Journal of NeuroEngineering and Rehabilitation最新文献

{"title":"Safety, feasibility and preliminary effects of Atalante exoskeleton-assisted gait training in amyotrophic lateral sclerosis: a prospective ABA pilot study.","authors":"Ghida Trad, Timothée Lenglet, Isabelle Ledoux, Giorgia Querin, Sophie Blancho, Véronique Marchand-Pauvert, Jean-Yves Hogrel, Pierre-François Pradat","doi":"10.1186/s12984-026-02046-y","DOIUrl":"10.1186/s12984-026-02046-y","url":null,"abstract":"<p><strong>Background: </strong>In amyotrophic lateral sclerosis (ALS), progressive weakness makes walking practice increasingly unsafe and difficult, accelerating loss of mobility and autonomy. Lower-limb exoskeletons could preserve task-specific stepping in a controlled setting, but evidence in ALS remains scarce. This study evaluated the safety of an intensive Atalante exoskeleton gait-training program and explored its effects on walking and related clinical outcomes.</p><p><strong>Methods: </strong>In this prospective, monocentric ABA pilot study, 10 ambulatory persons with ALS underwent three consecutive 6-week phases over 18 weeks: A1 (baseline, usual care), B (intervention: Atalante exoskeleton gait training added to usual care; 18 sessions, 3 times/week), and A2 (withdrawal, usual care), with repeated assessments every 3 weeks. The primary endpoint was safety, assessed by adverse events (AE). Secondary endpoints included ALS Functional Rating Scale-Revised, forced vital capacity, standardized walking tests (6-minute walk test, 10-meter walk test, Timed Up and Go test), Berg Balance Scale, postural control on a force platform, lower-limb strength with dynamometry, spasticity with isokinetic dynamometer, Fatigue Severity Scale, Modified Fatigue Impact Scale, ALS Assessment Questionnaire-40, and Hospital Anxiety and Depression Scale. Exoskeleton-specific patient-reported outcomes (PROs) included intrinsic motivation, participants' attitudes toward the intervention, perceived subjective impact of the training, perceived efficacy and interactivity of the exoskeleton. The results were analyzed with linear mixed-effects models.</p><p><strong>Results: </strong>No serious AE occurred, and one mild AE was certainly related to the intervention. No outcome showed significant phase-specific slopes or slope contrasts, although several measures displayed directionally consistent trends compatible with attenuated decline during phase B and a return toward a less favorable trajectory after withdrawal. Exoskeleton-specific PROs indicated high intrinsic motivation and acceptability (usefulness for standing, perceived safety, ease of participation, and ease of installation/uninstallation rated very highly), with perceived gait-training efficacy generally positive. Participants frequently reported reduced immobility and increased accomplishment (80% each) and postural improvement (70%), and the Net Promoter Score of recommendation was + 40.</p><p><strong>Conclusions: </strong>Atalante exoskeleton gait training was safe and feasible in ambulatory ALS. These pilot data can guide the optimization of future studies to test whether it preserves function. Trial registration ClinicalTrials.gov, NCT06199284. Registered on 29/12/2023.</p>","PeriodicalId":16384,"journal":{"name":"Journal of NeuroEngineering and Rehabilitation","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13591801/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148368736","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of repetitive transcranial magnetic stimulation on cognition through sleep slow-wave activity in older adults.","authors":"Michelle E Stepan, Ahmad Mayeli, Rachel Kaskie, Alexis B Whitehead, Andrew R Gerlach, Christine W Peng, Rima F Habte, Sabine A Janssen, Meredith L Wallace, Daniel J Buysse, Helmet T Karim, Fabio Ferrarelli, Kristine A Wilckens","doi":"10.1186/s12984-026-02064-w","DOIUrl":"10.1186/s12984-026-02064-w","url":null,"abstract":"<p><strong>Background: </strong>Increases in slow-wave activity (SWA) during sleep are associated with improvements in overnight memory retention and cognitive performance in young adults. Links between SWA and overnight improvements in cognition among older populations, however, are poorly understood. This proof-of-concept pilot study used a single session of excitatory repetitive transcranial magnetic stimulation (rTMS) during wakefulness to increase SWA during subsequent sleep in older adults with subjective cognitive decline. We examined whether this single night increase in SWA led to improvements in overnight memory retention, executive function, and vigilant attention.