The Combined Use of Non-Invasive Neurostimulation with Interactive Digital Technologies in Spinal Cord Injury Rehabilitation: A Scoping Review.

OBJECTIVE

To map the empirical evidence regarding the combined use of non-invasive neurostimulation with interactive digital technologies in spinal cord injury rehabilitation.

DESIGN

Scoping review.

METHODS

Seven databases facilitated a systematic, 3-block search. Additional searches were performed in Google Scholar, PEDro, and via forward and backward snowballing. Studies were required to report original, clinical data from individuals with spinal cord injury participating in interventions that combine non-invasive neurostimulation with interactive digital technologies. Screening and data extraction were performed by 2 independent reviewers according to pre-specified criteria.

RESULTS

A total of 494 unique records were identified via the database searches, in addition to the 34 unique records identified via additional searches. Twelve studies met the eligibility criteria. Eleven studies delivered peripheral neurostimulation (i.e., neuromuscular/functional electrical stimulation), and 1 study delivered spinal-directed neurostimulation (i.e., transcutaneous spinal cord stimulation). Interactive digital technologies ranged from manual interfaces controlling 2D avatars to immersive, autonomous closed-loop feedback systems.

CONCLUSION

The accumulated evidence suggests that combining non-invasive neurostimulation with interactive digital technologies may enhance task-specific motor recovery and engagement in spinal cord injury rehabilitation. However, the research area is characterized by a low evidentiary standard, prompting a need for higher-quality studies to establish long-term clinical viability.