Real-time approach to evaluate spinal cord topography of motor pool activation during gait

Real-time assessment of spinal motor output ("spinal maps") can provide insight into how neural control strategies during walking differ between healthy individuals and patients with neurological disorders. Abnormal spatiotemporal activation of spinal motor pools may underlie gait impairments, making spinal maps a potential physiological marker for guiding personalized rehabilitation. We present a stride-by-stride online visualization method for estimating spinal locomotor output from multi-muscle EMG signals mapped onto the approximate rostrocaudal location of motor pools, identifying activation patterns across lumbar and sacral motor pools. The primary objective of this framework is to serve as a near real-time neurophysiological monitoring and assessment tool during clinical gait analysis. Beyond this core diagnostic capability, the system is designed as an extensible platform that may support real-time feedback to therapists, exploratory biofeedback to patients, or future integration into closed-loop spinal neuromodulation protocols. The system enables online visualization of spinal maps and related parameters (such as timing, intensity, and coactivation of lumbar and sacral motor pools) through a flexible, user-friendly software interface. Preliminary tests in eight children with cerebral palsy and comparing with typically developing peers show that, despite stride-to-stride variability, the method may effectively differentiate in real-time impaired from typical spinal activation patterns, supporting its promise for clinical gait rehabilitation.