Transcutaneous spinal cord stimulation combined with robotic‑assisted body weight‑supported treadmill training enhances motor score and gait recovery in incomplete spinal cord injury: a double‑blind randomized controlled clinical trial

Journal of NeuroEngineering and Rehabilitation, 2025 · DOI: https://doi.org/10.1186/s12984-025-01545-8 · Published: January 7, 2025

Spinal Cord Injury Neurology Neurorehabilitation

Simple Explanation

This study investigates whether combining transcutaneous spinal cord stimulation (tSCS) with robotic-assisted gait training (RAGT) improves lower limb strength and walking ability in people with incomplete spinal cord injury (iSCI). Participants were randomly assigned to receive either real tSCS or a sham (placebo) tSCS while undergoing RAGT. Researchers then measured their lower limb strength and walking function. The study found that the group receiving real tSCS showed greater improvements in motor score and gait recovery at a 1-month follow-up compared to the sham group, suggesting that tSCS may enhance the benefits of RAGT for iSCI rehabilitation.

Study Duration

8 Weeks

Participants

27 subacute iSCI participants

Evidence Level

Level 1, Double-blind Randomized Controlled Clinical Trial

Key Findings

1
The tSCS group showed greater effects than the sham-tSCS group for LEMS (3.4 points; p = 0.033), 10MWT (37.5 s; p = 0.030), TUG (47.7 s; p = 0.009), and WISCI-II (3.4 points; p = 0.023) at the 1-month follow-up compared to baseline.
2
The percentage of subjects who were able to walk 10 m at the follow-up was greater in the tSCS group (85.7%) compared to the sham group (43.1%; p = 0.029).
3
A significant difference (p = 0.049) was observed in the comparison of the effects in the amplitude of the rectus femoris MEPs of tSCS group (− 0.97 mV) and the sham group (− 3.39 mV) at follow-up.

Research Summary

This study evaluated the effectiveness of transcutaneous spinal cord stimulation (tSCS) combined with robotic-assisted gait training (RAGT) on lower limb muscle strength and walking function in incomplete spinal cord injury (iSCI) participants. The outcomes of this study suggest that the combination of standard Lokomat training with tSCS for 20 sessions was effective for LEMS and gait recovery in subacute iSCI participants after 1 month of follow-up. The application of 20 sessions of tSCS over T11-T12 vertebrae combined with RAGT showed a greater improvement in lower limb motor score and gait recovery in subacute iSCI subjects at 1 month follow-up than the application of sham stimulation, without affecting hypertonia.

Practical Implications

Enhanced Rehabilitation

tSCS can be integrated into existing rehabilitation programs to improve motor outcomes in iSCI patients.

Clinical Applicability

The study demonstrates the feasibility and safety of tSCS in a clinical setting using readily available devices.

Long-Term Gains

The positive effects observed at the 1-month follow-up suggest potential for sustained improvements in motor function.

Study Limitations

1
Small sample size (n = 27), which could underestimate potentials effects that have not reached statistical significance
2
Differences at baseline in % body weight support and sex, and a higher proportion of AIS D participants in the active group compared to the sham group
3
The stimulation intensity of the current applied during active tSCS was not objectively determined.

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