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Characterizing spinal reflexes evoked by sensory spinal cord stimulation in people with lower-limb amputation.

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Title: Characterizing spinal reflexes evoked by sensory spinal cord stimulation in people with lower-limb amputation.
Authors: Bose, Rohit1,2,3,4 (AUTHOR), Dalrymple, Ashley N.1,5,6,7 (AUTHOR), Sarma, Devapratim1,5 (AUTHOR), Petersen, Bailey A.1,2,3,8 (AUTHOR), Barra, Beatrice1,9 (AUTHOR), Nanivadekar, Ameya C.1,2,3 (AUTHOR), Madonna, Tyler J.1,8 (AUTHOR), Liu, Monica F.1,2,3,10,11 (AUTHOR), Levy, Isaiah1,8 (AUTHOR), Helm, Eric R.8 (AUTHOR), Miele, Vincent J.12 (AUTHOR), Capogrosso, Marco1,12 (AUTHOR), Fisher, Lee E.1,2,3,8 (AUTHOR), Weber, Douglas J.1,5,13 (AUTHOR) dougweber@cmu.edu
Source: Journal of NeuroEngineering & Rehabilitation (JNER). 10/1/2025, Vol. 22 Issue 1, p1-15. 15p.
Subjects: Spinal cord, Leg amputation, Reflexes, Residual limbs, Electromyography, Human locomotion, Symmetry
Abstract: Background: People with lower-limb amputation lack sensory inputs from their missing limb, which increases their risk of falling. We recently demonstrated that spinal cord stimulation (SCS) can restore sensation in the missing lower limb. Previous studies have shown that SCS can affect motor control by exciting spinal reflex pathways after stroke or spinal cord injury. The effects of SCS on spinal reflex activation have not been studied in people with lower-limb amputation. Furthermore, it is unknown if SCS-evoked spinal reflex activation would perturb walking. Therefore, the goal of this study was to characterize SCS-evoked spinal reflexes in people with lower-limb amputation and quantify effects on gait parameters, including step cycle duration and limb alternation symmetry. Methods: We implanted percutaneous SCS electrodes over the lumbosacral enlargement in 3 people with transtibial amputation (2 diabetic neuropathy; 1 traumatic) for 28 or 84 days. SCS was delivered to restore sensation in the missing limb during walking based on signals from a pressure-sensing insole in the shoe under the prosthesis. We used electromyography (EMG) to record posterior root-muscle (PRM) reflexes in the residual limb while participants were seated, standing, or walking. We characterized rate-dependent depression and recruitment properties of the PRM reflexes. We used pressure data from instrumented insoles to measure the step cycle duration and limb alternation symmetry with and without SCS. Results: SCS evoked PRM reflexes in the residual limb muscles in all participants, which was confirmed by the presence of rate-dependent depression at stimulation frequencies ≥ 2 Hz. Overall, there was broad activation of residual limb muscles with SCS that varied with the position of the stimulating electrode relative to the lumbar spinal cord. PRM reflexes were also activated during walking, as confirmed by the presence of rate-dependent depression. However, SCS-evoked PRM reflexes did not disrupt gait, with similar step cycle duration or limb alternation symmetry with and without SCS. Conclusions: Restoring sensation in the missing limb using SCS excites spinal reflexes according to the expected rostral-caudal myotomes but does not disrupt the step cycle duration or limb alternation symmetry in people with transtibial amputation. Therefore, SCS can restore sensory feedback in the missing limb without disrupting the existing motor activation of the residual limb muscles. [ABSTRACT FROM AUTHOR]
Copyright of Journal of NeuroEngineering & Rehabilitation (JNER) is the property of BioMed Central and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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  Data: Characterizing spinal reflexes evoked by sensory spinal cord stimulation in people with lower-limb amputation.
