Feasibility and Safety of Combined Robot-Assisted Gait Training and Transcutaneous Spinal Cord Stimulation in Pediatric Incomplete Spinal Cord Injury: A Case Series

Background/Objectives: Pediatric spinal cord injury (SCI) is a rare yet highly disabling condition associated with substantial functional and psychosocial impairments. Although robot-assisted gait training (RAGT) and transcutaneous spinal cord stimulation (tSCS) have independently demonstrated promising results, evidence regarding their combined use in pediatric SCI is limited. This study aimed primarily to assess the feasibility and safety of combining RAGT with tSCS in children with incomplete SCI, and secondarily to explore its effects on clinical outcomes. Methods: A case series study was conducted that included three pediatric participants (<18 years) with chronic incomplete SCI (AIS C–D). Participants completed five consecutive sessions of RAGT using a Lokomat device combined with tSCS applied at the lumbosacral level. Each session consisted of 30 min of gait training, including 20 min of concurrent electrical stimulation. Safety was assessed through adverse-event monitoring and pain evaluation. Clinical outcomes included gait speed (10MWT), trunk control (SATCo), lower-limb strength (LEMS), and spasticity (MAS). Results: Session adherence reached 100%. Skin erythema was the most frequently reported adverse event and showed a clear association with tSCS. All participants demonstrated improvements in gait speed, with two exceeding the minimal clinically important difference. Secondary results showed similar outcomes for spasticity, strength, and trunk control, with no clinically meaningful changes in any case. Conclusions: The combined application of RAGT and tSCS appears to be a feasible and safe intervention for children with incomplete SCI. Preliminary findings suggest potential benefits in gait speed, thereby supporting the need for further investigation with larger samples and controlled study designs.