</p><p><strong>Methods: </strong>Participants (mean age = 70 years, SD = 5.2) with subjective reports of cognitive decline participated in a 40-min session of active (n = 11) or Sham (n = 9) high frequency (10 Hz) rTMS applied to the left dorsolateral prefrontal cortex. Participants spent two nights in a sleep lab pre- and post-rTMS with high-density EEG to assess changes in SWA. A behavioral task battery examining overnight memory retention (Word Pair Task, Face-Profession, Object Recognition), executive control (Stroop, Sternberg, task-switching) and vigilant attention (Psychomotor Vigilance Task) were also assessed pre- and post-rTMS.</p><p><strong>Results: </strong>Overall reaction time (RT) on the Stroop task, across task conditions, improved between sessions with rTMS, but not with Sham. There was no evidence of improved performance on other cognitive domains with rTMS. Increased fronto-parietal SWA in the first NREM period was associated with the improvement in overall Stroop RT. Stroop congruent and neutral trial RT, Stroop neutral trial accuracy, and Sternberg working memory RT were also associated with increased whole night and first NREM period SWA.</p><p><strong>Conclusions: </strong>These preliminary results suggest that acute increases in SWA are associated with improved processing speed in older adults at risk for cognitive decline, as evidenced by an improvement in overall Stroop RT as opposed to improvements on specific task conditions. Multi-session rTMS studies and randomized controlled trials are needed to fully assess the effect of enhanced SWA through rTMS on improvements in overnight memory retention and executive function.</p>","PeriodicalId":16384,"journal":{"name":"Journal of NeuroEngineering and Rehabilitation","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13591718/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148368657","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neuromechanical synergy patterns explain metabolic efficiency differences during the sit-to-walk transition.","authors":"Wanli Zang, Jiarong Wu, Chen Zhu, Qiuxia Zhang, Xianzuo Zhang","doi":"10.1186/s12984-026-02049-9","DOIUrl":"10.1186/s12984-026-02049-9","url":null,"abstract":"<p><p>The sit-to-walk (STW) transition is a key component of the Timed Up and Go test, yet the neuromuscular and cross-modal coordination features associated with metabolic cost during STW remain incompletely understood. This study developed a simulation-informed synergy analysis framework combining OpenSim-Umberger metabolic estimation, non-negative matrix factorization (NMF), and mixed-matrix factorization (MMF). Seventy-one healthy participants performed STW trials with kinematics, ground reaction forces, and eight-channel surface electromyography recorded. Model-derived metabolic cost was estimated using participant-specific musculoskeletal simulations, and an STW oxygen-consumption agreement analysis in a validation subsample supported the metabolic estimation workflow. Participants were stratified into residual-based metabolic-cost groups after adjustment for body mass, height, and sex. Across groups, joint kinematics and simulation-derived muscle-level outputs were broadly comparable. NMF identified localized differences in temporal activation coefficients after correction for the number of synergies, with group effects confined to early and late time windows rather than extending across the full analyzed cycle. Exploratory NMF weight comparisons further suggested potential differences in selected muscle weights. MMF characterized non-negative temporal coefficients and cross-modal EMG-biomechanical weight patterns; corrected analyses of MMF temporal coefficients identified limited, localized differences in selected MMF synergies, and exploratory weight comparisons indicated localized differences in selected EMG and biomechanical channel-synergy combinations. These findings suggest that residual-based metabolic-cost phenotypes during STW are associated with localized synergy-related features under broadly similar external movement patterns. The proposed framework provides a healthy-reference and hypothesis-generating approach for examining subtle internal coordination features linked to model-estimated metabolic cost.</p>","PeriodicalId":16384,"journal":{"name":"Journal of NeuroEngineering and Rehabilitation","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2026-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13591704/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148361213","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Topological data analysis of postural sway: characterizing balance control during childhood development.","authors":"Elaheh Azadian, Mahdi Majlesi","doi":"10.1186/s12984-026-02078-4","DOIUrl":"10.1186/s12984-026-02078-4","url":null,"abstract":"<p><strong>Background: </strong>Postural control matures through gradual refinement of sway organization, yet traditional CoP measures capture only variability and not the underlying geometric structure. Topological Data Analysis (TDA) offers a complementary approach by quantifying the persistence and complexity of sway dynamics. This study applied TDA to investigate developmental and task-related differences in CoP topology from childhood to adulthood.