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Peer-reviewedCC BY-NC-NDNature Medicine

Spinal cord stimulation for upper limb motor function in people with chronic post-stroke hemiparesis: a feasibility trial

  • Roberto Martins de Freitas1,2
  • Shovan Bhatia1,2
  • Erynn Sorensen3,1,2
  • Nikhil Verma4,5
  • Erick Carranza3,6,2
  • Scott Ensel3,2
  • Luigi Borda4,5
  • Amy Boos7,2
  • Jeff Goldsmith8
  • Lee E. Fisher3,9,6,2
  • Daryl Pinion Fields1,2
  • Marc P. Powell1,2
9 more authors
  • Shane Gordon10
  • Jeffrey R. Balzer1
  • Robert Max Friedlander1
  • George Frederick Wittenberg4,7,6,11,2
  • Peter Carlos Gerszten1,2
  • John W. Krakauer12,13,14,15
  • Elvira Pirondini16,3,6,2,17
  • Douglas J. Weber18,19,20
  • Marco Capogrosso21,22,23,24,25
25 affiliations
  1. 1Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA
  2. 2Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA
  3. 3Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
  4. 4Department of Mechanical Engineering, Carnegie Mellon University, Pittsburgh, PA, USA
  5. 5NeuroMechatronics Lab, Carnegie Mellon University, Pittsburgh, PA, USA
  6. 6Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA
  7. 7Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA
  8. 8Department of Biostatistics, Columbia University, New York, NY, USA
  9. 9Department of Biomedical Engineering, Carnegie Mellon University, Pittsburgh, PA, USA
  10. 10Procirca Center for Clinical Neurophysiology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
  11. 11HERL, TECH-GRECC, Veteran Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA
  12. 12Department of Neurology, Johns Hopkins University, Baltimore, MD, USA
  13. 13Department of Neuroscience, Johns Hopkins University, Baltimore, MD, USA
  14. 14Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD, USA
  15. 15The Sante Fe Institute, Sante Fe, NM, USA
  16. 16Center for the Neural Basis of Cognition, Pittsburgh, PA, USA
  17. 17University of Pittsburgh Clinical and Translational Science Institute (CTSI), Pittsburgh, PA, USA
  18. 18Department of Mechanical Engineering, Carnegie Mellon University, Pittsburgh, PA, USA. [email protected]
  19. 19NeuroMechatronics Lab, Carnegie Mellon University, Pittsburgh, PA, USA. [email protected]
  20. 20The Neuroscience Institute, Carnegie Mellon University, Pittsburgh, PA, USA. [email protected]
  21. 21Center for the Neural Basis of Cognition, Pittsburgh, PA, USA. [email protected]
  22. 22Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA. [email protected]
  23. 23Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA. [email protected]
  24. 24Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD, USA. [email protected]
  25. 25Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA. [email protected]
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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 .

Related

  1. Cervical epidural spinal cord stimulation is associated with enhanced voluntary upper-limb muscle activation in chronic post-stroke hemiparesis: a pilot feasibility study
    Ciou-Chan Wu, Hsiang-Ling Huang, Hsiang-Ling Huang +12
    Frontiers in Behavioral NeurosciencePeer-reviewedCC BYFull textNeuroscienceGeneral medicineDOAJ
  2. Effect of epidural spinal cord stimulation combined with personalized neurorehabilitation in chronic motor-complete spinal cord injury: study protocol for the phase II single-arm feasibility RESTORES (RESToration Of Rehabilitative function with Epidural spinal Stimulation) trial
    Kai Rui Wan, Zhi Yan Valerie Ng, Seng Kwee Wee +15
    Frontiers in NeurologyPeer-reviewedCC BY 4.0Full textNeurologyCrossrefEurope PMC
  3. Modulation of autonomic function and heart rate variability by transcutaneous spinal cord stimulation and physical therapy in individuals with chronic spinal cord injury
    Adriana Pliego-Carrillo, Daniella Pinto, Alejandra Méndez-Flores +6
    European Journal of Medical ResearchPeer-reviewedCC BYFull textCardiovascular medicineDOAJ
  4. Ventral Epidural Stimulation Restores Forelimb Function and Reduces Microglial Activation after Subacute Cervical Spinal Cord Injury
    Matthew K. Hogan, Allison M. Frazier, Daisy Delgado +10
    Journal of neurotraumaPeer-reviewedLicence not statedFull textNeurologyPMC
  5. Comparative Effectiveness of Differential Target Multiplexed Spinal Cord Stimulation and Traditional Spinal Cord Stimulation with or without Subcutaneous Peripheral Nerve Field Stimulation for Chronic Back and Leg Pain
    Boris Cehov, Maria Lynge Rosing, Pia Olesen +4
    Journal of Pain ResearchPeer-reviewedCC BY-NC 4.0Full textSurgery & anaesthesiaPMC

Cite

BibTeXRIS
BibTeX
@article{freitas2026spinal,
  title = {{Spinal cord stimulation for upper limb motor function in people with chronic post-stroke hemiparesis: a feasibility trial}},
  author = {Roberto Martins de Freitas and Shovan Bhatia and Erynn Sorensen and Nikhil Verma and Erick Carranza and Scott Ensel and Luigi Borda and Amy Boos and Jeff Goldsmith and Lee E. Fisher and Daryl Pinion Fields and Marc P. Powell and Shane Gordon and Jeffrey R. Balzer and Robert Max Friedlander and George Frederick Wittenberg and Peter Carlos Gerszten and John W. Krakauer and Elvira Pirondini and Douglas J. Weber and Marco Capogrosso},
  journal = {Nature Medicine},
  year = {2026},
  month = jun,
  doi = {10.1038/s41591-026-04435-1},
  url = {https://doi.org/10.1038/s41591-026-04435-1},
  note = {CC BY-NC-ND},
}
RIS
TY  - JOUR
TI  - Spinal cord stimulation for upper limb motor function in people with chronic post-stroke hemiparesis: a feasibility trial
AU  - Roberto Martins de Freitas
AU  - Shovan Bhatia
AU  - Erynn Sorensen
AU  - Nikhil Verma
AU  - Erick Carranza
AU  - Scott Ensel
AU  - Luigi Borda
AU  - Amy Boos
AU  - Jeff Goldsmith
AU  - Lee E. Fisher
AU  - Daryl Pinion Fields
AU  - Marc P. Powell
AU  - Shane Gordon
AU  - Jeffrey R. Balzer
AU  - Robert Max Friedlander
AU  - George Frederick Wittenberg
AU  - Peter Carlos Gerszten
AU  - John W. Krakauer
AU  - Elvira Pirondini
AU  - Douglas J. Weber
AU  - Marco Capogrosso
PY  - 2026
DA  - 2026/06/04
JO  - Nature Medicine
DO  - 10.1038/s41591-026-04435-1
UR  - https://doi.org/10.1038/s41591-026-04435-1
AB  - 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 .
SN  - 1078-8956
SN  - 1546-170X
SN  - 1744-7933
ER  -