The safety and efficacy of noninvasive spinal cord electrical stimulation has been thoroughly documented. Please refer to this list of published resources for more information.

 

List of Resources

  Facebook – Spinal Stimulation Spina Bifida Gerti Motavalli Instagram – @spinalstimgerti (videos of spinal stim and progress children made) Youtube – Subscribe to Gerti Motavalli’s channel.   Published Research Article about Gerti Motavalli’s Spinal Stimulation:

The application of functional electrical stimulation and noninvasive spinal cord electrical stimulation (transcutaneous spinal cord stimulation) protocols to a 6-month old infant with myelomeningocele has not been previously reported in the medical literature. The observed gradual development of previously absent sensory and motor responses in this infant was novel, surprising, and encouraging. Functional electrical stimulation and spinal cord electrical stimulation are well tolerated and have minimal, transient adverse events when applied to infants with spina bifida. The initial positive outcomes and safety of the novel application of electrical stimulation for this case infant provide a basis for further research into a new intervention approach which could enhance development for infants born with spina bifida. Published articles about the use and safety of spinal electrical stimulation General Side Effects & Tolerance

  • Holsheimer, J. (1995). Effectiveness of spinal cord stimulation parameters and configurations. Pain, 64(2), 211–219. This study explored how different electrode configurations (monopolar vs. multipolar) influence stimulation outcomes and side effects. Monopolar electrodes were found to produce more focused activation of dorsal column fibers and reduced unintended stimulation of nearby nerve roots, thus lowering the incidence of painful radicular symptoms—a common complication in early SCS systems. Link
  • Isagulyan, E. (2020). Spinal cord stimulation in chronic pain: technical advances. The Korean Journal of Pain, 33(2), 99–111. This review assessed the technological progress and safety considerations of SCS in managing neuropathic pain. It emphasized patient selection criteria, lead placement, stimulation parameters, and programming strategies. The paper concluded that adverse events are rare and manageable when proper protocols are followed, supporting SCS as a long-term, safe modality. Link
  • North, R.B., Kidd, D.H., Zahurak, M., James, C.S., & Long, D.M. (1993). Spinal cord stimulation for chronic, intractable pain: experience over two decades. Neurosurgery, 32(3), 384–394. Drawing from extensive clinical experience, this paper documented early complications associated with percutaneous SCS systems, including segmental paresthesias and discomfort localized to the dorsal spine. Despite these, long-term neurological harm was not reported. Proper calibration and electrode positioning were key to minimizing transient side effects. Link
  • Oakley, J.C. (2002). Spinal cord stimulation: mechanisms of action. Pain Research & Management, 7(3), 137–149. Oakley reviewed the evolving understanding of how SCS mitigates pain, covering gate-control theory, neurochemical modulation, and spinal network reorganization. He reaffirmed that while transient side effects like paresthesias are expected, the technique is neurologically safe over long durations when stimulation stays within therapeutic bounds. Link
  • Pluijms, W.A., Slangen, R., van Kleef, M., Joosten, E.A., & Reulen, J.P. (2015). Evoked potential latency improvements with SCS for diabetic neuropathy. Neuromodulation, 18(2), 126–132. This clinical study evaluated the impact of SCS on sensory transmission latency in patients with painful diabetic polyneuropathy. Improvements in evoked potential latencies suggest not only pain relief but also measurable changes in neural conduction—providing both functional and safety evidence in a difficult-to-treat population. Link
  • Prager, J.P. (2010). Mechanisms of action of spinal cord stimulation. Pain Medicine, 11(8), 1278–1285. Prager explored the current mechanistic theories behind SCS and emphasized its multi-modal effect, including dorsal column modulation and inhibitory interneuron activation. The article underscored that most side effects are minor and transient, with no evidence of structural spinal cord damage when standard protocols are followed. Link

