![]() ![]() In adults with iSCI, spinal locomotor control is compromised to various extents and consequently alters how the central nervous system (CNS) coordinates the muscles involved during locomotion. This analysis usually reveals a specific number of MSs (i.e., motor modules) with muscle weightings associated with gait sub-cycles. The L/E muscle coordination can be revealed by characterizing muscle synergies (MSs) using nonnegative matrix factorization (NNMF) algorithms. However, the effects of the various control modes on L/E muscle coordination underlying locomotion remain unknown, and clinical practice remains predominantly informed by clinical reasoning and accumulated experience. In the neurorehabilitation context, these L/E control modes allow rehabilitation professionals to personalize WRE-based rehabilitation interventions to maximize locomotion and locomotion-related abilities. To overcome these obstacles, while also increasing perceived utility and acceptability among rehabilitation professionals, some WRE manufacturers offer L/E control modes providing various levels of assistance or resistance, as well as non-imposed (i.e., non-controlled) trajectory guidance. In fact, such an approach may induce a habituation and sensitization phenomenon in which the spinal cord circuits adjust rapidly to repetitive activations of the same sensory pathways. As a result, after having gained sufficient experience with the WRE, active voluntary participation and stride-to-stride variability, which are essential components in motor learning, becomes regulated and may negatively affect walking recovery. Part of this difficulty relates to the fact that almost all evidence have been gathered using WRE with total lower extremity (L/E) motorized assistance and fixed trajectory guidance during treadmill walking. However, it still remains difficult to pinpoint how this intervention compares with conventional locomotor training interventions in adults with an incomplete spinal cord injury (iSCI). Overground locomotor training with Wearable robotic exoskeletons (WRE) represents an emerging and promising neurorehabilitation intervention that aligns with the basic principles of motor learning (e.g., specificity, repetition, and intensity) promoted after a neurological lesion. ![]()
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