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  Data: <searchLink fieldCode="AR" term="%22Bose%2C+Rohit%22">Bose, Rohit</searchLink><relatesTo>1,2,3,4</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Dalrymple%2C+Ashley+N%2E%22">Dalrymple, Ashley N.</searchLink><relatesTo>1,5,6,7</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Sarma%2C+Devapratim%22">Sarma, Devapratim</searchLink><relatesTo>1,5</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Petersen%2C+Bailey+A%2E%22">Petersen, Bailey A.</searchLink><relatesTo>1,2,3,8</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Barra%2C+Beatrice%22">Barra, Beatrice</searchLink><relatesTo>1,9</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Nanivadekar%2C+Ameya+C%2E%22">Nanivadekar, Ameya C.</searchLink><relatesTo>1,2,3</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Madonna%2C+Tyler+J%2E%22">Madonna, Tyler J.</searchLink><relatesTo>1,8</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Liu%2C+Monica+F%2E%22">Liu, Monica F.</searchLink><relatesTo>1,2,3,10,11</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Levy%2C+Isaiah%22">Levy, Isaiah</searchLink><relatesTo>1,8</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Helm%2C+Eric+R%2E%22">Helm, Eric R.</searchLink><relatesTo>8</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Miele%2C+Vincent+J%2E%22">Miele, Vincent J.</searchLink><relatesTo>12</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Capogrosso%2C+Marco%22">Capogrosso, Marco</searchLink><relatesTo>1,12</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Fisher%2C+Lee+E%2E%22">Fisher, Lee E.</searchLink><relatesTo>1,2,3,8</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Weber%2C+Douglas+J%2E%22">Weber, Douglas J.</searchLink><relatesTo>1,5,13</relatesTo> (AUTHOR)<i> dougweber@cmu.edu</i>
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  Data: <searchLink fieldCode="JN" term="%22Journal+of+NeuroEngineering+%26+Rehabilitation+%28JNER%29%22">Journal of NeuroEngineering & Rehabilitation (JNER)</searchLink>. 10/1/2025, Vol. 22 Issue 1, p1-15. 15p.
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  Data: <searchLink fieldCode="DE" term="%22Spinal+cord%22">Spinal cord</searchLink><br /><searchLink fieldCode="DE" term="%22Leg+amputation%22">Leg amputation</searchLink><br /><searchLink fieldCode="DE" term="%22Reflexes%22">Reflexes</searchLink><br /><searchLink fieldCode="DE" term="%22Residual+limbs%22">Residual limbs</searchLink><br /><searchLink fieldCode="DE" term="%22Electromyography%22">Electromyography</searchLink><br /><searchLink fieldCode="DE" term="%22Human+locomotion%22">Human locomotion</searchLink><br /><searchLink fieldCode="DE" term="%22Symmetry%22">Symmetry</searchLink>
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Background: People with lower-limb amputation lack sensory inputs from their missing limb, which increases their risk of falling. We recently demonstrated that spinal cord stimulation (SCS) can restore sensation in the missing lower limb. Previous studies have shown that SCS can affect motor control by exciting spinal reflex pathways after stroke or spinal cord injury. The effects of SCS on spinal reflex activation have not been studied in people with lower-limb amputation. Furthermore, it is unknown if SCS-evoked spinal reflex activation would perturb walking. Therefore, the goal of this study was to characterize SCS-evoked spinal reflexes in people with lower-limb amputation and quantify effects on gait parameters, including step cycle duration and limb alternation symmetry. Methods: We implanted percutaneous SCS electrodes over the lumbosacral enlargement in 3 people with transtibial amputation (2 diabetic neuropathy; 1 traumatic) for 28 or 84 days. SCS was delivered to restore sensation in the missing limb during walking based on signals from a pressure-sensing insole in the shoe under the prosthesis. We used electromyography (EMG) to record posterior root-muscle (PRM) reflexes in the residual limb while participants were seated, standing, or walking. We characterized rate-dependent depression and recruitment properties of the PRM reflexes. We used pressure data from instrumented insoles to measure the step cycle duration and limb alternation symmetry with and without SCS. Results: SCS evoked PRM reflexes in the residual limb muscles in all participants, which was confirmed by the presence of rate-dependent depression at stimulation frequencies ≥ 2 Hz. Overall, there was broad activation of residual limb muscles with SCS that varied with the position of the stimulating electrode relative to the lumbar spinal cord. PRM reflexes were also activated during walking, as confirmed by the presence of rate-dependent depression. However, SCS-evoked PRM reflexes did not disrupt gait, with similar step cycle duration or limb alternation symmetry with and without SCS. Conclusions: Restoring sensation in the missing limb using SCS excites spinal reflexes according to the expected rostral-caudal myotomes but does not disrupt the step cycle duration or limb alternation symmetry in people with transtibial amputation. Therefore, SCS can restore sensory feedback in the missing limb without disrupting the existing motor activation of the residual limb muscles. [ABSTRACT FROM AUTHOR]
– Name: AbstractSuppliedCopyright
  Label:
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  Data: <i>Copyright of Journal of NeuroEngineering & Rehabilitation (JNER) is the property of BioMed Central and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
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RecordInfo BibRecord:
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      – Type: doi
        Value: 10.1186/s12984-025-01720-x
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      – Code: eng
        Text: English
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    Subjects:
      – SubjectFull: Spinal cord
        Type: general
      – SubjectFull: Leg amputation
        Type: general
      – SubjectFull: Reflexes
        Type: general
      – SubjectFull: Residual limbs
        Type: general
      – SubjectFull: Electromyography
        Type: general
      – SubjectFull: Human locomotion
        Type: general
      – SubjectFull: Symmetry
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              Text: 10/1/2025
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