Neuromodulation of lumbosacral spinal networks enables independent stepping after complete paraplegia
Abstract
Spinal sensorimotor networks that are functionally disconnected from the brain because of spinal cord injury (SCI) can be facilitated via epidural electrical stimulation (EES) to restore robust, coordinated motor activity in humans with paralysis 1-3. Previously, we reported a clinical case of complete sensorimotor paralysis of the lower extremities in which EES restored the ability to stand and the ability to control step-like activity while side-lying or suspended vertically in a body-weight support system (BWS)4. Since then, dynamic task-specific training in the presence of EES, termed multimodal rehabilitation (MMR), was performed for 43 weeks and resulted in bilateral stepping on a treadmill, independent from trainer assistance or BWS. Additionally, MMR enabled independent stepping over ground while using a front-wheeled walker with trainer assistance at the hips to maintain balance. Furthermore, MMR engaged sensorimotor networks to achieve dynamic performance of standing and stepping. To our knowledge, this is the first report of independent stepping enabled by task-specific training in the presence of EES by a human with complete loss of lower extremity sensorimotor function due to SCI.
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This recovery has been documented in various independent studies, including in participants with complete sensorimotor paralysis.
“This recovery has been documented in various independent studies, including in participants with complete sensorimotor paralysis5,6,30–34.”
From Walking naturally after spinal cord injury using a brain–spine interface (2023) · cites this paper as [33]
The delivery of epidural electrical stimulation over the lumbar spinal cord has enabled many individuals with spinal cord injury to regain adaptive control over the activity of otherwise paralysed muscles.
“The delivery of epidural electrical stimulation over the lumbar spinal cord has enabled many individuals with spinal cord injury to regain adaptive control over the activity of otherwise paralysed muscles.”
From Walking naturally after spinal cord injury using a brain–spine interface (2023) · cites this paper as [33]
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“Epidural electrical stimulation–enabled motor activity During the first 5 days of testing with EES, both subjects attempted to perform motor tasks in the presence of EES.”
BackgroundResultInfluentialSelf-citationInjectable Biomedical Devices for Sensing and Stimulating Internal Body Organs
Jung, Y. H., Kim, J. U., Lee, J. S., Shin, J. H., Jung, W., Ok, J., & Kim, T. (2020) · Advanced Materials · doi:10.1002/adma.201907478 · Cited by 88 · see citing works
Calvert, J. S., Grahn, P. J., Zhao, K. D., & Lee, K. H. (2019) · Neuromodulation Technology at the Neural Interface · doi:10.1111/ner.12938 · Cited by 84 · see citing works
“To date, all reported subjects using EES for motor recovery following paraplegia have achieved the results following months of motor training prior to implant of the device to demonstrate lack of recovery with motor training without EES followed by EES in combination with motor training (39,40,42,44,45,48).”
BackgroundInfluentialSelf-citationHofer, A., & Schwab, M. E. (2019) · Current Opinion in Neurology · doi:10.1097/wco.0000000000000750 · Cited by 89 · see citing works
Control of Mammalian Locomotion by Somatosensory Feedback
Frigon, A., Akay, T., & Prilutsky, B. I. (2021) · Comprehensive physiology · doi:10.1002/cphy.c210020 · Cited by 91 · see citing works
On the reflex mechanisms of cervical transcutaneous spinal cord stimulation in human subjects
Milosevic, M., Masugi, Y., Sasaki, A., Sayenko, D. G., & Nakazawa, K. (2019) · Journal of Neurophysiology · doi:10.1152/jn.00802.2018 · Cited by 81 · see citing works
“…has been demonstrated in individuals with chronic spinal cord injury (SCI), leading to the recovery of standing, stepping, and voluntary control of lower limbs (Angeli et al. 2018; Edgerton and Harkema 2011; Gill et al. 2018; Harkema et al. 2011; Minassian and Hofstoetter 2016; Wagner et al. 2018).”
