SENSORIMOTOR REHABILITATION AFTER SPINAL CORD INJURY ENHANCED BY SYNERGISTIC VIRTUAL REALITY AND TRANSCUTANEOUS ELECTRICAL STIMULATION

Spinal Cord Injury (SCI) is a severe neurological condition that often results in long-term functional disability. In the chronic stage, recovery frequently plateaus, partly due to limited access to rehabilitation and the availability of specialized therapists, highlighting the need for independent, at-home tools to support continued care. Moreover, conventional neurorehabilitation primarily targets motor output, overlooking sensory and self-perception deficits, which play a pivotal role in motor control.

To address these limitations, we developed a portable multimodal digital platform integrating immersive Virtual Reality (VR) with Transcutaneous Electrical Nerve Stimulation (TENS) to support upper-limb rehabilitation after SCI. The platform was tested in individuals with cervical SCI presenting minimal residual hand movement during a two-week, task-oriented intervention in the VR environment, with synchronized TENS-feedback targeting the median nerve. Kinematic and task-performance metrics were recorded during each session, alongside clinical assessments.

Participants intuitively engaged with the VR tasks from the first session. Over the intervention period, we observed increased range of motion (ROM) and a significant reduction in task-completion time. Notably, TENS elicited somatotopically consisent sensations in the targeted fingers and hands, even in those participants with no naturally elicitable touch perception in said areas. Body-representation assessments revealed a progressive realignment of perceived hand shape toward anatomical proportions. Importantly, improvements generalized beyond VR, with increased hand ROM outside the digital environment.

These preliminary findings support the feasibility of multimodal digital rehabilitation in individuals with severe SCI and motivate the use of integrated kinematic and clinical measures to track short-term functional changes.