Functional recovery of paralyzed limbs has a high priority in the rehabilitation of spinal cord injuries (SCIs). In recent years, there has been an increased focus on robotic technologies for recovery and rehabilitative treating. Several complex lower limb exoskeletons (EXO) are commercially available, and others are in the prototype stage. STAND-ALONE proposes a paradigm change in rehabilitation and assistance of patients with SCI for optimizing human-machine interactions. STAND-ALONE aims to generate new knowledge on the multisensory modulation of motor bodily experiences, and the impact of adopting an embodied approach when using robotic legs in cases of brain-body disconnection. Enriching bodily perceptions in patients with SCI call for intensive sensorimotor learning, and STAND-ALONE provides an important scientific platform to study neural plasticity. The project addresses some crucial aspects of the consolidation of learning and memory during sleep in shaping/reshaping new learning, contributing to basic research on sleep functions and potentially maximizing the success of neurorehabilitation via EXO prototypes. SCI patients can thus benefit in two scenarios: (i) rehabilitation in the sub-acute phase, by maximizing the recovery of, e.g., locomotion and associated functions; (ii) assistance in the chronic phase, by maximizing patient independence. Based on various approaches ranging from multisensory methods and actigraphy as a measure of wake-sleep activity, a new communication form between EXOs and SCIs will be investigated and developed.
Aims 1: Study sleep changes that are strictly linked to modifications related to the use of EXO, and examine how these measures predict the extent of rehabilitation.
Aims 2: Develop new methods for enriching bodily perceptions in patients with an SCI, thus inducing strong senses of identification and agency that are crucial for making the inclusion of a robotic EXO much more flexible and effective.
Expected outcomes
The objective of the ramp-up phase will be to (a) identify the requirements for tool embodiment, including in situations of brain-body disconnection; (b) develop new methods for enriching bodily perceptions in patients with SCI, thus inducing a strong sense of identification and agency that are crucial to obtaining and optimizing the control over wearable exoskeletons; (c) clarify if a specific prosthetic learning directly affect sleep activity in humans; (d) add an important evaluation, based on the analysis of pain-related signals, to the standard procedures, making the inclusion of new tools much more flexible and effective than before; (e) gather, or if necessary, acquire, unique theory-constraining data and neural architectures for modelers to use as benchmarks; (f) understand how body maps in the brains of people with disabilities change to include assistive tools, for example, by compensating for bodily changes, such as the loss of a limb, by adjusting the internal body map; (g) translate these neural architectures into a cognitive architecture for embodiment and sense of agency of a salient tool; and (i) disseminate the key findings to relevant stakeholders, resulting in enhanced safety and functionality of wearable exoskeletons in neuro-rehabilitation centers.