2026· Journal of Indian Federation of Neurorehabilitation· pp. 23-33· 0 citations
TL;DR
This case demonstrates clinically meaningful neurological and functional recovery following prolonged, high-intensity multidisciplinary rehabilitation incorporating technology-assisted interventions after traumatic thoracic SCI and supports the potential role of individualized, task-specific, high-dose rehabilitation in maximizing functional recovery.
Abstract
Background: Traumatic thoracic spinal cord injury (SCI) frequently results in severe impairments in motor function, postural control, mobility and independence. Although spontaneous neurological recovery may occur during the early post-injury period, intensive multidisciplinary rehabilitation incorporating technology-assisted interventions has emerged as a promising strategy to facilitate activity- dependent neuroplasticity and improve functional outcomes. However, detailed longitudinal reports describing structured high-intensity rehabilitation protocols in thoracic SCI remain limited.
Case presentation: A 20-year-old man sustained a traumatic thoracic SCI in a motorcycle accident in December 2024, following which he underwent emergency spinal decompression and posterior instrumentation for stabilization. After achieving medical stability, he was enrolled in a comprehensive inpatient neurorehabilitation program consisting of three to four supervised physiotherapy sessions each day, 6 days per week, over a period of approximately 10 months. The rehabilitation protocol integrated conventional therapeutic exercises with advanced rehabilitation technologies, including robotic-assisted cycling, sensor-based upper- and lower-limb training, progressive trunk control exercises, graded weight-bearing activities, gait retraining, and task-oriented functional practice. Sequential neurological assessments revealed the re-emergence of voluntary motor activity below the neurological level of injury, consistent with clinical progression from a motor-complete to a motor-incomplete SCI. Because a complete follow-up international standards for neurological classification of spinal cord injury (ISNCSCI) examination was unavailable, formal American spinal injury association impairment scale (AIS) reclassification was not performed. Functional improvements were observed across multiple outcome measures, including functional independence measure (FIM) (42/126–57/126), Walking Index for SCI II (0–6), trunk impairment scale (TIS) (2–11), trunk extensor strength (1/5–3/5), lower-limb muscle strength, and pain intensity [visual analogue scale (VAS): 7/10–3/10].
Conclusion: This case demonstrates clinically meaningful neurological and functional recovery following prolonged, high-intensity multidisciplinary rehabilitation incorporating technology-assisted interventions after traumatic thoracic SCI. Although spontaneous recovery and resolution of spinal shock cannot be excluded as contributing factors, the findings support the potential role of individualized, task-specific, high-dose rehabilitation in maximizing functional recovery. Future well-designed prospective studies involving larger patient cohorts are needed to clarify the specific contribution of technology-assisted rehabilitation to functional recovery and to support the development of standardized, evidence-based rehabilitation protocols for individuals with SCI.
Thoracolumbar spinal cord injuries are associated with limited ability to attain an upright position, impaired balance, reduced exercise tolerance, and loss of independent walking. One of the promising approaches in motor rehabilitation is the use of robotic exoskeleton systems, which reproduce a near-physiological gait pattern and allow repeated performance of locomotor movements. Objective - to evaluate the effects of robot-assisted exoskeleton therapy on tolerance to vertical loading, balance, coordination, walking ability, and functional independence in patients with thoracolumbar spinal cord injuries. Materials and Methods: the study included 78 patients aged 18–65 years with motor-incomplete spinal cord injuries at the Th10–L2 level classified as AIS C–D. The main group comprised 40 patients who received standard rehabilitation combined with exoskeleton-assisted therapy, while the comparison group included 38 patients who underwent standard restorative treatment. The treatment course consisted of 20 sessions lasting 30–45 minutes, performed five times per week. Effectiveness was assessed before treatment, after 4 weeks, and at 3 months using the duration of tolerated standing, the six-minute walk distance, 10-m walking speed, the Walking Index for Spinal Cord Injury II, computerized stabilography, and the Spinal Cord Independence Measure III. Results: after 3 months, tolerance to vertical loading increased from 8.7±3.1 to 35.2±8.4 minutes in the main group and from 8.9±3.2 to 23.6±7.3 minutes in the comparison group (p<0.001). The six-minute walk distance reached 158.2±43.6 and 112.4±38.9 m, respectively, while walking speed was 0.32±0.11 and 0.22±0.09 m/s (p<0.001). The Walking Index for Spinal Cord Injury II increased to 12.7±3.5 points in the main group compared with 9.4±3.3 points in the comparison group. The center-of-pressure sway area decreased by 49.8% in the main group and by 27.4% in the comparison group. The most pronounced improvement was observed in patients classified as AIS D and in those with a baseline strength of at least 3 points in the key lower-extremity muscle groups. Conclusion: the inclusion of exoskeleton-assisted therapy in the comprehensive rehabilitation of patients with thoracolumbar spinal cord injuries improves tolerance to vertical loading, balance, coordination, and walking ability, while also promoting greater functional independence.
