Spinal Cord Stimulation Improves Feedback Control of Reaching Post-Stroke

Cervical spinal cord stimulation (SCS) improves upper-limb function in individuals with chronic post-stroke hemiparesis, yet how it shapes motor control of arm movement remains unclear. During goal-directed reaching in healthy individuals, movements consist of a coordinated acceleration phase toward the target followed by a deceleration phase that stabilizes the limb near the endpoint. Disruptions in neuromotor control post-stroke can be partially restored by SCS, with prominent improvements occurring in the deceleration phase. To quantitatively characterize these effects, we used a proportional-derivative (PD) control model to fit planar reaching data from 12 healthy and 5 stroke participants. Movements were well described by the model, with proportional gain terms capturing the acceleration phase and derivative gain terms capturing velocity-dependent deceleration. In healthy individuals, model fits revealed a consistent balance between position and velocity-dependent torques that closely matched the optimal solution for smooth and stable reaching predicted by optimal feedback control simulations. In stroke, this balance was altered and partially normalized by SCS, with the most consistent changes observed in the velocity-dependent term. While the prevailing hypothesis is that SCS boosts motor drive to weak agonistic muscles, these results indicate a synergistic and potentially dominant effect in suppressing hyperexcitability of antagonistic muscles controlling the deceleration phase of movement. Finally, the PD controller model revealed frequency-dependent effects of SCS, suggesting that the model parameters may serve as biomarkers for guiding the selection of stimulation parameters. This work serves as a framework for characterizing how neuromodulatory therapies influence arm control .