The Integrated Neurological Change Score (INCS) combines changes in sensory and motor subscores from the International Standards for Spinal Cord Injury Classification (ISNCSCI) into a composite measure. We evaluated the INCS sensitivity to therapeutic outcomes, robustness against ceiling effects, and association to functional improvement in patients with acute cervical spinal cord injury (SCI). To this end, we conducted a retrospective analysis of data from the Nogo Inhibition in Spinal Cord Injury (NISCI) clinical trial alongside a matched cohort from the European Multicenter Study about Spinal Cord Injury (EMSCI). The NISCI trial assessed the safety and efficacy of the anti-Nogo-A antibody (NG-101) in acute cervical SCI, reporting a potential therapeutic effect in motor incomplete patients. Our findings show that the sensitivity of INCS to the effect of NG-101 is comparable to that obtained employing the changes in the Upper Extremity Motor Score (the primary outcome in the NISCI trial). Moreover, the INCS is less susceptible to ceiling effects compared to measures of upper and lower extremity or total motor scores, as observed in the NISCI trial and in the matched EMSCI cohort. This robustness may facilitate the design of more inclusive clinical trials without compromising statistical power. Finally, INCS correlates strongly with functional outcomes in self-care and walking ability, outperforming ISNCSCI motor scores. In conclusion, the INCS represents a sensitive measure of neurological change corroborating the value of ISNCSCI standards for use in SCI trials.

Study design Multicentre randomised controlled trial. Setting Eight spinal cord injury (SCI) centres and 15 rehabilitation centres in Germany. Objectives To demonstrate the superiority of neuromuscular feedback therapy using an exoskeleton compared to conventional therapy in terms of improving walking ability in patients with chronic SCI. Methods A total of 180 patients with chronic complete or incomplete SCI and residual motor function in the lower extremities are to be included. Baseline examination will be carried out at the recruiting SCI centres, followed by 1:1 randomisation at the rehabilitation centre allocating patients to the control group (conventional therapy) or the intervention group (Hybrid Assistive Limb therapy). Both interventions take place to the same extent (5×/week, 60 min) over a period of 12 weeks at the rehabilitation centres. After the 12-week intervention phase, the primary (therapy response defined as relevant improvement in at least one of the following: 6 min walk test, 10 m walk test and Walking Index for Spinal Cord Injury II score) and secondary endpoints (quality of life, pain, bladder and bowel function) are recorded by blinded observers at the SCI centres or via patient app. The effects of the intervention will be evaluated in the middle and at the end of the 6-month follow-up period. Ethics and dissemination The study is approved by the ethics committee of the Medical Association of Westphalia-Lippe (register no. 2025–2014 f-S). The participants were informed about the aims and procedures of the study and gave their written consent. This protocol follows the Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) statement. The study results will be published in accordance with the Consolidated Standards of Reporting Trials (CONSORT), regardless of whether the results are positive or negative. The datasets belong to the Joint Federal Committee of Germany and are available there on request. Trial registration number DRKS 00035487.

Abstract NG101 is a recombinant antibody that neutralizes the nerve growth inhibitor Nogo-A, promoting neural repair and improving upper extremity motor function in spinal cord injury (SCI). This study evaluated spinal cord MRI biomarkers to detect treatment-related structural changes and enhance patient stratification using data from 106 participants with acute cervical SCI in the phase 2b NISCI trial. We assessed lesion volume, tissue bridges, and remote changes in cross-sectional cord area (CSA), and tract-specific myelin-sensitive magnetization transfer saturation (MTsat) over six months. Compared to placebo, NG101-treated participants exhibited faster lesion volume reduction and a slower decline of CSA and MTsat in the corticospinal tracts and dorsal columns. Crucially, multimodal stratification incorporating MRI and electrophysiological measures substantially enhanced the detection of clinical treatment effects. These findings suggest NG101 slows trauma-induced progressive macro- and microstructural degeneration or promotes fiber sprouting. Combining MRI with electrophysiology enables sensitive detection of treatment effects and efficient trial designs. ClinicalTrials.gov identifier: NCT03935321.

