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Review
. 2024 May 15;10(1):12.
doi: 10.1186/s42234-024-00144-7.

Unintentionally intentional: unintended effects of spinal stimulation as a platform for multi-modal neurorehabilitation after spinal cord injury

Gerson N Moreno Romero #  1   2 , Avery R Twyman #  1   2 , Maria F Bandres  1   2 , Jacob Graves McPherson  3   4   5   6   7
Affiliations
Review

Unintentionally intentional: unintended effects of spinal stimulation as a platform for multi-modal neurorehabilitation after spinal cord injury

Gerson N Moreno Romero et al. Bioelectron Med. .

Abstract

Electrical stimulation of spinal neurons has emerged as a valuable tool to enhance rehabilitation after spinal cord injury. In separate parameterizations, it has shown promise for improving voluntary movement, reducing symptoms of autonomic dysreflexia, improving functions mediated by muscles of the pelvic floor (e.g., bowel, bladder, and sexual function), reducing spasms and spasticity, and decreasing neuropathic pain, among others. This diverse set of actions is related both to the density of sensorimotor neural networks in the spinal cord and to the intrinsic ability of electrical stimulation to modulate neural transmission in multiple spinal networks simultaneously. It also suggests that certain spinal stimulation parameterizations may be capable of providing multi-modal therapeutic benefits, which would directly address the complex, multi-faceted rehabilitation goals of people living with spinal cord injury. This review is intended to identify and characterize reports of spinal stimulation-based therapies specifically designed to provide multi-modal benefits and those that report relevant unintended effects of spinal stimulation paradigms parameterized to enhance a single consequence of spinal cord injury.

Keywords: Bioelectronic medicine; Neural engineering; Neuromodulation; Rehabilitation; Spinal cord injury; Spinal stimulation.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Graphical summary of spinal stimulation-based therapies designed for multi-modal rehabilitation and/or reporting unintended effects. A-F Proportion of manuscripts (N = 36 total) in each category. G Chord diagram mapping stimulation targets to intended multi-modal or unintended effect(s); tgt: primary target of stimulation; ot: multi-modal or unintended effect. Numbers represent the number of papers in each chord. Note that chords are not mutually exclusive; e.g., some manuscripts primarily targeting movement but reporting unintended effects on bowel and bladder function may also be represented in other cords, such as motor to autonomic/cardiovascular function. H Literal number of manuscripts (of 36) for each primary stimulation target. I Number of manuscripts reporting therapeutically beneficial (solid bars) vs. bothersome (shaded bars) unintended effects of stimulation
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