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Epidural and Transcutaneous Spinal Cord Stimulation Strategies for Motor Recovery After Spinal Cord Injury

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Neuroprosthetics and Brain-Computer Interfaces in Spinal Cord Injury

Abstract

Recent studies combining spinal cord stimulation (SCS) with intense neurorehabilitation training have demonstrated unprecedented improvements of motor function in individuals with chronic, severe spinal cord injury (SCI). Invasive and non-invasive methods for SCS have emerged, all with the goal to augment functional activity of spared spinal circuits distal to the lesion. Here we provide background information on the development and function of these SCS techniques and give a detailed and critical view on contemporary studies that have shaped a new era of neurorehabilitation in SCI. Epidural lumbar SCS using conventional technology has enabled intentional movement of paralyzed legs, standing, and overground stepping with training when SCS was applied and participants actively contributed. A novel strategy of spatiotemporal epidural SCS interfaced with leg-kinematic feedback has induced unparalleled recovery of motor function lasting even without stimulation. Skin-surface electrode based methods for non-invasive lumbar SCS, with conventional or Russian currents, have produced qualitatively similar improvements like those seen with epidural stimulation. Early studies of cervical SCS in tetraplegic patients found augmented upper extremity motor function and increased grip strength. Together, these neuromodulation therapies provide various perspectives for recovery of motor function in chronic patients in whom limited improvement is expected with standard-of-care rehabilitative options.

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Authors and Affiliations

  1. Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria

    Karen Minassian, Ivan Perret & Ursula S. Hofstoetter

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  1. Karen Minassian
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  2. Ivan Perret
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  3. Ursula S. Hofstoetter
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Correspondence to Karen Minassian .

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Editors and Affiliations

  1. Institute of Neural Engineering, BCI Lab, Graz University of Technology, Graz, Austria

    Gernot Müller-Putz

  2. Heidelberg University Hospital – Spinal Cord Injury Center, Heidelberg, Germany

    Rüdiger Rupp

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Minassian, K., Perret, I., Hofstoetter, U.S. (2021). Epidural and Transcutaneous Spinal Cord Stimulation Strategies for Motor Recovery After Spinal Cord Injury. In: Müller-Putz, G., Rupp, R. (eds) Neuroprosthetics and Brain-Computer Interfaces in Spinal Cord Injury. Springer, Cham. https://doi.org/10.1007/978-3-030-68545-4_7

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