# Modulation of Forward Propulsion and Foot Dorsiflexion by Spinal and Muscular Stimulation During Human Stepping

## TL;DR

This paper introduces a new stimulation technology that helps regulate walking by targeting specific spinal and muscle areas during different phases of movement.

## Contribution

The study introduces a novel method combining spinal and muscular stimulation to regulate both stance and swing phases of human stepping.

## Key findings

- Posterior root stimulation at T12 with tibialis anterior muscle stimulation regulates foot dorsiflexion during the swing phase.
- Posterior root stimulation at L2 with hamstrings and medial gastrocnemius stimulation regulates forward propulsion during the stance phase.
- Combined stimulation during both phases results in the most coordinated stepping movements.

## Abstract

(1) Background: We developed a novel technology that regulates human locomotion using transcutaneous electrical spinal cord stimulation to activate spinal locomotor networks and posterior root stimulation to activate leg flexor and extensor motor pools during swing and stance phases, respectively. This technology effectively restores walking in post-stroke individuals while forward propulsion in the stance phase and foot dorsiflexion in the swing phase are insufficient. In this study the effectiveness of regulating the stance and swing phases while healthy volunteers walked on a treadmill with transcutaneous electrical stimulation of the posterior roots, leg muscles, and their combined effects has been examined. (2) Methods: We analyzed the kinematic characteristics of stepping movements in healthy participants with spinal stimulation of the posterior roots and flexor/extensor leg muscles. (3) Results: Our findings clearly show that posterior root stimulation at T12 combined with tibialis anterior muscle stimulation during the swing phase effectively regulates foot dorsiflexion, whereas posterior root stimulation at L2 combined with hamstrings and medial gastrocnemius stimulation during the stance phase effectively regulates forward propulsion. (4) Conclusions: Combined stimulation in the stance and swing phases within the same gait cycle resulted in the most coordinated stepping, and effective control of forward propulsion and foot dorsiflexion.