Corticomuscular Connectivity during Walking in Able Bodied and Individuals with Incomplete Spinal Cord Injury.

This exploratory study used EEG as mobile imaging method to study cortico-muscular connectivity (CMC) during walking in able-bodied individuals (AB) and individuals with spinal cord injury (iSCI), while walking with and without exoskeleton walking robot (EWR) assistance. We also explored change in CMC after intensive training using EWR assistance in iSCI. Results showed no different in CMC within the AB group during walking with and without robot assistance. However, before training the iSCI subjects showed lower CMC during walking with robot assistance. The intensive 40 hours of walking training with EWR improved the walking function in iSCI participants allowing them to walk with robot assistance set to lower assistance level. This decrease in assistance level and improvement in walking function correlated with increase in CMC, reducing the difference in CMC during walking with and without EWR assistance. The findings suggest that high level of robot assistance and low walking function in iSCI correlates with weaker connectivity between primary motor cortices and lower extremity muscles. Further research is needed to better understand the importance of intention and cortical involvement in training of walking function using EWRs. Clinical Relevance - This study provides innovative data on CMC during walking and how it changes with EWR assistance and with training. This research is important to the clinical field to provide recommendations of how training of walking function can be delivered to maximize cortical engagement and improve rehabilitation outcomes.