Recent research has indicated that functional recovery can be achieved by taking advantage of the remaining neural connections to re-enable sensorimotor function. Upper motor neurons lose the feedback of afferent signals and the descending efferent signals terminate at the level of the SCI lesion, though in some cases, propriospinal connections can still provide indirect access to afferent signals. Most cases of SCI have an intervening gap of intact tissue at the site of injury while this tissue is anatomically intact, it is functionally silent due to disruptions to the flow of information within the spinal cord. Recent research has demonstrated novel methods to improve post-SCI recovery and reverse the deleterious outcomes of SCI. Keywords: Spinal cord injury, Spinal cord stimulation, Electrical stimulation Although this review highlights SCS as a promising therapeutic neuromodulatory technique to improve rehabilitation in patients with SCI, further mechanistic studies and stimulus parameter optimization are necessary before clinical translation. One hundred eight of 127 patients saw improvement in sensorimotor function, 51 of 70 patients saw improvement in autonomic genitourinary function, 32 of 32 patients saw improvement in autonomic pulmonary function, and 32 of 36 patients saw improvement in autonomic cardiovascular function. The total participant sample comprised of 327 patients with spinal cord injury, each evaluated using different stimulation protocols, some for sensorimotor function and others for various autonomic functions. Seventy-one relevant studies were included for review, specifically examining changes in volitional movement, changes in muscle activity or spasticity, or return of cardiovascular pulmonary, or genitourinary autonomic function. The current literature on human clinical eSCS and tSCS for spinal cord injury was reviewed. This review aims to assess the efficacy of spinal cord stimulation, both epidural (eSCS) and transcutaneous (tSCS), on the return of function in individuals with chronic spinal cord injury. Recent advancements in spinal cord electrical stimulation (SCS) for spinal cord injury have provided potential avenues for restoration of neurologic function in affected patients. Traumatic spinal cord injury often leads to loss of sensory, motor, and autonomic function below the level of injury.
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