Evidence map›Paper›PMID 41034988›Full record

ArticleJournal of neuroengineering and rehabilitation2025

Characterizing spinal reflexes evoked by sensory spinal cord stimulation in people with lower-limb amputation.

Rohit Bose, Ashley N Dalrymple, Devapratim Sarma, Bailey A Petersen, Beatrice Barra, Ameya C Nanivadekar, Tyler J Madonna, Monica F Liu, Isaiah Levy, Eric R Helm and 4 more

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article 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. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–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.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. 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

14 authors.

Rohit Bose *Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA.
Ashley N Dalrymple *Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA.
Devapratim SarmaRehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA.
Bailey A PetersenRehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA.
Beatrice BarraRehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA.
Ameya C NanivadekarRehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA.
Tyler J MadonnaRehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA.
Monica F LiuRehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA.
Isaiah LevyRehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA.
Eric R HelmDepartment of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA.
Vincent J MieleDepartment of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA.
Marco CapogrossoRehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA.
Lee E FisherRehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA.
Douglas J WeberRehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA. dougweber@cmu.edu.

Funding

The effect of spinal cord stimulation on spinal reflex gain and dorsal column sensory pathway and their correlation with phantom limb painUH3NS100541 · NINDS · UNIVERSITY OF PITTSBURGH AT PITTSBURGH · PI FISHER, LEE E, WEBER, DOUGLAS J · 2017 to 2022
$4.6M
National Institute of Child Health and Human Development F30HD0987984NINDS NIH HHS UH3 NS100541NINDS NIH HHS UH3NS100541
6 · The paper itself

Abstract

backgroundPeople with lower-limb amputation lack sensory inputs from their missing limb, which increases their risk of falling. We recently demonstrated that spinal cord stimulation (SCS) can restore sensation in the missing lower limb. Previous studies have shown that SCS can affect motor control by exciting spinal reflex pathways after stroke or spinal cord injury. The effects of SCS on spinal reflex activation have not been studied in people with lower-limb amputation. Furthermore, it is unknown if SCS-evoked spinal reflex activation would perturb walking. Therefore, the goal of this study was to characterize SCS-evoked spinal reflexes in people with lower-limb amputation and quantify effects on gait parameters, including step cycle duration and limb alternation symmetry.

methodsWe implanted percutaneous SCS electrodes over the lumbosacral enlargement in 3 people with transtibial amputation (2 diabetic neuropathy; 1 traumatic) for 28 or 84 days. SCS was delivered to restore sensation in the missing limb during walking based on signals from a pressure-sensing insole in the shoe under the prosthesis. We used electromyography (EMG) to record posterior root-muscle (PRM) reflexes in the residual limb while participants were seated, standing, or walking. We characterized rate-dependent depression and recruitment properties of the PRM reflexes. We used pressure data from instrumented insoles to measure the step cycle duration and limb alternation symmetry with and without SCS.

resultsSCS evoked PRM reflexes in the residual limb muscles in all participants, which was confirmed by the presence of rate-dependent depression at stimulation frequencies ≥ 2 Hz. Overall, there was broad activation of residual limb muscles with SCS that varied with the position of the stimulating electrode relative to the lumbar spinal cord. PRM reflexes were also activated during walking, as confirmed by the presence of rate-dependent depression. However, SCS-evoked PRM reflexes did not disrupt gait, with similar step cycle duration or limb alternation symmetry with and without SCS.

conclusionsRestoring sensation in the missing limb using SCS excites spinal reflexes according to the expected rostral-caudal myotomes but does not disrupt the step cycle duration or limb alternation symmetry in people with transtibial amputation. Therefore, SCS can restore sensory feedback in the missing limb without disrupting the existing motor activation of the residual limb muscles.

Indexed as

Amputation, SurgicalLower ExtremityReflexSpinal CordSpinal Cord StimulationAdultAgedElectromyographyFemaleGaitHumansMaleMiddle AgedWalkingAmputationElectromyographyNeural prosthesisPosterior root muscle reflexesSpinal cord stimulation

Identifiers

PMID41034988
PMCPMC12487058

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC-ND
Read underepoch 390

Registered trials

None linked

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.