Individuals with tetraplegia, typically attributed to spinal cord injuries (SCI) at the cervical level, experience significant health care costs and loss of independence due to their limited reaching and grasping capabilities. Neuromuscular electrical stimulation (NMES) is a promising intervention to restore arm and hand function because it activates a person's own paralyzed muscles; however, NMES sometimes lacks the accuracy and repeatability necessary to position the limb for functional tasks, and repeated muscle stimulation can lead to fatigue. Robotic devices have the potential to restore function when used as assistive devices to supplement or replace limited or lost function of the upper limb following SCI. Unfortunately, most robotic solutions are bulky or require significant power to operate, limiting their applicability to restore functional independence in a home environment. Combining NMES and robotic support systems into a single hybrid neuroprosthesis is compelling, since the robotic device can supplement the action of the muscles and improve repeatability and accuracy. Research groups have begun to explore applications of movement assistance for individuals with spinal cord injury using these technologies in concert. In this review, we present the state of the art in hybrid NMES-orthotic systems for upper limb movement restoration following spinal cord injury, and suggest areas for emphasis necessary to move the field forward. Currently, NMES-robotic systems use either surface or implanted electrodes to stimulate muscles, with rigid robotic supports holding the limb against gravity, or providing assistance in reaching movements. Usability of such systems outside of the lab or clinic is limited due to the complexity of both the mechanical components, stimulation systems, and human-machine interfaces. Assessment of system and participant performance is not reported in a standardized way. Future directions should address wearability through improvements in component technologies and user interfaces. Further, increased integration of the control action between NMES and robotic subsystems to reanimate the limb should be pursued. Standardized reporting of system performance and expanded clinical assessments of these systems are also needed. All of these advancements are critical to facilitate translation from lab to home.

患有四肢瘫痪的人通常归因于子宫颈水平的脊髓损伤（SCI），由于其伸手和抓握能力有限，因此他们承受着巨大的医疗保健费用并失去独立性。神经肌肉电刺激（NMES）是恢复手臂和手功能的有前途的干预措施，因为它可以激活人自己的瘫痪肌肉。但是，NMES有时缺乏将肢体定位以执行功能性任务所必需的准确性和可重复性，并且反复的肌肉刺激会导致疲劳。机器人设备用作辅助设备以补充或替代SCI后上肢有限或丧失的功能时，具有恢复功能的潜力。不幸的是，大多数机器人解决方案体积庞大，或者需要大量动力才能运行，限制了它们在恢复家庭环境中的功能独立性方面的适用性。将NMES和机器人支持系统组合到单个混合型神经假体中非常引人注目，因为机器人设备可以补充肌肉的作用并提高可重复性和准确性。研究小组已开始探索使用这些技术共同为脊髓损伤患者提供运动辅助的应用。在这篇综述中，我们介绍了混合NMES矫形系统在脊髓损伤后上肢运动恢复方面的最新技术，并提出了推动该领域向前发展的重点领域。当前，NMES机器人系统使用表面电极或植入电极来刺激肌肉，并使用刚性机器人支撑装置来保持肢体不受重力作用，或提供辅助动作。由于机械部件，刺激系统和人机界面的复杂性，此类系统在实验室或诊所之外的可用性受到限制。系统和参与者绩效的评估未以标准化方式报告。未来的方向应该通过组件技术和用户界面的改进来解决可穿戴性。此外，应寻求在NMES和机器人子系统之间增强控制动作以使肢体恢复活力的集成。还需要系统性能的标准化报告和这些系统的扩展临床评估。所有这些进步对于促进从实验室到家庭的翻译至关重要。和人机界面。系统和参与者绩效的评估未以标准化方式报告。未来的方向应该通过组件技术和用户界面的改进来解决可穿戴性。此外，应寻求在NMES和机器人子系统之间增强控制动作以使肢体恢复活力的整合。还需要系统性能的标准化报告和这些系统的扩展临床评估。所有这些进步对于促进从实验室到家庭的翻译至关重要。和人机界面。系统和参与者绩效的评估未以标准化方式报告。未来的方向应该通过组件技术和用户界面的改进来解决可穿戴性。此外，应寻求在NMES和机器人子系统之间增强控制动作以使肢体恢复活力的整合。还需要系统性能的标准化报告和这些系统的扩展临床评估。所有这些进步对于促进从实验室到家庭的翻译至关重要。NMES和机器人子系统之间的控制动作的集成应增加，以使肢体恢复活力。还需要系统性能的标准化报告和这些系统的扩展临床评估。所有这些进步对于促进从实验室到家庭的翻译至关重要。NMES和机器人子系统之间的控制动作的集成应增加，以使肢体恢复活力。还需要系统性能的标准化报告和这些系统的扩展临床评估。所有这些进步对于促进从实验室到家庭的翻译至关重要。