Abstract
Concurrent stimulation and reinforcement of motor and sensory pathways has been proposed as an effective approach to restoring function after developmental or acquired neurotrauma. This can be achieved by applying multimodal rehabilitation regimens, such as thought-controlled exoskeletons or epidural electrical stimulation to recover motor pattern generation in individuals with spinal cord injury (SCI). However, the human neuromusculoskeletal (NMS) system has often been oversimplified in designing rehabilitative and assistive devices. As a result, the neuromechanics of the muscles is seldom considered when modeling the relationship between electrical stimulation, mechanical assistance from exoskeletons, and final joint movement. A powerful way to enhance current neurorehabilitation is to develop the next generation prostheses incorporating personalized NMS models of patients. This strategy will enable an individual voluntary interfacing with multiple electromechanical rehabilitation devices targeting key afferent and efferent systems for functional improvement. This narrative review discusses how real-time NMS models can be integrated with finite element (FE) of musculoskeletal tissues and interface multiple assistive and robotic devices with individuals with SCI to promote neural restoration. In particular, the utility of NMS models for optimizing muscle stimulation patterns, tracking functional improvement, monitoring safety, and providing augmented feedback during exercise-based rehabilitation are discussed.
Highlights
Spinal cord injury (SCI) partially or fully interrupts physiological connections between the brain, the spinal cord, and the muscles
Model-Based Prostheses for Spinal Injury and brain for proprioceptive input to motor pattern generators, somatosensorimotor perception, and neocortical/conscious interpretation. This feedback loop must be reconnected if mobility, motor pattern generation, and sensation are to reoccur after SCI (Jackson and Zimmermann, 2012)
To maximize likelihood of neural restoration, afferent signals need to be redirected to intact somatosensory areas for neocortical and conscious interpretation (Jackson and Zimmermann, 2012)
Summary
Spinal cord injury (SCI) partially or fully interrupts physiological connections between the brain, the spinal cord, and the muscles. Motorized rehabilitation robotics require users to preselect gait kinematics and/or kinetics, which are used to drive the patient during rehabilitation These sets of parameters need to be maintained within safe limits to prevent injury (He et al, 2017; Angeli et al, 2018). Otherwise, applying electrical stimulation or powered rehabilitation robotics can result in excessive tissue strains and consequent tissue failure given the atrophied musculoskeletal tissues and low bone density present in individuals with SCI (He et al, 2017) These approaches to assisted therapy are currently often not personalized to the patient, which could potentially result in poor patient engagement, and sub-optimal interactionenhanced neural plasticity. Search terms included “FES,” “BCI,” ”neural prosthesis,” “exoskeleton,” “rehabilitation robotics,” “NMS modeling,” “finite element (FE) modeling,” and “digital twin.” Abstracts were reviewed, and papers with a focus on applications in SCI were further analyzed in detail
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