G. A. Boymurodov, Z. Mavlyanova· Journal of modern medicine· 0 citations
Background Epidural spinal cord stimulation (eSCS) has shown promise in facilitating motor recovery in chronic spinal cord injury (SCI); however, long-term functional trajectories beyond 12 months and the neurophysiological mechanisms underlying eSCS-mediated recovery remain poorly characterized. This pilot cohort study investigated the 24-month functional recovery trajectory following eSCS combined with structured rehabilitation in patients with chronic SCI and evaluated the immediate neuromuscular facilitation effects of eSCS using surface electromyography. Methods Eleven patients with chronic SCI (median age, 56 years; 90.9% male; AIS grades A-D; median time since injury, 7 years) who underwent eSCS implantation and completed at least 24 months of follow-up were included. Motor score, pinprick sensory score, Barthel Index, WISCI II, VAS for pain, and WHOQOL-BREF were assessed at baseline and at 3, 6, 9, 12, 18, and 24 months. Surface electromyography of bilateral rectus femoris and tibialis anterior was obtained 1 month post-implantation under stimulation-off and stimulation-on conditions. Longitudinal changes were evaluated using the Wilcoxon signed-rank test. Results Significant improvements were observed across all functional domains over 24 months. Median motor score increased from 60 to 66 (Δ = +6.0, p = 0.001), Barthel Index from 40 to 60 (Δ = +20.0, p = 0.001), and WISCI II from 5 to 13 (Δ = +8.0, p = 0.001). VAS decreased from 6 to 3 (Δ = −3.0, p = 0.002), and WHOQOL-BREF increased from 39 to 53 (Δ = +14.0, p = 0.001). All 11 patients (100%) exceeded minimal clinically important difference thresholds for motor function, functional independence, and ambulation; 82% achieved the threshold for pain reduction. Pinprick sensory score improved significantly from 9 months onward. Surface electromyography demonstrated immediate neuromuscular facilitation in all participants under stimulation-on conditions, with median rectus femoris and tibialis anterior facilitation ratios of 1.24 and 1.14, respectively (both p = 0.003), including in patients with motor-complete injuries. Conclusion In patients with chronic SCI, eSCS combined with structured rehabilitation produced sustained and clinically meaningful improvements across multiple functional domains over 24 months, with recovery continuing beyond the first year. These findings support eSCS as a long-term therapeutic strategy for chronic SCI and highlight the importance of extended follow-up to capture the full recovery trajectory.
Hsiang-ling Huang, Yu-Chen Chen, Po-Kai Wang et al.· Frontiers in Neurology· 0 citations
OBJECTIVE
Spinal cord transcutaneous stimulation (scTS) combined with activity-based training (ABT) has shown promise for improving upper limb function after cervical spinal cord injury (SCI). However, factors underlying variability in functional recovery remain unclear. This study examined the functional recovery and inter-individual variability in response to scTS + ABT in individuals with chronic cervical SCI.
DESIGN AND SETTING
Preliminary multi-case study with pre- and post-intervention evaluations conducted in a rehabilitation laboratory.
PARTICIPANTS
Five male adults with chronic cervical SCI (C3-C7; AIS A-D).
INTERVENTIONS
All participants received scTS delivered over cervical/thoracic segments combined with upper limb ABT. Intervention dosage ranged from 16 to 54 sessions (60 min per session, 2-3 sessions per week).
OUTCOME MEASURES
The Graded Redefined Assessment of Strength, Sensibility, and Prehension (GRASSP), handgrip and elbow flexion strength, Neuromuscular Recovery Scale (NRS), and Modified Functional Reach Test (MFRT). Spinally evoked potentials (SEP) were recorded in one participant to evaluate spinal excitability changes.
RESULTS
All participants demonstrated improvements in at least one GRASSP subdomain, with the most consistent gains observed in strength. NRS and MFRT outcomes also improved, indicating enhanced trunk stability and upper limb control. Moderate-to-strong positive correlations (ρ = 0.67-1.0) were found between intervention dosage and functional gains, although confidence intervals were broad. SEP analysis revealed increased slope and reduced activation thresholds of recruitment curves, suggesting enhanced spinal excitability.
CONCLUSION
scTS + ABT led to measurable functional improvements across participants; however, substantial variability was observed, likely influenced by injury characteristics and training dosage. Given the small sample size, participant heterogeneity, and lack of long-term follow-up, these findings should be interpreted as preliminary. Further controlled studies are warranted to evaluate the efficacy of individualized neuromodulation strategies for optimizing upper limb recovery after cervical SCI.
