Spinal Cord Injury: Present and Future Therapeutic Devices and Prostheses

Abstract

Summary:A range of passive and active devices are under development or are already in clinical use to partially restore function after spinal cord injury (SCI). Prosthetic devices to promote host tissue regeneration and plasticity and reconnection are under development, comprising bioengineered bridging materials free of cells. Alternatively, artificial electrical stimulation and robotic bridges may be used, which is our focus here. A range of neuroprostheses interfacing either with CNS or peripheral nervous system both above and below the lesion are under investigation and are at different stages of development or translation to the clinic. In addition, there are orthotic and robotic devices which are being developed and tested in the laboratory and clinic that can provide mechanical assistance, training or substitution after SCI. The range of different approaches used draw on many different aspects of our current but limited understanding of neural regeneration and plasticity, and spinal cord function and interactions with the cortex. The best therapeutic practice will ultimately likely depend on combinations of these approaches and technologies and on balancing the combined effects of these on the biological mechanisms and their interactions after injury. An increased understanding of plasticity of brain and spinal cord, and of the behavior of innate modular mechanisms in intact and injured systems, will likely assist in future developments. We review the range of device designs under development and in use, the basic understanding of spinal cord organization and plasticity, the problems and design issues in device interactions with the nervous system, and the possible benefits of active motor devices.

Regulation of Caveolin-1 and Junction Proteins by bFGF Contributes to the Integrity of Blood–Spinal Cord Barrier and Functional Recovery

“…Previous research focuses largely on improving neurological manifestations through the improvement of sensory function and locomotor function [1][2][3][4], but study of the bloodLi-Bing Ye and Xi-Chong Yu contributed equally to this work.…”

Artificial motor control for electrically stimulated upper limbs of plegic or paretic people

“…Externally, there is a programming central of the stimulation parameters with radiofrequency broadcasting (Peckham and Knutson, 2005). The first Freehand  systems ( Figure 3a) contained a shoulder motion sensor controlling the degree of opening and closing the hand (Giszter, 2008;Peckham et al, 2001). Later, in the most advanced Freehand systems (Figure 3b), the function has been provided by additional stimulation channels and it was used for activating the intrinsic hand muscles, brachial triceps and forearm pronators.…”

“…So, the shoulder (Peckham and Knutson, 2005) motion sensor was eliminated. The development of neuroprosthesis provided improvement in grip movement to subjects with complete SCI at the level C5-C6 (Giszter, 2008). There is another neuroprosthesis system known commercially as FESMate  that uses up to 30 percutaneous electrodes placed on the upper limbs and artificial movements are performed based on natural activation models, with specific limits and various command (Peckham and Knutson, 2005) sources.…”

Use of Neuromuscular Electrical Stimulation in the Treatment of Neonatal Brachial Plexus Palsy: A Literature Review

“…NMES has been used by therapists in the rehabilitation of multiple central neurological conditions, including stroke, cerebral palsy, and spinal cord injury, with demonstrable success (Giszter, 2008;Kerr, McDowell, & McDonough, 2004;Pomeroy, King, Pollock, Baily-Hallam, & Langhorne, 2006). The evidence for its effectiveness in treating peripheral nerve injury is less robust.…”