Pediatric Applications

  • Bakr, S.M., Knight, J.A., Shlobin, N.A., et al. (2022). Spinal cord stimulation for adolescent chronic neuropathic pain: a systematic review. Neurosurgical Focus, 53(4), E13. This systematic review and meta-analysis investigated the use of implanted SCS in adolescents. The complication profile (lead migration, infection, and hardware malfunction) was comparable to adults. The authors advocated for more pediatric-specific protocols but found the therapy generally well-tolerated and beneficial for chronic neuropathic conditions. Link
  • Barišić, N., Nemir, J., Perković, R., et al. (2025). Neuromodulation outcomes of SCS in pediatric chronic pain. European Journal of Paediatric Neurology, 54, 186–192. A clinical series demonstrating that pediatric patients with neuropathic pain syndromes experienced substantial pain relief and improved mobility after SCS implantation. The study reported no serious adverse events, highlighting the feasibility and safety of SCS in younger patients when managed by experienced teams. Link
  • Keller, A., Singh, G., Sommerfeld, J.H., & King, M. (2021). Noninvasive spinal stimulation enables upright posture in pediatric SCI. Nature Communications, 12, 5887. Using transcutaneous (non-invasive) spinal cord stimulation, this study enabled children with spinal cord injury to achieve upright posture. The absence of seizure activity, infection, or other complications supported its safety. Functional gains were attributed to neuromodulatory effects on trunk and limb control. Link
  • Novikov, A., Maldova, M., Shandybina, N., & Shalmiev, I. (2023). First use of non-invasive SCS in children with SMA. Life, 13(2), 449. A pioneering study applying non-invasive SCS in children with spinal muscular atrophy. The intervention was paired with physical therapy and led to improved motor function with no reported side effects, suggesting its utility in early-stage neuromotor rehabilitation. Link
  • Tyagi, P., Tsai, E., & Hankinson, T.C. (2015). SCS for recurrent tethered cord syndrome in a pediatric patient: case report. JNS: Pediatrics, 18, 105–108. This unique case study explored the use of SCS in a child with recurrent tethered cord syndrome. Despite ethical considerations and anatomical challenges, SCS provided lasting pain relief. The authors highlighted the importance of individualized decision-making in pediatric neurosurgery. Link

Psychological & Quality-of-Life Effects

  • Cebalo, N., Cebalo, J., Budak, L., et al. (2025). TENS reduces anxiety in pediatric dental procedures. Dental and Medical Problems, 62(3), 419–426. Though not focused on spinal neuromodulation, this study demonstrated that transcutaneous electrical nerve stimulation (TENS) significantly reduced anxiety in children undergoing dental procedures. This supports the idea that mild, non-invasive electrical neuromodulation can positively influence mood and stress in pediatric populations. Link
  • Cheng, Y.C., Lee, J.H., Hsu, H.J., et al. (2022). Neuromodulation improves anxiety and sleep: a meta-analysis. Psychological Medicine, 52(2), 234–247. This meta-analysis evaluated the effects of non-invasive neuromodulation (tDCS, TMS) across populations with depression, anxiety, and sleep disorders. While primarily adult data was included, the findings support broader psychiatric and QOL benefits of electrical brain and spinal stimulation methods. Link
  • Rajapakse, T., & Kirton, A. (2013). Non-invasive brain stimulation in children: emerging evidence. Developmental Medicine & Child Neurology, 55(8), 648–655. This review synthesized emerging evidence on the safety and outcomes of TMS and tDCS in pediatric neuropsychiatry. It identified favorable safety profiles and noted improvements in mood and executive functioning, indirectly supporting the idea that spinal stimulation may yield similar psychological benefits. Link
  • Selected Research on Pediatric SCS and Motor Function

    • Barišić, N., Nemir, J., Perković, R., & Frančić, M. (2025). Spinal cord stimulation (SCS) induced favorable neuromodulative outcome in the treatment of chronic neuropathic pain syndrome in children. European Journal of Paediatric Neurology, 54, 186–192.
      This case series reported the use of epidural SCS in pediatric patients suffering from chronic neuropathic pain and motor deficits. Both children achieved near-complete pain relief and significant restoration of motor function, with no adverse events. The study demonstrates that carefully applied SCS may trigger functional neuromodulation in children with complex neuro-orthopedic conditions.
      Link

    • Ikoeva, G.A., Nikityuk, I.E., & Kivoenko, O.I. (2016). Assessment of the efficiency of motor rehabilitation in children with cerebral palsy using robotic mechanotherapy and transcutaneous electrical stimulation of the spinal cord. Pediatric Traumatology, Orthopaedics and Reconstructive Surgery, 4(4), 47–55.
      This study compared robotic-assisted therapy with and without the addition of transcutaneous spinal stimulation in children with spastic cerebral palsy. Those receiving stimulation demonstrated superior gains in motor control, strength, and posture, suggesting synergistic effects between electrical and mechanical interventions.
      Link

