Abstract
Transcutaneous spinal cord stimulation (tSCS) has the potential to promote improved sensorimotor rehabilitation by modulating the circuitry of the spinal cord non-invasively. Little is currently known about how cervical or lumbar tSCS influences the excitability of spinal and corticospinal networks, or whether the synergistic effects of multi-segmental tSCS occur between remote segments of the spinal cord. The aim of this review is to describe the emergence and development of tSCS as a novel method to modulate the spinal cord, while highlighting the effectiveness of tSCS in improving sensorimotor recovery after spinal cord injury. This review underscores the ability of single-site tSCS to alter excitability across multiple segments of the spinal cord, while multiple sites of tSCS converge to facilitate spinal reflex and corticospinal networks. Finally, the potential and current limitations for engaging cervical and lumbar spinal cord networks through tSCS to enhance the effectiveness of rehabilitation interventions are discussed. Further mechanistic work is needed in order to optimize targeted rehabilitation strategies and improve clinical outcomes.
Highlights
Neuromodulation of the spinal cord by means of non-invasive transcutaneousand implanted epidural spinal cord stimulation may improve sensorimotor rehabilitation after spinal cord injury (SCI) [1,2,3,4]
The aims of this review are as follows: first, to identify the parameters and the potential underlying mechanisms that allow tSCS to facilitate ongoing motor output; secondly, to highlight the effects of tSCS on excitability across multiple segments of the spinal cord; thirdly, to address the ability of multiple sites of tSCS to converge and enhance modulation of spinal reflex and corticospinal pathways; and to explore the potential and limitations for engaging cervical and lumbar spinal cord networks through tSCS to enhance the effectiveness of rehabilitation interventions
This work demonstrates that the activation of spinal cord networks with tSCS alters excitability over multiple segments of the spinal cord, with differential properties depending on the site, waveform, and parameters of tSCS
Summary
Neuromodulation of the spinal cord by means of non-invasive transcutaneous (tSCS). and implanted epidural (eSCS) spinal cord stimulation may improve sensorimotor rehabilitation after spinal cord injury (SCI) [1,2,3,4]. ESCS applied to the lumbar spinal cord, in conjunction with intensive locomotor training, enabled persons with clinically motor-complete SCI to walk over ground for short distances [4,13,18]. This demonstrates that dormant neurons that survive the injury may be reengaged with spinal neuromodulation, and can produce stepping-like movements [19,20]. This review will underscore the need for further mechanistic work to optimize tSCS parameters that, when paired with targeted rehabilitation strategies, can effectively improve clinical outcomes
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