Journal of NeuroEngineering and Rehabilitation最新文献

Background: The amputation of a limb constitutes one of the most severe disruptions of body integrity. Nevertheless, many individuals with limb amputation report a restored sense of integrity when wearing a prosthesis. The rubber limb illusion (RLI) has been proposed as an experimental model to study such experiences. In this paradigm, correlated visuo-tactile stimulation of the residual limb and an artificial limb can induce amputated individuals to experience ownership of the latter one which is then perceived as a counterpart of the missing limb. However, due to methodical limitations in previous setups, the neural processes underlying alterations in the sense of body integrity remain insufficiently understood.

Methods: In this cross-sectional study, we developed a novel RLI setup to systematically manipulate the sense of body integrity in a sample of N = 34 individuals with unilateral lower limb amputation. Participants completed six randomized trials across two experiments. In Experiment 1, we varied artificial limb appearance (intact vs. impaired) and visuo-tactile stimulation (synchronous vs. asynchronous) on the residual limb. In Experiment 2, we manipulated artificial limb appearance and induced the RLI on both the residual and the non-amputated limb. Neural activity was assessed using functional magnetic resonance imaging.

Results: Synchronous visuo-tactile stimulation of the residual limb and an intact artificial counterpart induced artificial limb ownership and was associated with improvements in perceived body integrity. Neuroimaging revealed specific activation in the left superior parietal lobule associated with dynamic changes in the sense of body integrity. Neural activity underlying RLI processing did not significantly differ between the residual limb and the non-amputated limb.

Conclusion: Appropriate multimodal sensory stimulation can strengthen the sense of body integrity in most individuals with lower limb amputation. This effect appears to be mediated by the brain's capacity for sensory integration within the body representation network. These insights advance our understanding of prosthesis-related experiences and may inform the development of improved prosthetic devices that employ non-invasive somatosensory feedback, thereby promoting positive rehabilitative outcomes through enhanced prosthesis embodiment.

Background: Walking while performing a concurrent cognitive task leads to cognitive-motor interference, resulting in slower and more variable gait. This is particularly the case in Parkinson's disease (PD), where dual-task situations exacerbate walking impairments, increasing fall risk and reducing quality of life. Cognitive-motor impairment has been linked to excessive attentional demands due to reduced locomotor automaticity. Neuroimaging studies suggest over-reliance on prefrontal resources potentially reflecting compensatory mechanisms. However, few studies link automaticity, performance, and cognitive capacity to prefrontal activity, particularly in PD. In older adults (OA) and people with PD, this study aims to: (1) describe dual-task effects and prefrontal cortical activity during walking with and without a dual-task, (2) determine the connection between prefrontal cortical activity and step time variability as a measure of gait automaticity, (3) explore associations between prefrontal cortical activity and other measures of gait automaticity and prioritization and (4) investigate executive function as a potential moderator in the compensatory relationship.

Methods: Data from 44 OA and 37 people with PD walking with and without an auditory Stroop task were analyzed. Gait variables were measured using inertial measurement units, and prefrontal activity was assessed with functional near-infrared spectroscopy (fNIRS). Executive function was determined with a trail making test. Data analysis involved linear regression models to explore relationships between prefrontal activity, gait automaticity, and executive function.

Results: Most participants had a cognitive priority trade-off when dual-tasking, and the OA group had more prefrontal activity compared to the PD group during single-task and dual-task walking. For PD there was a significant positive relationship between step time variability and prefrontal activity (β = 0.38, T = 6.26, p < 0.01), while OA had a relationship between age and prefrontal activity (β = 0.53, T = 2.33, p = 0.04). Secondary analyses showed relationships between prefrontal activity and dual-task cost of gait speed (β = 0.25, T = 2.90, p = 0.02) and Stroop response time (β = 0.27, T = 3.10, p = 0.01) in PD, but not in OA. No moderation effects were detected in the relationship between gait automaticity and prefrontal activity.

Conclusions: In PD, loss of gait automaticity is linked to increased prefrontal activity, suggesting compensatory mechanisms. In OA, prefrontal activity during walking seems to be primarily age-related.

