The effect of device-based neuromodulation on the motor recovery of patients with spinal cord injury.

Abstract

This paper systematically analyzes literature from PubMed, MEDLINE, Embase, and Cochrane databases over the past 10 years (up to May 25, 2025). It employs defined search terms, inclusion/exclusion criteria, and a documented search flow to evaluate mechanisms, efficacy, challenges, and future directions of neuromodulation technologies for spinal cord injury rehabilitation. The results synthesize findings from clinical trials, and representative papers. This review aims to evaluate the mechanisms and clinical applications of device-based neuromodulation technologies in spinal cord injury (SCI) rehabilitation, focusing on their efficacy, challenges, and future directions. The countries and regions worldwide participating in neuromodulation. We systematically analyzed advancements in neuromodulation over the past decade, including brain-spinal interfaces (BSI), brain-computer interfaces (BCI), cranial stimulation techniques (DBS, TMS, tDCS), spinal cord stimulation (SCS), robotic exoskeletons. The review integrates findings from clinical trials. Neuromodulation technologies demonstrate significant potential in restoring motor and sensory function post-SCI. BSI and BCI improve mobility but face infection and cybersecurity risks. Cranial stimulation techniques enhance neuroplasticity, with DBS and TMS showing efficacy, while tDCS requires further validation. Epidural SCS enables motor recovery in complete paralysis but has high infection rates. Robotic exoskeletons benefit younger patients. Neuromodulation technologies represent promising interventions for SCI, yet challenges remain in precision, safety, and efficacy. Future research should prioritize AI-driven parameter optimization, wearable device development, and multicenter randomized trials to establish these methods as core treatments, ultimately improving patient outcomes and quality of life.