Researchers in UofL’s provided a combination therapy to five children with complete paralysis. The children, ages 7-12, took part in a clinical study in which they received external electrical stimulation over the spine, combined with activity-based therapy and encouragement to consciously intend to step. During the study, the children all gained the ability to take steps and experienced unexpected improvements in sensation, bladder function, transferring and other abilities. The study was published in the.

“We have found that electrical stimulation can “charge” the spinal cord, making it possible for a paralyzed individual to step voluntarily,” said Andrea Behrman, professor in the UofL Department of Neurological Surgery and director of the Center for Pediatric NeuroRecovery, who led the study. “This ability increases over time when the stimulation is combined with locomotor training and mental intent to step.”

Stimulation + activation + intent

In the study, children who were completely paralyzed for more than a year, unable to move below their level of spinal injury, participated in a series of 60 sessions that included noninvasive, transcutaneous (through the skin) electrical stimulation of the sensory nerves to the spinal cord and specialized physical therapy.

The electrical stimulation was applied with a specially designed technique for external electrical stimulation developed by Yury Gerasimenko, now gratis professor of the UofL Department of Physiology. The technique consisted of several small stimulators, about the size of a quarter, placed on the child’s skin over the sensory nerves of the spinal cord. During the sessions, electrical stimulation was applied through the pads while the children took part in physical therapy known as activity-based locomotor training.

This therapy consists of researchers and therapy technicians manually facilitating the child’s legs in stepping motions as they lay on their side on a table with their legs suspended and also during assisted walking with part of their body weight supported over a treadmill. In addition, the children were encouraged to consciously attempt to step.

Over the course of the study, the children were able to initiate and control the stepping themselves. After various numbers of sessions, they were able to take steps over ground, voluntarily initiating the steps both with and without the stimulation present. Three to six months after the sessions were completed, all of the children still were able to take steps with and without the stimulation.

“The results we see with this study confirm what I have learned more and more over the last two decades working with children with spinal cord injury,” Behrman said. “Your spinal cord is more than a conduit or a pipeline for nervous system messages. It processes information and is smart like your brain. The spinal cord can’t decide to go to Starbucks for coffee, but it can help you with more automatic movements such as sitting up better and taking steps. It also works somewhat like a battery and needs the right charge to help produce steps and respond to therapy.” ��

For many years, the medical community as a whole has believed that after injury in which communication along the spinal cord was interrupted and the patient could not move on their own, that function below the injury could never be restored. As a result, treatment for most people with complete paralysis included helping them adapt to mobility with wheelchairs and other forms of assistance.

For the parents of children participating in Behrman’s studies and clinical care, even the small gains achieved through the sessions have a significant positive impact on their child’s quality of life and often, their health.

Kalyn MacIntyre, whose son Malcolm participated in the study, said that even three years after the study concluded, he retains many of the benefits he gained from his sessions.

“He can still step on the treadmill, he can kick a ball consistently. He can now feel when he needs to go to the restroom and his overall health has been good,” Kalyn said, adding that he also has sensory gains. “I don’t know what his future is as far as walking. I just want him to be functionally capable of doing things on his own – to have more independence – and I want him to be healthy. We have more of that here because of this study.”

The personal connection

One of the most challenging aspects of the research is motivating the children during long training sessions.

“We can have the most beautifully designed study, but if a child can’t get into it and you can’t help them be successful, it will not work,” Behrman said. “You can’t just come in and say, ‘Do this 50 times.’ For each child, you must figure out how to connect with who they are.”

To engage them in the activities, Behrman and the therapists working with the children have cultivated the art of motivation by incorporating their personal interests. One child in the study was a basketball player before he was injured, so Behrman used a whistle to encourage him to go faster or drive harder, similar to when he was running drills for basketball.

For Malcolm, the research staff devised a point system to reward him for every time he was able to kick a ball. Behrman recalled one session when she told him that instead of the 10 or 20 points he received for kicking the ball off the treadmill, she would award him 10,000 points if he could kick the ball to hit a target on the opposite wall.

On the next try, Malcolm’s kick sent the ball sailing across the room, squarely hitting the target.

Previous success

Previously, researchers at UofL achieved remarkable success in restoring function to adults with spinal cord injury in studies using surgically implanted electrical spinal cord stimulators. In one study, adults who were completely paralyzed were able to take steps over ground with stimulation after a series of intensive physical therapy sessions and mental intent to take steps.

This new study shows that similar results can be achieved without the invasive procedure. In addition, the adults could only step when the stimulator was on, whereas the children in Behrman’s study were able to step long after the stimulation sessions had ceased.

For additional photos and video clips, visit . All images courtesy University of Louisville. The images with “study image” in the name were captured during the study sessions, 2021-2023.

The largest of these gifts, a $3 million investment��in the Neonatal Intensive Care Unit (NICU) at��,��will help create eight new private family rooms designed to improve outcomes for medically fragile newborns.

“Through their investment in UofL and UofL Health, Kosair for Kids makes it possible for us to provide critical care to pediatric patients and their families—from the NICU, to Frazier Rehab��Institute, to the School of Dentistry,” said University of Louisville President and Chair of the UofL Health Board of Directors Gerry Bradley. “Family-centered care is proven to improve outcomes, and these investments will truly change lives. We are honored to join Kosair for Kids in making this care possible for the children of our region.”

