Application of Brain-Computer Interface, Robot, Transcranial Magnetic Stimulation in Spinal Cord Injury Rehabilitation

Spinal cord injury (SCI) is a serious condition that leaves most patients impaired or paralyzed throughout their lifetime. As an approach to managing paralysis and concomitant impairments, rehabilitation is proven effective and beneficial for patients. How rehabilitation influences the remodeling of spinal axonal connections is essential. Still, answers to this question remain difficult to obtain clinically, and its underlying neuronal mechanisms resulting in functional improvements remain unclear. A number of emerging strategies have been brought to clinical practice, including brain-computer interface (BCI), robot, transcranial magnetic stimulation (TMS), etc. However, there is still insufficient evidence supporting new application in clinical settings due to limited research. In neurorehabilitation, BCI can be coupled with a movement-assisting device (i.e., robot or electrical stimulator) and used as a short-term intervention to promote recovery of motor function after SCI. In the past decade, robotic devices that initiate or augment movement have been used in SCI rehabilitation, mainly to enhance recovery through repetitive, functional movement and increased neural plasticity and to act as a mobility aid beyond orthoses and wheelchairs. In addition, lower extremity exoskeletons have been shown to benefit the secondary medical conditions after SCI, such as pain, spasticity, and decreased bone density. The repeated administration of the transcranial magnetic pulses at a certain frequency is thought to induce short to long-term changes in corticospinal excitability and affect plasticity mechanisms. For SCI, this field is novel. Preliminary results suggest potential benefits for motor and sensory recovery and address secondary complications such as spasticity and chronic pain. However, standardized TMS protocols remain to be determined.

This Research Topic aims to highlight new research on the underlying mechanism and emerging strategies, especially studies on BCI, robots, and TMS. We welcome specific themes that may include, but are not limited to, the following:

- The new clinical application of therapeutic approaches for functional recovery after SCI, such as BCI, robot, and TMS
- Research that can improve the evidence-base for the above emerging rehabilitation interventions, especially randomized and controlled trials that included an enormous number of patients
- Research that emphasizes optimal or standardized protocols of the above emerging strategies, such as protocols for TMS, including optimal stimulation parameters (i.e., stimulation frequency, intensity, duration of trains, number of pulses, etc.), number of sessions, and duration of each session, and potential combination with other rehabilitation interventions
- A better understanding of the underlying neuronal mechanisms resulting in functional improvements and how rehabilitation work after SCI, new tools to investigate and harness these mechanisms, particularly neuroimaging and neuro-electrophysiology