Combining Neuromuscular Electrical Stimulation with Activity Based Training in Children with Chronic Cervical Spinal Cord Injury: A Retrospective Case Series.

BACKGROUND/OBJECTIVES: Neuromuscular electrical stimulation (NMES) is a promising adjunct to activity-based training for individuals with spinal cord injury (SCI). While lower extremity NMES applications are well documented, upper extremity (UE) outcomes remain underexplored in pediatric SCI. The objective of this case series was to evaluate outcomes following a combined NMES and activity-based therapy program targeting the UE in children with chronic SCI. METHODS: In this retrospective case series, we analyzed outcomes from five children, ages 4 to 15 years old, with chronic cervical level SCI who completed an individualized activity-based training program with concurrent wide pulse neuromuscular electrical stimulation (WPS-NMES). Participants were children with chronic SCI (≥6 months post-injury). Functional assessments were conducted by pre- and post-intervention. Pre- and post-intervention outcomes were summarized descriptively at the individual case level. RESULTS: Five children with chronic cervical SCI (ages 4-15 years) completed a mean of 54 intervention sessions. All patients demonstrated improved trunk control, with Segmental Assessment of Trunk Control (SATCo) increases of 1-6 points. UE gains on the Peds-NRS were observed in 4/5 patients, primarily in overhead reach and object-to-mouth items. Box and Blocks Test scores improved in 4/5 patients in at least one UE, while one patient remained at 0 bilaterally, and one patient experienced a unilateral decline. One patient demonstrated proximal and trunk improvements without changes in manual dexterity. No unanticipated adverse events were reported. CONCLUSIONS: Observed improvements in selected trunk and UE outcomes occurred during participation in a multimodal rehabilitation program incorporating WPS-NMES. These preliminary findings describe functional changes observed during the rehabilitation program and may help inform the design of future controlled studies evaluating multimodal rehabilitation approaches for children with chronic SCI.