Consecutive Transcutaneous and Epidural Spinal Cord Neuromodulation to Restore Complete Paralysis

Abstract In this study the effect of transcutaneous (tSCS) and epidural electrical spinal cord stimulation (EES) to facilitate volitional movements, balance, and non-motor functions was consecutively tested in two subjects with motor complete spinal cord injury (SCI). We hypothesized that tSCS and EES have different but complimentary effects on restoration after SCI. In both subjects tSCS demonstrated minimal improvement in volitional movements critical to initiate tSCS-enabled rehabilitation. Compared to tSCS, following EES demonstrated immediate restoration of volitional movements, while tSCS was more effective in improving balance. Continuous improvement in non-motor functions was found during tSCS-enabled and then EES-enabled rehabilitation. These results show significant difference in effect of tSCS and EES on recovery of neurologic functions and demonstrate advantages of consecutive tSCS and EES therapy of SCI. Proposed approach will help to select responsive to neuromodulation subjects and early initiate therapy, particularly for motor complete SCI with minimal effect from conventional rehabilitation.