Transcutaneous Spinal Cord Stimulation Disrupts Conscious Ankle Proprioception and Produces a More Constrained Locomotor Pattern in Unimpaired Adults

Abstract

Transcutaneous spinal cord stimulation (tSCS) modulates spinal sensorimotor circuits primarily through activation of afferent networks. While prior work has emphasized locomotor performance and spinal excitability, how tSCS affects conscious proprioceptive perception and the extent to which such effects parallel changes in locomotor control remain unclear. We investigated the acute and training-related effects of tSCS on ankle proprioception and gait in unimpaired adults (n = 14), with an independent control group (n = 14) completing identical proprioceptive training without stimulation. Proprioception was quantified using a bilateral robotic assessment of dynamic ankle localization ability (Crisscross), gross motor output using maximum dorsiflexion strength, and gait during normal and tandem treadmill walking using spatiotemporal, trunk-sway, and mediolateral center-of-mass (CoM) excursion measures. Acute tSCS increased ankle proprioceptive error (p < 0.001) while dorsiflexion strength was unchanged (p = 0.30). Gait shifted toward a modestly more constrained locomotor pattern, characterized by reduced step width and ML CoM excursion (p < 0.05). With continued training under stimulation, proprioceptive error decreased and, unlike the control group, the tSCS group showed progressive improvement that persisted after stimulation ended. Sagittal-plane gait measures recovered toward or beyond baseline, whereas mediolateral measures remained constrained, revealing a direction-dependent reorganization of locomotor control. Together, these findings show that tSCS influences multiple aspects of the sensorimotor control loop, disrupting conscious proprioception while reshaping locomotor behavior, and that the nervous system can adapt to altered afferent input through training.