There are no approved interventional therapies, aside from neurorehabilitation, that enhance neurological recovery after acute traumatic spinal cord injury. A key challenge is the lack of biomarkers surpassing clinical standards for optimal stratification. We evaluated electrophysiological markers of preserved neuronal function to improve enrichment strategies over clinical measures. We hypothesized that participants with preserved electrophysiological markers would achieve greater neurological and functional recovery in response to a plasticity-inducing intervention. We conducted a retrospective stratification analysis of data from the recently completed randomized, placebo-controlled, phase 2b Nogo Inhibition in spinal cord injury (NISCI) trial (NCT03935321) investigating the efficacy of NG101, a recombinant human antibody that neutralizes the neurite outgrowth-inhibiting protein Nogo-A. Participants aged 18-70 years with acute (4-28 days) cervical spinal cord injury were eligible. At screening, all participants underwent clinical neurological examination and electrophysiological recordings (i.e. somatosensory evoked potentials). Treatment effect sizes for the recovery of upper extremity motor scores and spinal cord independence measure of self-care (6-month change) between NG101 and placebo groups were compared for stratification based on clinical versus electrophysiological criteria. Power analyses were conducted to estimate the required sample sizes needed for each method. The cohort included 116 participants (45.5 ± 16.8 years old, 74 NG101 and 41 placebo). Clinical stratification showed greater functional recovery in motor-incomplete participants treated with NG101 versus placebo [estimate 0.02 (95% confidence interval: 0.006-0.038), P = 0.007]. Electrophysiological stratification revealed greater functional recovery in participants with preserved somatosensory evoked potentials treated with NG101 versus placebo [0.04 (0.015-0.054), P < 0.001]. Effect sizes were large for electrophysiological stratification (Cohen's d = 0.94) but small for clinical stratification (Cohen's d = 0.46). Power analyses demonstrated smaller required sample sizes for electrophysiological stratification (required n = 32) versus clinical stratification (required n = 120). This study shows the value of electrophysiology in comparison to clinical measures for biomarker-driven enrichment and improved power in acute spinal cord injury trials. We emphasize the importance of functionally spared neuronal pathways in promoting recovery in response to plasticity-inducing interventions, such as anti-Nogo-A antibodies.

Clinical prospective study. To histologically examine puncture biopsies of early neurogenic heterotopic ossification (NHO) in spinal cord injured individuals. University of Bochum, Germany. After acute spinal trauma, participants underwent a sonographic examination of the hip joints and a routine laboratory examination. Magnetic resonance imaging (MRI) or computed tomography (CT) of the pelvis was performed if there were clinical and laboratory signs of NHO and sonographic evidence of edema and/or calcifications in the tissue around the hip joint. If NHO were detected, tissue was obtained and preserved for histological examination from the involved tissue around the hip joint affected by NHO and from an unaffected calf as control. Nine participants with a complete spinal cord lesion American Spinal Injury Association Impairment Scale (AIS) grade A and evidence of an acute NHO in the hip joint muscles were recruited for the study. In all sonographic examinations of the hip joint, edematous changes could be detected. In one case, calcifications were detected sonographically. In MRI/CT in six participants, ossification could already be detected. All histological specimens from the NHO-affected gluteal region showed varying degrees of tissue deformation. The unaffected reference samples showed regular muscular structure microscopically. It was possible to show and compare histological changes in NHO-affected tissue with MRI/CT imaging, depending on the stage of NHO. DRKS, DRKS00034049. Registered 12 April 2024 - Retrospectively registered, https://www.drks.de/DRKS00034049 .

Noncontinuous multilevel fractures (NMF) are complex injuries characterized by spinal fractures at non-adjacent levels, with reported incidence ranging from 1.6 to 17.7

