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Author Notes:

Edelle C. Field-Fote, edelle.field-fote@shephard.org ; Tel.: +1-404-603-4274

Conceptualization, J.M.H. and E.C.F.-F.; methodology, J.M.H. and E.C.F.-F.; formal analysis, J.M.H.; investigation, J.M.H.; writing—original draft preparation, J.M.H.; writing—review and editing, J.M.H. and E.C.F.-F.; visualization, J.M.H.; supervision, E.C.F.-F.; funding acquisition, J.M.H. and E.C.F.-F. All authors have read and agreed to the published version of the manuscript.

We would like to thank the participants and the study staff that made this study possible: Stephen Estes; Anastasia Zarkou; Jennifer Iddings; Elizabeth Sasso; Casey Kandilakis; Cathy Furbish; Ryan Koter; Kyle Condon; Allison McIntyre; Marissa Mirecki; Nicholas Evans; Cazmon Suri; Jessica Gilliam; Evan Sandler; and Tori Le.

The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.


Research Funding:

This study was funded by the Wings for Life: (WFL-US-2/17 to Estes), NIH National Institute of Child Health and Human Development (NICHD) National Research Service Award (NRSA; F31HD101151 to Hope), and by the Hulse Spinal Cord Injury Research Fund.


  • Science & Technology
  • Life Sciences & Biomedicine
  • Technology
  • Biotechnology & Applied Microbiology
  • Engineering, Biomedical
  • Engineering
  • foot drop
  • locomotor training
  • transcutaneous spinal stimulation
  • spasticity
  • SCI

Assessment of Dorsiflexion Ability across Tasks in Persons with Subacute SCI after Combined Locomotor Training and Transcutaneous Spinal Stimulation


Journal Title:



Volume 10, Number 5


Type of Work:

Article | Final Publisher PDF


In people with spinal cord injury (SCI), transcutaneous spinal stimulation (TSS) has an immediate effect on the ability to dorsiflex the ankle, but persistent effects are not known. Furthermore, TSS has been associated with improved walking, increased volitional muscle activation, and decreased spasticity when combined with locomotor training (LT). In this study, the persistent impact of combined LT and TSS on dorsiflexion during the swing phase of walking and a volitional task in participants with SCI is determined. Ten participants with subacute motor-incomplete SCI received 2 weeks of LT alone (wash-in phase), followed by 2 weeks of either LT + TSS (TSS at 50 Hz) or LT + TSSSham (intervention phase). There was no persistent effect of TSS on dorsiflexion during walking and inconsistent effects on the volitional task. There was a strong positive correlation between the dorsiflexor ability for both tasks. There was a moderate effect of 4 weeks of LT on increased dorsiflexion during the task (d = 0.33) and walking (d = 0.34) and a small effect on spasticity (d = −0.2). Combined LT + TSS did not show persistent effects on dorsiflexion ability in people with SCI. Four weeks of locomotor training was associated with increased dorsiflexion across tasks. Improvements in walking observed with TSS may be due to factors other than improved ankle dorsiflexion.

Copyright information:

© 2023 by the authors.

This is an Open Access work distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by/4.0/).
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