Spinal cord injury: present and future therapeutic devices and prostheses.

A range of passive and active devices are under development or are already in clinical use to partially restore function after spinal cord injury (SCI). Prosthetic devices to promote host tissue regeneration and plasticity and reconnection are under development, comprising bioengineered bridging materials free of cells. Alternatively, artificial electrical stimulation and robotic bridges may be used, which is our focus here. A range of neuroprostheses interfacing either with CNS or peripheral nervous system both above and below the lesion are under investigation and are at different stages of development or translation to the clinic. In addition, there are orthotic and robotic devices which are being developed and tested in the laboratory and clinic that can provide mechanical assistance, training or substitution after SCI. The range of different approaches used draw on many different aspects of our current but limited understanding of neural regeneration and plasticity, and spinal cord function and interactions with the cortex. The best therapeutic practice will ultimately likely depend on combinations of these approaches and technologies and on balancing the combined effects of these on the biological mechanisms and their interactions after injury. An increased understanding of plasticity of brain and spinal cord, and of the behavior of innate modular mechanisms in intact and injured systems, will likely assist in future developments. We review the range of device designs under development and in use, the basic understanding of spinal cord organization and plasticity, the problems and design issues in device interactions with the nervous system, and the possible benefits of active motor devices.