Mechanisms Underlying the Neuromodulation of Spinal Circuits for Correcting Gait and Balance Deficits after Spinal Cord Injury

Neuron. 2016 Feb 17;89(4):814-28. doi: 10.1016/j.neuron.2016.01.009. Epub 2016 Feb 4.


Epidural electrical stimulation of lumbar segments facilitates standing and walking in animal models and humans with spinal cord injury. However, the mechanisms through which this neuromodulation therapy engages spinal circuits remain enigmatic. Using computer simulations and behavioral experiments, we provide evidence that epidural electrical stimulation interacts with muscle spindle feedback circuits to modulate muscle activity during locomotion. Hypothesis-driven strategies emerging from simulations steered the design of stimulation protocols that adjust bilateral hindlimb kinematics throughout gait execution. These stimulation strategies corrected subject-specific gait and balance deficits in rats with incomplete and complete spinal cord injury. The conservation of muscle spindle feedback circuits across mammals suggests that the same mechanisms may facilitate motor control in humans. These results provide a conceptual framework to improve stimulation protocols for clinical applications.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Analysis of Variance
  • Animals
  • Biomechanical Phenomena
  • Computer Simulation
  • Electric Stimulation Therapy
  • Electromyography
  • Feedback, Physiological / physiology
  • Female
  • Gait Disorders, Neurologic / etiology*
  • Gait Disorders, Neurologic / rehabilitation*
  • Hindlimb / physiopathology
  • Locomotion / physiology
  • Models, Neurological
  • Motor Neurons / physiology
  • Nerve Net / physiology
  • Postural Balance / physiology*
  • Rats
  • Rats, Inbred Lew
  • Sensation Disorders / etiology
  • Sensation Disorders / therapy*
  • Spinal Cord Injuries / complications*