Background Spinal cord injury results in permanent neurological impairment and disability due to the absence of spontaneous regeneration. NG101, a recombinant human antibody, neutralises the neurite growth-inhibiting protein Nogo-A, promoting neural repair and motor recovery in animal models of spinal cord injury. We aimed to evaluate the efficacy of intrathecal NG101 on recovery in patients with acute cervical traumatic spinal cord injury. Methods This randomised, double-blind, placebo-controlled phase 2b clinical trial was done at 13 hospitals in the Czech Republic, Germany, Spain, and Switzerland. Patients aged 18-70 years with acute, complete or incomplete cervical spinal cord injury (neurological level of injury C1-C8) within 4-28 days of injury were eligible for inclusion. Participants were initially randomly assigned 1:1 to intrathecal treatment with 45 mg NG101 or placebo (phosphate- buffered saline); 18 months into the study, the ratio was adjusted to 3:1 to achieve a final distribution of 2:1 to improve enrolment and drug exposure. Randomisation was done using a centralised, computer-based randomisation system and was stratified according to nine distinct outcome categories with a validated upper extremity motor score (UEMS) prediction model based on clinical parameters at screening. Six intrathecal injections were administered every 5 days over 4 weeks, starting within 28 days of injury. Investigators, study personnel, and study participants were masked to treatment allocation. The primary outcome was change in UEMS at 6 months, analysed alongside safety in the full analysis set. The completed trial was registered at ClinicalTrials.gov, NCT03935321. Findings From May 20, 2019, to July 20, 2022, 463 patients with acute traumatic cervical spinal cord injury were screened, 334 were deemed ineligible and excluded, and 129 were randomly assigned to an intervention (80 patients in the NG101 group and 49 in the placebo group). The full analysis set comprised 78 patients from the NG101 group and 48 patients from the placebo group. 107 (85%) patients were male and 19 (15%) patients were female, with a median age of 515 years (IQR 300-600). Across all patients, the primary endpoint showed no significant difference between groups (with UEMS change at 6 months 137 [95% CI -144 to 418]; placebo group mean 1920 [SD 1178] at baseline and 3091 [SD 1549] at day 168; NG101 group mean 1823 [SD 1514] at baseline and 3131 [1954] at day 168). Treatment-related adverse events were similar between groups (nine in the NG101 group and six in the placebo group). 25 severe adverse events were reported: 18 in 11 (14%) patients in the NG101 group and seven in six (13%) patients in the placebo group. Although no treatment-related fatalities were reported in the NG101 group, one fatality not related to treatment occurred in the placebo group. Infections were the most common adverse event affecting 44 (92%) patients in the placebo group and 65 (83%) patients in the NG101 group. Interpretation NG101 did not improve UEMS in patients with acute spinal cord injury. Post-hoc subgroup analyses assessing UEMS and Spinal Cord Independence Measure of self-care in patients with motor-incomplete injury indicated potential beneficial effects that require investigation in future studies.

Background/Objectives: The growing incidence of acetabular revisions has highlighted the importance of achieving reliable fixation to the remaining bone. Proximal transiliac fixation (TIF) of pelvic implants is becoming an increasingly common approach for managing extensive bone defects. This study seeks to provide guidance on TIF implantation by analyzing the optimal screw placement in partial pelvic replacements for acetabular defects. Methods: Between 2014 and 2024, a cohort of 96 consecutive patients (65 females and 31 males) who underwent customized partial pelvic replacement (PPR) with transiliac fixation (TIF) were examined. The angle and entry point of the ideal TIF were determined using preoperative three-dimensional planning and compared with potential influencing factors. Results: All PPRs were successfully implanted, with an average TIF length of 77 mm. The mean anteroposterior angle for TIF was 18° medially and 27° dorsally. Conclusions: Analysis of the entry point showed concentration around the second radius and between the eleven o’clock and one o’clock positions. The AP angle is notably affected by gender and height. Considering the precision of human judgment, a recommendation for TIF placement would be 20° medial and 30° dorsal deviation, with the entry point around the twelve o’clock position and the second ring from the center of the cup.

Spinal cord injuries almost always lead to irreversible damage with a variety of paralysis symptoms. As such, an acute traumatic spinal cord injury is an absolute emergency from the time of rescue and is always accompanied by drastic changes for those affected. Rehabilitation begins with pre-clinical care and is carried out by a multidisciplinary and multi-professional team.

Background and study aims Colonoscopies in patients with spinal cord injury (SCI) frequently remain incomplete. This study aimed to evaluate the feasibility and impact of water exchange colonoscopy (WE) in patients with SCI. Patients and methods Three matched groups, each of 31 patients (WE in SCI patients [WE-SCI]) and in the general population (WE-GP), carbon dioxide-based colonoscopy in SCI patients (CO 2 -SCI)) were analyzed retrospectively. Results Intubation of the cecum and the terminal ileum was achieved in every case in both WE groups. The intubations among the CO 2 -SCI patients succeeded in 29 cases (93.5 %, ns) and 20 cases (64.5 %, P <0.001), respectively. The cecal insertion time (23:17 ± 10:17 min vs. 22:12 ± 16:48 min) and bowel preparation during cecal insertion did not differ between WE-SCI groups. Insertion in the general population was faster (13:38 ± 07:00 min, P <.001) and cleanliness was better. Both WE-SCI groups showed significantly better cleansing results during drawback; the improvement in cleanliness was highest in the WE-SCI (based on the five-step scale 1.4 ± 0.8 vs. 0.8 ± 0.8, P = 0.001). Conclusions The WE in SCI patients is feasible and safe and has the potential to improve the quality of colonoscopies substantially.

