Restoring locomotion in motor-complete spinal cord injury via trunk-mediated control using a commercial epidural spinal cord stimulator

Background: Spinal cord stimulation is emerging as a novel approach to restore movement in patients affected by spinal cord injury. Recent advances have shown restoration of locomotion in patients with complete motor lesions using sophisticated new systems including a brain machine interface. Despite the great potential, this approach is hindered by the inherent complexity and absence of approvals for clinical use. Methods: Here, we tested a novel strategy to restore locomotion in patients with motor-complete spinal cord injury using voluntary trunk movements to modulate the motor output produced by a commercially available epidural spinal cord stimulator. Findings: Four participants with thoracic AIS A-B injuries gained volitional modulation of stimulation-enabled movement without external interfaces or brain decoding, achieving standing and walking over four months of rehabilitation. The approach transformed passive stimulation into self-initiated movement, enabling functional mobility. Conclusions: This simple and potentially scalable method successfully leverages clinically available spinal cord stimulators to allow locomotion even in patients unable to produce voluntary contractions below the lesion, advancing accessible neuromodulation for motor-complete spinal cord injury. Funding: This work was funded by Università Vita-Salute San Raffaele, Boston Scientific Spa, Fondazione Cariplo, Bertarelli Foundation, #NEXTGENERATIONEU (NGEU), and the Ministry of University and Research (MUR).