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Journal of NeuroEngineering and Rehabilitation
Article . 2025 . Peer-reviewed
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DIGITAL.CSIC
Article . 2026 . Peer-reviewed
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Transcutaneous spinal cord stimulation combined with robotic-assisted body weight-supported treadmill training enhances motor score and gait recovery in incomplete spinal cord injury: a double-blind randomized controlled clinical trial

Authors: Comino Suárez, Natalia; Moreno, Juan C; Megía García, Álvaro; Del Ama, Antonio J.; Serrano Muñoz, Diego; Avendaño Coy, Juan; Gil Agudo, Ángel; +3 Authors

Transcutaneous spinal cord stimulation combined with robotic-assisted body weight-supported treadmill training enhances motor score and gait recovery in incomplete spinal cord injury: a double-blind randomized controlled clinical trial

Abstract

Abstract Background Although transcutaneous spinal cord stimulation (tSCS) has been suggested as a safe and feasible intervention for gait rehabilitation, no studies have determined its effectiveness compared to sham stimulation. Objective To determine the effectiveness of tSCS combined with robotic-assisted gait training (RAGT) on lower limb muscle strength and walking function in incomplete spinal cord injury (iSCI) participants. Methods A randomized, double-blind, sham-controlled clinical trial was conducted. Twenty-seven subacute iSCI participants were randomly allocated to tSCS or sham-tSCS group. All subjects conducted a standard Lokomat walking training program of 40 sessions (5 familiarization sessions, followed by 20 sessions combined with active or sham tSCS, and finally the last 15 sessions with standard Lokomat). Primary outcomes were the lower extremity motor score (LEMS) and dynamometry. Secondary outcomes included the 10-Meter Walk Test (10MWT), the Timed Up and Go test (TUG), the 6-Minute Walk test (6MWT), the Spinal Cord Independence Measure III (SCIM III) and the Walking Index for Spinal Cord Injury II (WISCI-II). Motor evoked potential (MEP) induced by transcranial magnetic stimulation (TMS) were also assessed for lower limb muscles. Assessments were performed before and after tSCS intervention and after 3-weeks follow-up. Results Although no significant differences between groups were detected after the intervention, the tSCS group showed greater effects than the sham-tSCS group for LEMS (3.4 points; p = 0.033), 10MWT (37.5 s; p = 0.030), TUG (47.7 s; p = 0.009), and WISCI-II (3.4 points; p = 0.023) at the 1-month follow-up compared to baseline. Furthermore, the percentage of subjects who were able to walk 10 m at the follow-up was greater in the tSCS group (85.7%) compared to the sham group (43.1%; p = 0.029). Finally, a significant difference (p = 0.049) was observed in the comparison of the effects in the amplitude of the rectus femoris MEPs of tSCS group (− 0.97 mV) and the sham group (− 3.39 mV) at follow-up. Conclusions The outcomes of this study suggest that the combination of standard Lokomat training with tSCS for 20 sessions was effective for LEMS and gait recovery in subacute iSCI participants after 1 month of follow-up. Trial registration ClinicalTrials.gov (NCT05210166).

Country
Spain
Keywords

Adult, Male, Robotic-assisted gait training, Neurosciences. Biological psychiatry. Neuropsychiatry, Spinal cord injury, Double-Blind Method, Humans, Transcutaneous spinal cord stimulation, Muscle Strength, Motor function, Gait rehabilitation, Gait Disorders, Neurologic, Spinal Cord Injuries, Spinal Cord Stimulation, Research, Body Weight, Recovery of Function, Robotics, Middle Aged, Exercise Therapy, Treatment Outcome, Robotic‑assisted gait training, Transcutaneous Electric Nerve Stimulation, Feasibility Studies, Female, Lokomat, RC321-571

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    popularity
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    Top 10%
    influence
    This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
    Top 10%
    impulse
    This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
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selected citations
These citations are derived from selected sources.
This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Citations provided by BIP!
popularity
This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.
BIP!Popularity provided by BIP!
influence
This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Influence provided by BIP!
impulse
This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
BIP!Impulse provided by BIP!
18
Top 10%
Top 10%
Top 10%
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