STUDY DESIGN:Observational study. OBJECTIVES:To evaluate the perceptions of patients requiring a tracheostomy tube and to identify possible different perceptions in critically ill patients with tracheostomy tubes who have acute (ASCI) or chronic spinal cord injuries (CSCI). SETTING:Medical and surgical intensive care units (ICU) and intermediate care unit of the BG University Hospital Bergmannsheil Bochum, Germany. METHODS:Patients who met the inclusion criteria completed a 25-item questionnaire on two consecutive days regarding their experiences and perceptions in breathing, coughing, pain, speaking, swallowing, and comfort of the tracheostomy tube. RESULTS:A total of 51 persons with ASCI (n = 31) and CSCI (n = 20) were included with a mean age of 53 years. Individuals with ASCI reported significantly more frequent pain and swallowing problems as compared to individuals with CSCI (p ≤ 0.014) at initial assessment. There were no differences between ASCI and CSCI reported with respect to speaking and overall comfort. CONCLUSIONS:It is necessary to regularly assess the perceptions of critically ill patients with tracheostomy tubes with ASCI or CSCI in the daily ICU care routine. We were able to assess these perceptions in different categories. For the future, evaluating the perception of individuals with SCI and a tracheostomy should be implemented to their daily routine care. TRIAL REGISTRATION:DRKS00022073.

Rückenmarkverletzungen führen fast ausnahmslos zu irreversiblen Schädigungen mit vielfältigen Lähmungserscheinungen. Insofern ist eine akute traumatische Rückenmarkverletzung ab dem Zeitpunkt der Bergung ein absoluter Notfall und geht für die Betroffenen immer mit drastischen Veränderungen einher. Die Rehabilitation beginnt bei der präklinischen Versorgung und wird im multidisziplinären und multiprofessionellen Team durchgeführt.

INTRODUCTION:There is not much data on traumatic spinal cord injuries sustained during sports in Germany. This study aims to present the frequency of traumatic spinal cord injuries with neurological involvement within various sports over the past 22 years. METHODS:This study is a retrospective evaluation of traumatic spinal cord injuries (tSCI) in sports sustained in the past 22 years. The study was performed by a German level 1 trauma centre with a department for spinal cord injuries. The files of inpatients treated in the years 1998 to 2020 were evaluated with regard to patients' histories and traumatic spinal cord injuries. In addition, injury location and gender distribution were recorded. RESULTS:A total of 1630 patients with traumatic spinal cord injuries with neurological involvement were recorded. Of the 1630 patients, N=116 (7.1%) had had sports accidents. The age of this subpopulation was significantly younger at 41 years (p=0.05) than the age of the total group of tSCI at 50 years. A more detailed analysis of the sports injuries showed that in descending order equestrian sports (N=22), winter (N=18), air (N=16), motor sports (N=16) and cycling (N=15) were the most common causal factors for these particularly serious spinal injuries. As regards the distribution of the location of the spinal cord injury with a view to the type of sports practiced, a significant result was shown in aerial sports, with patients from this group mainly having had lumbar spine injuries (p <0.01), and in diving with cervical spine injuries (p=0). Gender distribution in the individual sports shows a significant difference in equestrian sports (male < female, p <0.01) as well as a significant difference in air sports (male > female, p = 0.05) and cycling (male > female, p=0.07). CONCLUSION:In summary, equestrian sports is the most common cause of spinal cord injuries with neurological involvement in the sports sector with a higher proportion of female participants, although the proportion of female patients is smaller compared with male patients in the section of traumatic spinal cord injuries. Winter (N=18), air (N=16), motor sports (N=15) and cycling (N=15) come next in descending order.Patients with traumatic spinal cord injuries caused by sports accidents are significantly younger than the entirety of patients with traumatic spinal cord injuries.

