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66 reviewsSpinal cord stimulation (SCS) improves motor control after paralysis. This evidence led to the hypothesis thatSCS facilitates residual supraspinal inputs to spinal motoneurons. Here, we demonstrate that this hypothesisis not supported by experimental evidence. Instead, we show that residual supraspinal inputs modulate motoneurons’ membrane potential to transform subthreshold SCS pulses into suprathreshold action potentials,thereby entraining motoneuron activity to SCS. Despite this entrainment, residual supraspinal inputs cancontrol motoneuron firing rates by modulating the number of subthreshold SCS pulses transformed into action potentials, resulting in volitional modulation of motor output for a restricted set of SCS parameters.Furthermore, we predict that residual supraspinal inhibitory drive can silence unwanted suprathresholdmotoneuron activity, enlarging the functional set of SCS parameters. Finally, we demonstrate that this setof functional stimulation parameters is further restricted by lesion severity, highlighting an intrinsic limitationof SCS in cases of severe injury.
