Patient & Family Education

Movement Recovery After Brain Injury

Start with standard rehabilitation. Measure progress carefully. If important goals remain unmet, newer options such as spinal cord stimulation (SCS) may be discussed in selected patients.

Important: SCS for movement recovery after brain injury is still an investigational treatment. It should not replace proven rehabilitation.

Start with standard rehabilitation

This remains the foundation of recovery and has the strongest evidence.

✓ Physical therapy: strength, balance, standing, walking

✓ Occupational therapy: arm, hand and daily activities

✓ Task-specific, repetitive practice

✓ Spasticity and pain treatment when needed

✓ Cognitive, speech and swallowing therapy when appropriate

✓ Good seizure control and general medical care

Reassess progress

Recovery should be judged against the goals that matter to the patient and family.

✓ Is strength improving?

✓ Is walking, transfer or hand use improving?

✓ Is the patient more independent?

✓ Are personal goals being reached?

✓ Are there treatable barriers such as spasticity, contracture, pain or poor seizure control?

If important goals are still not reached

Additional options can be discussed. One recently developed option is epidural spinal cord stimulation (SCS).

✓ SCS does not repair the injured brain

✓ It stimulates spinal sensory pathways and motor networks

✓ It may help remaining brain signals activate muscles more effectively

✓ It is usually combined with intensive rehabilitation

✓ A temporary stimulation trial may be considered before a permanent implant, depending on the clinical protocol

The treatment goal is not “to do SCS.”

The goal is the best possible recovery, independence and quality of life. SCS is only one possible tool if conventional rehabilitation does not achieve enough meaningful improvement.

Explore the pathway

Click each question to open it.

How long should standard rehabilitation be tried?

There is no single duration that fits everyone. The program should be individualized and continued while the patient is making meaningful gains or while specific functional goals remain realistically achievable. Progress should be reassessed using objective measures rather than time alone.

What should be measured before considering SCS?

Useful measures may include motor power, Fugl-Meyer motor score, hand function, walking speed, walking distance, balance, transfers, spasticity, activities of daily living and the patient’s own functional goals.

Who may be a reasonable candidate for an SCS discussion?

A potential candidate would generally have a chronic, stable neurological deficit; incomplete recovery despite appropriate rehabilitation; realistic goals; ability to participate in intensive rehabilitation; and evidence that useful brain-to-spinal pathways may still remain. Detailed neurological and rehabilitation assessment is essential.

What if the patient has post-traumatic seizures?

Seizure history needs specific review. Current evidence for SCS specifically in patients with post-traumatic epilepsy is limited. Seizures should be medically assessed and reasonably controlled before an investigational neuromodulation procedure is considered.

Is SCS proven to restore normal movement?

No. Early human studies are encouraging, but they are small and SCS remains investigational for motor recovery after brain injury. Improvement, when it occurs, may involve strength, movement, spasticity or ability to perform rehabilitation tasks. Normal recovery cannot be promised.

What do early human studies show?

These numbers are encouraging, but they should be interpreted as early research, not a guarantee of benefit.

severe TBI patients

2024 retrospective series; 9 had hemiparesis.

61.8% had reduced spasticity.
35.3% developed or increased active movement in paretic limbs.

chronic stroke patients

2023 first-in-human cervical SCS study.

Grip strength increased by about 40% in one participant and 108% in the other during stimulation; movement speed improved about 30–40%.

chronic stroke patients

2026 feasibility study.

Average strength increased 32% with stimulation. Immediate Fugl-Meyer improvement averaged +5.6 points, with +6.6 points at study end.

Continue standard rehabilitation when…

✓ The patient is still improving

✓ Meaningful goals are being reached

✓ There are modifiable problems that have not yet been optimized

✓ The expected benefit of an experimental procedure is uncertain

Discuss advanced options when…

✓ Deficits are chronic and stable

✓ Appropriate rehabilitation has been tried

✓ Important goals remain unmet

✓ The patient understands the uncertainty

✓ A specialist believes there is a reasonable biological and functional basis for a trial

Selected References

Vorobyev AA, et al. Clinical Outcome After Epidural Spinal Cord Stimulation in Patients With Severe Traumatic Brain Injury. 2024.
Wagner FB, et al. Epidural stimulation of the cervical spinal cord for post-stroke upper-limb paresis. Nature Medicine. 2023.
de Freitas et al. Cervical epidural spinal cord stimulation for chronic post-stroke upper-limb paresis: feasibility study. Nature Medicine. 2026.

For education only. This page does not replace individualized medical assessment. SCS for motor recovery after traumatic brain injury or stroke is not established standard treatment and is best considered in specialized centers or research-oriented protocols.