Combined Epidural Stimulation and Virtual Reality Rehabilitation for Comprehensive Neuromotor Recovery Following Spinal Cord Injury: A Single Arm Study

Study Design Prospective pre–post interventional study. Objectives To evaluate the effects of epidural spinal cord stimulation (ESCS) combined with task-specific rehabilitation on mobility, sitting balance, bladder control, lower limb strength, and postural stability in individuals with spinal cord injury. Methods Fifteen participants with chronic thoracic SCI received daily ESCS sessions combined with physiotherapy and Tyromotion-based robotic balance training for 8 weeks. Outcome measures included: Timed Up and Go (TUG) test for mobility, Walking Index for Spinal Cord Injury II for ambulatory function, Neurogenic Bladder Symptom Score for bladder control, Manual Muscle Testing for knee extension strength, and anterior–posterior displacement for postural stability and Modified Ashworth Scale (MAS) for spasticity from . Results All participants successfully completed the study. The Timed Up and Go (TUG) test time significantly improved from 430.25 ± 265.2 seconds to 141.9 ± 92.6 seconds ( P < 0.001). The Walking Index for Spinal Cord Injury II (WISCI II) score increased markedly from 0.07 ± 0.26 to 6.07 ± 1.03 ( P < 0.001). Antero-posterior (AP) displacement during standing balance decreased from 18.2 ± 3.5 mm to 11.4 ± 2.9 mm ( P < 0.001), indicating enhanced static postural control. The Neurogenic Bladder Symptom Score (NBSS) improved significantly, reducing from 24.05 ± 6.91 to 7.4 ± 5.08 ( P < 0.001). Manual Muscle Testing (MMT) of knee extension increased from 0.25 ± 0.44 to 3.85 ± 0.37 ( P < 0.001). Finally, the Modified Ashworth Scale (MAS) scores were significantly reduced from 3.6 ± 0.257 to 1.26 ± 0. ( P < 0.001), reflecting decreased lower limb spasticity. Conclusions ESCS with Tyromotion significantly improves motor strength, trunk balance, gait function, and bladder control in thoracic SCI. These findings support task-specific therapies in SCI recovery programs.