Optimizing Transcutaneous Spinal Cord Stimulation: An Exploratory Study on the Role of Electrode Montages and Stimulation Intensity on Reflex Pathway Modulation

Authors

Shirin Madarshahian, Thomas Jefferson UniversityFollow
Michael Trakhtorchuck, Thomas Jefferson UniversityFollow
Tatiana Guerrero, Thomas Jefferson UniversityFollow
Kristin Gustafson, Thomas Jefferson UniversityFollow
James Harrop, Thomas Jefferson UniversityFollow
Caio Matias, Thomas Jefferson UniversityFollow
M. J. Mulcahey, Thomas Jefferson UniversityFollow
Alessandro Naopli, Thomas Jefferson UniversityFollow
Alex Vaccaro, Thomas Jefferson UniversityFollow
Mijail Serruya, Thomas Jefferson UniversityFollow

Document Type

Article

Publication Date

4-12-2025

Comments

This article is the author's final published version in Bioengineering, Volume 12, Issue 4, April 2025, Article number 410.

The published version is available at https://doi.org/10.3390/bioengineering12040410.

Copyright © 2025 by the authors

Abstract

Transcutaneous spinal cord stimulation (tSCS) is a promising non-invasive method to improve motor function in individuals with spinal cord injury (SCI) by enhancing spinal reflex pathways. This study aimed to investigate the effects of different tSCS electrode placement montages and targeted spinal levels on neurophysiological responses such as spinally evoked motor responses (sEMRs), dorsal root reflex activation, and muscle recruitment in individuals with SCI and healthy controls to optimize stimulation strategies for motor recovery. Five participants (three individuals with SCI and two controls) underwent transcutaneous spinal cord stimulation using various electrode montages, target spinal level stimulation, and single- and paired-pulse paradigms. Electromyographic responses were analyzed to determine sEMR threshold, amplitudes, and paired-pulse attenuation. Different spinal levels and spatial configurations of electrode placements influenced the sEMR threshold and incidence of sEMR across all participants. Paired-pulse analysis showed more pronounced second-pulse attenuation in SCI participants (48 ± 36%) than in controls (12 ± 20%, p = 0.0425), with distinct trends observed across montages and muscle groups. These findings suggest that spinal level, electrode configuration, and paired-pulse effects are key factors in personalizing tSCS, informing the development of patient-centered therapeutic strategies. Future studies with larger and more diverse cohorts are needed to validate and expand these findings.

Recommended Citation

Madarshahian, Shirin; Trakhtorchuck, Michael; Guerrero, Tatiana; Gustafson, Kristin; Harrop, James; Matias, Caio; Mulcahey, M. J.; Naopli, Alessandro; Vaccaro, Alex; and Serruya, Mijail, "Optimizing Transcutaneous Spinal Cord Stimulation: An Exploratory Study on the Role of Electrode Montages and Stimulation Intensity on Reflex Pathway Modulation" (2025). Farber Institute for Neuroscience Faculty Papers. Paper 68.
https://jdc.jefferson.edu/farberneursofp/68

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 License.

PubMed ID

40281770

Language

English