Progressive functional recovery following technology-assisted neurorehabilitation in a young adult with thoracic spinal cord injury

Abstract

Background: Traumatic thoracic spinal cord injury (SCI) frequently results in severe impairments in motor function, postural control, mobility and independence. Although spontaneous neurological recovery may occur during the early post-injury period, intensive multidisciplinary rehabilitation incorporating technology-assisted interventions has emerged as a promising strategy to facilitate activity- dependent neuroplasticity and improve functional outcomes. However, detailed longitudinal reports describing structured high-intensity rehabilitation protocols in thoracic SCI remain limited. Case presentation: A 20-year-old man sustained a traumatic thoracic SCI in a motorcycle accident in December 2024, following which he underwent emergency spinal decompression and posterior instrumentation for stabilization. After achieving medical stability, he was enrolled in a comprehensive inpatient neurorehabilitation program consisting of three to four supervised physiotherapy sessions each day, 6 days per week, over a period of approximately 10 months. The rehabilitation protocol integrated conventional therapeutic exercises with advanced rehabilitation technologies, including robotic-assisted cycling, sensor-based upper- and lower-limb training, progressive trunk control exercises, graded weight-bearing activities, gait retraining, and task-oriented functional practice. Sequential neurological assessments revealed the re-emergence of voluntary motor activity below the neurological level of injury, consistent with clinical progression from a motor-complete to a motor-incomplete SCI. Because a complete follow-up international standards for neurological classification of spinal cord injury (ISNCSCI) examination was unavailable, formal American spinal injury association impairment scale (AIS) reclassification was not performed. Functional improvements were observed across multiple outcome measures, including functional independence measure (FIM) (42/126–57/126), Walking Index for SCI II (0–6), trunk impairment scale (TIS) (2–11), trunk extensor strength (1/5–3/5), lower-limb muscle strength, and pain intensity [visual analogue scale (VAS): 7/10–3/10]. Conclusion: This case demonstrates clinically meaningful neurological and functional recovery following prolonged, high-intensity multidisciplinary rehabilitation incorporating technology-assisted interventions after traumatic thoracic SCI. Although spontaneous recovery and resolution of spinal shock cannot be excluded as contributing factors, the findings support the potential role of individualized, task-specific, high-dose rehabilitation in maximizing functional recovery. Future well-designed prospective studies involving larger patient cohorts are needed to clarify the specific contribution of technology-assisted rehabilitation to functional recovery and to support the development of standardized, evidence-based rehabilitation protocols for individuals with SCI.