Each year, the NICU at UofL Hospital provides care for more than 400 newborns, with nearly 90% coming from low-income households.��The NICU expansion will convert outdated open-bay nursery space into private rooms, allowing parents to stay with their infants, strengthening family bonds and supporting improved medical outcomes.

“We are deeply grateful to Kosair for Kids for their extraordinary generosity and continued partnership with UofL Health and UofL. This investment in our NICU is transformational,” said UofL Health Interim CEO Jason Smith. “It means more families can remain together during critical moments of care and more babies will have the best possible chance at a healthy start. Thanks to Kosair for Kids, we can extend hope and healing to the youngest and most vulnerable in our community.”

In addition to the NICU expansion, Kosair for Kids will also be supporting two additional initiatives:

• $47,300 to����to purchase specialized pediatric rehabilitation equipment, including the Bioness L300 Go Plus System, which helps children with neurological conditions strengthen mobility and independence.
• $50,000 to the , ensuring children and families experiencing financial hardship continue to receive essential oral health services.

For more than a century, Kosair for Kids has been dedicated to enhancing the health and well-being of children in Kentucky and southern Indiana. These latest gifts build on its longstanding collaboration with UofL and UofL Health, helping ensure every child has the best opportunity to grow, heal and thrive.

Integrating these functions will enhance research collaboration, improve patient care and increase treatment capacity by 50%, allowing up to 24 children per day to receive life-changing therapies.

The expansion is also made possible thanks to federal support and philanthropic generosity. Congressman Morgan McGarvey and Honorable former Congressman John Yarmuth championed a Health Resources and Services Administration (HRSA) grant that provided $2 million toward the project. Their leadership helped secure critical funding to support this vital expansion in pediatric care. In addition, the university recognizes with deep gratitude a bequest realized from the estate of Jane Burian in memory of Dr. Frank J. Burian and Henrietta S. Burian, whose legacy will have a lasting impact on the lives of children and families served by the center.

For over a decade, UofL’s pediatric neurorecovery program, led by Dr. Andrea Behrman, has transformed the lives of children recovering from spinal cord injuries, growing from serving one child per day to 16, with more than 21 daily visits for occupational and physical therapy. However, the program has long outgrown its existing facilities, which are scattered across multiple floors and repurposed spaces within Frazier Rehab Institute.

“Our mission is to not only provide the best care for children affected by spinal cord injuries but to push the boundaries of what is possible for their recovery,” said Behrman, director of the center and professor in the UofL Department of Neurological Surgery. “Thanks to the unwavering support of Kosair for Kids, we will now have a facility designed specifically for this groundbreaking work, enabling us to reach more children and provide even better outcomes.”

Additionally, the center will serve as a hub for training the next generation of therapists, researchers and physicians specializing in restorative pediatric neurorecovery.

“Kosair for Kids has proudly supported this center since its inception,” said Barry Dunn, president and CEO of Kosair for Kids. “We have witnessed Kosair Kids regain movement and hope, ability and joy. This expanded partnership with UofL delivers on the Kosair for Kids promise to help every child live life to the fullest. This is what it means to bring hope and healing to our community.”

The center’s research is part of the work of the , funded by the Kentucky Spinal Cord and Head Injury Research Trust. Jim Shaughnessy, director of the Kentucky Spinal Cord and Head Injury Research Board, emphasized the impact of the new space on the center’s broader mission:

“This expansion is a critical step forward in our mission to drive innovative, research-based care for children with spinal cord injuries,” said Shaughnessy. “By bringing research and therapy together under one roof, we are accelerating the path from discovery to recovery and creating a model that can be replicated worldwide.”

Highlights of the center’s new location:

• Integrated therapy and research spaces to ensure seamless collaboration between clinicians and scientists.
• Dedicated teen therapy areas and specialized equipment to accommodate all pediatric age groups.
• Private consultation rooms for families to meet with health care professionals.
• A family-friendly common space for caregivers to rest, network with other families, or work remotely during therapy sessions.
• Advanced rehabilitation technology tailored to pediatric neurorecovery needs.

Gifts to the assist families whose insurance does not fully cover the cost of therapy, allowing more children with spinal cord injuries have full access to activity-based therapies to make their lives better. ��

See .��

The A. Keith Inman Pediatric NeuroRecovery Community Service Awards were presented to Kosair for Kids and Ronald McDonald House Charities of Kentuckiana for their ongoing service to children with spinal cord injury. Chris Williams, senior vice president of communications, accepted the award on behalf of Kosair for Kids. Hal Hedley, CEO, accepted on behalf of Ronald McDonald House Charities.

The Susan J. Harkema, PhD Pediatric NeuroRecovery Research Award went to the Todd Crawford Foundation to Cure Paralysis for their commitment to pediatric research.

The awards, first given in 2022, were named for A. Keith Inman, former president of Kosair for Kids, and UofL spinal cord injury researcher Susan J. Harkema for their vision and support of the Kosair for Kids Center for Pediatric NeuroRecovery.

This year’s awards were presented in May during the 2024 Pediatric NeuroRecovery Summit, a biennial forum for health care professionals, researchers, graduate students, post-doctoral fellows and parents to advance recovery for children with spinal cord injuries. The summit is held every two years in conjunction with the��.