    • Johnston, T.E., Smith, B.T., Oladeji, O., & Betz, R.R. (2008). Outcomes of a home cycling program using functional electrical stimulation or passive motion for children with spinal cord injury: a case series. Journal of Spinal Cord Medicine, 31(2), 215–222.
      This paper examined motor outcomes in children using at-home cycling combined with functional electrical stimulation (FES). Improvements were observed in leg strength, joint mobility, and daily activity levels, particularly in the FES group. It supports home-based neuromodulation as a safe and effective adjunct to formal therapy.
      Link

    • Karabay, İ., Doğan, A., Arslan, M.D., & Dost, G. (2012). Effects of functional electrical stimulation on trunk control in children with diplegic cerebral palsy. Disability and Rehabilitation, 34(12), 1–7.
      Investigated the use of FES applied to gluteal muscles in children with diplegic CP. Significant improvements in trunk stability and sitting balance were observed, as measured by GMFM scores. The study suggests that neuromuscular stimulation can improve core function critical to motor independence.
      Link

    • Keller, A., Singh, G., Lucas, K., Borders, C., & Stout, D. (2024). Safety and feasibility of cervical and thoracic transcutaneous spinal cord stimulation to improve hand motor function in children with chronic spinal cord injury. Journal of Pediatric Rehabilitation Medicine, In Press.
      This study evaluated non-invasive transcutaneous SCS in children with cervical and thoracic spinal cord injuries. Children showed enhanced hand function, improved grip strength, and greater voluntary motor control with no adverse events. The authors propose tSCS as a viable tool to harness plasticity in pediatric SCI rehabilitation.
      Link

    • Mulcahey, M.J., & Betz, R.R. (1997). Upper and lower extremity applications of functional electrical stimulation: a decade of research with children and adolescents with spinal injuries. Pediatric Physical Therapy, 9(3), 119–126.
      Summarized 10 years of clinical data on FES in pediatric spinal injury, highlighting its application in both upper and lower limbs. Improved voluntary control, muscle tone regulation, and enhanced participation in ADLs were consistently observed. This foundational work paved the way for broader adoption of FES in pediatric rehab.
      Link

    • Triolo, R.J., Betz, R.R., Mulcahey, M.J., & Gardner, E.R. (1994). Application of functional neuromuscular stimulation to children with spinal cord injuries: candidate selection for upper and lower extremity research. Spinal Cord, 32(10), 679–688.
      This paper detailed methods for selecting pediatric SCI patients most likely to benefit from neuromuscular stimulation based on injury level, residual function, and therapy goals. It helped standardize protocols for incorporating FES into clinical research and rehabilitation practice.
      Link

    • Vissarionov, S.V., & Solokhina, I.Y. (2017). Application of non-invasive electric stimulation of the spinal cord in motor rehabilitation of children with vertebral and cerebrospinal injury. Pediatric Traumatology, Orthopaedics and Reconstructive Surgery, 5(4), 48–52.
      Evaluated non-invasive spinal stimulation in children with various spinal injuries. Noted significant motor improvements including coordination and voluntary control. Benefits were sustained over time, suggesting real functional gains linked to neuroplasticity.
      Link

    • Non-Invasive SCS for Bowel and Bladder Control in Pediatrics

      • Besendörfer, M., Kohl, M., Schellerer, V., & Carbon, R. (2020). A pilot study of non-invasive sacral nerve stimulation in treatment of constipation in childhood and adolescence. Frontiers in Pediatrics, 8, 169.
        This prospective pilot study assessed non-invasive sacral nerve stimulation in children with chronic constipation. Patients showed improvements in stool frequency, consistency, and reductions in incontinence episodes. The intervention was well-tolerated, with no adverse events reported, supporting its feasibility for functional bowel disorders in youth.
        Link

      • Ladi-Seyedian, S.S., Sharifi-Rad, L., & Kajbafzadeh, A.M. (2020). Management of bladder bowel dysfunction in children by pelvic floor interferential electrical stimulation and muscle exercises: a randomized clinical trial. Journal of Pediatric Urology, 16(5), 535.e1–535.e8.
        This randomized trial evaluated interferential (non-invasive) electrical stimulation and pelvic floor training in children with bladder and bowel dysfunction. Statistically significant improvements were observed in urinary continence and defecation habits. The study supports conservative, stimulation-based rehabilitation in children with non-neurogenic dysfunction.
        Link

      • Parittotokkaporn, S., Varghese, C., & O’Grady, G. (2020). Non-invasive neuromodulation for bowel, bladder and sexual restoration following spinal cord injury: a systematic review. Clinical Neurophysiology Practice, 5, 145–153.
        This systematic review included pediatric and adult studies involving non-invasive techniques such as tSCS and TENS. Findings suggest that even non-invasive neuromodulation can enhance autonomic function related to continence and voiding. Pediatric evidence is emerging but increasingly positive.
        Link

