Spinal cord-computer interfaces for neurorehabilitation: Technical challenges and clinical perspectives.

Abstract

This Perspective aims to clarify the clinical and engineering scope of spinal cord-computer interfaces (SCCIs) in neurorehabilitation, distinguishing them from adjacent brain-computer interface, neuromodulation, and assistive-technology approaches while identifying the key barriers to translation. We synthesize evidence from epidural electrical stimulation, spinal bioelectronics, neural decoding, actuator control, brain-spine interfaces, and activity-dependent rehabilitation to define SCCIs as closed-loop or potentially closed-loop spinal interfaces. We then organize the major translational barriers into five interdependent domains: implantation strategy, long-term interface stability, spinal signal integration, actuator coupling, and activity-dependent circuit reconstruction. Our synthesis identifies five barriers that currently limit SCCI translation: surgical targeting and localization, chronic interface degradation, heterogeneous spinal pathophysiology, real-time decoding and actuator compatibility, and incomplete understanding of activity-dependent circuit remodeling. Although targeted spinal stimulation and hybrid brain-spine systems have shown functional benefits in selected populations, these advances remain difficult to generalize without adaptive, patient-specific system architectures. By distinguishing SCCIs from adjacent neurotechnology paradigms and linking engineering barriers to clinical decision points, this framework may support consistent terminology, calibrated translational claims, and the development of adaptive, patient-specific closed-loop strategies for restoring native motor control.

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