Method Article

Noninvasive Temporal Interference Electrical Stimulation for Spinal Cord Rehabilitation

DOI:

10.3791/68574

⸱

October 31st, 2025

 ,  ,  ,  ,  ,  , 
1Key Laboratory of Biomedical Engineering of Ministry of Education, Qiushi Academy for Advanced Studies, Zhejiang University, 2Department of Biomedical Engineering, Zhejiang University, 3College of Information Science and Electronic Engineering, Zhejiang University, 4Department of Computer Science and Technology, Zhejiang University, 5State Key Laboratory of Brain-Machine Intelligence, Zhejiang University, 6The MOE Frontier Science Center for Brain Science & Brain-machine Integration, Zhejiang University, 7Center of Excellence in Biomedical Research on Advanced Integrated-on-Chips Neurotechnologies (CenBRAIN Neurotech), School of Engineering, Westlake University, 8Center for Rehabilitation Medicine, Rehabilitation & Sports Medicine Research Institute of Zhejiang Province, Department of Rehabilitation Medicine, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), 9School of Rehabilitation, Hangzhou Medical College, 10Westlake Institute for Optoelectronics, Westlake University

In This Article

Summary

$$\rightleftharpoonup{xx}$$ $$\longleftharp{xx}$$, $$\longrightharp{xx}$$,

This study proposes a TI stimulation protocol for spinal cord injury that optimizes electrode placement for specific regions and efficiently implements this optimized strategy in clinical application.

Abstract

$$\rightleftharpoonup{xx}$$ $$\longleftharp{xx}$$, $$\longrightharp{xx}$$,

Spinal cord injury (SCI) can lead to permanent loss of motor, sensory, and autonomic functions, presenting a significant clinical challenge for rehabilitation. In addition to conventional rehabilitation approaches, epidural spinal cord stimulation (eSCI) is often used to enhance recovery. However, the invasive nature of eSCI limits patient acceptance and widespread application. Compared to traditional spinal cord stimulation, temporal interference (TI) stimulation offers a noninvasive approach to stimulate deep spinal cord regions, making it a promising technique for SCI treatment. A critical factor in achieving effective TI stimulation for SCI rehabilitation is the accurate placement of two electrode pairs on the skin surface to generate a high electric field envelope within the targeted spinal cord area. We propose a unique protocol that utilizes electric field simulations and parameter optimization to determine the optimal electrode placement for specific SCI regions. Additionally, this protocol provides a systematic description of how to efficiently implement the optimized electrode placement strategy in clinical TI stimulation.

Introduction

$$\rightleftharpoonup{xx}$$ $$\longleftharp{xx}$$, $$\longrightharp{xx}$$,

Spinal cord injury (SCI) is a debilitating central nervous system disorder that can result in the permanent loss of motor, sensory, and autonomic functions below the level of injury1,2. Consequently, the treatment and rehabilitation of SCI patients have become a focal point of both scientific research and clinical practice. Traditional treatment approaches, including pharmacological and physical therapies, have certain limitations in promoting functional recovery3,4,5,6. Among physic....

Access restricted. Please log in or start a trial to view this content.

Protocol

$$\rightleftharpoonup{xx}$$ $$\longleftharp{xx}$$, $$\longrightharp{xx}$$,

This study involves human subjects and was conducted in accordance with the Declaration of Helsinki. Ethical approval was obtained from the Institutional Review Board of Zhejiang University. Written informed consent was obtained from all participants prior to their inclusion, ensuring they were fully informed of the study's purpose, procedures, potential risks, and their right to withdraw at any time without penalty. The reagents and the equipment used in this study are listed in the Table of Materials.

Contraindications and special considerations
SCI patients are assessed for eligibility using a ....

Access restricted. Please log in or start a trial to view this content.

Results

$$\rightleftharpoonup{xx}$$ $$\longleftharp{xx}$$, $$\longrightharp{xx}$$,

When conducting TI simulations without errors, the average electric field intensity in the target spinal cord region stimulated by the current group of electrode pairs can be obtained. Taking Group 10 stimulating the C5 target area as an example (Figure 9), the "Volume Weighted Average" displayed in the interface is 0.50 V/m. Additionally, by clicking "Max Modulation - Mask Filter - Viewers - Surface Viewer", a 3D view of the electric field distribution on .......

Access restricted. Please log in or start a trial to view this content.

Discussion

$$\rightleftharpoonup{xx}$$ $$\longleftharp{xx}$$, $$\longrightharp{xx}$$,

Critical steps

Setting up simulation conditions
When electrodes are placed on the surface of the human model's skin, the cylindrical electrodes are partially embedded into the skin to ensure there is no air gap between the electrodes and the skin. Otherwise, the current cannot pass through the air and into the human body. The distance from the electrode to the origin (d1, d2) is measured along the skin surface, as the skin is n.......

Access restricted. Please log in or start a trial to view this content.

Disclosures

$$\rightleftharpoonup{xx}$$ $$\longleftharp{xx}$$, $$\longrightharp{xx}$$,

All authors declare no conflicts of interest related to this article.

Acknowledgements

$$\rightleftharpoonup{xx}$$ $$\longleftharp{xx}$$, $$\longrightharp{xx}$$,

Research supported by the National Natural Science Foundation of China (52407261), the "Pioneer" and "Leading Goose" R&D Program of Zhejiang (2025C01137), Key Research and Development Plan of Zhejiang Province (2024C03040), Research Special Fund Project of Zhejiang Association of Rehabilitation Medicine (ZKKY2024008), and Sim4Life by ZMT, www.zmt.swiss.

....

Access restricted. Please log in or start a trial to view this content.

Materials

List of materials used in this article
NameCompanyCatalog NumberComments
3T MRI or CT system Siemens HealthineersMAGNETOM Skyra (MRI) / SOMATOM X.cite (CT)
Adhesive Tape3MDurapore 1538-1
Alcohol WipesPDI HealthcareS41125
BatteryNeurodomeAccessory of NervioX-1000
Computer Dell TechnologiesPrecision 366016 GB RAM, multi-core processor
Electrically conductive gelSoterix HD-1AGE-12
Electrodes adapterNeurodomeAccessory of NervioX-1000
Electromagnetic simulation softwareZMT Zurich MedTech AGSim4Life v8.0
Human simulation models IT’IS FoundationVirtual Population 3.0Duke (Static) 3.0, Ella (Static) 3.0
Isopropyl AlcoholMedline IndustriesMDS098003Z
Measuring tapeStanley Tools33-725
Paper TowelKimberly-ClarkKimwipes 34155
Syringe or ApplicatorBD305857
TI stimulatorNeurodomeNervioX-1000Temporal Interference Stimulation Device
Two pairs of Ag/AgCl electrodes and cablesShanhai Medical LtdSHTIS
Washable MarkerCrayola58-7726

References

$$\rightleftharpoonup{xx}$$ $$\longleftharp{xx}$$, $$\longrightharp{xx}$$,
  1. Hu, X., et al. Spinal cord injury: Molecular mechanisms and therapeutic interventions. Signal Transduct Target Ther. 8 (1), 245(2023).
  2. Lu, Y., et al. Global incidence and characteristics of spinal cord....

Access restricted. Please log in or start a trial to view this content.

Reprints and Permissions

Request permission to reuse the text or figures of this JoVE article

Request Permission

Tags

Temporal Interference StimulationSpinal Cord RehabilitationSpinal Cord InjuryNoninvasive StimulationEpidural StimulationElectrode PlacementElectric Field SimulationParameter OptimizationMotor Function RecoveryDeep Spinal Stimulation
Video Coming Soon

Related Articles