BackgroundMethodSelf-citationHachmann, J. T., Yousak, A., Wallner, J. J., Gad, P. N., Edgerton, V. R., & Gorgey, A. S. (2021) · Journal of Neurophysiology · doi:10.1152/jn.00020.2021 · Cited by 82 · see citing works
Self-citationRegulating Endogenous Neural Stem Cell Activation to Promote Spinal Cord Injury Repair
Gilbert, E. A. B., Lakshman, N., Lau, K. S. K., & Morshead, C. M. (2022) · Cells · doi:10.3390/cells11050846 · Cited by 80 · see citing works
Bertels, H., Vicente-Ortiz, G., Kanbi, K. E., & Takeoka, A. (2022) · Nature Neuroscience · doi:10.1038/s41593-022-01067-9 · Cited by 81 · see citing works
Advances in Conductive Hydrogel for Spinal Cord Injury Repair and Regeneration
Qin, C., Qi, Z., Pan, S., Xia, P., Kong, W., Sun, B., Du, H., Zhang, R., Zhu, L., Zhou, D., et al. (2023) · International Journal of Nanomedicine · doi:10.2147/ijn.s436111 · Cited by 80 · see citing works
Electronics with shape actuation for minimally invasive spinal cord stimulation
Woodington, B. J., Curto, V. F., Yu, Y.-L., Martínez-Domínguez, H., Coles, L., Malliaras, G. G., Proctor, C. M., & Barone, D. G. (2021) · Science Advances · doi:10.1126/sciadv.abg7833 · Cited by 75 · see citing works
Hofstoetter, U. S., Freundl, B., Binder, H., & Minassian, K. (2019) · PLoS ONE · doi:10.1371/journal.pone.0227057 · Cited by 73 · see citing works
Low‐Frequency Brain Oscillations Track Motor Recovery in Human Stroke
Bönstrup, M., Krawinkel, L. A., Schulz, R., Cheng, B., Feldheim, J. F., Thomalla, G., Cohen, L. G., & Gerloff, C. P. (2019) · Annals of Neurology · doi:10.1002/ana.25615 · Cited by 78 · see citing works
Laliberté, A. M., Goltash, S., Lalonde, N. R., & Bui, T. V. (2019) · Frontiers in Cellular Neuroscience · doi:10.3389/fncel.2019.00512 · Cited by 77 · see citing works
Mesenchymal Stem Cells in Treatment of Spinal Cord Injury and Amyotrophic Lateral Sclerosis
Syková, E., Cizkova, D., & Kubinová, Š. (2021) · Frontiers in Cell and Developmental Biology · doi:10.3389/fcell.2021.695900 · Cited by 76 · see citing works
Han, Q., Ordaz, J. D., Liu, N., Richardson, Z., Wu, W., Xia, Y., Qu, W., Wang, Y., Dai, H., Zhang, Y. P., et al. (2019) · Nature Communications · doi:10.1038/s41467-019-13854-3 · Cited by 73 · see citing works
Bareyre, F., & Loy, K. (2018) · Neural Regeneration Research · doi:10.4103/1673-5374.245951 · Cited by 72 · see citing works
“Likewise, dynamic and intense task-specific training in the presence of epidural electrical stimulation, performed on a patient with a clinically complete injury resulted in bilateral stepping on a treadmill and enabled independent stepping with a walker (Gill et al., 2018).”
Advances in Spinal Cord Stimulation
Lam, C. M., Latif, U., Sack, A., Govindan, S., Sanderson, M., Vu, D. T., Smith, G. V., Sayed, D., & Khan, T. W. (2023) · Bioengineering · doi:10.3390/bioengineering10020185 · Cited by 70 · see citing works
“Moreover, EES in humans with complete loss of motor function after SCI enabled restoration of flexion and extension of leg movements, standing, and stepping following several months of training [84,85].”
BackgroundPeripheral nerve bionic interface: a review of electrodes
Russell, C., Roche, A. D., & Chakrabarty, S. (2019) · International Journal of Intelligent Robotics and Applications · doi:10.1007/s41315-019-00086-3 · Cited by 67 · see citing works
Epidural electrical stimulation for spinal cord injury
Choi, E. H., Gattas, S., Brown, N. J., Hong, J. D., Limbo, J. N., Chan, A. Y., & Oh, M. Y. (2021) · Neural Regeneration Research · doi:10.4103/1673-5374.313017 · Cited by 73 · see citing works
“These findings have been further supported by the restoration of independent stepping from complete SCI with EES and task-specific training (Gill et al., 2018; Wagner et al., 2018).”
