The paralysis of the muscles controlling the hand dramatically limits the quality of life of individuals living with spinal cord injury (SCI). Here, we present a non-invasive neural interface technology that will change the lives of individuals living with cervical SCI (C4-C6). We demonstrate that eight motor- and sensory-complete SCI individuals (C5-C6, n = 7; C4, n = 1) are still able to task-modulate in real-time the activity of populations of spinal motor neurons with spared corticospinal pathways. In all tested patients, we identified groups of motor units under voluntary control that encoded a variety of hand movements. The motor unit discharges were mapped into more than 10 degrees of freedom, ranging from grasping to individual hand digit flexions and extensions. We then mapped the neural dynamics into a real-time controlled virtual hand. The patients were able to match the cue hand posture by proportionally controlling four degrees of freedom (opening and closing the hand and index flexion/extension). These results demonstrate that wearable muscle sensors provide access to voluntarily controlled neural activity in complete cervical SCI individuals.

The authors have declared no competing interest.

This work was partially funded by d.hip (Digital Health Innovation Platform), a cooperation between Siemens Healthineers, Medical Valley, University Hospital Erlangen, and Friedrich-Alexander Universität.

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The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

Ethics Committee of the Friedrich-Alexander-Universität Erlangen-Nürnberg gave ethical approval for this work (application 22-138-Bm).

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