The challenge of neuropathic pain in Spinal Cord Injuries: the advances of exoskeleton use.

Spinal cord injuries (SCI) include alteration of the somatosensory system and development of chronic and neuropathic pain. Although various treatment are available, pain is refractory in many people with SCIs since it appears to be related to somatosensory cortices changes. The need for better access to effective non-invasive treatment options to alleviate pain makes the effect of powered exosckeletons on pain of particular interest. Since training with an exoskeleton has been found to affect pain perception and the intensity of neuropathic pain deafferented body parts. Twelve patients with complete (n= 5) and incomplete (n= 8) traumatic SCI in a chronic pathology phase participated in a weekly two-hour training with the exoskeleton. We analyzed the variation of Tactile Threshold (TT) and pain intensity, collecting data both before the beginning of the training protocol and after nine training session to assess long-term changes. TT was detected through a computerized pressure argomenterò, while pain intensity was measured by a Numerical Rating Scale (NRS). We observed a significant reduction in the TT and pain intensity after the training. Specifically, we found tactile perception to have a strong improvement in the upper part of the leg but not in the lower. These results sustain the idea of neuropatico pain as a consequence of maladaptive plasticity. Indeed, the prolonged use of the exoskeleton would allow the stimulation of spared sensitive fibers and the upload of the altered body image. This would re-estabilish a functional cortical organization, particularly for the upper part of the legs, which encounter major changes from the wheelchair to the exoskeleton. Moder assistive Wearable Robots are more flexible and powerful than traditional rehabilitation devices; this could be helpful in he clinical challenge of user-centered neurprosthetic technologies, which is a key element for natural learning. These potential aspects should also be used to improve chronic complications of SCI, such as pain.