Spinal cord injury (SCI) rehabilitation remains a major clinical challenge, especially in cases involving chronic, complete injury. Existing interventions for assisting patients with SCI in walking, including body weight support systems, robotic assistance, and functional electrostimulation of the legs, have not shown evidence of generating significant clinical improvement in somatosensory function below the level of the injury. In the past 2 decades, brain-machine interfaces (BMIs) have become popular tools for restoring limb function in paralyzed patients, although no study has suggested that long-term training with BMI-based paradigms and physical training could trigger neurological recovery, particularly in patients with complete SCI.1However, the prospect of neurological recovery is supported by postmortem anatomical studies that have shown that 60% to 80% of patients with “complete” SCI show viable axons crossing the level of the SCI. In this study, Donati et al2 show partial neurological and clinical improvement in patients with SCI subjected to long-term training with a multistage BMI-based gait protocol called the Walk Again Neurorehabilitation protocol (WA-NR).
Donati et al implemented WA-NR in 8 patients with chronic (> 1 year) paraplegic SCI. Seven patients had complete SCI (American Spinal Injury Association Impairment Scale A), and 1 patient had partial SCI (American Spinal Injury Association Impairment Scale B). The 6-component protocol of WA-NR (Figure, A) started with seated virtual reality and progressed to gait training with a brain-controlled exoskeleton.
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