# Prediction of isometric forces from combined epidural spinal cord and neuromuscular electrical stimulation in the rat lower limb

## TL;DR

This study shows that combining spinal and muscle stimulation in rats can predictably restore limb movement, which could help improve rehabilitation after spinal cord injuries.

## Contribution

The study demonstrates that combined spinal and muscle stimulation responses can be accurately predicted using linear summation.

## Key findings

- Spinal and muscle co-stimulation forces were closely predicted by summing individual responses.
- Prediction errors were relatively low in healthy anesthetized rats.
- The results suggest potential for simplified control schemes in spinal cord injury rehabilitation.

## Abstract

Although epidural spinal cord and muscle stimulation have each been separately used for restoration of movement after spinal cord injury, their combined use has not been widely explored. Using both approaches in combination could provide more flexible control compared to using either approach alone, but whether responses evoked from such combined stimulation can be easily predicted is unknown. We evaluate whether responses evoked by combined spinal and muscle stimulation can be predicted simply, as the linear summation of responses produced by each type of stimulation individually. Should this be true, it would simplify the prediction of co-stimulation responses and the development of control schemes for spinal cord injury rehabilitation. In healthy anesthetized rats, we measured hindlimb isometric forces in response to spinal and muscle stimulation. Force prediction errors were calculated as the difference between predicted and observed co-stimulation forces. We found that spinal and muscle co-stimulation could be closely predicted as the linear summation of the individual spinal and muscle responses and that the errors were relatively low. We discuss the implications of these results to the use of combined muscle and spinal stimulation for the restoration of movement following spinal cord injury.