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Children
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Emerging Trends in Neuromodulation for Children with Neurological Conditions
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Emerging Trends in Neuromodulation for Children with Neurological Conditions

A special issue of Children (ISSN 2227-9067). This special issue belongs to the section "Pediatric Neurology & Neurodevelopmental Disorders".

Deadline for manuscript submissions: 5 May 2025 | Viewed by 5273

Special Issue Editors

Dr. Laura Krisa

E-Mail Website
Guest Editor
Department of Physical Therapy, Department of Occupational Therapy, Thomas Jefferson University, Philadelphia, PA 19107, USA
Interests: advanced MRI neuroimaging; spinal cord injury; translational research
Prof. Dr. Mary Jane Mulcahey

E-Mail Website
Guest Editor
Department of Occupational Therapy, Thomas Jefferson University, Philadelphia, PA 19107, USA
Interests: spinal cord injury; measurement; neurorehabilitaiton

Special Issue Information

Dear Colleagues,

The field of neuromodulation is constantly growing and providing new avenues for promoting function following a neurological insult or impairment. While the number of clinical trials in adults that use neuromodulation as a treatment and/or therapy greatly outweighs the number of studies in the pediatric population, the pediatric field is growing, and more studies are demonstrating the requirements and benefits of this emerging technology.

This Special Issue will delineate current areas of research in pediatric neuromodulation and disseminate their exciting findings. Additionally, this Special Issue will address the necessary next steps needed to make neuromodulation techniques accessible for the pediatric population with neurological impairments.

We welcome cutting-edge research in neuromodulation for children. 

We welcome original articles, case studies, and reviews that study any form of neuromodulation in the neurologically impaired pediatric population. The methods used may include the use of a device to alleviate symptoms, increase function, or be restorative.

Dr. Laura Krisa
Prof. Dr. Mary Jane Mulcahey
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Children is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2400 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • neuromodulation
  • neurological impairment
  • transcranial magnetic stimulation
  • functional electronic stimulation
  • peripheral nerve stimulation
  • deep brain stimulation
  • transcranial direct current stimulation
  • spinal cord stimulation

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Further information on MDPI's Special Issue policies can be found here.

Published Papers (3 papers)

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Research

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11 pages, 2088 KiB  
Article
Transcutaneous Spinal Cord Stimulation Enables Recovery of Walking in Children with Acute Flaccid Myelitis
by Elizabeth Neighbors, Lia Brunn, Agostina Casamento-Moran and Rebecca Martin
Children 2024, 11(9), 1116; https://doi.org/10.3390/children11091116 - 12 Sep 2024
Viewed by 2193
Abstract
Background: Limited research exists for use of transcutaneous spinal stimulation (TSS) in pediatric spinal cord injuries (SCI) to improve walking outcomes, especially in children diagnosed with SCI secondary to acute flaccid myelitis (AFM). Objective: This case series demonstrates the feasibility and efficacy of [...] Read more.
Background: Limited research exists for use of transcutaneous spinal stimulation (TSS) in pediatric spinal cord injuries (SCI) to improve walking outcomes, especially in children diagnosed with SCI secondary to acute flaccid myelitis (AFM). Objective: This case series demonstrates the feasibility and efficacy of TSS paired with gait training in children diagnosed with AFM. Methods: A total of 4 participants diagnosed with incomplete SCI secondary to AFM completed 22, 2-h therapy sessions over 5–8 weeks. TSS paired with body weight-supported treadmill training (BWSTT) was provided for the first 30 min of each session. Changes in walking function were assessed through the 6 min walk test (6MWT), Timed Up and Go (TUG), 10 m walk test (10MWT), and walking index for spinal cord injury II (WISCI-II). To assess safety and feasibility, pain, adverse events, and participant and therapist exertion were monitored. Results: All participants tolerated the TSS intervention without pain or an adverse response. Changes in the 6MWT exceeded the minimal clinically important difference (MCID) for three participants and WISCI-II exceeding the minimal detectable change (MDC) for two of the participants. Conclusions: These results demonstrate that TSS is a safe and clinically feasible intervention for pediatric patients with AFM and may supplement gait-based interventions to facilitate improvements in walking function. Full article
(This article belongs to the Special Issue Emerging Trends in Neuromodulation for Children with Neurological Conditions)
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Review

