Epidural stimulation restores muscle synergies by modulating neural drives in participants with sensorimotor complete spinal cord injuries

Rajat Emanuel Singh, Aliya Ahmadi, Ann M. Parr, Uzma Samadani, Andrei V. Krassioukov, Theoden I. Netoff, David P. Darrow

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Multiple studies have corroborated the restoration of volitional motor control after motor-complete spinal cord injury (SCI) through the use of epidural spinal cord stimulation (eSCS), but rigorous quantitative descriptions of muscle coordination have been lacking. Six participants with chronic, motor and sensory complete SCI underwent a brain motor control assessment (BMCA) consisting of a set of structured motor tasks with and without eSCS. We investigated how muscle activity complexity and muscle synergies changed with and without stimulation. We performed this analysis to better characterize the impact of stimulation on neuromuscular control. We also recorded data from nine healthy participants as controls. Competition exists between the task origin and neural origin hypotheses underlying muscle synergies. The ability to restore motor control with eSCS in participants with motor and sensory complete SCI allows us to test whether changes in muscle synergies reflect a neural basis in the same task. Muscle activity complexity was computed with Higuchi Fractal Dimensional (HFD) analysis, and muscle synergies were estimated using non-negative matrix factorization (NNMF) in six participants with American Spinal Injury Association (ASIA) Impairment Score (AIS) A. We found that the complexity of muscle activity was immediately reduced by eSCS in the SCI participants. We also found that over the follow-up sessions, the muscle synergy structure of the SCI participants became more defined, and the number of synergies decreased over time, indicating improved coordination between muscle groups. Lastly, we found that the muscle synergies were restored with eSCS, supporting the neural hypothesis of muscle synergies. We conclude that eSCS restores muscle movements and muscle synergies that are distinct from those of healthy, able-bodied controls.

Original languageEnglish (US)
Article number59
JournalJournal of NeuroEngineering and Rehabilitation
Issue number1
StatePublished - Dec 2023

Bibliographical note

Funding Information:
The authors would like to thank the funding source; MN Office of Higher Education, and St. Jude/Abbott for device donation. We would also like to thank the participants of this study and study coordinators who were crucial for the success of the present study.

Funding Information:
This study is funded by a MN State SCI/TBI Grant from the Minnesota Office of Higher Education. Devices are donated by Abbott/St. Jude.

Publisher Copyright:
© 2023, The Author(s).


  • Brain motor control assessment
  • Complexity
  • Electromyography
  • Muscle synergies
  • Spinal Cord Injury

PubMed: MeSH publication types

  • Journal Article
  • Research Support, Non-U.S. Gov't


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