Fan Zhang, M. Ravi, Steven Kirshblum et al.· Journal of Spinal Cord Medic...· 0 citations
Traumatic brain injury (TBI) is a major cause of morbidity and mortality among young individuals, often resulting in motor, sensory, and functional impairments that compromise independence and quality of life. This study aimed to report the clinical evolution of an adolescent who underwent physiotherapeutic rehabilitation after severe TBI caused by a motorcycle accident. This is a descriptive and observational case report conducted at a university physiotherapy clinic. The initial assessment revealed tetraparesis predominantly affecting the left side, impaired trunk control, balance deficits, absence of functional gait, and reduced muscle strength. The rehabilitation program included strengthening exercises, joint mobilization, balance training, postural control, proprioceptive neuromuscular facilitation, functional training, and assisted gait training. After treatment, improvements were observed in muscle strength, postural control, motor coordination, assisted gait, and functional independence. These findings highlight the importance of neurofunctional physiotherapy in promoting functional recovery and improving the quality of life of patients with TBI sequelae.
João Carlos da Silva Pita, Matheus Felipe Ribeiro da Silva, Elaine Aparecida Pedrozo Azevedo et al.· Revista de Estudos Interdisc...· 0 citations
Cervical spinal cord injury (CSCI) leads to severe impairment of the upper limb, which leads to tetraplegia and decreased independence in aspects of self-care and grasping. Conventional rehabilitation provides limited recovery, particularly in the case of complete American Spinal Injury Association (ASIA) Impairment Scale (AIS) A–B injuries, and there is a growing interest in multimodal rehabilitation strategies. This systematic review summarized evidence from 38 studies including pilot studies, preclinical investigations, and randomized controlled trials published between 2016 and 2026. Interventions were systematically classified and data extracted for the primary upper-limb outcomes, the Action Research Arm Test, grip strength, Graded Redefined Assessment of Strength, Sensibility and Prehension, Upper Extremity Motor Score, and Spinal Cord Independence Measure. About three-quarters of the studies reported improvements in at least one upper-limb outcome and almost half the studies had clinically meaningful improvements. However, 44% of studies were judged to have a high or critical risk of bias due to small sample sizes and limited controls; more than 90% reported no major safety concerns. Orthotic and robotic interventions maintained functional improvements, whereas hybrid neuromodulation approaches led to the largest gains in grip strength. Pharmacological therapies were of little benefit. In conclusion, multimodal non-invasive rehabilitation strategies might be promising for the improvement of upper-limb recovery after CSCI, but larger, high-quality clinical trials are needed.
Received: 24 March 2026 | Revised: 18 June 2026 | Accepted: 11 August 2026
Conflict of Interest
The authors declare that they have no conflicts of interest to this work.
Data Availability Statement
Data sharing is not applicable to this article as no new data were created or analyzed in this study.
Author Contribution Statement
Krishnakumar Sankar: Conceptualization, Methodology, Validation, Investigation, Resources, Data curation, Writing – original draft, Writing – review & editing, Visualization, Supervision, Project administration. Yazhini Arulselvam: Conceptualization, Investigation, Data curation, Writing – original draft, Writing – review & editing, Visualization. Supriya Harikrishna: Conceptualization, Investigation, Data curation, Writing – original draft, Writing – review & editing, Visualization.
To describe the longitudinal functional recovery of a patient with refractory lower‐limb complex regional pain syndrome (CRPS), a disabling condition associated with pain and motor dysfunction, following individualized KAFO‐assisted rehabilitation, and to explore potential mechanisms underlying the observed recovery. Longitudinal case study with retrospective and prospective data collection from 2017 onward, including clinical assessment and validated outcome measures: Numeric Rating Scale, SF‐36v2, and Barthel Index. A 62‐year‐old woman with refractory lower‐limb CRPS, multimorbidity, osteoporosis, and multiple fragility fractures developed progressive functional decline and wheelchair dependence despite pharmacological therapy, sympathectomy, and spinal cord stimulation. An individualized rehabilitation program incorporating a carbon‐fiber knee–ankle–foot orthosis (KAFO) was introduced. This was associated with marked pain reduction, improved independence, regained assisted ambulation, and sustained functional improvement over time. The observed recovery may reflect not only biomechanical stabilization and safer weight‐bearing, but also improved sensory input, body representation, and sensorimotor integration. This case supports a function‐oriented approach to advanced CRPS and suggests that orthosis‐assisted rehabilitation may contribute to functional and neurophysiological recovery in selected complex patients.
H. Marreiros· Clinical Case Reports· 0 citations
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