Amirova Liubov, Keller Anastasia, Singh Goutam, King Molly, Parikh Parth, Stepp Nicole, Ugiliweneza Beatrice, Gerasimenko Yury, Behrman Andrea L
Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY 40202, USA.
Kosair for Kids Center for Pediatric NeuroRecovery, University of Louisville, Louisville, KY 40202, USA.
Children (Basel). 2025 Jun 21;12(7):817. doi: 10.3390/children12070817.
BACKGROUND/OBJECTIVES: Non-invasive spinal cord transcutaneous stimulation (scTS) has expanded the therapeutic landscape of spinal cord injury (SCI) rehabilitation, offering potential benefits beyond compensatory approaches to paralysis. Children with SCI are particularly susceptible to developing neuromuscular scoliosis due to trunk muscle paralysis and ongoing skeletal growth, making targeted interventions crucial. As demonstrated in adults and pediatrics with SCI, the ability of scTS to acutely and safely enable an upright posture and trunk control could be leveraged as a therapeutic adjunct. Activity-based locomotor training (AB-LT) alone significantly improves trunk control in children with SCIs; combining it with scTS may enhance outcomes. This pilot study evaluated the safety, feasibility, and cumulative effects of AB-LT combined with scTS on trunk control in children with SCI.
Three children with SCI completed 19 to 64 sessions of combined AB-LT and scTS. Adverse effects were monitored session to session, and trunk control was assessed pre- and post-intervention.
Across 130 interventions in three participants, 88.5% of sessions were free from adverse effects. Reported adverse events included autonomic dysreflexia (5.4%), skin redness at electrode sites (4.6%), and headaches (1.5%). No significant impact of scTS on fatigue or central hemodynamic parameters was observed. Post-intervention, all participants demonstrated improved trunk control during quiet and perturbed sitting.
These findings provide the first evidence supporting the safety and feasibility of this combinatorial approach in pediatric SCI rehabilitation while emphasizing the importance of monitoring skin integrity and signs of autonomic dysreflexia. This intervention shows potential synergistic benefits, warranting further research to confirm efficacy and optimize therapeutic protocols.
背景/目的：无创脊髓经皮刺激（scTS）拓展了脊髓损伤（SCI）康复的治疗领域，带来了超越瘫痪代偿方法的潜在益处。由于躯干肌肉麻痹和骨骼持续生长，SCI儿童特别容易发生神经肌肉型脊柱侧弯，因此针对性干预至关重要。正如在成人和小儿SCI患者中所证明的那样，scTS能够急性且安全地实现直立姿势和躯干控制，这一能力可作为一种治疗辅助手段。单纯的基于活动的运动训练（AB-LT）能显著改善SCI儿童的躯干控制能力；将其与scTS相结合可能会增强治疗效果。这项前瞻性研究评估了AB-LT联合scTS对SCI儿童躯干控制的安全性、可行性和累积效应。
三名SCI儿童完成了19至64节AB-LT与scTS相结合的课程。逐节监测不良反应，并在干预前后评估躯干控制能力。
在三名参与者的130次干预中，88.5%的课程没有不良反应。报告的不良事件包括自主神经反射异常（5.4%）、电极部位皮肤发红（4.6%）和头痛（1.5%）。未观察到scTS对疲劳或中心血流动力学参数有显著影响。干预后，所有参与者在安静和受干扰坐姿下的躯干控制能力均有所改善。
这些发现首次证明了这种联合方法在小儿SCI康复中的安全性和可行性，同时强调了监测皮肤完整性和自主神经反射异常体征的重要性。这种干预显示出潜在的协同效益，需要进一步研究以确认疗效并优化治疗方案。