      • Samejima, S., Shackleton, C., McCracken, L., & Malik, R.N. (2022). Effects of non-invasive spinal cord stimulation on lower urinary tract, bowel, and sexual functions in individuals with chronic motor-complete spinal cord injury: Protocol for a randomized crossover trial. PLOS ONE, 17(12), e0278425.
        This study protocol details a clinical trial applying transcutaneous spinal cord stimulation (tSCS) in individuals with SCI. Though adult participants are primary, the protocol’s inclusion of validated autonomic function measures (e.g., Neurogenic Bowel Dysfunction Score) and pediatric safety principles makes it relevant to future pediatric applications.
        Link

      • Unal, B., Pisirici, P., Kurt, A.K., & Tugtepe, H. (2025). Comparison of the efficiency of transcutaneous electrical nerve stimulation and manual therapy in children with cerebral palsy with lower urinary system dysfunction: A randomized trial. Journal of Pediatric Urology, In Press.
        This study directly compared TENS with manual therapy in children with cerebral palsy experiencing urinary dysfunction. TENS significantly improved daytime continence, bladder capacity, and reduced urgency. No adverse events occurred, affirming its safety in this neurodevelopmentally vulnerable population.
        Link

      • Wright, A.J., & Haddad, M. (2017). Electroneurostimulation for the management of bladder bowel dysfunction in childhood. European Journal of Pediatric Neurology, 21(6), 916–925.
        This review categorized the current evidence base for non-invasive electroneurostimulation in children. Methods included TENS, tSCS, and sacral neuromodulation, with the majority of studies showing improvements in continence and reduced incontinence-related anxiety. The authors advocated for greater standardization and long-term follow-up.
        Link

      • Non-Invasive SCS in Spinal Muscular Atrophy (SMA)

        • Novikov, A., Maldova, M., Shandybina, N., & Shalmiev, I. (2023). First use of non-invasive spinal cord stimulation in motor rehabilitation of children with spinal muscular atrophy. Life, 13(2), 449.
          This pioneering clinical study evaluated transcutaneous SCS in five pediatric SMA patients. All participants were undergoing concurrent nusinersen therapy. The stimulation sessions were well-tolerated, and patients showed improvements in trunk control, limb mobility, and general motor engagement without any reported adverse events.
          Link

        • Novikov, A., Maldova, M., Shamantseva, N., & Shalmiev, I. (2024). Non-invasive spinal cord stimulation for motor rehabilitation of patients with spinal muscular atrophy treated with orphan drugs. Biomedicines, 12(6), 1162.
          In this extension study, the authors demonstrated the safety and efficacy of tSCS in both type II and III SMA patients. Benefits included enhanced sitting balance, head control, and increased active movement. The treatment was again paired with existing pharmacological interventions, showing that neuromodulation may act synergistically.
          Link

        • Moshonkina, T., Novikov, A., Maldova, M., & Shalmiev, I. (2024). Non-Invasive Spinal Cord Stimulation for Motor Rehabilitation of Patients with Spinal Muscular Atrophy Treated with Orphan Drugs. Preprints, Published Manuscript.
          This preprint complements the prior studies, highlighting similar motor gains and emphasizing scalability in outpatient and early-stage pediatric rehabilitation. The authors reinforce that tSCS enhances the effects of disease-modifying drugs by engaging central pattern generators and promoting trunk-limb coordination.
          Link (PDF)

        • Williams, S.E., Koch, K.C., & Disselhorst-Klug, C. (2020). Non-invasive assessment of motor unit activation in relation to motor neuron level and lesion location in stroke and spinal muscular atrophy. Clinical Neurophysiology, 131(10), 2341–2350.
          Though not an intervention study, this research used surface EMG to assess motor unit recruitment in SMA versus stroke patients. The authors propose that such monitoring could guide targeted non-invasive interventions like tSCS, especially in type II SMA where some voluntary control remains.
          Link

        • Spinal Cord Stimulation and Muscle Tone Modulation

          • Ahmed, Z. (2014). Trans-spinal direct current stimulation alters muscle tone in mice with and without spinal cord injury with spasticity. The Journal of Neuroscience, 34(5), 1701–1714.
            This foundational animal study demonstrated that trans-spinal direct current stimulation (tsDCS) could modulate muscle tone in both healthy and spinal cord-injured mice. Notably, dorsal cathodal stimulation decreased hypertonia (spasticity), while ventral anodal stimulation increased tone, suggesting therapeutic roles in both hyper- and hypotonic conditions.
            Link (PDF)

