NIH grant: Closing the loop on functional recovery: Personalized spinal neuromodulation for locomotor rehabilitation (1R21EB038597-01)

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NIH grant 1R21EB038597-01: Closing the loop on functional recovery: Personalized spinal neuromodulation for locomotor rehabilitation
Institute: {'code': 'EB', 'abbreviation': 'NIBIB', 'name': 'National Institute of Biomedical Imaging and Bioengineering', 'admin_org_id': '12500035', 'admin_funding_url': ''}. PI: Kimberly A. Ingraham. Award: $212265.
Start: 2026-08-21T00:00:00.
Project Summary
Individuals with neurological impairments from multiple sclerosis, stroke, spinal cord injury (SCI), traumatic brain
injury, Parkinson’s disease, and cerebral palsy often experience severely impaired walking function, which
greatly limits their activity and participation. Current locomotor rehabilitation programs are limited, and
participants often do not achieve functional recovery. Nearly 1 million individuals worldwide sustain a new spinal
cord injury (SCI) each year, and two-thirds of these injuries are classified as ‘incomplete’, which indicates some
capacity for neurological recovery with promising new treatments. Recent evidence has shown that adding
transcutaneous spinal stimulation (tSCS) to locomotor rehabilitation can durably improve walking function in
individuals with incomplete SCI compared to rehabilitation alone. However, these results depend on a trained
researcher or clinician to carefully and manually tune the parameters of the stimulation waveform for each
individual and training session. Presently, stimulation amplitude is tuned subjectively using trial-and-error.
Further, stimulation amplitude is typically set to a static value within a session, which cannot account for dynamic
physiological changes that occur between steps or over the course of a session. There are currently no
standardized clinical tools that can efficiently and effectively personalize tSCS parameters to maximize
neuroplastic treatment effects and promote functional recovery. This proposed research project seeks to fill this
gap by developing a closed-loop system to personalize tSCS amplitude in real time during locomotor
rehabilitation based on objective neuromechanical measurements obtained from wearable sensors. Specifically,
we will collect experimental data to establish neuromechanical benchmarks that can be used to determine the
optimal stimulation amplitude for maximizing walking performance during locomotor rehabilitation (Aim 1). We
will then design and implement an algorithm that automatically modulates tSCS amplitude based on objective
neuromechanical measurements and evaluate changes in the short-term walking performance of individuals with
incomplete SCI using our personalized tSCS method compared to the standard open-loop tuning approach (Aim
2). We hypothesize that closed-loop tSCS will more efficiently converge on the optimal stimulation amplitude
compared to an open-loop tuning approach, and that participants will achieve better walking performance with
the closed-loop system. Our approach is an innovative departure from this standard practice because our
technology will enable the automatic personalization of spinal stimulation based on real-time neuromechanical
measurements from wearable sensors. This work lays the foundation to pursue large-scale studies that evaluate
the clinical efficacy of locomotor rehabilitation with real-time personalized tSCS in individuals with SCI. In the
future, this research has the potential to fundamentally transform clinical care for locomotor rehabilitation for
individuals with a broad spectrum of neurological disabilities.

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