OBJECTIVE:Recent studies reveal that Hybrid Assistive Limb (HAL®) locomotion training in paraplegic patients suffering from chronic spinal cord injury (SCI) induces improvements in functional and ambulatory mobility. The purpose of this study was to determine the safety, feasibility, and functional effectiveness of HAL® locomotion training in the initial rehabilitation of acute SCI patients. This clinical trial represents the first systematic intervention worldwide for acute SCI patients using a neurologically controlled exoskeleton.DESIGN:Single center, prospective study.SETTING:BG University Hospital Bergmannsheil, Bochum, Germany.PARTICIPANTS:Fifty acute SCI patients (14 women, 36 men).INTERVENTIONS:All participants received a daily (5 times/week) HAL® exoskeleton supported training for 12 weeks (mean amount of training sessions 60.4 ± 30.08).OUTCOME MEASURES:Functional outcome for overground walking was monitored using the 10-m-walk test (10 MWT) combined with the WISCI II score, 6-minute-walk test (6 MWT) and the timed-up and go test (TUG test). Treadmill-related parameters (speed, distance and walking time) and the Lower Extremity Motor Score (LEMS) were recorded separately.RESULTS:Significant improvements were observed for HAL®-associated (walking time, distance and speed) and for functional outcomes (10 MWT, 6 MWT and TUG-test). WISCI-II-Score and the LEMS increased significantly compared with the status prior to training.CONCLUSION:HAL® locomotion training is feasible and safe in the rehabilitation of acute SCI patients. The HAL® exoskeleton enables the patient to perform effective treadmill training and leads to improvements in functional and ambulatory mobility. However, spontaneous recovery vs training-related effects remain unclear and findings should not be extrapolated beyond the acute in-patient rehabilitation setting.Trial registration: German Clinical Trials Register identifier: DRKS00010250..

Study design Retrospective matched case-control study including patients with spinal cord injury who presented with an anus-near pressure injury. Two groups were formed based on the presence of a diverting stoma. Objectives To evaluate the primary microbial colonisation and secondary infection of anus-near pressure injuries depending on the presence of a pre-existing diverting stoma and to investigate the effect on the wound healing. Setting University hospital with a spinal cord injury unit. Methods A total of 120 patients who had undergone surgery of an anus-near decubitus stage 3 or 4 were included in a matched-pair cohort study. Matching was realised according to age, gender, body mass index and general condition. Results The most common species in both groups was Staphylococcus spp.(45.0%). The only significantly different primary colonisation affected Escherichia coli, that was found in the stoma patients less often (18.3 and 43.3%, p < 0.01). A secondary microbial colonisation occurred in 15.8% and was equally distributed, except for Enterococcus spp. that was present in the stoma group only (6.7%, p < 0.05). The time to complete cure took longer in the stoma group (78.5 versus 57.0 days, p < 0.05) and was associated with a larger ulcer size (25 versus 16 cm 2 , p < 0.01). After correction for the ulcers’ size, there was no association to outcome parameters such as overall success, healing time or adverse events. Conclusions The presence of a diverting stoma alters the microbial flora of an anus-near decubitus slightly without impact on the healing process.

To provide a summary and overview of the use of Hybrid Assistive Limb in spinal cord injured patients over the past 10 years. A review of the literature was performed via Web of Science and PubMed using the search terms "Hybrid assistive limb" or "HAL" or "wearable robot" or "exoskeleton" and "SCI" or "spinal cord injury" by two of the authors. Relevant articles were then studied in full text. Our review of the literature found 21 articles that met the inclusion criteria of this narrative review including 344 participants. Articles were sorted into two general categories: (1) clinical trials, and (2) single-case or two-case reports. The vast majority of patients improved functionally, showing increased walking distances, walking speeds, and endurance. In addition, a variety of other advances were described, such as temporary decrease in spasticity, improvement in bladder and bowel management, pain reduction, and change in muscle activity. Even though there is no uniform application of HAL training in people living with SCI the current study situation suggests that many patients could benefit from this innovative training within their means.

The development of increasingly more complex computer and electromotor technologies enables the increasing use and expansion of robot-assisted systems in trauma surgery rehabilitation; however, the currently available devices are rarely comprehensively applied but are often used within pilot projects and studies. Different technological approaches, such as exoskeletal systems, functional electrical stimulation, soft robotics, neurorobotics and brain-machine interfaces are used and combined to read and process the communication between, e.g., residual musculature or brain waves, to transfer them to the executing device and to enable the desired execution.Currently, the greatest amount of evidence exists for the use of exoskeletal systems with different modes of action in the context of gait and stance rehabilitation in paraplegic patients; however, their use also plays a role in the rehabilitation of fractures close to the hip joint and endoprosthetic care. So-called single joint systems are also being tested in the rehabilitation of functionally impaired extremities, e.g., after knee prosthesis implantation. At this point, however, the current data situation is still too limited to be able to make a clear statement about the use of these technologies in the trauma surgery "core business " of rehabilitation after fractures and other joint injuries.For rehabilitation after limb amputation, in addition to the further development of myoelectric prostheses, the current development of "sentient " prostheses is of great interest. The use of 3D printing also plays a role in the production of individualized devices.Due to the current progress of artificial intelligence in all fields, ground-breaking further developments and widespread application possibilities in the rehabilitation of trauma patients are to be expected.

