Merging neural stimulation and exoskeletons to enhance sensorimotor hand functions after brain or spinal cord injury

Sophisticated hand movements are essential for daily activities, but central neurological impairments often compromise them. Since full recovery through conventional physiotherapy is rare, assistance is crucial. While neural implants show promise, clinical use remains distant, urging immediate assistive alternatives. Current exoskeletons and neurostimulation garments lack sufficient motor support and sensory feedback, limiting dexterity. We developed a neurorobotic system combining portable exoskeletons with targeted neurostimulation via custom-made e-sleeve and tested it in 14 individuals with central neural injuries. We provide evidence of restored finger mobility and tactile perception, even in patients with clinically complete sensory loss, by recruiting residual peripheral pathways. Eight participants completed functional assessments, in which they exploited neurostimulation to improve grasp precision and enhance strength. This enabled manipulation of fragile and cumbersome objects, essential for everyday activities. Personalized assistive technologies have clinical potential to promote independence and support the reintegration of people with neurological impairments into society.