Sharif Salman, Ali Syed Maroof
Department of Neurosurgery, Liaquat National Hospital and Medical College, Karachi, Pakistan.
Department of Neurosurgery, Liaquat National Hospital and Medical College, Karachi, Pakistan.
World Neurosurg. 2020 Aug;140:602-613. doi: 10.1016/j.wneu.2020.05.131. Epub 2020 May 21.
Spinal cord injury (SCI) has no cure and individuals with SCI become dependent on others for life. After injury, the signals below the lesion are disrupted, but the brain still produces motor commands. Researchers have bypassed this obstacle, which has given rise to the brain-machine interface (BMI). BMI devices are implanted in the brain or spinal cord, where they decode and send signals beyond the injured segment. Experiments were initially conducted on animals, with favorable results. BMIs are classified according to their type, function, signal generation, and so on. Because of invasiveness, their long-term use is questionable, because of infections and complications. The use of an implantable epidural array in patients with chronic SCI showed that participants were able to walk with the help of a stimulator, and after months of training, they were able to walk with the stimulator turned off. Another innovation is a robotic suit for paraplegics and tetraplegics that supports the movement of limbs. The research on stem cells has not shown favorable results. In future, one of these cutting-edge technologies will prevail over the other, but BMI seems to have the upper hand. The future of BMI with fusion of robotics and artificial intelligence is promising for patients with chronic SCI. These modern devices need to be less invasive, biocompatible, easily programmable, portable, and cost-effective. After these hurdles are overcome, the devices may become the mainstay of potential rehabilitation therapy for partial recovery. The time may come when all patients with severe SCI are told "You will walk again."
脊髓损伤(SCI)无法治愈,脊髓损伤患者一生都依赖他人。受伤后,损伤部位以下的信号被中断,但大脑仍会产生运动指令。研究人员绕过了这一障碍,从而催生了脑机接口(BMI)。BMI设备被植入大脑或脊髓,在那里它们解码并发送信号越过受伤节段。实验最初是在动物身上进行的,结果良好。BMI根据其类型、功能、信号产生等进行分类。由于具有侵入性,其长期使用存在疑问,因为会出现感染和并发症。在慢性脊髓损伤患者中使用可植入硬膜外阵列表明,参与者能够在刺激器的帮助下行走,经过数月训练后,他们能够在关闭刺激器的情况下行走。另一项创新是一种为截瘫和四肢瘫痪患者设计的机器人套装,可辅助肢体运动。干细胞研究尚未取得良好成果。未来,这些前沿技术中的某一项将胜过其他技术,但BMI似乎占据上风。融合机器人技术和人工智能的BMI未来对于慢性脊髓损伤患者很有前景。这些现代设备需要具有更小的侵入性、生物相容性、易于编程、便于携带且成本效益高。克服这些障碍后,这些设备可能会成为部分恢复的潜在康复治疗的支柱。也许有一天,所有严重脊髓损伤患者都会被告知:“你将再次行走。”