</p><p><strong>Methods: </strong>A total of 460 healthy participants (ages 7-12 years and young adults) completed eight standing balance tasks that manipulated visual input, base of support (BoS), and cognitive load. For each 30-s CoP trial, Vietoris-Rips persistence diagrams were computed, and four H1-based TDA metrics were extracted: H1_Wasserstein distance, H1_TotalPersistence, Persistent Entropy, and H1_NumLongLoops. Mixed-design ANOVAs evaluated the effects of Age, Gender, Vision, BoS, and Cognitive Dual-Tasking (CDT) on each metric.</p><p><strong>Results: </strong>All TDA metrics exhibited strong age effects (all p < 0.001), with children showing greater persistence magnitudes and more long-lived loops than adults, reflecting less stable and more oscillatory sway organization. Vision significantly modulated H1_Wasserstein and Total Persistence (p < 0.001), with eye closure producing pronounced increases. Single-leg stance robustly amplified all TDA measures (p < 0.001). CDT induced moderate but significant alterations in several metrics, whereas Persistent Entropy remained insensitive to visual deprivation (p = 0.168). Gender differences were generally small but interacted with task difficulty for selected outcomes.</p><p><strong>Conclusion: </strong>TDA revealed systematic developmental transitions in the topology of CoP dynamics, shifting from rich multi-loop structures in childhood to topologically simpler and more stable configurations in adulthood. These findings support TDA as a sensitive and physiologically meaningful approach for evaluating balance maturation and may aid in detecting atypical postural control patterns in clinical or developmental contexts.</p>","PeriodicalId":16384,"journal":{"name":"Journal of NeuroEngineering and Rehabilitation","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2026-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13579808/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148352110","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Peripheral and central vestibular neuromodulation improve postural control in adolescent idiopathic scoliosis: a randomized, sham-controlled, multi-arm intervention study.","authors":"Huaqing Chen, Liping Zhao, Yuelong Li, Qiuhua Yu, Lingling Shen, Raymond Kai-Yu Tong, Shijue Li, Chunlin Chen, Hongmin Wu, Disheng Xie, Guifang Zhang, Ying-Shing Chan, Xiao-Qian Hu, Chuhuai Wang","doi":"10.1186/s12984-026-02056-w","DOIUrl":"10.1186/s12984-026-02056-w","url":null,"abstract":"<p><strong>Background: </strong>Adolescent idiopathic scoliosis (AIS) features structural spinal deformity and impaired postural control, which may be associated with altered vestibular function and multisensory integration. Neuromodulatory approaches such as noisy galvanic vestibular stimulation (nGVS) and high-definition transcranial direct current stimulation (HD-tDCS) have shown promise in enhancing balance in healthy and older populations. However, whether peripheral and cortical vestibular neuromodulation exert distinct or combined effects on postural control in AIS remains unknown. This study aimed to compare the immediate post-stimulation effects of peripheral (nGVS), central (HD-tDCS), and combined (nGVS + HD-tDCS) vestibular modulation on postural control in AIS and explore their neuromuscular and cortical correlates.</p><p><strong>Methods: </strong>Forty adolescents with AIS were randomly assigned to sham, nGVS, HD-tDCS (anodal CP6), or nGVS+tDCS groups. Center of pressure (COP), surface electromyography (EMG) for bilateral gastrocnemius (GM), tibialis anterior (TA), and erector spinae (ES), and functional near-infrared spectroscopy (fNIRS) for bilateral inferior parietal lobule (IPL), superior parietal lobule (SPL), supplementary motor area (SMA), and primary motor cortex (M1) were simultaneously recorded during an eyes-closed foam-standing Romberg task to evaluate behavior, muscular and cortical responses before and after a single-session neuromodulation intervention.