Therapeutic Potential of Transcutaneous Spinal Cord Stimulation in Individuals with Spinal Cord Injury

Abstract

Introduction: Transcutaneous spinal cord stimulation (tSCS) is a non-invasive neuromodulation technique that provides a novel approach to the rehabilitation of individuals with spinal cord injury (SCI). Its goal is to increase the excitability of spinal circuits and facilitate residual neuronal connections that remain preserved but dysfunctional after SCI.

Methods: This review summarizes the current knowledge on the use of tSCS in motor, autonomic, and respiratory functions, as well as its effects on spasticity and postural stability. It draws from available scientific literature, including randomized controlled trials, case reports, and pilot studies focused on the impact of tSCS in individuals with different levels and severities of SCI. The studies were evaluated based on their mechanisms of action, technical stimulation parameters, and the clinical outcomes achieved.

Results: Studies have demonstrated that tSCS increases the excitability of spinal neuronal networks and promotes the activation of previously dysfunctional motor pathways. Notable improvements include enhanced voluntary movement in the upper and lower limbs, increased muscle strength, improved trunk control while sitting, and positive effects on respiratory parameters such as respiratory muscle strength. Additionally, enhancements in autonomic functions—particularly micturition, defecation, and blood pressure regulation—along with reduced spasticity, have been observed. These effects were also evident in the chronic phase of injury and, in some cases, persisted after stopping stimulation, indicating the potential for long-term neuroplasticity.

Conclusion: tSCS is a promising, safe, and easily accessible method that could expand treatment options in neurorehabilitation for individuals with SCI. Future research should focus on optimizing stimulation protocols and combining them with other rehabilitation methods.