          • Alfieri, V., Prati, R., Visconti, S., & Alfieri, A.G.M. (1997). Spinal cord injury and electric stimulation: types and characteristics of spasticity. BAM, 7(2), Article 5.
            This paper explored the impact of electrical stimulation on different forms of spasticity in spinal cord injury. It found that electrical therapy, including surface and implanted methods, modulates spasticity characteristics—particularly in hypotonic or hypotrophic muscles where tone was normalized.
            Link (PDF)

          • Olsen, P.Z., & Diamantopoulos, E. (1967). Excitability of spinal motor neurons in normal subjects and patients with spasticity, Parkinsonian rigidity, and cerebellar hypotonia. Journal of Neurology, Neurosurgery, and Psychiatry, 30(2), 124–132.
            This early study used electrophysiology to demonstrate that spinal excitability differs in spasticity versus hypotonia. Though predating modern SCS techniques, it laid the groundwork for understanding how spinal circuits respond differently to stimulation in tone disorders.
            Link (PDF)

          • Eisen, A. (1987). Electromyography in disorders of muscle tone. Canadian Journal of Neurological Sciences, 14(3), 429–438.
            While not an interventional study, this review emphasized how electrophysiological patterns in spasticity and hypotonia can be used to tailor neuromodulatory interventions like SCS. It underscored the diagnostic value of EMG in guiding SCS application.
            Link (PDF)

          • Strommen, J.A. (2013). Management of spasticity from spinal cord dysfunction. Neurologic Clinics, 31(3), 465–485.
            This clinical review noted the role of dorsal column stimulation (a form of SCS) as a potential adjunct for managing spasticity in SCI. Though historically underutilized, the paper suggests SCS could help reduce tone and facilitate movement in patients with both supraspinal and spinal-origin spasticity.
            Link

          • Non-Invasive SCS and Neurogenic Scoliosis (Pediatrics)

            • Keller, A., Singh, G., Sommerfeld, J.H., & King, M. (2021). Noninvasive spinal stimulation safely enables upright posture in children with spinal cord injury. Nature Communications, 12, 5887.
              This study applied transcutaneous spinal cord stimulation (tSCS) in children with chronic SCI, enabling improved upright posture and trunk control—two key factors implicated in the development and progression of neuromuscular scoliosis. No adverse effects were observed, and stimulation was well-tolerated.
              Link

            • Novikov, A., Maldova, M., Shandybina, N., & Shalmiev, I. (2023). First use of non-invasive spinal cord stimulation in motor rehabilitation of children with spinal muscular atrophy. Life, 13(2), 449.
              This early clinical trial in pediatric SMA patients demonstrated that tSCS improved trunk and postural stability, which are commonly compromised in neuromuscular scoliosis. Though scoliosis was not a direct endpoint, the study supports spinal stimulation’s potential role in mitigating secondary deformities through neuromuscular activation.
              Link

            • Lucas, K., Singh, G., Alvarado, L.R., King, M., & Stepp, N. (2025). Non-invasive spinal neuromodulation enables stepping in children with complete spinal cord injury. Brain, Advance Article.
              In this longitudinal trial, upright posture and coordinated stepping were restored in children with motor-complete SCI using tSCS. Restoration of axial muscle engagement contributes to spinal alignment—highlighting tSCS as a potential adjunct to non-surgical scoliosis management.
              Link

            • Daroszewski, P., Huber, J., & Kaczmarek, K. (2024). “Real-Time Neuromonitoring” Increases the Safety and Non-Invasiveness and Shortens the Duration of Idiopathic Scoliosis Surgery. Journal of Clinical Medicine, 13(5), 1497.
              While focused on intraoperative neuromonitoring, this paper introduces non-invasive techniques for real-time spinal assessment. Although the emphasis is on idiopathic scoliosis surgery, the framework points to emerging non-invasive strategies—including SCS—for monitoring and guiding therapy in neurogenic scoliosis.
              Link

            • Lewis, C. (2012). A Review of Non-Invasive Treatment Interventions. In Physical Therapy Perspectives in the 21st Century: Challenges and Possibilities.
              This book chapter discusses non-invasive neuromuscular interventions for neuromuscular scoliosis, including electrical stimulation as a supportive strategy to slow spinal curvature progression and enhance posture. Though dated, it serves as a conceptual foundation for more recent SCS trials.
              Link (PDF, see pg. 79)