{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T16:51:09Z","timestamp":1775148669612,"version":"3.50.1"},"reference-count":34,"publisher":"American Spinal Injury Association","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,1]]},"abstract":"\n Objectives:<\/jats:title>\n To describe changes in the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) exam in sublesional motor and sensory domains following short-term epidural electrical stimulation of lumbosacral spinal segments in individuals with spinal cord injury (SCI).<\/jats:p>\n <\/jats:sec>\n \n Methods:<\/jats:title>\n Twenty individuals with SCI underwent implantation of percutaneous epidural spinal cord stimulation followed by stimulation parameter optimization and 10-12 sessions of stimulation-enabled motor training. Pre-\/postintervention ISNCSCI exams were compared to determine changes in motor\/sensory scores for regions within 3 levels of the neurological level of injury (NLI) and caudal to this, with subanalyses per motor\/sensory complete versus incomplete baseline status.<\/jats:p>\n <\/jats:sec>\n \n Results:<\/jats:title>\n \n Individuals with motor complete SCI gained 6% \u00b1 3% of available motor points within 3 levels of NLI and 1% \u00b1 0% of motor points caudal to this (\n P<\/jats:italic>\n = .08). Motor incomplete individuals gained 9% \u00b1 22% of available motor points within 3 levels of NLI and lost 4% \u00b1 7% of motor points caudal to this (\n P<\/jats:italic>\n = .63). Following stimulation, changes in motor scores with potential high functional impact occurred in 3 individuals (5 total muscle groups with conversion from baseline <3\/5 strength to \u22653\/5 at completion). Individuals with sensory complete SCI had fewer sensory gains within 3 levels of NLI (6%) compared to those with sensory incomplete SCI (30%,\n P<\/jats:italic>\n = .02).\n <\/jats:p>\n <\/jats:sec>\n \n Discussion:<\/jats:title>\n Spinal cord stimulation after SCI rapidly induces changes in both motor and sensory domains that are retained after stimulation is removed. These changes primarily occur within 3 levels of the NLI and occur to a greater degree in those with incomplete SCI.<\/jats:p>\n <\/jats:sec>","DOI":"10.46292\/sci25-00017","type":"journal-article","created":{"date-parts":[[2025,8,22]],"date-time":"2025-08-22T17:05:28Z","timestamp":1755882328000},"page":"68-76","source":"Crossref","is-referenced-by-count":1,"title":["ISNCSCI Exam Changes Following Spinal Cord Stimulation"],"prefix":"10.46292","volume":"31","author":[{"given":"Ryan J.","family":"Solinsky","sequence":"first","affiliation":[{"name":"Rehabilitation Medicine Research Center, Department of Physical Medicine & Rehabilitation, Mayo Clinic, Rochester, Minnesota"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel D.","family":"Veith","sequence":"additional","affiliation":[{"name":"Rehabilitation Medicine Research Center, Department of Physical Medicine & Rehabilitation, Mayo Clinic, Rochester, Minnesota"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Megan L.","family":"Gill","sequence":"additional","affiliation":[{"name":"Rehabilitation Medicine Research Center, Department of Physical Medicine & Rehabilitation, Mayo Clinic, Rochester, Minnesota"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lisa A.","family":"Beck","sequence":"additional","affiliation":[{"name":"Rehabilitation Medicine Research Center, Department of Physical Medicine & Rehabilitation, Mayo Clinic, Rochester, Minnesota"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Candee J.","family":"Mills","sequence":"additional","affiliation":[{"name":"Rehabilitation Medicine Research Center, Department of Physical Medicine & Rehabilitation, Mayo Clinic, Rochester, Minnesota"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anders J.","family":"Asp","sequence":"additional","affiliation":[{"name":"Rehabilitation Medicine Research Center, Department of Physical Medicine & Rehabilitation, Mayo Clinic, Rochester, Minnesota"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"K. A.","family":"Fernandez","sequence":"additional","affiliation":[{"name":"Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic, Rochester, Minnesota"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Omid","family":"Jahanian","sequence":"additional","affiliation":[{"name":"Rehabilitation Medicine Research Center, Department of Physical Medicine & Rehabilitation, Mayo Clinic, Rochester, Minnesota"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kristin D.","family":"Zhao","sequence":"additional","affiliation":[{"name":"Rehabilitation Medicine Research Center, Department of Physical Medicine & Rehabilitation, Mayo Clinic, Rochester, Minnesota"},{"name":"Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic, Rochester, Minnesota"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter J.","family":"Grahn","sequence":"additional","affiliation":[{"name":"Rehabilitation Medicine Research Center, Department of Physical Medicine & Rehabilitation, Mayo Clinic, Rochester, Minnesota"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"25425","reference":[{"issue":"5","key":"b1","series-title":"Brain","first-page":"1394","article-title":"Altering spinal cord excitability enables voluntary movements after chronic complete paralysis in humans","volume":"137","author":"Angeli CA","year":"2014","unstructured":"Angeli CA, Edgerton VR, Gerasimenko YP, Harkema SJ. Altering spinal cord excitability enables voluntary movements after chronic complete paralysis in humans. Brain. 2014;137(5):1394-1409."},{"issue":"11","key":"b2","series-title":"Nature Med","first-page":"1677","article-title":"Neuromodulation of lumbosacral spinal networks enables independent stepping after complete paraplegia","volume":"24","author":"Gill ML","year":"2018","unstructured":"Gill ML, Grahn PJ, Calvert JS, et al. Neuromodulation of lumbosacral spinal networks enables independent stepping after complete paraplegia. Nature Med. 2018;24(11):1677-1682."},{"key":"b3","series-title":"Nature Med","first-page":"pp","article-title":"Non-invasive spinal cord electrical stimulation for arm and hand function in chronic tetraplegia: a safety and efficacy trial","author":"Moritz C","year":"2024","unstructured":"Moritz C, Field-Fote EC, Tefertiller C, et al. Non-invasive spinal cord electrical stimulation for arm and hand function in chronic tetraplegia: a safety and efficacy trial. Nature Med. 2024: pp.1-8."},{"key":"b4","series-title":"McMullen to Nathalie Gilat","author":"Letter David P","year":"2024","unstructured":"Letter David P. McMullen to Nathalie Gilat. December 19, 2024. DEN240014-S001.Letter.DENG.pdf"},{"issue":"5","key":"b5","series-title":"J Spinal Cord Med","first-page":"653","article-title":"Current barriers and ethical considerations for clinical implementation of epidural stimulation for functional improvement after spinal cord injury","volume":"43","author":"Solinsky R","year":"2020","unstructured":"Solinsky R, Specker-Sullivan L, Wexler A. Current barriers and ethical considerations for clinical implementation of epidural stimulation for functional improvement after spinal cord injury. J Spinal Cord Med. 2020;43(5):653-656."},{"issue":"2","key":"b6","series-title":"Top Spinal Cord Injury Rehabil","first-page":"1","article-title":"International standards for neurological classification of spinal cord injury: Revised 2019","volume":"27","author":"Rupp R","year":"2021","unstructured":"Rupp R, Biering-S\u00f8rensen F, Burns SP, et al. International standards for neurological classification of spinal cord injury: Revised 2019. Top Spinal Cord Injury Rehabil. 2021;27(2):1."},{"issue":"3","key":"b7","series-title":"Top Spinal Cord Injury Rehabil","first-page":"241","article-title":"Reliability and validity of the sensory component of the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI): a systematic review","volume":"21","author":"Hales M","year":"2015","unstructured":"Hales M, Biros E, Reznik JE. Reliability and validity of the sensory component of the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI): a systematic review. Top Spinal Cord Injury Rehabil. 2015;21(3):241-249."},{"key":"b8","series-title":"Spine","first-page":"S87","article-title":"The Sygen\u00ae multicenter acute spinal cord injury study","volume":"26","author":"Geisler FH","year":"2001","unstructured":"Geisler FH, Coleman WP, Grieco G, Poonian D; Sygen Study Group. The Sygen\u00ae multicenter acute spinal cord injury study. Spine, 2001;26(24S):S87-S98."},{"issue":"8","key":"b9","series-title":"Spinal Cord","first-page":"914","article-title":"Effects of hybrid-functional electrical stimulation (FES) rowing whole-body exercise on neurologic improvement in subacute spinal cord injury: Secondary outcomes analysis of a randomized controlled trial","volume":"58","author":"Chou RC","year":"2020","unstructured":"Chou RC, Taylor JA, Solinsky R. Effects of hybrid-functional electrical stimulation (FES) rowing whole-body exercise on neurologic improvement in subacute spinal cord injury: Secondary outcomes analysis of a randomized controlled trial. Spinal Cord. 2020;58(8):914-920."