The effects of epidural stimulation on individuals living with spinal cord injury or disease: a scoping review

Abstract

Background Spinal cord injury/disease (SCI/D) impacts sensory, motor and autonomic function. Epidural stimulation (ES) has the potential to improve function across many domains. Objective To synthesize the effects of ES on functional goals for individuals with SCI/D. Methods Seven biomedical databases were searched. Inclusion criteria required (1) ES as the primary intervention, (2) human participants with SCI/D, (3) pre-post measure of an orthotic and/or therapeutic effect, and (4) original data. Data extracted were participant characteristics, ES and exercise parameters, outcome measures, complications, orthotic and/or therapeutic effects. Data were synthesized descriptively according to functional goal. Critical appraisal was completed using the Downs and Black modified checklist. Results Included studies were case studies or case-series (n = 24), or pre-post interventions (n = 23). One study was a case-control. Research quality was poor to fair. There were mixed results of ES on bladder and sexual function, and standing in participants with SCI/D. Effects of ES included improved bowel function, increased cardiorespiratory and cardiometabolic function, pain reduction, decreased spasms and spasticity, and, when combined with repetitive movement training, improved gait parameters. In the one study focused on the upper extremity, grip strength improved. Conclusions ES shows promise as an intervention to improve functional goals after SCI/D with a focus on locomotion.