Supraspinal control of motoneurons after paralysis enabled by spinal cord stimulation

Author:

Capogrosso Marco1ORCID,Balaguer Josep-Maria2ORCID,Prat-Ortega Genis1,Verma Nikhil3,Yadav Prakarsh3,Sorensen Erynn1,de Freitas Roberto1,Ensel Scott4,Borda Luigi3,Donadio Serena1,Liang Lucy1,Ho Jonathan1,Damiani Arianna1,Grigsby Erinn1,Fields Daryl5,Gonzalez-Martinez Jorge6,Gerszten Peter5,Weber Douglas3,Pirondini Elvira1

Affiliation:

1. University of Pittsburgh

2. Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA

3. Carnegie Mellon University

4. University of Pittsburg

5. UPMC

6. Cleveland Clinic

Abstract

Abstract Spinal cord stimulation (SCS) restores motor control after spinal cord injury (SCI) and stroke. This evidence led to the hypothesis that SCS facilitates residual supraspinal inputs to spinal motoneurons. Instead, here we show that SCS does not facilitate residual supraspinal inputs but directly triggers motoneurons action potentials. However, supraspinal inputs can shape SCS-mediated activity, mimicking volitional control of motoneuron firing. Specifically, by combining simulations, intraspinal electrophysiology in monkeys and single motor unit recordings in humans with motor paralysis, we found that residual supraspinal inputs transform subthreshold SCS-induced excitatory postsynaptic potentials into suprathreshold events. We then demonstrated that only a restricted set of stimulation parameters enables volitional control of motoneuron firing and that lesion severity further restricts the set of effective parameters. Our results explain the facilitation of voluntary motor control during SCS while predicting the limitations of this neurotechnology in cases of severe loss of supraspinal axons.

Publisher

Research Square Platform LLC

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