REVIEW article
Front. Hum. Neurosci.
Sec. Brain Imaging and Stimulation
This article is part of the Research TopicTutorials on various neuroimaging and stimulation topicsView all 3 articles
Modelling strategies in non-invasive spinal stimulation: perspectives on state-of-the-art
Provisionally accepted
- Instituto de Biofísica e Engenharia Biomédica, Faculdade de Ciências da Universidade de Lisboa, Campo Grande, 1749-016 Lisbon, Portugal, Lisboa, Portugal
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Non-invasive Spinal Stimulation (NISS) is of increasing interest for clinicians addressing spinal dysfunctions, such as spasticity, chronic pain and hypotonia. NISS can be an alternative when surgically-implanted stimulators or pharmacological therapy are not compatible nor viable. Trans-spinal direct current stimulation (tsDCS) is one NISS strategy that delivers direct currents (DC) of low intensity (1-4 mA) through large electrodes (8-25 cm2) placed over selected targets in the vertebral column. Since 2008, tsDCS researchers have build-up evidence regarding modulation of spinal reflexes and sensorimotor responses measured by electromyography. Biophysical constructs based on computational numerical methods provide a well-grounded framework to determine the most effective protocols designed according to each patient's needs. Additionally, models can work as theoretical labs to investigate how the EF profile induced by stimulation can relate with the changes observed in spinal responses. The accuracy of predictions in tsDCS biophysical constructs strongly rely on how realistic are the digital twins of the spine. The main strategy used is to adapt accurate template models to have a fine description of spinal structures down to the millimetre resolution. However, this strategy lacks the personalized approach of MRI-based realistic models. This is due to the fact that development of pipelines for semi-automatic segmentation of the spinal cord is still in its early stages. This work aims to discuss the current state-of-the art regarding computational constructs of tsDCS, what is known on its effects on spinal networks, based on combined modelling-experimental approaches, and what lies ahead for a more targeted and personalized application.
Keywords: direct current, FEM, Finite element method, MRI, non-invasive, Spinal Cord, stimulation, trans-spinal
Received: 08 Dec 2025; Accepted: 26 Jan 2026.
Copyright: © 2026 Fernandes. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Sofia Rita Cardoso Fernandes
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