Evidence map›Paper›PMID 40301929›Full record

Trial reportJournal of neuroengineering and rehabilitation2025

Activity-based recovery training with spinal cord epidural stimulation improves standing performance in cervical spinal cord injury.

Claudia A Angeli, Enrico Rejc, Beatrice Ugiliweneza, Maxwell Boakye, Gail F Forrest, Katelyn Brockman, Justin Vogt, Brittany Logsdon, Katie Fields, Susan J Harkema

Registry-linked trialAbstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Journal of neuroengineering and rehabilitation, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT03364660 (Task and Physiological Specific Stimulation for Recovery of Autonomic Function, Voluntary Movement, and Standing Using Epidural Stimulation and Training After Severe Spinal Cord Injury), which is not on this map. Cited by 3 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT03364660 narecruitingnot on this map

Task and Physiological Specific Stimulation for Recovery of Autonomic Function, Voluntary Movement, and Standing Using Epidural Stimulation and Training After Severe Spinal Cord Injury

TypeinterventionalSponsorUniversity of LouisvilleRan2017 to 2024Enrolled36ConditionsSpinal Cord InjuriesArmsAcute epidural stimulation for cardiovascular stability, Long Term Epidural Stimulation for Cardiovascular Stability, Participants undergo approximately 4 months of epidural stimulation for voluntary movement., Long Term Epidural Stimulation for Cardiovascular Stability plus Stand Training, Participants undergo approximately 4 months of epidural stimulation for voluntary movement plus stand training.
3 · Its place in the literature

Who cites it

3 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Review
  3. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Claudia A AngeliTim and Caroline Reynolds Center for Spinal Stimulation, Kessler Foundation, West Orange, NJ, USA. cangeli@kesslerfoundation.org.
Enrico RejcTim and Caroline Reynolds Center for Spinal Stimulation, Kessler Foundation, West Orange, NJ, USA.
Beatrice UgiliwenezaKentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, USA.
Maxwell BoakyeKentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, USA.
Gail F ForrestTim and Caroline Reynolds Center for Spinal Stimulation, Kessler Foundation, West Orange, NJ, USA.
Katelyn BrockmanKentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, USA.
Justin VogtKentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, USA.
Brittany LogsdonKentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, USA.
Katie FieldsKentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, USA.
Susan J HarkemaTim and Caroline Reynolds Center for Spinal Stimulation, Kessler Foundation, West Orange, NJ, USA.

Funding

Christopher and Dana Reeve Foundation ES_BI-2017
6 · The paper itself

Abstract

backgroundIndividuals with a clinically complete spinal cord injury are unable to stand independently without external assistance. Studies have shown the combination of spinal cord epidural stimulation (scES) targeted for standing with activity-based recovery training (ABRT) can promote independence of standing in individuals with spinal cord injury. This cohort study aimed to assess the effects of stand-ABRT with scES in individuals with cervical chronic spinal cord injury. We evaluated the ability of these individuals to stand independently from physical assistance across multiple sessions.

methodsThirty individuals participated in this study, all unable to stand independently at the start of the intervention. Individuals were participating in a randomized clinical trial and received stand-ABRT in addition to targeted cardiovascular scES or voluntary scES. During the standing intervention, participants were asked to stand 2 h a day, 5 days a week for 80 sessions (Groups 1 and 2) or 160 sessions (Groups 3 and 4).

resultsA total of 3,524 training days were considered for analysis. Group 1 had 507 days, group 2 with 578 days, and 1152 and 1269 days for groups 3 and 4 respectively. 71% of sessions reached the two-hour standing goal. All individuals achieved outcomes of lower limb independent extension with spinal cord epidural stimulation, with a wide range throughout a training day. Sixteen participants achieved unassisted hip extension while maintaining unassisted bilateral knee and trunk extension. Participants receiving initial voluntary scES training performed better in unassisted bilateral knee and trunk extension than those receiving initial cardiovascular scES. The lower-limb standing activation pattern changes were consistent with the greater standing independence observed by all groups.

conclusionsIndividuals with chronic cervical spinal cord injury were able to achieve various levels of extension without manual assistance during standing with balance assist following stand-ABRT with scES. These results provide evidence that scES modulates network excitability of the injured spinal cord to allow for the integration of afferent and supraspinal descending input to promote standing in individuals with spinal cord injury.

trial registrationThe study was registered on Clinical Trials.gov (NCT03364660) prior to subject enrollment.

Indexed as

Exercise TherapyPostural BalanceSpinal Cord InjuriesSpinal Cord StimulationStanding PositionAdultCervical CordCervical VertebraeFemaleHumansMaleMiddle AgedRecovery of FunctionYoung AdultCervical spinal cord injuryEpidural spinal stimulationIndependenceRehabilitationStanding

Identifiers

PMID40301929
PMCPMC12042302

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.