BackgroundTaylor, C., McHugh, C., Mockler, D., Minogue, C. M., Reilly, R. B., & Fleming, N. (2021) · PLoS ONE · doi:10.1371/journal.pone.0260166 · Cited by 71 · see citing works
“Examples of this approach can be seen in the detailed qualitative [96] and quantitative [97] comparisons of EMG recorded from patients with SCI during stepping in the presence or absence of eSCS.”
BackgroundGao, Z., Pang, Z., Chen, Y., Lei, G., Zhu, S., Li, G., Shen, Y., & Xu, W. (2022) · Neuroscience Bulletin · doi:10.1007/s12264-022-00959-x · Cited by 74 · see citing works
Valle, G., Katic, N., Eggemann, D., Gorskii, O., Pavlova, N., Petrini, F. M., Čvančara, P., Stieglitz, T., Евгеньевич, М. П., Bumbaširević, M., et al. (2024) · Nature Communications · doi:10.1038/s41467-024-45190-6 · Cited by 75 · see citing works
“Indeed, neural stimulation of the peripheral somatic nerves (PNS) 7 – 10 , spinal cord 11 – 15 , and somatosensory cortex (S1) 16 – 18 showed the ability to restore missing sensations, resulting in closed-loop neuroprostheses able to establish a bidirectional link between humans and machines.”
BackgroundShapkova, E. Y., Pismennaya, E. V., Емельянников, Д. В., & Ivanenko, Y. P. (2020) · Frontiers in Neuroscience · doi:10.3389/fnins.2020.00416 · Cited by 72 · see citing works
Eisdorfer, J. T., Smit, R. D., Keefe, K. M., Lemay, M. A., Smith, G. M., & Spence, A. J. (2020) · Frontiers in Molecular Neuroscience · doi:10.3389/fnmol.2020.00163 · Cited by 65 · see citing works
“Although the mechanism of action of DREADDs agonist clozapine-Noxide (CNO) has been questioned (Gomez et al., 2017; Mahler and Aston-Jones, 2018), experimental designs with betweensubject controls canmake CNO (3–5mg/kg) a suitable DREADD agonist (Jendryka et al., 2019).”
BackgroundSamejima, S., Caskey, C. D., İnanıcı, F., Shrivastav, S. R., Brighton, L. N., Pradarelli, J. J., Martínez, V., Steele, K. M., Saigal, R., & Moritz, C. T. (2021) · Physical Therapy · doi:10.1093/ptj/pzab228 · Cited by 67 · see citing works
Lai, B., Zeng, X., Han, W., Che, M., Ding, Y., Li, G., & Zeng, Y. (2021) · Biomaterials · doi:10.1016/j.biomaterials.2021.121211 · Cited by 66 · see citing works
Bonizzato, M., James, N. D., Pidpruzhnykova, G., Pavlova, N., Shkorbatova, P. Y., Baud, L., Martinez‐Gonzalez, C., Squair, J. W., DiGiovanna, J., Barraud, Q., et al. (2021) · Nature Communications · doi:10.1038/s41467-021-22137-9 · Cited by 63 · see citing works
Meyer, C., Hofstoetter, U. S., Hubli, M., Hassani, R. H., Rinaldo, C., Curt, A. E. P., & Bolliger, M. (2020) · Journal of Clinical Medicine · doi:10.3390/jcm9113541 · Cited by 64 · see citing works
McHugh, L. V., Miller, A. A., Leech, K. A., Salorio, C. F., & Martin, R. H. (2020) · Spinal Cord Series and Cases · doi:10.1038/s41394-020-00359-1 · Cited by 65 · see citing works
Hofstoetter, U. S., Freundl, B., Lackner, P., & Binder, H. (2021) · Brain Sciences · doi:10.3390/brainsci11040472 · Cited by 59 · see citing works
Pizzolato, C., Gunduz, M. A., Palipana, D. B., Wu, J., Grant, G. D., Hall, S., Dennison, R., ZAFONTE, R. D., Lloyd, D. G., & Teng, Y. D. (2021) · Experimental Neurology · doi:10.1016/j.expneurol.2021.113612 · Cited by 61 · see citing works
Neuromusculoskeletal Modeling-Based Prostheses for Recovery After Spinal Cord Injury
