Lower Extremity Motor System Neuroprostheses

Abstract Depending on the extent of neuromuscular deficits, interventions to improve or restore upright mobility to persons paralyzed from central nervous system (CNS) disorders can include bracing, neuroprostheses employing surface or implanted neural stimulation, motorized exoskeletons, and hybrid neuroprostheses combining neural stimulation with passive or actively controlled orthotics. Neuroprosthetic interventions can often replace, augment, or surpass the function of conventional bracing and range from simple one- or two-channel systems to address focal deficits at a single joint, such as foot drop, to surgically implanted technologies that interface directly with the peripheral motor nerves to control the actions of multiple joints and muscles. This chapter reviews the current status and future development of these options, with a particular focus on the outcomes of neuroprostheses for standing, stepping, and seated trunk control and balance after spinal cord injury (SCI), stroke, or multiple sclerosis (MS), as well as new options for exercise and recreation in the community.