Motor rehabilitation of spinal cord disorders

Abstract

This article provides an overview of the incidence, prevalence, and causes of spinal cord disorders in Germany together with recent trends. Determining the level and severity of the spinal cord injury (SCI) with the International Standards for Neurological Classification of SCI (ISNCSCI) is particularly important in the early phase after SCI, in order to make assessments regarding neurological recovery capacity and, based on this, treatment planning. The treatment goals depend primarily on the severity and time after onset of SCI: the more incomplete the lesion and the earlier after spinal cord damage, the more likely a restorative therapy approach is used with the goal of restoring lost motor functions. In contrast, in more complete and chronic SCI, compensatory therapy approaches are chosen to compensate for the permanent impairment of muscle functions by means of compensatory movements or assistive devices. For both approaches, a number of technical training and assistive devices are nowadays available. It is becoming apparent that with combinatorial therapy approaches consisting of intensive task-specific, robotic-assisted therapy and novel neuromodulatory approaches such as electrical stimulation of the lumbar spinal cord, significantly greater functional gains can be achieved in the future than has been possible to date. In cases with an injury of the cervical spinal cord and preserved shoulder-elbow functions, the grasp function can be improved with neuroprostheses based on functional electrical stimulation. Currently, research is being conducted in people with high cervical SCI on the independent control of complex arm neuroprostheses or robotic arms via novel user interfaces such as brain-computer interfaces. However, these systems still have to prove their suitability for everyday use in the future.