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18 pages, 289 KiB  
Review
Bridging the Gap in FDA Approval for Pediatric Neuromodulation Devices
by Ammar Shaikhouni, Cameron Brandon and Cory Criss
Children 2025, 12(2), 148; https://doi.org/10.3390/children12020148 - 27 Jan 2025
Viewed by 1417
Abstract
While neuromodulation devices for managing neurological conditions have significantly advanced, there remains a substantial gap in FDA-approved devices specifically designed for pediatric patients. Devices like deep brain stimulators (DBS), vagus nerve stimulators (VNS), and spinal cord stimulators (SCS) are primarily approved for adults, [...] Read more.
While neuromodulation devices for managing neurological conditions have significantly advanced, there remains a substantial gap in FDA-approved devices specifically designed for pediatric patients. Devices like deep brain stimulators (DBS), vagus nerve stimulators (VNS), and spinal cord stimulators (SCS) are primarily approved for adults, with few options for children. To meet pediatric needs, off-label use is common; however, unique challenges to pediatric device development—such as ethical concerns, small trial populations, and financial disincentives due to the limited market size—continue to hinder progress. This review examines these barriers to pediatric neuromodulation device development and FDA (Food and Drug Administration) approval, as well as the current efforts, such as FDA initiatives and consortia support, that address regulatory and financial challenges. Furthermore, we discuss pathways like the Humanitarian Device Exemptions and Real-World Evidence programs that aim to streamline the approval process and address unmet clinical needs in pediatric care. Addressing these barriers could expand access to effective neuromodulation treatments and improve patient care. Full article
(This article belongs to the Special Issue Emerging Trends in Neuromodulation for Children with Neurological Conditions)

Other

Jump to: Research, Review

13 pages, 1135 KiB  
Case Report
Transcutaneous Spinal Stimulation Combined with Locomotor Training Improves Functional Outcomes in a Child with Cerebral Palsy: A Case Study
by Darryn Atkinson, Kristen Barta, Fabian Bizama, Hazel Anderson, Sheila Brose and Dimitry G Sayenko
Children 2024, 11(12), 1439; https://doi.org/10.3390/children11121439 - 26 Nov 2024
Viewed by 1059
Abstract
Background and Purpose: activities-based locomotor training (AB-LT) is a restorative therapeutic approach to the treatment of movement deficits in people with non-progressive neurological conditions, including cerebral palsy (CP). Transcutaneous spinal stimulation (TSS) is an emerging tool in the rehabilitation of individuals with sensorimotor [...] Read more.
Background and Purpose: activities-based locomotor training (AB-LT) is a restorative therapeutic approach to the treatment of movement deficits in people with non-progressive neurological conditions, including cerebral palsy (CP). Transcutaneous spinal stimulation (TSS) is an emerging tool in the rehabilitation of individuals with sensorimotor deficits caused by neurological dysfunction. This non-invasive technique delivers electrical stimulation over the spinal cord, leading to the modulation of spinal sensorimotor networks. TSS has been used in combination with AB-LT and has been shown to improve muscle activation patterns and enhance motor recovery. However, there are no published studies comparing AB-LT + TSS to AB-LT alone in children with CP. The purpose of this case study was to compare the impact of AB-LT alone versus AB-LT combined with TSS on functional movement and quality of life in a child with CP. Methods: A 13-year-old male with quadriplegic CP participated in this pilot study. He was classified in the Gross Motor Function Classification System (GMFCS) at Level III. He completed 20 sessions of AB-LT (5x/week), then a 2-week washout period, followed by 20 sessions of body-AB-LT + TSS. Treatment sessions consisted of 1 h of locomotor training with body weight support and manual facilitation and 30 min of overground play-based activities. TSS was applied using the RTI Xcite®, with stimulation at the T11 and L1 vertebral levels. Assessments including the Gross Motor Function Measure (GMFM), 10-m walk test (10 MWT), and Pediatric Balance Scale (PBS) were performed, while spatiotemporal gait parameters were assessed using the Zeno Walkway®. All assessments were performed at three time points: before and after AB-LT, as well as after AB-LT + TSS. OUTCOMES: After 19/20 sessions of AB-LT alone, the participant showed modest improvements in the GMFM scores (from 86.32 to 88), 10 MWT speed (from 1.05 m/s to 1.1 m/s), and PBS scores (from 40 to 42). Following the AB-LT combined with TSS, scores improved to an even greater extent compared with AB-LT alone, with the GMFM increasing to 93.7, 10 MWT speed to 1.43 m/s, and PBS to 44. The most significant gains were observed in the GMFM and 10 MWT. Additionally, improvements were noted across all spatiotemporal gait parameters, particularly at faster walking speeds. Perhaps most notably, the child transitioned from the GMFCS level III to level II by the end of the study. Discussion: Higher frequency and intensity interventions aimed at promoting neuroplasticity to improve movement quality in children with CP are emerging as a promising alternative to traditional physical therapy approaches. This case study highlights the potential of TSS to augment neuroplasticity-driven treatment approaches, leading to improvements in neuromotor function in children with CP. These findings suggest that TSS could be a valuable addition to rehabilitation strategies, warranting further research to explore its efficacy in larger populations. Full article
(This article belongs to the Special Issue Emerging Trends in Neuromodulation for Children with Neurological Conditions)
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