</p><p><strong>Results: </strong>Active interventions (nGVS, HD-tDCS, and combined nGVS + HD-tDCS) significantly reduced COP path length and sway area versus sham, with the combined nGVS + HD-tDCS demonstrating the greatest reduction in path length. EMG analysis showed reduced gastrocnemius exertion following nGVS (right side) and combined stimulation (both sides). fNIRS revealed no hemodynamic changes after nGVS, while HD-tDCS increased activation in the right IPL, and enhanced functional connectivity (FC) between the right IPL and right SMA. Combined nGVS + HD-tDCS further amplified right IPL and right SPL activity, and strengthened connectivity within bilateral SMA and between the right IPL and right SMA.</p><p><strong>Conclusions: </strong>nGVS, HD-tDCS, and their combination improve postural control in AIS through distinct neuromodulation mechanisms. Combined stimulation was associated with the largest improvement in COP path length and broader cortical network modulation. Trial registration Registered at Chinese Clinical Trial Registry (ChiCTR2500110347) on July 25, 2025.</p>","PeriodicalId":16384,"journal":{"name":"Journal of NeuroEngineering and Rehabilitation","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2026-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13584406/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148361163","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ankle-foot orthosis mechanical testing: a scoping review.","authors":"Katherine Vaiciulis, Zachary Williston, Deema Totah","doi":"10.1186/s12984-026-02072-w","DOIUrl":"10.1186/s12984-026-02072-w","url":null,"abstract":"<p><strong>Background: </strong>Ankle-foot orthoses (AFOs) are assistive devices that support the ankle during gait. AFO mechanical properties, such as rotational stiffness about the ankle, influence the level of support these devices provide. Interest in quantifying AFO mechanical properties is on the rise but is limited by the lack of standardized measurement and assessment techniques. This scoping review discusses existing techniques for the measurement of AFO mechanical properties and introduces a taxonomy for organizing and describing these methods.</p><p><strong>Methods: </strong>A scoping review was conducted using a snowballing approach starting from two previously published literature reviews and a database search using PubMed, Engineering Village (Compendex), and Web of Science. Articles with methods that experimentally measured the mechanical properties of AFOs were eligible for inclusion. Data extracted from the selected articles included operation specifications, planes/joints tested, and presence of a biological or surrogate limb during AFO testing.</p><p><strong>Discussion: </strong>The majority of methods utilize benchtop AFO testing, with a few in-situ methods that involve a biological limb. We highlight key design challenges related to replicating biological gait, including bending axis location and design, motion in single versus multiple planes, and limited testing speeds and range of motion.</p><p><strong>Conclusion: </strong>We introduced a taxonomy for describing AFO testing methods to facilitate cross-device comparisons and inform future development. Future work should include developing standardized, biomimetic methods and validation techniques for testing a variety of AFO designs. This would enable more accurate AFO measurement and enable cross-study comparisons, ultimately leading to optimized AFO properties and improved user performance outcomes.</p>","PeriodicalId":16384,"journal":{"name":"Journal of NeuroEngineering and Rehabilitation","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2026-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13587519/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148361181","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The classification of walking and phases of gait using EEG: a scoping review.","authors":"Cormac Ryan, Conor White, Olive Lennon","doi":"10.1186/s12984-026-02076-6","DOIUrl":"10.1186/s12984-026-02076-6","url":null,"abstract":"<p><p>Brain-computer interfaces (BCIs) have the potential to optimise robotic-assisted gait rehabilitation by closing the loop between user and device. Developing such systems requires reliable methods for classifying walking and its component phases to enable real-time feedback. However, research into electroencephalography (EEG)-based gait classification remains limited, with no consensus on optimal methodological or classification approaches. This scoping review aimed to identify (i) gait states and phases classified to date, (ii) methodological processes employed in gait and gait phase classification and (iii) classification systems used. A pre-registered scoping review was conducted. SCOPUS, EMBASE, PubMed and Web of Science were searched. Studies investigating EEG-based gait or gait phase