Perspectives of current and future use of transcutaneous spinal stimulation and integration in the home.

Abstract

While quantitative studies on transcutaneous spinal stimulation (TSS), a noninvasive neuromodulatory intervention, show promise for functional recovery after spinal cord injury (SCI), less is known about stakeholder perspectives on home use. This study explored experiences, expectations, and implementation considerations of TSS among persons with lived experience of SCI (PLEX), caregivers, and clinician scientists. Fourteen participants participated in three virtual focus groups. Discussion data were analyzed using a hybrid thematic approach combining deductive and inductive coding. Perspectives on home TSS use were discussed across six interrelated themes: benefits, challenges, facilitators, barriers, expectations, and acceptability. PLEX described perceived benefits such as improvements in upper extremity function and sensation from prior TSS use. All participants identified safety concerns and caregiver investment as key challenges influencing home use. While some PLEX noted unpleasant sensations during stimulation, they generally described TSS as acceptable when meaningful benefits were evident. All participants emphasized that training and support from clinicians and caregivers are essential facilitators for successful home use. While interest in TSS is strong, practical challenges must be addressed. Centering the experiences, priorities, and goals of those who will use TSS is essential for supporting meaningful outcomes and successful home integration.