Preferential activation of proprioceptive and cutaneous sensory fibers compared to motor fibers during cervical transcutaneous spinal cord stimulation: A computational study

ObjectiveCervical transcutaneous spinal cord stimulation (tSCS) is a promising technology that can support motor function recovery of upper-limbs after spinal cord injury. Its efficacy may depend on the ability to recruit sensory afferents and convey excitatory inputs onto motoneurons. Therefore, understanding its physiological mechanisms is critical to accelerate its development towards clinical applications. In this study, we used an anatomically realistic computational model of the cervical spine to compare -motor, A-sensory, and A{beta}-sensory fiber activation thresholds and activation sites. ApproachWe developed a tridimensional geometry of the cervical body and tSCS electrodes with a cathode centred at the C7 spinous process and an anode placed over the anterior neck. The geometrical model was used to estimate the electric potential distributions along motor and sensory fiber trajectories at the C7 spinal level using a finite element method. We implemented dedicated motor and sensory fiber models to simulate the -motor and A-sensory fibers using 12, 16, and 20 m diameter fibers, and A{beta}-sensory fibers using 6, 9, and 12 m diameter fibers. We estimated nerve fiber activation thresholds and sites for a 2 ms monophasic stimulating pulse and compared them across the fiber groups. Main resultsOur results showed lower activation thresholds of A- and A{beta}-sensory fibers compared with -motor fibers, suggesting preferential sensory fiber activation. We also found no differences between activation thresholds of A-sensory and large A{beta}-sensory fibers, implying they were co-activated. The activation sites were located at the dorsal and ventral root levels. SignificanceUsing a realistic computational model, we demonstrated preferential activation of dorsal root A- and A{beta}-sensory fibers compared with ventral root -motor fibers during cervical tSCS. These findings suggest high proprioceptive and cutaneous contributions to neural activations during cervical tSCS, which inform the underlying mechanisms of upper-limb functional motor recovery.