{
  "abstract": "Chronic arm and hand hemiparesis is a major cause of disability after stroke. Unfortunately, standard-of-care rehabilitation falls well short of the high doses required to experience improvements. In this feasibility study, we explored the use of cervical epidural spinal cord stimulation (SCS) to assist motor function and provide meaningful functional improvements without the need of a high-dose rehabilitation program. Here we report the final outcomes of this study testing safety, feasibility and preliminary efficacy of cervical SCS as a neuroprosthetic approach for chronic post-stroke upper limb hemiparesis. We implanted seven participants with profound motor deficits (Fugl-Meyer Assessment (FMA) scores 15-35) using two leads implanted unilaterally in the cervical spinal cord for 4 weeks. No serious adverse events occurred. Under SCS ON, motor function immediately improved regardless of impairment severity (average +32% strength and +5.6 FMA points). Notably, three of seven participants with residual corticospinal connectivity to finger muscles improved hand/finger movement with SCS. Despite performing only 8.6 hours of motor activity (5.5 hours with SCS ON), participants improved by an average of +6.6 FMA points at the end of the study compared to baseline, and spasticity decreased in all participants. Although all benefited, our preliminary analysis indicates that spared sensory function may be a determinant of responsiveness to SCS. These findings provide preliminary evidence of the safety, feasibility and efficacy of cervical SCS for chronic post-stroke hemiparesis, suggesting its potential as a fully implantable neuroprosthetic solution for assisting upper limb function in daily living. ClinicalTrials.gov identifier: NCT04512690 .",
  "abstract_shown": true,
  "affiliations": [
    "Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA",
    "Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA",
    "Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA",
    "Department of Mechanical Engineering, Carnegie Mellon University, Pittsburgh, PA, USA",
    "NeuroMechatronics Lab, Carnegie Mellon University, Pittsburgh, PA, USA",
    "Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA",
    "Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA",
    "Department of Biostatistics, Columbia University, New York, NY, USA",
    "Department of Biomedical Engineering, Carnegie Mellon University, Pittsburgh, PA, USA",
    "Procirca Center for Clinical Neurophysiology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA",
    "HERL, TECH-GRECC, Veteran Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA",
    "Department of Neurology, Johns Hopkins University, Baltimore, MD, USA",
    "Department of Neuroscience, Johns Hopkins University, Baltimore, MD, USA",
    "Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD, USA",
    "The Sante Fe Institute, Sante Fe, NM, USA",
    "Center for the Neural Basis of Cognition, Pittsburgh, PA, USA",
    "University of Pittsburgh Clinical and Translational Science Institute (CTSI), Pittsburgh, PA, USA",
    "Department of Mechanical Engineering, Carnegie Mellon University, Pittsburgh, PA, USA. dougweber@cmu.edu",
    "NeuroMechatronics Lab, Carnegie Mellon University, Pittsburgh, PA, USA. dougweber@cmu.edu",
    "The Neuroscience Institute, Carnegie Mellon University, Pittsburgh, PA, USA. dougweber@cmu.edu",
    "Center for the Neural Basis of Cognition, Pittsburgh, PA, USA. mcapo@pitt.edu",
    "Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA. mcapo@pitt.edu",
    "Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA. mcapo@pitt.edu",
    "Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD, USA. mcapo@pitt.edu",
    "Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA. mcapo@pitt.edu"
  ],
  "article_type": null,
  "arxiv": null,
  "author_total": 21,
  "authors": [
    {
      "affs": [
        0,
        1
      ],
      "name": "Roberto Martins de Freitas",
      "orcid": "0000-0002-4169-5692"
    },
    {
      "affs": [
        0,
        1
      ],
      "name": "Shovan Bhatia",
      "orcid": "0000-0001-8090-7208"
    },
    {
      "affs": [
        2,
        0,
        1
