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This approach enables the spinal cord to generate lower limb extension patterns during weight bearing, allowing individuals with SCI to achieve upright standing. We have shown that the human spinal cord can generate some standing postural responses during self-initiated body weight shifting. In this study, we investigated the ability of individuals with motor complete SCI receiving epidural stimulation to generate standing reactive postural responses after external perturbations were applied at the trunk. A cable-driven robotic device was used to provide constant assistance for pelvic control and to deliver precise trunk perturbations while participants used their hands to grasp onto handlebars for self-balance support (hands-on) as well as when participants were without support (free-hands). Five individuals with motor complete SCI receiving lumbosacral spinal cord epidural stimulation parameters specific for standing (Stand-scES) participated in this study. Trunk perturbations (average magnitude: 17\u2009\u00b1\u20093% body weight) were delivered randomly in the four cardinal directions. Participants attempted to control each perturbation such that upright standing was maintained and no additional external assistance was needed. Lower limb postural responses were generally more frequent, larger in magnitude, and appropriately modulated during the free-hands condition. This was associated with trunk displacement and lower limb loading modulation that were larger in the free-hands condition. Further, we observed discernible lower limb muscle synergies that were similar between the two perturbed standing conditions. These findings suggest that the human spinal circuitry involved in postural control retains the ability to generate meaningful lower limb postural responses after SCI when its excitability is properly modulated. Moreover, lower limb postural responses appear enhanced by a standing environment without upper limb stabilization that promotes afferent inputs associated with a larger modulation of ground reaction forces and trunk kinematics. These findings should be considered when developing future experimental frameworks aimed at studying upright postural control and activity-based recovery training protocols aimed at promoting neural plasticity and sensory-motor recovery.<\/jats:p>","DOI":"10.1089\/neu.2023.0403","type":"journal-article","created":{"date-parts":[[2023,11,27]],"date-time":"2023-11-27T03:57:51Z","timestamp":1701057471000},"page":"1133-1145","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":6,"title":["Standing Reactive Postural Responses of Lower Limbs With and Without Self-Balance Assistance in Individuals With Spinal Cord Injury Receiving Epidural Stimulation"],"prefix":"10.1177","volume":"41","author":[{"given":"Collin D.","family":"Bowersock","sequence":"first","affiliation":[{"name":"Kentucky Spinal Cord Injury Research Center, Departments of University of Louisville, Louisville, Kentucky, USA."},{"name":"Neurological Surgery, University of Louisville, Louisville, Kentucky, USA."},{"name":"Department of Mechanical Engineering, Northern Arizona University, Flagstaff, Arizona, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tanvi","family":"Pisolkar","sequence":"additional","affiliation":[{"name":"Kentucky Spinal Cord Injury Research Center, Departments of University of Louisville, Louisville, Kentucky, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xupeng","family":"Ai","sequence":"additional","affiliation":[{"name":"Department of Mechanical Engineering, Columbia University, New York, New York, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chenfei","family":"Zhu","sequence":"additional","affiliation":[{"name":"Department of Mechanical Engineering, Columbia University, New York, New York, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudia A","family":"Angeli","sequence":"additional","affiliation":[{"name":"Kentucky Spinal Cord Injury Research Center, Departments of University of Louisville, Louisville, Kentucky, USA."},{"name":"Frazier Rehabilitation Institute, University of Louisville Health, Louisville, Kentucky, USA."},{"name":"Bioengineering, University of Louisville, Louisville, Kentucky, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan J","family":"Harkema","sequence":"additional","affiliation":[{"name":"Kentucky Spinal Cord Injury Research Center, Departments of University of Louisville, Louisville, Kentucky, USA."},{"name":"Neurological Surgery, University of Louisville, Louisville, Kentucky, USA."},{"name":"Frazier Rehabilitation Institute, University of Louisville Health, Louisville, Kentucky, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gail","family":"Forrest","sequence":"additional","affiliation":[{"name":"Kessler Foundation, West Orange, New Jersey, USA."},{"name":"Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, New Jersey, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sunil","family":"Agrawal","sequence":"additional","affiliation":[{"name":"Department of Mechanical Engineering, Columbia University, New York, New York, USA."},{"name":"Department of Rehabilitation and Regenerative Medicine, Columbia University, New York, New York, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Enrico","family":"Rejc","sequence":"additional","affiliation":[{"name":"Kentucky Spinal Cord Injury Research Center, Departments of University of Louisville, Louisville, Kentucky, USA."},{"name":"Neurological Surgery, University of Louisville, Louisville, Kentucky, USA."},{"name":"Kessler Foundation, West Orange, New Jersey, USA."},{"name":"Department of Medicine, University of Udine, Udine, Italy."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2024,5,25]]},"reference":[{"key":"e_1_3_5_2_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41591-021-01663-5"},{"key":"e_1_3_5_3_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41591-018-0175-7"},{"key":"e_1_3_5_4_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1803588"},{"key":"e_1_3_5_5_2","doi-asserted-by":"publisher","DOI":"10.1089\/neu.2016.4516"},{"key":"e_1_3_5_6_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0133998"},{"key":"e_1_3_5_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.pmr.2018.12.009"},{"key":"e_1_3_5_8_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-019-50938-y"},{"key":"e_1_3_5_9_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00221-021-06272-9"},{"key":"e_1_3_5_10_2","first-page":"255","volume-title":"Handbook of Physiology","author":"Horak F","year":"1996","unstructured":"Horak F, , Macpherson J. 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