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Abnormal spatiotemporal activation of spinal motor pools may underlie gait impairments, making spinal maps a potential physiological marker for guiding personalized rehabilitation. We present a stride-by-stride online visualization method for estimating spinal locomotor output from multi-muscle EMG signals mapped onto the approximate rostrocaudal location of motor pools, identifying activation patterns across lumbar and sacral motor pools. The primary objective of this framework is to serve as a near real-time neurophysiological monitoring and assessment tool during clinical gait analysis. Beyond this core diagnostic capability, the system is designed as an extensible platform that may support real-time feedback to therapists, exploratory biofeedback to patients, or future integration into closed-loop spinal neuromodulation protocols. The system enables online visualization of spinal maps and related parameters (such as timing, intensity, and coactivation of lumbar and sacral motor pools) through a flexible, user-friendly software interface. Preliminary tests in eight children with cerebral palsy and comparing with typically developing peers show that, despite stride-to-stride variability, the method may effectively differentiate in real-time impaired from typical spinal activation patterns, supporting its promise for clinical gait rehabilitation.<\/jats:p>","DOI":"10.3389\/fbioe.2026.1753344","type":"journal-article","created":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T05:36:01Z","timestamp":1784612161000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Real-time approach to evaluate spinal cord topography of motor pool activation during gait"],"prefix":"10.3389","volume":"14","author":[{"given":"Priscilla","family":"Avaltroni","sequence":"first","affiliation":[{"name":"Laboratory of Neuromotor Physiology, LIFE - Istituto di Ricerca e Cura - Santa Lucia IRCCS","place":["Rome, Italy"]},{"name":"Department of Systems Medicine and Center of Space Biomedicine, University of Rome Tor Vergata","place":["Rome, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Germana","family":"Cappellini","sequence":"additional","affiliation":[{"name":"Laboratory of Neuromotor Physiology, LIFE - Istituto di Ricerca e Cura - Santa Lucia IRCCS","place":["Rome, Italy"]},{"name":"Department of Systems Medicine and Center of Space Biomedicine, University of Rome Tor Vergata","place":["Rome, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesca","family":"Sylos-Labini","sequence":"additional","affiliation":[{"name":"Laboratory of Neuromotor Physiology, LIFE - Istituto di Ricerca e Cura - Santa Lucia IRCCS","place":["Rome, Italy"]},{"name":"Department of Systems Medicine and Center of Space Biomedicine, University of Rome Tor Vergata","place":["Rome, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barbara","family":"La Scaleia","sequence":"additional","affiliation":[{"name":"Laboratory of Neuromotor Physiology, LIFE - Istituto di Ricerca e Cura - Santa Lucia IRCCS","place":["Rome, Italy"]},{"name":"Department of Systems Medicine, University of Rome Tor Vergata","place":["Rome, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Lacquaniti","sequence":"additional","affiliation":[{"name":"Laboratory of Neuromotor Physiology, LIFE - Istituto di Ricerca e Cura - Santa Lucia IRCCS","place":["Rome, Italy"]},{"name":"Department of Systems Medicine and Center of Space Biomedicine, University of Rome Tor Vergata","place":["Rome, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yury","family":"Ivanenko","sequence":"additional","affiliation":[{"name":"Laboratory of Neuromotor Physiology, LIFE - Istituto di Ricerca e Cura - Santa Lucia IRCCS","place":["Rome, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,21]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"e70120","DOI":"10.1002\/pri.70120","article-title":"Artificial intelligence in biomechanics: a narrative review of current applications in diagnostic and physical rehabilitation","volume":"30","author":"Abdelmohsen","year":"2025","journal-title":"Physiother. 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