Pizzolato, C., Saxby, D. J., Palipana, D. B., Diamond, L. E., Barrett, R., Teng, Y. D., & Lloyd, D. G. (2019) · Frontiers in Neurorobotics · doi:10.3389/fnbot.2019.00097 · Cited by 60 · see citing works
A review of emerging neuroprotective and neuroregenerative therapies in traumatic spinal cord injury
Hejrati, N., & Fehlings, M. G. (2021) · Current Opinion in Pharmacology · doi:10.1016/j.coph.2021.08.009 · Cited by 61 · see citing works
Electrical Stimulation as a Tool to Promote Plasticity of the Injured Spinal Cord
Jack, A. S., Hurd, C., Martin, J. H., & Fouad, K. (2020) · Journal of Neurotrauma · doi:10.1089/neu.2020.7033 · Cited by 58 · see citing works
Zhou, K., Wei, W., Yang, D., Zhang, H., Yang, W., Zhang, Y., Nie, Y., Hao, M., Wang, P., Ruan, H., et al. (2024) · Nature Communications · doi:10.1038/s41467-024-44898-9 · Cited by 58 · see citing works
Seáñez, I., & Capogrosso, M. (2021) · Bioelectronic Medicine · doi:10.1186/s42234-021-00077-5 · Cited by 58 · see citing works
“In 2018, three independent groups demonstrated, for the first time, that participants with chronic motor-complete SCI could achieve overground walking with SCS (Angeli et al. 2018; Gill et al. 2018; Wagner et al. 2018).”
BackgroundInfluentialTargeting Sensory and Motor Integration for Recovery of Movement After CNS Injury
Asan, A. S., McIntosh, J. R., & Carmel, J. B. (2022) · Frontiers in Neuroscience · doi:10.3389/fnins.2021.791824 · Cited by 59 · see citing works
Izzy, S. (2024) · CONTINUUM Lifelong Learning in Neurology · doi:10.1212/con.0000000000001392 · Cited by 55 · see citing works
Wang, X., Zhou, T., Maynard, G. D., Terse, P., Cafferty, W. B. J., Kocsis, J. D., & Strittmatter, S. M. (2020) · Brain · doi:10.1093/brain/awaa116 · Cited by 53 · see citing works
“This point is highlighted by the ability of caudal stimulation to support limited voluntary movement recovery in otherwise clinically complete SCI cases (Angeli et al., 2018; Gill et al., 2018; Wagner et al., 2018).”
BackgroundEpidural Spinal Cord Stimulation for Spinal Cord Injury in Humans: A Systematic Review
Chalif, J. I., Chavarro, V. S., Mensah, E. O., Johnston, B. R., Fields, D. P., Chalif, E. J., Chiang, M., Sutton, O. M., Yong, R. J., Trumbower, R. D., et al. (2024) · Journal of Clinical Medicine · doi:10.3390/jcm13041090 · Cited by 56 · see citing works
“Although several of the studies reported results from trials registered on Clinical-trials.gov [39–41, 43, 45, Finally, most articles utilized qualitative assessments as the primary outcomes (Table 3).”
BackgroundResultInfluentialPaired corticospinal-motoneuronal stimulation and exercise after spinal cord injury
Jo, H. J., Richardson, M. S. A., Oudega, M., & Pérez, M. A. (2021) · Journal of Spinal Cord Medicine · doi:10.1080/10790268.2021.1970908 · Cited by 52 · see citing works
Herrity, A. N., Aslan, S. C., Ugiliweneza, B., Mohamed, A., Hubscher, C. H., & Harkema, S. J. (2021) · Frontiers in Systems Neuroscience · doi:10.3389/fnsys.2020.614691 · Cited by 52 · see citing works
A Review of Functional Restoration From Spinal Cord Stimulation in Patients With Spinal Cord Injury
Lin, A., Shaaya, E. A., Calvert, J. S., Parker, S. R., Borton, D. A., & Fridley, J. (2022) · Neurospine · doi:10.14245/ns.2244652.326 · Cited by 52 · see citing works
Self-citationComplications of epidural spinal stimulation: lessons from the past and alternatives for the future
