This case study aimed to examine how exoskeleton training influences cortical activity during turning-while-walking in an individual with iSCI, focusing on neural changes that may contribute to motor recovery and cortical reorganization.
Data were obtained from a 47-year-old female with incomplete spinal cord injury (ASIA-D at C6, 28 years post-injury), who participated in a 12-week exoskeleton training program. A portable 54-channel fNIRS system, consisting of 20 light emitters and 16 detectors, was used to assess cortical activity. Optodes were arranged to target key cortical regions, including the prefrontal cortex (PFC), supplementary motor area (SMA), premotor cortex (PMC), primary sensorimotor cortex (SMC), and somatosensory association cortex (SAC). The system sampled at a rate of 25 Hz, and a 3D digitizer was employed to localize channels in the MNI standard brain.
The protocol comprised three conditions: 1) static standing, 2) turning-while-walking without the exoskeleton, and 3) turning-while-walking with the exoskeleton. Four trials were recorded for each condition at baseline and post-intervention. Data analysis was performed using the Homer2 software package in MATLAB. Relative changes in oxyhemoglobin (HbO2) and deoxyhemoglobin (HbR) concentrations were computed, with trial averages used to improve the signal-to-noise ratio.
At baseline, the participant showed increased cortical activation in the PFC, SMA, and SAC during exoskeleton-assisted walking compared to walking without the exoskeleton. After the intervention, cortical activation in these regions decreased during exoskeleton-assisted walking. In contrast, post-intervention, unassisted walking showed more global locomotor network activation compared to baseline.
Exoskeleton training appears to influence cortical reorganization in individuals with iSCI, particularly in areas related to motor planning during turning-while-walking tasks. This case study highlights the feasibility of using fNIRS for real-time monitoring of cortical activity, suggesting that exoskeleton training may enhance neuroplastic changes and improve motor function. Future research with larger samples and diverse injury levels is necessary to validate these findings.
Incorporating exoskeleton training and fNIRS monitoring into physiotherapy can optimize rehabilitation strategies, reduce fall risks, and enhance functional independence for individuals with iSCI.
Neuroplasticity
Functional near infrared spectroscopy (fNIRS)
