Prediction of isometric forces from combined epidural spinal cord and neuromuscular electrical stimulation in the rat lower limb.

Both epidural spinal cord and muscle stimulation have been widely used for restoration of movement after spinal cord injury. However, using both approaches simultaneously could provide more flexible control compared to using either approach alone. We evaluate whether responses evoked by combined spinal and muscle stimulation can be predicted by the linear summation of responses produced by each individually. Should this be true, it would simplify the prediction of co-stimulation responses and the development of control schemes for spinal cord injury rehabilitation. In anesthetized rats, we measured hindlimb isometric forces in response to spinal and muscle stimulation across a range of amplitudes. Force prediction errors were calculated as the difference between predicted co-stimulation vectors and observed co-stimulation vectors whereby small errors signified evidence for linear summation. We found that the errors for spinal and muscle co-stimulation were significantly larger than expected. Using a bootstrapping analysis, we find that these larger errors do not reflect a nonlinear interaction between spinal and muscle responses. Instead, they can be attributed to the variability of spinal stimulation responses. We discuss the implications of these results to the use of combined muscle and spinal stimulation for the restoration of movement following spinal cord injury.