Taccola, G., Barber, S. M., Horner, P. J., Bazo, H. A. C., & Sayenko, D. G. (2020) · Spinal Cord · doi:10.1038/s41393-020-0505-8 · Cited by 51 · see citing works
“Although transcutaneous SCS can augment and enable stepping movements [98–102, 118] and postural control during sitting [104] and standing [105], the fine and selective voluntary activation of specific agonists (with minimum co-contraction of antagonists) below spinal lesion after clinically diagnosed motor “complete”…”
BackgroundSelf-citationClinical guidelines for neurorestorative therapies in spinal cord injury (2021 China version)
Guo, X., Feng, Y., Sun, T., Feng, S., Tang, J., Chen, L., Cao, X., Lin, H., He, X., Li, M.-H., et al. (2021) · Journal of Neurorestoratology · doi:10.26599/jnr.2021.9040003 · Cited by 50 · see citing works
Mendez, A., Islam, R., Latypov, T. H., Basa, P., Joseph, O. J., Knudsen, B. E., Siddiqui, A. M., Summer, P., Staehnke, L. J., Grahn, P. J., et al. (2021) · Mayo Clinic Proceedings · doi:10.1016/j.mayocp.2020.07.039 · Cited by 51 · see citing works
Self-citationMechanisms of Stem Cell Therapy in Spinal Cord Injuries
Shinozaki, M., Nagoshi, N., Nakamura, M., & Okano, H. (2021) · Cells · doi:10.3390/cells10102676 · Cited by 53 · see citing works
Liu, G., An, Z., Lu, Y., Wu, Y., Shi, Z., Li, X., Li, X., Wen, H., Peng, Z., Han, R. P. S., et al. (2023) · Nano Energy · doi:10.1016/j.nanoen.2023.109098 · Cited by 50 · see citing works
Transspinal stimulation increases motoneuron output of multiple segments in human spinal cord injury
Murray, L. M., & Knikou, M. (2019) · PLoS ONE · doi:10.1371/journal.pone.0213696 · Cited by 48 · see citing works
Spinal motor mapping by epidural stimulation of lumbosacral posterior roots in humans
Hofstoetter, U. S., Perret, I., Bayart, A., Lackner, P., Binder, H., Freundl, B., & Minassian, K. (2020) · iScience · doi:10.1016/j.isci.2020.101930 · Cited by 47 · see citing works
Angeli, C., Rejc, E., Boakye, M., Herrity, A. N., Mesbah, S., Hubscher, C. H., Forrest, G. F., & Harkema, S. J. (2023) · Neuromodulation Technology at the Neural Interface · doi:10.1016/j.neurom.2023.03.014 · Cited by 47 · see citing works
Woodington, B. J., Jiang, L., Carnicer‐Lombarte, A., Güemes, A., Naegele, T. E., Hilton, S., Hadwe, S. E., Trivedi, R. A., Malliaras, G. G., & Barone, D. G. (2024) · Science Advances · doi:10.1126/sciadv.adl1230 · Cited by 48 · see citing works
Posteroanterior cervical transcutaneous spinal stimulation targets ventral and dorsal nerve roots
Wu, Y., Levine, J. M., Wecht, J. R., Maher, M. T., LiMonta, J. M., Saeed, S., Santiago, T. M., Bailey, E., Kastuar, S., Guber, K. S., et al. (2019) · Clinical Neurophysiology · doi:10.1016/j.clinph.2019.11.056 · Cited by 47 · see citing works
“Targeted stimulation of the spinal cord, as demonstrated with lumbar epidural stimulation (Harkema et al. 2011; Angeli et al. 2014, 2018; Gill et al. 2018; Wagner et al. 2018), may recruit endogenous circuitry that leads to re-expression of natural movement synergies (Giszter 2015; Wenger et al.”
Barss, T. S., Parhizi, B., Porter, J., & Mushahwar, V. K. (2022) · Journal of Clinical Medicine · doi:10.3390/jcm11030639 · Cited by 45 · see citing works
“Most recently, eSCS applied to the lumbar spinal cord, in conjunction with intensive locomotor training, enabled persons with clinically motor-complete SCI to walk over ground for short distances [4,13,18].”
