Self-assisted standing enabled by non-invasive spinal stimulation after spinal cord injury

Dimitry G. Sayenko, Mrinal Rath, Adam R. Ferguson, Joel W. Burdick, Leif A. Havton, V. Reggie Edgerton, Yury P. Gerasimenko

Research output: Contribution to journalArticlepeer-review

129 Scopus citations


Neuromodulation of spinal networks can improve motor control after spinal cord injury (SCI). The objectives of this study were to (1) determine whether individuals with chronic paralysis can stand with the aid of non-invasive electrical spinal stimulation with their knees and hips extended without trainer assistance, and (2) investigate whether postural control can be further improved following repeated sessions of stand training. Using a double-blind, balanced, within-subject cross-over, and sham-controlled study design, 15 individuals with SCI of various severity received transcutaneous electrical spinal stimulation to regain self-assisted standing. The primary outcomes included qualitative comparison of need of external assistance for knee and hip extension provided by trainers during standing without and in the presence of stimulation in the same participants, as well as quantitative measures, such as the level of knee assistance and amount of time spent standing without trainer assistance. None of the participants could stand unassisted without stimulation or in the presence of sham stimulation. With stimulation all participants could maintain upright standing with minimum and some (n = 7) without external assistance applied to the knees or hips, using their hands for upper body balance as needed. Quality of balance control was practice-dependent, and improved with subsequent training. During self-initiated body-weight displacements in standing enabled by spinal stimulation, high levels of leg muscle activity emerged, and depended on the amount of muscle loading. Our findings indicate that the lumbosacral spinal networks can be modulated transcutaneously using electrical spinal stimulation to facilitate self-assisted standing after chronic motor and sensory complete paralysis.

Original languageEnglish
Pages (from-to)1435-1450
Number of pages16
JournalJournal of Neurotrauma
Issue number9
StatePublished - 1 May 2019
Externally publishedYes


  • balance control
  • neuromodulation
  • neuroplasticity
  • paralysis
  • transcutaneous electrical spinal cord stimulation


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