classification, with or without robotic assistance were included. From 15,915 unique studies, 62 were included. Ten studies classified gait phases, with most limited to two phases (n = 5). The majority involved treadmill walking (n = 8), with only two investigating overground walking. Only one study addressed gait phase classification (swing versus stance) during robotic-assisted gait training (RAGT), achieving a maximum accuracy of 83.06%. No studies investigated gait phase classification in a neurological population. Almost all gait phase studies used offline analysis (n = 9). One study performed online analysis, achieving an accuracy of 82.3% for swing versus stance classification. The remaining studies classified gait against other forms of movement. Sensorimotor area electrodes were most frequently used for classification and sensorimotor regions consistently exhibited gait-related discriminative EEG features. Collation of methodological processes identified little consensus within the field. Furthermore, classification accuracy was variable. This scoping review summarises EEG-based gait classification systems, highlighting the need for methodological consensus. Knowledge gaps include the classification of more than two gait phases during free overground walking and limited RAGT-based studies. Notably, gait phase classification research in neurological populations is entirely lacking. Addressing these gaps is critical to advance BCIs for gait rehabilitation.</p>","PeriodicalId":16384,"journal":{"name":"Journal of NeuroEngineering and Rehabilitation","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2026-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13587400/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148361171","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Biohybrid cochlear implants: neural interfaces, regenerative pathways, and translational benchmarks.","authors":"Akihiro J Matsuoka, Andrew N Carpino, Audrey Meador, Beatriz O Nicolau, Gabriela M Fortuño, Huimin Zhu, Tifany T Nguyen, Kiersten R Russ, Hudson Liu, Jae Joon Kim, Winston Loh, James Friend","doi":"10.1186/s12984-026-02069-5","DOIUrl":"10.1186/s12984-026-02069-5","url":null,"abstract":"<p><p>Cochlear implants (CIs) restore hearing by electrically stimulating the auditory nerve, yet the millimeter-scale electrode-neuron separation limits spatial selectivity and temporal fidelity. Rather than relocating the electrode array, we propose a biohybrid strategy that preserves the conventional scala tympani insertion and closes this gap biologically by interposing living neural constructs between the array and the modiolus. This approach leverages the Canaliculi Perforantes of Schuknecht (CPS) to deliver spatially confined biochemical, mechanical, and electrical cues from the scala tympani, biasing spiral ganglion neurites toward contacts while respecting surgical practicality. We review CPS microanatomy and transport, auditory neuron/stem cell-regeneration prospects, hydrogel/assembloid niches, surface and material stacks, and conclude with translational benchmarks, constraints, and a near-mid-long-term roadmap.</p>","PeriodicalId":16384,"journal":{"name":"Journal of NeuroEngineering and Rehabilitation","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2026-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13591839/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148361179","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transcutaneous spinal stimulation with upper extremity robotic training in chronic stroke and spinal cord injury: individual neurophysiological and clinical responses.","authors":"Jeonghoon Oh, Michelle S Scheffler, Shane T King, Erin E Mahan, Melissa Lee, Catherine Martin, Alexander G Steele, Jony Sheynin, Jenny Dinh, Argyrios Stampas, Teresa Kaldis, Timea M Hodics, Marcia K O'Malley, Dimitry G Sayenko","doi":"10.1186/s12984-026-02036-0","DOIUrl":"10.1186/s12984-026-02036-0","url":null,"abstract":"<p><strong>Background: </strong>Damage to the corticospinal tract after stroke and spinal cord injury (SCI) often results in persistent upper extremity (UE) impairment. Transcutaneous spinal stimulation (TSS) and robotic technologies have been explored as approaches to facilitate motor training; however, their combined effects on UE sensorimotor recovery remain poorly understood. The purpose of this study was to examine the effects of TSS combined with UE robotic training in individuals with chronic stroke or SCI.