In recent years, advanced technologies featuring wearable powered exoskeletons and neuromodulation of lumbosacral spinal networks have been developed to facilitate stepping and promote motor recovery in humans with paralysis. Here we studied a combined effect of spinal cord electrical stimulation (SCES) and exoskeleton walk training (EWT) during an intensive 2-week rehabilitative protocol in spinal cord injury individuals (n = 19, American Spinal Injury Association Impairment Scale (AIS) A-11, B-5, C-3). The purpose of this study was to evaluate the compatibility of methods and to explore the main effects of combined SCES and EWT. All participants had a chronic state of paralysis (1–11 years after trauma). In addition, in the control group (n = 16, AIS A-7, B-5, C-4), we performed EWT without SCES. For EWT, we used a powered exoskeleton (ExoAtlet), while stability was assisted by crutches, with automatic arrest of stepping if excessive torques were detected. SCES was applied to the level of the mid-lumbar cord over the Th12 vertebra at 1 or 3 pulses/s (4 individuals with severe spasticity were also stimulated in an anti-spastic mode 67 pulses/s). The vertical component of the ground reaction force was recorded using the F-Scan system at the onset and after training with SCES. EWT with SCES significantly increased the foot loading forces, could decrease their asymmetry and 8 out of 19 subjects improved their Hauser Ambulation Index. The anti-spastic mode of stimulation also allowed individuals with severe spasticity to walk with the aid of the exoskeleton. Participants reported facilitation when walking with SCES, paresthesia in leg muscles and new non-differential sensation of passive motion in leg joints. Neurological examination showed an increase of tactile (7) and/or pain (7) sensation and an increase of the AIS motor scale in 9 individuals, including both incomplete and complete paralysis. Improvements in the neurological scores were, however, limited in the control group (EWT without SCES). The results suggest that SCES may facilitate training and walking in the exoskeleton by activating the locomotor networks and augmenting compensative sensitivity.

中文翻译：

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瘫痪个体的外骨骼步行训练受益于经皮腰带强直电刺激

近年来，已经开发出以可穿戴动力外骨骼和腰骶脊柱网络神经调节为特征的先进技术，以促进瘫痪人类的行走和运动恢复。在这里，我们研究了脊髓电刺激 (SCES) 和外骨骼步行训练 (EWT) 在脊髓损伤个体（n = 19，美国脊髓损伤协会损伤量表 (AIS) A- 11、B-5、C-3）。本研究的目的是评估方法的兼容性并探讨组合 SCES 和 EWT 的主要影响。所有参与者都处于慢性瘫痪状态（创伤后 1-11 年）。此外，在对照组（n = 16、AIS A-7、B-5、C-4）中，我们在没有 SCES 的情况下进行了 EWT。对于 EWT，我们使用了动力外骨骼 (ExoAtlet)，而稳定性由拐杖辅助，如果检测到过大的扭矩，则会自动停止踩踏。SCES 以 1 或 3 个脉冲/秒的速度应用于 Th12 椎骨上的中腰脊髓水平（4 个严重痉挛的个体也以 67 个脉冲/秒的抗痉挛模式刺激）。地面反作用力的垂直分量在开始时和用 SCES 训练后使用 F-Scan 系统记录。带有 SCES 的 EWT 显着增加了足部负荷力，可以减少他们的不对称性，19 名受试者中有 8 名改善了他们的 Hauser 走动指数。抗痉挛刺激模式还允许患有严重痉挛的人在外骨骼的帮助下行走。参与者报告说，当使用 SCES 行走时有促进作用，腿部肌肉感觉异常和腿部关节被动运动的新非差异感觉。神经学检查显示 9 名个体的触觉 (7) 和/或疼痛 (7) 感觉增加以及 AIS 运动量表增加，包括不完全和完全瘫痪。然而，神经系统评分的改善在对照组（没有 SCES 的 EWT）中是有限的。结果表明，SCES 可以通过激活运动网络和增强补偿敏感性来促进外骨骼的训练和行走。限制在对照组（没有 SCES 的 EWT）。结果表明，SCES 可以通过激活运动网络和增强补偿敏感性来促进外骨骼的训练和行走。限制在对照组（没有 SCES 的 EWT）。结果表明，SCES 可以通过激活运动网络和增强补偿敏感性来促进外骨骼的训练和行走。