Effects of transcutaneous spinal stimulation with gait training on walking-related outcomes in stroke survivors: a systematic review

Background: Stroke survivors present with various deficits, and gait training has been reported to have a positive impact on stroke survivors. Transcutaneous spinal stimulation (TSS; e.g., tsDCS, tSCS, and phasic TSS) is an emerging technique for post-stroke recovery. Objectives: This systematic review evaluated the scientific evidence on the effects of gait training (GT) combined with transcutaneous spinal stimulation (TSS) on walking and related outcomes in stroke survivors. Methods: In this systematic review, the EMBASE, PubMed, PEDro, Cochrane Library, and Web of Science databases were searched from their inception to November 2025. Randomised controlled trials were included, and their methodological quality and risk of bias (ROB) were evaluated using the PEDro scale and Cochrane ROB assessment tool, respectively. Qualitative and quantitative syntheses were used for the data analysis. Results: Cathodal transcutaneous spinal stimulation combined with gait training probably improves primary gait outcomes (walking capacity, cadence, paretic lower limb strength, and walking speed) with moderate certainty, while exhibiting little or no difference in secondary gait outcomes. In contrast, anodal tsDCS showed variable/mixed effects on gait outcomes. Conclusions: Moderate-certainty evidence shows that cathodal transcutaneous spinal stimulation combined with gait training probably improves primary walking outcomes in stroke survivors.