</p><p><strong>Methods: </strong>Five participants with stroke and six with SCI completed a 14-week, sham controlled, single blind crossover study consisting of four total weeks of assessments (one week each pre and post for both training phases), four weeks of UE training with sham TSS, a two-week washout period, and four weeks of UE training with active TSS. Each one-hour session (three days/week) included robotic exoskeleton-assisted UE movements and hand grip training, performed concurrently with sham or active TSS. Assessments included electrophysiological measurements and standardized rehabilitation outcomes.</p><p><strong>Results: </strong>Descriptive analysis revealed meaningful individual improvements masked by group-level heterogeneity. In the stroke group, three participants showed grip strength improvement (assessed without stimulation) after the active phase (+ 9.4 Newtons [N] to + 23.9 N), with two-to-four-fold increases in forearm muscle activation. Mean Fugl-Meyer overall UE scores improved from 89 to 94.2. In the SCI group, two participants showed grip strength gains. One participant exhibited a six-fold immediate force increase (1.0 N to 6.2 N) during stimulation. Another participant achieved improved grip strength without stimulation (23.9 N to 36.8 N) and a three-fold increase in electromyography (EMG) activity from the flexor carpi radialis and first dorsal interosseous muscles, alongside partial pin-prick sensory recovery and self-reported restoration of previously affected perspiration during the active TSS phase.</p><p><strong>Conclusions: </strong>Varied outcomes in participants confirm that therapeutic effects of combined TSS and robotic UE training are highly individualized. Three critical elements must be blended for the best outcomes of this combinatorial approach: residual UE function, a curated stimulation paradigm, and tailored UE training that provides appropriate challenge, intensity, and salience. The results suggest TSS with UE robotic training hold key potential when considered in the context of the physiological and functional profile of each participant.</p>","PeriodicalId":16384,"journal":{"name":"Journal of NeuroEngineering and Rehabilitation","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2026-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13595636/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148352115","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Residual muscle activity associated with phantom limb movements after transhumeral amputation without surgical reinnervation: a preliminary ultrasound study.","authors":"Susannah Engdahl, Ahmed Bashatah, György Lévay, Rahul Kaliki, Ajul Shah, Ananya Dhawan, Siddhartha Sikdar","doi":"10.1186/s12984-026-02073-9","DOIUrl":"10.1186/s12984-026-02073-9","url":null,"abstract":"<p><p>Transhumeral amputations often result in significant functional limitations. Multiarticulated myoelectric prostheses for individuals with transhumeral amputations are often unreliable because of limitations in signal quality and challenges with accurately detecting motion intent from the available musculature in the residual limb, leading to high prosthesis rejection rates. Surgical approaches like targeted muscle reinnervation have been proposed to mitigate these challenges by biologically amplifying motor signals but are not suitable for all individuals. There is intriguing evidence that distinct muscle activation patterns associated with voluntary mobilization of the phantom limb may be produced in the residual limb after transhumeral amputation even without surgical intervention. However, this phenomenon has not been sufficiently investigated. This study explores the potential of ultrasound imaging to visualize muscle activity associated with phantom hand movements in an individual with transhumeral amputation who has not undergone targeted muscle reinnervation. We demonstrate that ultrasound imaging can capture these patterns, with each tested phantom movement corresponding to unique residual limb muscle activity. The activation patterns for each motion showed greater consistency across repetitions (correlation range: 0.41-0.86) compared to their average similarity with other motions (correlation range 0.06-0.32). These findings provide preliminary imaging evidence suggesting functional innervation of the residual upper arm muscles with digit-level specificity after transhumeral amputation. We recommend further research into modalities that can sense phantom limb mobilization to improve prosthesis control after transhumeral amputation.</p>","PeriodicalId":16384,"journal":{"name":"Journal of NeuroEngineering and Rehabilitation","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2026-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13584292/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148352099","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}