Background: Spinal cord injury (SCI) results in devastating motor and sensory deficits below the level of injury. Transcutaneous spinal cord stimulation (tSCS) has emerged as a promising non-invasive neuromodulation technique for improving motor function in individuals with SCI. However, the effectiveness of tSCS for lower limb rehabilitation remains unclear.

Objective: To systematically review the effectiveness of tSCS for improving lower limb motor function, walking ability, spasticity, and functional independence in individuals with SCI.

Methods: We conducted a comprehensive search of PubMed, Web of Science, Embase, Scopus, CINAHL, MEDLINE, Cochrane Library, and Physiotherapy Evidence Database (PEDro) from inception to March 2025. We included randomized controlled trials (RCTs), non-randomized studies, and case series examining tSCS for lower limb rehabilitation in adults with SCI. Two reviewers independently screened studies, extracted data, and assessed risk of bias using appropriate tools (Cochrane RoB 2, ROBINS-I, JBI Critical Appraisal Checklist). We used GRADE to assess certainty of evidence.

Results: From 2042 identified records, 14 studies (n = 183 participants) met inclusion criteria, including 5 RCTs, 4 non-randomized studies, and 5 case series. Due to substantial clinical and methodological heterogeneity, we conducted a narrative synthesis. The single high-quality RCT (Comino-Suárez 2025) showed significant improvements in Lower Extremity Motor Score (LEMS) at follow-up (MD: 3.37, 95% CI: 0.29-6.46) and 10-meter walk test (10MWT) speed (MD: - 37.51 s, 95% CI: - 72.78 to - 2.23), but no significant effects on 6-minute walk test (6MWT) or spasticity. Most studies reported only mild adverse events (skin irritation, tingling). The certainty of evidence was very low for clinical outcomes and moderate for safety.

Conclusions: Current evidence suggests tSCS may improve lower limb motor function and walking speed in SCI, with a favorable safety profile. However, the evidence base has significant limitations including small sample sizes, heterogeneous protocols, and methodological concerns. Well-designed, adequately powered RCTs with standardized protocols are urgently needed.

Background: Aerobic cycle-training counters deconditioning and induces muscle and cardiorespiratory benefits in various neuromuscular disorders. However, its application to Duchenne muscular dystrophy (DMD) is limited due to lack of exercise prescription guidelines, particularly for intensity. A balance between beneficial versus harmful effects of muscle activity must be established given the weakness and concerns of contraction-induced damage inherent to DMD. Previous studies in DMD used motor-assisted cycling applying subjective ratings of perceived exertion to guide exercise intensity, whereas objective parameters such as heart rate (HR) or work performed were not reported. In efforts to develop exercise guidelines for DMD, we designed a motor-assisted cycle-exercise paradigm using closed-loop control of motor effort and individualization of intensity based on HR. Feasibility of this paradigm in DMD was tested in the home setting with remote clinical supervision.

Methods: A closed-loop controller was developed with user-defined saturation points for cadence and baseline motor inputs to ensure safety of cycling and adjustments in level of muscle overload (assistive current). The controller allowed remote, interactive adjustment of current based on HR biofeedback, providing cycling assistance when velocity approached a lower-bound and resistance when the upper-bound was approached. A target intensity of 40-50% HR reserve was individualized for each participant and motor effort was adjusted accordingly by the clinician. Force-sensors were embedded in the pedals for quantification of passive and active power.

Results: Six ambulatory boys with DMD (aged 7.7 ± 0.9 years) completed at least two bouts of cycling exercise (3-10 min per bout) with an average 0.53 ± 0.15 amps assistive current (range 0.3-0.8 amps). HR increased from rest during passive and active cycling (mean 109.2 ± 6.1; 119.2 ± 8.5; 149.7 ± 4.6 bpm respectively), where boys were actively exercising at 45% of HR reserve at an average cycling power of 5.7 ± 1.3 watts (ranging 3-8 watts depending on disease severity).

Conclusion: These results show for the first time that boys with DMD can cycle actively to generate power and raise HR to a prescribed intensity, supporting feasibility of this home-based, remotely-supervised control paradigm. They warrant future study to establish clinical exercise prescription parameters and the potential of aerobic cycling as a rehabilitative strategy in DMD.