ORIGINAL RESEARCH article
Front. Neurol.
Sec. Neurorehabilitation
Volume 16 - 2025 | doi: 10.3389/fneur.2025.1647103
This article is part of the Research TopicNew methods in neurorehabilitationView all 10 articles
Transspinal stimulation preceding assisted step training reorganizes neuronal excitability and function of inhibitory networks in spinal cord injury: A randomized controlled trial
Provisionally accepted
- 1Physical Therapy & Neuroscience, The City University of New York, New York, United States
- 2Klab4Recovery Research Program, The City University of New York, New York, United States
- 3James J Peters VA Medical Center, New York, United States
- 4Icahn School of Medicine at Mount Sinai Department of Medicine, New York, United States
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ABSTRACT Introduction: In this pilot randomized sham-controlled clinical trial, we characterized the spinal neuronal and network excitability in human spinal cord injury (SCI) when transspinal stimulation preceded locomotor training within the same session. Methods: Fourteen participants with chronic SCI received an average of 40 sessions with 30 Hz transspinal stimulation delivered for 30 minutes during standing (active: n= 4; sham: n= 5) or supine (active: n= 5) followed by 30-minutes of robotic assisted step training. Before and 1-2 days after completion of all training sessions, we assessed the soleus H-reflex homosynaptic depression and soleus H-reflex recruitment curve, and the amount of reciprocal and presynaptic inhibition following conditioning stimulation of the antagonistic common peroneal nerve. Results: Transspinal stimulation administered before locomotor training increased the amount of homosynaptic depression in the active-standing and active-supine groups, while presynaptic inhibition exerted on Ia afferent terminals increased in all study groups. Reciprocal Ia inhibition improved in the sham-standing and active-supine groups while in all groups the excitability threshold of soleus motoneurons decreased in all groups. Conclusion: This study demonstrated that transspinal stimulation preceding locomotor training partially restores some of the spinal inhibitory mechanisms acting presynaptic or postsynaptic, and produces network reorganization in chronic SCI. Noninvasive transspinal stimulation can increase the benefits of locomotor training, bringing spinal neuronal networks to a more functional state in chronic SCI.
Keywords: spinal cord injury, transspinal stimulation, Locomotor training, network excitability, Neurorecovery, Multimodal rehabilitation
Received: 14 Jun 2025; Accepted: 20 Aug 2025.
Copyright: © 2025 Sayed Ahmad, MD, Zaaya, MD, Harel, MD, PhD and Knikou, PT, MBA, PhD. 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: Maria Knikou, PT, MBA, PhD, Physical Therapy & Neuroscience, The City University of New York, New York, 10314, United States
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