Combined cervical transcutaneous with lumbosacral epidural stimulation improves voluntary control of stepping movements in spinal cord injured individuals

This study explores a novel approach to improve walking in individuals with spinal cord injury by combining two types of spinal cord stimulation: transcutaneous (applied through the skin) and epidural (applied via an implanted device). The researchers hypothesized that this combined stimulation could enhance the communication between the brain and spinal cord, leading to better control of leg movements. The study involved four participants who already had an epidural stimulator implanted in their lower back. The researchers then added transcutaneous stimulation at the neck and measured muscle activity and leg movements during attempted stepping, both with and without body weight support. The results suggest that the combined stimulation approach can improve the range of motion, coordination, and muscle output during stepping compared to epidural stimulation alone. This indicates that stimulating the spinal cord at multiple points may be a promising strategy for improving motor function after spinal cord injury.

• 1
  Cervical transcutaneous stimulation (scTS) suppressed the amplitude of motor evoked potentials induced by lumbosacral epidural stimulation (scES) in most lower-extremity muscles.
• 2
  The combination of scES + scTS generally generated a greater EMG amplitude in the extensors and improved coordination of flexors and extensors during intentional stepping in a gravity neutral device.
• 3
  On a treadmill with body weight support, individuals with prior step training showed less variability in EMG activity and improved coordination when both scES and scTS were applied.