Location-, intensity-, and frequency-optimized epidural stimulation restores hand function after complete spinal cord injury
Oh, J.; Steele, A. G.; Scheffler, M.; Martin, C.; Sheynin, J.; Dietz, V. A.; Valdivia-Padilla, A.; Stampas, A.; Korupolu, R.; Karmonik, C.; Hodics, T. M.; Freyvert, Y.; Manzella, M.; Faraji, A. H.; Horner, P. J.; Sayenko, D. G.
Show abstract
Cervical spinal cord injury (SCI) causes profound and persistent loss of hand function, and effective neuromodulation strategies remain limited. We report the first-in-human implantation of a 32-contact cervical epidural paddle array in two individuals with severe chronic SCI. Individualized motor pool recruitment maps, derived from systematic bipolar and multipolar configurations, enabled person-specific stimulation parameters. Optimized stimulation restored volitional hand opening, closing and coordinated upper-limb movements that were previously unattainable. This approach achieved a >91% success rate in complex reach-grasp-lift-release sequences, supported by substantial gains in range of motion, grip, and pinch strength. Electrophysiological and kinematic analyses demonstrated parameter-dependent, selective recruitment of flexor and extensor motor pools. Personalized stimulation programs integrated with goal-directed activities enabled functional hand use in home and community settings, sustained over several months of continued autonomous use. These findings establish a mechanistically grounded and translational framework for restoring upper-limb function after chronic severe SCI.
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