      ],
      "name": "Erynn Sorensen",
      "orcid": "0000-0003-0988-4132"
    },
    {
      "affs": [
        3,
        4
      ],
      "name": "Nikhil Verma",
      "orcid": "0009-0004-5533-6887"
    },
    {
      "affs": [
        2,
        5,
        1
      ],
      "name": "Erick Carranza",
      "orcid": "0000-0002-8502-3222"
    },
    {
      "affs": [
        2,
        1
      ],
      "name": "Scott Ensel",
      "orcid": "0000-0003-0264-3686"
    },
    {
      "affs": [
        3,
        4
      ],
      "name": "Luigi Borda",
      "orcid": "0009-0003-4670-8530"
    },
    {
      "affs": [
        6,
        1
      ],
      "name": "Amy Boos",
      "orcid": "0009-0007-7399-3276"
    },
    {
      "affs": [
        7
      ],
      "name": "Jeff Goldsmith"
    },
    {
      "affs": [
        2,
        8,
        5,
        1
      ],
      "name": "Lee E. Fisher",
      "orcid": "0000-0002-9072-3119"
    },
    {
      "affs": [
        0,
        1
      ],
      "name": "Daryl Pinion Fields",
      "orcid": "0000-0002-4594-2996"
    },
    {
      "affs": [
        0,
        1
      ],
      "name": "Marc P. Powell",
      "orcid": "0000-0002-4880-2745"
    },
    {
      "affs": [
        9
      ],
      "name": "Shane Gordon"
    },
    {
      "affs": [
        0
      ],
      "name": "Jeffrey R. Balzer",
      "orcid": "0000-0001-7523-6972"
    },
    {
      "affs": [
        0
      ],
      "name": "Robert Max Friedlander",
      "orcid": "0000-0002-5008-7592"
    },
    {
      "affs": [
        3,
        6,
        5,
        10,
        1
      ],
      "name": "George Frederick Wittenberg",
      "orcid": "0000-0001-5603-1197"
    },
    {
      "affs": [
        0,
        1
      ],
      "name": "Peter Carlos Gerszten",
      "orcid": "0000-0002-1483-6090"
    },
    {
      "affs": [
        11,
        12,
        13,
        14
      ],
      "name": "John W. Krakauer",
      "orcid": "0000-0002-4316-1846"
    },
    {
      "affs": [
        15,
        2,
        5,
        1,
        16
      ],
      "name": "Elvira Pirondini",
      "orcid": "0000-0002-8078-3951"
    },
    {
      "affs": [
        17,
        18,
        19
      ],
      "name": "Douglas J. Weber",
      "orcid": "0000-0002-9782-3497"
    },
    {
      "affs": [
        20,
        21,
        22,
        23,
        24
      ],
      "name": "Marco Capogrosso",
      "orcid": "0000-0002-0975-316X"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/a18frcj6jksm0.bib",
  "cited_by": 8,
  "doi": "10.1038/s41591-026-04435-1",
  "fulltext_url": null,
  "id": "a18frcj6jksm0",
  "issns": [
    "1078-8956",
    "1546-170X",
    "1744-7933"
  ],
  "landing_url": "https://doi.org/10.1038/s41591-026-04435-1",
  "language": "en",
  "licence": "CC-BY-NC-ND",
  "licence_label": "CC BY-NC-ND",
  "licence_source": "journal",
  "licence_url": "https://creativecommons.org/licenses/by-nc-nd/4.0/",
  "metadata_licence": null,
  "native_subjects": [
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      "openalex",
      "2742|Stroke Rehabilitation and Recovery"
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  "openalex": "W7163589545",
  "pdf_url": null,
  "pmcid": "PMC12393459",
  "pmid": "40894062",
  "published": "2026-06-04",
  "publisher": "Nature Portfolio",
  "ris": "https://research.draconitic.com/paper/a18frcj6jksm0.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T13:26:56Z",
      "native_id": "W7163589545",
      "source": "openalex",
      "url": "https://doi.org/10.1038/s41591-026-04435-1"
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  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2742|Stroke Rehabilitation and Recovery",
      "subfield": "general"
    }
  ],
  "title": "Spinal cord stimulation for upper limb motor function in people with chronic post-stroke hemiparesis: a feasibility trial",
  "title_text": "Spinal cord stimulation for upper limb motor function in people with chronic post-stroke hemiparesis: a feasibility trial",
  "type": "peer-reviewed",
  "updated_at": "2026-11-03T13:20:37Z",
  "url": "https://research.draconitic.com/paper/a18frcj6jksm0",
  "venue": "Nature Medicine",
  "versions": []
}