton gait training with spinal cord neuromodulation

Front Hum Neurosci. 2023 May 11:17:1194702. doi: 10.3389/fnhum.2023.1194702. eCollection 2023.

Authors

Yury Ivanenko¹, Elena Y Shapkova^{2

3}, Daria A Petrova⁴, Daria F Kleeva⁴, Mikhail A Lebedev^{5

6}

Affiliations

¹ IRCCS Santa Lucia Foundation, Rome, Italy.
² Saint-Petersburg State Research Institute of Phthisiopulmonology, Saint Petersburg, Russia.
³ Institute of Translational Biomedicine, St. Petersburg State University, Saint Petersburg, Russia.
⁴ Vladimir Zelman Center for Neurobiology and Brain Rehabilitation, Skolkovo Institute of Science and Technology, Moscow, Russia.
⁵ Faculty of Mechanics and Mathematics, Lomonosov Moscow State University, Moscow, Russia.
⁶ Sechenov Institute of Evolutionary Physiology and Biochemistry of the Russian Academy of Sciences, Saint Petersburg, Russia.

Abstract

Neuromodulating the locomotor network through spinal cord electrical stimulation (SCES) is effective for restoring function in individuals with gait deficits. However, SCES alone has limited effectiveness without concurrent locomotor function training that enhances activity-dependent plasticity of spinal neuronal networks by sensory feedback. This mini review discusses recent developments in using combined interventions, such as SCES added to exoskeleton gait training (EGT). To develop personalized therapies, it is crucial to assess the state of spinal circuitry through a physiologically relevant approach that identifies individual characteristics of spinal cord function to develop person-specific SCES and EGT. The existing literature suggests that combining SCES and EGT to activate the locomotor network can have a synergistic rehabilitative effect on restoring walking abilities, somatic sensation, and cardiovascular and bladder function in paralyzed individuals.

Keywords: exoskeleton; gait; neuromodulation of spinal networks; neurorehabilitation; spinal cord injury.

Publication types

Review

Grants and funding

This work was supported by the Russian Science Foundation, grant no 21-75-30024, and by the Italian Ministry of Health (Ricerca corrente, IRCCS Fondazione Santa Lucia).