Two decades of breakthroughs: charting the future of NeuroEngineering and Rehabilitation

Abstract

The Journal of NeuroEngineering and Rehabilitation (JNER) has become a major actor for the dissemination of knowledge in the scientific community, bridging the gaps between innovative neuroengineering and rehabilitation. Major fields of innovations have emerged these last 25 years, such as machine learning and the ongoing AI revolution, wearable technologies, human machine interfaces, robotics, advanced prosthetics, functional electrical stimulation and various neuromodulation techniques. With the major burden of disorders impacting on the central/peripheral nervous system and the musculoskeletal system both in adults and in children, successful tailored neurorehabilitation has become a major objective for the research and clinical community at a world scale. JNER contributes to this challenging goal, publishing groundbreaking cutting-edge research using the open access model. The multidisciplinary approaches at the crossroads of biomedical engineering, neuroscience, physical medicine and rehabilitation make of the journal a unique growing platform welcoming breakthrough discoveries to reshape the field and restore function.

As the Journal of NeuroEngineering and Rehabilitation (JNER) enters its third decade, it stands as a testament to the transformative progress in the field of rehabilitation. From its inception in 2004 as an open access “experiment” at the intersection of biomedical engineering, neuroscience, and physical medicine and rehabilitation, JNER has evolved into the leading journal in the field. This success is not coincidental but rather a reflection of the fact that advances in rehabilitation medicine have been driven by discoveries in the field of neuroscience and have been enabled by the development of new technologies [1].

For example, neuroscience has significantly advanced our understanding of neuroplasticity, which has guided the design of targeted interventions for motor and cognitive recovery [2]. Neuromodulation techniques have demonstrated the ability to enhance neuroplasticity, achieving clinically meaningful improvements and impacting on daily life activities. Concurrently, advances in engineering fields have provided new tools (e.g., robotics, virtual and augmented reality, wearable sensors) to maximize motivation to engage in rehabilitation as well as intervention dosage (key “ingredients” to regain function), have expanded the range of patient-technology interactions (e.g., brain-computer and peripheral nerve interfaces), and have enabled both restoration and replacement of function through technologies like functional electrical stimulation and robotic prostheses [3–4]. Meanwhile, clinical researchers have emphasized the need for improved methods to measure intervention outcomes, tailored approaches to personalize treatments, and user-friendly technologies that integrate seamlessly into clinical practice and the real world.

During JNER’s first decade, manuscripts predominantly explored the feasibility of emerging technologies, often through small-scale studies designed to establish proof of concept and refine interventions. This foundational work laid the groundwork for the second decade, which saw an increasing number of large-scale clinical trials evaluating sophisticated and often commercially available technologies, as well as an explosion of development of new wearable technologies, such as robotic exoskeletons for gait rehabilitation and augmentation, and advanced upper-limb prostheses [5,6,7]. Many studies revealed substantial variability in patients’ responsiveness to rehabilitation interventions, sparking significant interest in developing systematic approaches for personalized treatments, a field now referred to as precision rehabilitation, which focuses on tailoring interventions to individual needs based on biomarkers and advanced analytics. In addition, the modest effect sizes achieved with both conventional and robot-facilitated training has spurred the development of complementary technologies to enhance neuroplasticity during training. Finally, there is growing recognition that integrating the lived experiences of individuals with disabilities is essential both for asking the right questions and for developing practical, impactful solutions [8].

Looking ahead, recent advances in our understanding of the biology of rehabilitation and the development of technologies to track it (e.g., point-of-care technology to monitor biomarkers) are likely to be key factors in the future of rehabilitation medicine. The ongoing revolution in artificial intelligence (AI) has the potential to generate novel insights from the vast datasets accumulating in open data repositories as well from each patient’s own medical records and wearable sensor history of usage, paving the way for precision rehabilitation approaches that are adaptive, and data driven [9,10,11]. Significant progress is anticipated in the design of patient-specific interventions, tracking clinical endpoints to assess effectiveness, and dynamically adjusting strategies based on AI-driven predictions of long-term outcomes. Further, neuromodulation will become an integral part of rehabilitation technologies, complementing the other methods applied to promote plasticity and recovery for rare or more common disorders affecting the central or peripheral nervous system such as stroke, spinal cord injuries, peripheral nerve disorders or myopathic diseases.

Building on its leadership in publishing groundbreaking research in format that is freely accessible worldwide to persons with a disability, clinicians, and engineers alike, JNER is poised to drive a new era in rehabilitation medicine—one that is more precise, adaptive, and effective. The next decade will undoubtedly build on this foundation, pushing the boundaries of what is possible in restoring function and improving quality of life via novel rehabilitation technology interventions.