},{"issue":"6","key":"b10","series-title":"Cell Stem Cell","first-page":"941","article-title":"A first-in-human, phase I study of neural stem cell transplantation for chronic spinal cord injury","volume":"22","author":"Curtis E","year":"2018","unstructured":"Curtis E, Martin JR, Gabel B, et al. A first-in-human, phase I study of neural stem cell transplantation for chronic spinal cord injury. 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Functional outcomes and participants\u2019 perspectives during short-term application of spinal stimulation in individuals with spinal cord injury. J Spinal Cord Med. 2024;47(1):1\u201312. https:\/\/doi.org\/10.1080\/10790268.2024.2383377."},{"issue":"6","key":"b13","series-title":"J Spinal Cord Med","first-page":"684","article-title":"Challenging questions regarding the international standards","volume":"41","author":"Solinsky R","year":"2018","unstructured":"Solinsky R, Kirshblum SC. Challenging questions regarding the international standards. J Spinal Cord Med. 2018;41(6):684-690."},{"issue":"6","key":"b14","series-title":"Spinal Cord","first-page":"444","article-title":"Inter-rater reliability of motor and sensory examinations performed according to American Spinal Injury Association standards","volume":"45","author":"Savic G","year":"2007","unstructured":"Savic G, Bergstr\u00f6m EMK, Frankel HL, Jamous MA, Jones PW. Inter-rater reliability of motor and sensory examinations performed according to American Spinal Injury Association standards. Spinal Cord. 2007;45(6):444-451."},{"key":"b15","series-title":"Br Med J","first-page":"351","article-title":"Understanding the Hawthorne effect","author":"Sedgwick P","year":"2015","unstructured":"Sedgwick P, Greenwood N. Understanding the Hawthorne effect. Br Med J. 2015:351."},{"key":"b16","series-title":"Front Syst Neurosci","first-page":"35","article-title":"Long-term spinal cord stimulation after chronic complete spinal cord injury enables volitional movement in the absence of stimulation","volume":"14","author":"Pe\u00f1a Pino I","year":"2020","unstructured":"Pe\u00f1a Pino I, Hoover C, Venkatesh S, et al. Long-term spinal cord stimulation after chronic complete spinal cord injury enables volitional movement in the absence of stimulation. 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Reliability and validity of the sensory component of the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI): a systematic review. Top Spinal Cord Injury Rehabil. 2015;21(3):241-249."},{"key":"b8","series-title":"Spine","first-page":"S87","article-title":"The Sygen\u00ae multicenter acute spinal cord injury study","volume":"26","author":"Geisler FH","year":"2001","unstructured":"Geisler FH, Coleman WP, Grieco G, Poonian D; Sygen Study Group. The Sygen\u00ae multicenter acute spinal cord injury study. Spine, 2001;26(24S):S87-S98."},{"issue":"8","key":"b9","series-title":"Spinal Cord","first-page":"914","article-title":"Effects of hybrid-functional electrical stimulation (FES) rowing whole-body exercise on neurologic improvement in subacute spinal cord injury: Secondary outcomes analysis of a randomized controlled trial","volume":"58","author":"Chou RC","year":"2020","unstructured":"Chou RC, Taylor JA, Solinsky R. Effects of hybrid-functional electrical stimulation (FES) rowing whole-body exercise on neurologic improvement in subacute spinal cord injury: Secondary outcomes analysis of a randomized controlled trial. Spinal Cord. 2020;58(8):914-920."},{"issue":"6","key":"b10","series-title":"Cell Stem Cell","first-page":"941","article-title":"A first-in-human, phase I study of neural stem cell transplantation for chronic spinal cord injury","volume":"22","author":"Curtis E","year":"2018","unstructured":"Curtis E, Martin JR, Gabel B, et al. A first-in-human, phase I study of neural stem cell transplantation for chronic spinal cord injury. 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Inter-rater reliability of motor and sensory examinations performed according to American Spinal Injury Association standards. Spinal Cord. 2007;45(6):444-451."},{"key":"b15","series-title":"Br Med J","first-page":"351","article-title":"Understanding the Hawthorne effect","author":"Sedgwick P","year":"2015","unstructured":"Sedgwick P, Greenwood N. Understanding the Hawthorne effect. Br Med J. 2015:351."},{"key":"b16","series-title":"Front Syst Neurosci","first-page":"35","article-title":"Long-term spinal cord stimulation after chronic complete spinal cord injury enables volitional movement in the absence of stimulation","volume":"14","author":"Pe\u00f1a Pino I","year":"2020","unstructured":"Pe\u00f1a Pino I, Hoover C, Venkatesh S, et al. Long-term spinal cord stimulation after chronic complete spinal cord injury enables volitional movement in the absence of stimulation. 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