MethodMultisite Hebbian Plasticity Restores Function in Humans with Spinal Cord Injury
Jo, H. J., Kizziar, E., Sangari, S., Chen, D., Kessler, A., Kim, K., Anschel, A. S., Heinemann, A. W., Mensh, B. D., Awadalla, S., et al. (2023) · Annals of Neurology · doi:10.1002/ana.26622 · Cited by 48 · see citing works
“walking with assistive devices during epidural stimulation with an implanted stimulator after 278 or 113 stimulation sessions combined with exercise training.(5,6) In another study, three participants with incomplete SCI regained voluntary control over previously paralyzed muscles and could walk or cycle in outdoor se…”
MethodCalvert, J. S., Manson, G. A., Grahn, P. J., & Sayenko, D. G. (2019) · Journal of Neurophysiology · doi:10.1152/jn.00454.2019 · Cited by 46 · see citing works
Self-citationMesbah, S., Ball, T., Angeli, C., Rejc, E., Dietz, N. E., Ugiliweneza, B., Harkema, S. J., & Boakye, M. (2020) · Brain · doi:10.1093/brain/awaa423 · Cited by 45 · see citing works
Spinal Cord Injury: Animal Models, Imaging Tools and the Treatment Strategies
Cizkova, D., Murgoci, A., Cubinkova, V., Humeník, F., Mojzisova, Z., Maloveská, M., Čížek, M., Fournier, I., & Salzet, M. (2019) · Neurochemical Research · doi:10.1007/s11064-019-02800-w · Cited by 43 · see citing works
Optimization of Spinal Cord Stimulation Using Bayesian Preference Learning and Its Validation
Zhao, Z., Ahmadi, A., Hoover, C., Grado, L. L., Peterson, N., Wang, X., Freeman, D., Murray, T. A., Lamperski, A., Darrow, D., et al. (2021) · IEEE Transactions on Neural Systems and Rehabilitation Engineering · doi:10.1109/tnsre.2021.3113636 · Cited by 39 · see citing works
Using a high-frequency carrier does not improve comfort of transcutaneous spinal cord stimulation
Dalrymple, A. N., Hooper, C. A., Kuriakose, M. G., Capogrosso, M., & Weber, D. J. (2022) · Journal of Neural Engineering · doi:10.1088/1741-2552/acabe8 · Cited by 42 · see citing works
Romeni, S., Losanno, E., Emedoli, D., Albano, L., Agnesi, F., Mandelli, C., Barzaghi, L. R., Pompeo, E., Mura, C., Alemanno, F., et al. (2025) · Science Translational Medicine · doi:10.1126/scitranslmed.adp9607 · Cited by 45 · see citing works
- Authors
- Gill, M. L., Grahn, P. J., Calvert, J. S., Linde, M. B., Lavrov, I. A., Strommen, J. A., Beck, L. A., Sayenko, D. G., Van Straaten, M. G., Drubach, D. I., Veith, D. D., Thoreson, A. R., Lopez, C., Gerasimenko, Y. P., Edgerton, V. R., Lee, K. H., & Zhao, K. D.
- Affiliations
- Mayo Clinic (US)
- Houston Methodist (US)
- Russian Academy of Sciences (RU)
- University of California, Los Angeles (US)
- Corresponding author
- Lee, Kendall H.
- Zhao, Kristin D.
- ORCID
- Venue
- Nature Medicine
- Published
- 2018-09-24
- Volume
- 24
- Issue
- 11
- Pages
- 1677-1682
- ISSN
- 1078-8956 (ISSN-L)
- 1546-170X
- OpenAlex
- W2892074957
- Cited by
- 574
- References
- 43
- Citations by year
- 2026: 51 · 2025: 63 · 2024: 58 · 2023: 81 · 2022: 87 · 2021: 94 · 2020: 72 · 2019: 50 · 2018: 16
- FWCI
- 44.13
- Type
- journal article
- Language
- en
- Update notices
- correction (2018-10-23)
- Open access
- closed
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Nature Medicine (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Nature
- Topics
- Health Sciences › Medicine › Pathology and Forensic Medicine › Spinal Cord Injury Research
- Health Sciences › Medicine › Rehabilitation › Stroke Rehabilitation and Recovery
- Physical Sciences › Engineering › Biomedical Engineering › Prosthetics and Rehabilitation Robotics
- Keywords
- spinal cord injury, complete paraplegia, epidural stimulation, multimodal rehabilitation, task-oriented training, body weight support, standing, paraplegia
- MeSH terms
- Adult, Electric Stimulation, Transcutaneous Electric Nerve Stimulation, Electromyography, Humans, Male, Motor Activity, Nerve Net, Paralysis, Paraplegia, Spinal Cord Injuries, Muscle, Skeletal
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