Functioning and Disability
Liang Chen, n/a
Medical student
Tzu Chi university
Taipei, Taipei, Taiwan (Republic of China)
Shih-Chieh Yen, MD
Dr
Kaohsiung Chang Gung Memorial Hospital
Kaohsiung City, Kaohsiung, Taiwan (Republic of China)
Di Huang, MBBS
Dr
Hualien Tzu Chi hospital
Hualien City, Hualien, Taiwan (Republic of China)
.jpg "Kai Sheng Khor, MD photo")
Kai Sheng Khor, MD
Dr
Johns Hopkins School of Medicine
Baltimore, Maryland, United States
Yu-Ning Peng, MD
Physician
McGill University Health Center
Montréal, Quebec, Canada
Malcolm Winkle, MD
Attending Physician, Neurological Rehabilitation
Johns Hopkins University School of Medicine
Baltimore, Maryland, United States
Lower-limb motor impairment limits independence after spinal cord injury (SCI). Emerging randomized trials indicate that transcutaneous spinal cord stimulation (tSCS) may modulate lumbosacral spinal circuits in ways that support gait-related rehabilitation. This review synthesized evidence from randomized controlled trials to determine the effectiveness of tSCS in improving lower-limb motor recovery and walking performance in individuals with SCI.
Design:
A systematic search of PubMed, Embase, and Scopus was conducted through November 2025. Eight randomized controlled trials (233 participants) met inclusion criteria. Risk of bias was assessed using RoB 2. Random-effects models were applied to account for variations in study characteristics. Evaluated outcomes included gait speed (10-Meter Walk Test; 10MWT), walking endurance (6-Minute Walk Test; 6MWT), and lower-limb motor strength (Lower Extremity Motor Score; LEMS).
Results:
tSCS demonstrated consistent benefits for lower-limb function. Gait velocity showed a borderline but clinically meaningful trend favoring tSCS (10MWT: MD 0.11 m/s; 95% CI 0.00–0.23; p = 0.06; I² = 0%). Walking endurance improved significantly (6MWT: MD 12.76 m; 95% CI 0.93–24.59; p = 0.03; I² = 0%). Lower-limb strength also increased (LEMS: MD 3.27; 95% CI 0.24–6.30; p = 0.03; I² = 36%). Limitations included incomplete reporting of mean/SD values in several studies and restricted access to two trials from the China database.
Conclusion:
tSCS provides meaningful gains in lower-limb motor activation, gait speed, and functional endurance in individuals with SCI, especially when paired with locomotor or robotic-assisted gait training. These findings support tSCS as a promising non-invasive neuromodulatory intervention for enhancing lower-limb recovery. Although the certainty of evidence is limited by small sample sizes and methodological constraints, the consistent direction of benefit supports further investigation of tSCS in SCI rehabilitation.