Zusammenfassung Einführung Aktuell gibt es nur wenige Daten zu traumatischen Wirbelsäulenverletzungen mit neurologischer Beteiligung im Hinblick auf Sportunfälle in Deutschland. Ziel dieser Studie ist es, die Häufigkeit traumatischer Rückenmarksverletzungen, verursacht durch verschiedene Sportunfälle, aus den letzten 22 Jahren darzustellen. Methoden Die vorliegende Studie ist eine retrospektive Auswertung traumatischer Rückenmarksverletzungen (tSCI) bei sportlicher Aktivität eines Level-1-Traumazentrums mit Abteilung zur Behandlung von Rückenmarksverletzungen in Deutschland der letzten 22 Jahre.Die Akten der in den Jahren 1998–2020 behandelten Patient*innen wurden im Hinblick auf die Anamnese untersucht und diejenigen Fälle genauer betrachtet, bei denen es sich ursächlich um Sportaktivitäten handelte. Zusätzlich wurden Art und Schwere der Verletzung sowie die Geschlechtsverteilung erfasst. Ergebnisse Insgesamt wurden 1630 Patient*innen mit traumatischen Wirbelsäulenverletzungen mit Rückenmarksbeteiligung eingeschlossen. Von diesen 1630 Patient*innen waren n=116 (7,1%) Sportunfälle. Das Alter dieser Subpopulation war mit 41 Jahren signifikant jünger (p=0,05) als die Gesamtgruppe der tSCI mit 50 Jahren. Eine detailliertere Analyse der Sportverletzungen ergab, dass in absteigender Reihenfolge Reit- (n=22), Winter- (n=18), Luft- (n=16), Motor- (n=16) und Radsport (n=15) die häufigsten ursächlichen Faktoren für diese besonders schweren Wirbelsäulenverletzungen waren. Bei der Verteilung der Lokalisation der Wirbelsäulenverletzung in Bezug auf die Art des ausgeübten Sports zeigte sich im Luftsport ein signifikantes Ergebnis, wonach sich die Patient*innen dieser Gruppe hauptsächlich Verletzungen der Lendenwirbelsäule zuzogen (p<0,01). Die Geschlechterverteilung der einzelnen Sportarten zeigt im Pferdesport (männlich < weiblich, p < 0,01), im Luftsport (männlich > weiblich, p = 0,05) und im Radsport (männlich > weiblich, p = 0,07) signifikante Ergebnisse. Fazit Zusammengefasst ist vor allem Reitsport beim weiblichen Geschlecht in der Kategorie Sportverletzungen am häufigsten ursächlich für traumatische Wirbelsäulenverletzungen, obwohl Frauen insgesamt einen deutlich geringeren Anteil der Patient*innen mit traumatischen Wirbelsäulenverletzungen einnehmen als Männer. Ferner führen Winter- (n=18), Luft- (n=16), Motor- (n=15) und Radsport (n=15) zu häufigen traumatischen Wirbelsäulenverletzungen im Sportsektor. Patient*innen mit traumatischen Wirbelsäulenverletzungen mit spinaler Beteiligung bedingt durch Sportunfälle waren signifikant jünger als diejenigen der Gesamtheit aller traumatischer Wirbelsäulenverletzungen.

Mind-controlled wheelchairs are an intriguing assistive mobility solution applicable in complete paralysis. Despite progress in brain-machine interface (BMI) technology, its translation remains elusive. The primary objective of this study is to probe the hypothesis that BMI skill acquisition by end-users is fundamental to control a non-invasive brain-actuated intelligent wheelchair in real-world settings. We demonstrate that three tetraplegic spinal-cord injury users could be trained to operate a non-invasive, self-paced thought-controlled wheelchair and execute complex navigation tasks. However, only the two users exhibiting increasing decoding performance and feature discriminancy, significant neuroplasticity changes and improved BMI command latency, achieved high navigation performance. In addition, we show that dexterous, continuous control of robots is possible through low-degree of freedom, discrete and uncertain control channels like a motor imagery BMI, by blending human and artificial intelligence through shared-control methodologies. We posit that subject learning and shared-control are the key components paving the way for translational non-invasive BMI.