Augmenting rehabilitation robotics with spinal cord neuromodulation: A proof of concept

• DOI: 10.1126/scirobotics.adn5564
• Publication Date: 2025-03-12T17:58:21Z
• Authors: Nicolas Hankov; Miroslav Caban; Robin Demesmaeker; Margaux Roulet; Salif Komi; Michele Xiloyannis; Anne Gehrig; Camille Varescon; Martina Rebeka Sp...; Serena Maggioni; Chiara Basla; Gleb Koginov; Florian Haufe; Marina D’Ercole; Cathal Harte; Sergio D. Hernand...; Aurelie Paley; Manon Tschopp; Natacha Herrmann; Nadine Intering; Edeny Baaklini; Francesco Acquati; Charlotte Jacquet; Anne Watrin; Jimmy Ravier; Frédéric Merlos; Grégoire Eberlé; Katrien Van den K...; Hendrik Lambert; Henri Lorach; Rik Buschman; Nicholas Buse; Timothy Denison; Dino De Bon; Jaime E. Duarte; Robert Riener; Auke Ijspeert; Fabien Wagner; Sebastian Tobler; Léonie Asboth; Joachim von Zitze...; Jocelyne Bloch; Grégoire Courtine

Rehabilitation robotics aims to promote activity-dependent reorganization of the nervous system. However, people with paralysis cannot generate sufficient activity during robot-assisted rehabilitation and, consequently, do not benefit from these therapies. Here, we developed an implantable spinal cord neuroprosthesis operating in a closed loop to promote robust activity during walking and cycling assisted by robotic devices. This neuroprosthesis is device agnostic and designed for seamless implementation by nonexpert users. Preliminary evaluations in participants with paralysis showed that the neuroprosthesis enabled well-organized patterns of muscle activity during robot-assisted walking and cycling. A proof-of-concept study suggested that robot-assisted rehabilitation augmented by the neuroprosthesis promoted sustained neurological improvements. Moreover, the neuroprosthesis augmented recreational walking and cycling activities outdoors. Future clinical trials will have to confirm these findings in a broader population.