Non-invasive spinal cord neuromodulation enables volitional anti-gravity leg movements after motor-complete…

Randomized trialJournal of neuroengineering and rehabilitation· May 2026

Non-invasive spinal cord neuromodulation enables volitional anti-gravity leg movements after motor-complete spinal cord injury: responders vs. non-responders.

Raza N Malik, Soshi Samejima, Alison M M Williams … Andrei V Krassioukov

NeuromuscularRandomized trialQ1IF 6.0

Half of participants regained voluntary anti-gravity leg movement with spinal cord stimulation.

Non-invasive spinal cord neuromodulation enables volitional anti-gravity leg movements after motor-complete spinal cord injury: responders vs. non-responders.

Raza N Malik … Andrei V Krassioukov

Journal of neuroengineering and rehabilitation · May 2026

Background

Transcutaneous spinal cord stimulation (tSCS) is an emerging treatment for motor recovery following spinal cord injury (spinal cord injury).

Purpose

To identify markers of responsiveness, we assessed the integrity of the corticospinal tract (motor evoked potentials; MEPs), ascending sensory pathways (somatosensory evoked potentials; SEPs), spinal cord reflexes (H-reflex), and motor neurons (compound muscle action potential, CMAP), along with muscle morphology using ultrasound echo-intensity.

Methods

This observational cohort study was reported in accordance with STROBE guidelines.

n = 10 individuals

Results

Five of 10

half regained voluntary knee and ankle movement against gravity with stimulation

n = 10 individuals

More results

Tibialis anterior MEPs were observed in one responder only and tibial nerve SEPs were not observed in any participants.

All participants showed poor tibialis anterior muscle morphology.

Four responders had a soleus H-reflex (compared to 2/5 non-responders) and a normal amplitude fibular CMAPs (compared to 2/5 non-responders).

More results

Using conventional neurophysiological techniques, we were unable to consistently demonstrate the pathways facilitating voluntary control or the factors differentiating responders versus non-responders, but trends were observed.

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Conclusion

Additional assessments are needed to develop biomarkers for stratifying motor responders to tSCS.

Non-invasive spinal cord neuromodulation enables volitional anti-gravity leg movements after motor-complete spinal cord injury: responders vs. non-responders.

Non-invasive spinal cord neuromodulation enables volitional anti-gravity leg movements after motor-complete spinal cord injury: responders vs. non-responders.

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