This review starts with a brief introduction of the pathophysiological principles of ESCS, which were mostly investigated in preclinical studies. This scoping review was not registered and no review protocol was produced. Moreover, the checklist of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extensions for Scoping Reviews (PRISMA-ScR) was used.

This scoping review followed the methodological framework described in the PRISMA guidelines ( ) for conducting a scoping study.

The following keywords and MeSH terms were chosen and applied in different combinations: “epidural stimulation”, “paralysis”, “spinal cord injury”, “paraplegia”, “quadriplegia”, “tetraplegia”, “locomotion”, “autonomic function”, “bladder function”. The aim of this review is to provide a structured overview of the available clinical data regarding the application of ESCS to promote clinically meaningful neurological and functional improvement following SCI.įor this scoping review we conducted a systematic literature search within Medline and Cochrane as well as the Nature Medicine library. Remarkably, even in the most challenging population-people with chronic and complete SCI-ESCS has shown the potential to facilitate non-voluntary standing and stepping movements. In recent years, a number of clinical studies reporting substantial effects of epidural electrical spinal cord stimulation (ESCS) on partial restoration of sensorimotor function in people with incomplete SCI have been published. It represents one of the most advanced concepts in respect to successful translation towards routine clinical use. Spinal cord stimulation has the potential to amplify the effects of activity-based targeted rehab interventions. Although clinically relevant functional improvement can be achieved with neurorehabilitation, its effect size is limited, which explains the need for adjunct neuromodulatory interventions. At the current state the only proven treatments for augmentation of functional recovery are intensive, task-oriented neurorehabilitative therapies activating neural plasticity at different levels of the central nervous system. However, the translation of preclinical results of neuroregenerative approaches to clinical application represents a huge challenge still lacking evidence for efficacy in humans. Worldwide, intensive research activities aim to develop restorative therapies, which foster regeneration of the damaged/injured spinal cord, thus promoting recovery of sensorimotor and autonomic function beyond natural recovery. Rehabilitative efforts aiming at improvement of motor function are often compromised by SCI associated complications such as high levels of pain, spasticity or cardiovascular dysfunction such as orthostatic hypotension or autonomic dysreflexia. In people with sensorimotor complete SCI and limited spontaneous neurological recovery, the aim of rehabilitation is to compensate for the permanently lost voluntary function by assistive devices such as wheelchairs or other walking aids. In people with acute incomplete SCI and a high potential for neurological recovery, medical (causal treatment of acute non-traumatic causes, decompression surgery in acute traumatic SCI) and rehabilitative interventions aim to promote sensorimotor improvements and restoration of grasping/reaching and standing/walking function. Beyond these symptoms, which become apparent immediately after injury, secondary disease conditions such as neuropathic pain evolve, which in addition affect the wellbeing and quality of life in SCI patients. In addition, SCI patients present with more or less pronounced autonomic dysfunction including bladder and bowel control as well as cardiovascular malfunction. Spinal cord injury either due to a traumatic or non-traumatic cause severely affects sensorimotor function in upper and lower extremities depending on the neurological level of injury and injury severity.

Downside to dorsal column stimulation