Conditioning electrical nerve stimulation enhances functional rewiring in a mouse model of nerve transfer to treat chronic spinal cord injury

Background/Objectives: Nerve transfer surgery is a state-of-the-art surgical approach to restore hand and arm function in individuals living with tetraplegia, significantly im-pacting daily life. While nearly a third of all individuals with chronic spinal cord injury may benefit from this intervention, variability in outcomes can limit the functional im-pact. A bedside to bench approach was taken to address the variable response of tetra-plegic individuals to nerve transfer surgery. Methods: We used a hierarchical multiple factor analysis to evaluate the effects of conditioning electrical stimulation (CES) on out-comes in a mouse model of nerve transfer to treat chronic cervical spinal cord injury. Results: We found that CES of donor nerves one week prior to nerve transfer surgery enhanced anatomical and functional measures of innervation of targeted muscles. Fur-thermore, CES increased the rate of recovery of naturalistic behavior. Conclusions: While the model has some limitations due to the small size of the rodent, our results support the use of CES as an effective approach to improve outcomes in clinical nerve repair settings.