Personalized electrode placement for spinal cord injury rehabilitation

For people with spinal cord injuries, transcutaneous spinal cord stimulation (tSCS) is a noninvasive therapeutic approach for gait rehabilitation. Electrodes placed on the lumbar region of a patient’s back can modulate spinal activity and restore voluntary motor control.

To make tSCS more precise, researchers have recently begun exploring multi-electrode configurations for targeting specific muscle groups. However, electrode placement and parameter tuning are typically performed manually.

To address this, Zorkot et al. developed a technology to enhance multi-electrode tSCS selectivity and assist in clinical adoption.

Previous studies suggest that multi-electrode tSCS showed correlations between muscle-specific recruitment based on spinal anatomy.

“Clinical translation remains challenging for both single- and (mainly) multi-electrode approaches due to the limited reliability of manual electrode placement on the back and the subjective adjustment of stimulation parameters,” said author Mouhamed Zorkot.

This variability may reduce rehabilitation efficiency and complicate the clinical implementation of tSCS, since determining the optimal configuration for each electrode can be inefficient in routine clinical practice.

The researchers used two independent algorithms in their study: a ranking based approach to determine spinal cord placement, and a selectivity-driven approach to quantitatively assess muscle activity. They tested their algorithms on healthy patients to validate their performance and safety under controlled conditions.

This method supports a shift toward personalized neuromodulation by advancing a multi-electrode tSCS approach that enhances stimulation selectivity and expands its potential for gait rehabilitation, enabling individualized electrode placement and stimulation parameter selection based on clinical profile.

“By integrating technical innovation with clinical expertise, we aim to ensure that the approach is not only scientifically robust but also practical and meaningful for real-world rehabilitation,” Zorkot said.

Source: “Improving muscle recruitment via multi-electrode transcutaneous spinal cord stimulation using automated selectivity-driven algorithms,” by Mouhamed Zorkot, Solaiman Shokur, Riccardo Carpineto, Silvestro Micera, and Mohamed Bouri, APL Bioengineering (2026). The article can be accessed at https://doi.org/10.1063/5.0298057 .