Hybrid Home-Based FES Protocol for Spinal Cord Injury Rehabilitation: A Single-Center Observational Cohort Study

Background: Spinal cord injury (SCI) causes sensorimotor deficits and functional impairments that compromise quality of life in people with SCI (PwSCI). Although neuroplasticity-based therapies such as functional electrical stimulation (FES) are promising, accessibility barriers hinder their translation and long-term use. Objectives: To evaluate the effectiveness and usability of a home-based multidisciplinary rehabilitation protocol combining FES neuromodulation and virtual-based therapy for PwSCI. Methods: Eighty PwSCI received a hybrid intervention (synchronous and asynchronous), using a portable, app-based FES system with cloud monitoring. Outcome measures included SCIM-III, Motor Index Score (MIS), Timed Up & Go, five times sit-to-stand, and American Spinal Injury Association Impairment Scale (AIS) changes, along with feasibility and usability measures such as adherence, patient satisfaction, heuristic analysis, among others. Results: Motor incomplete paraplegia (AIS C/D) showed significant SCIM-III improvements (Δ+10 points, P < .001) and enhanced motor scores (MIS: Δ+4 points, P < .001), along with high adherence (70%) and satisfaction (84%). AIS changes showed in 32.5% of the patients. Motor complete injuries exhibited limited gains, highlighting thresholds for residual plasticity. Conclusion: A multidisciplinary protocol combining virtual therapy and FES may enhance motor recovery and independence in PwSCI, providing a scalable, accessible alternative to conventional rehabilitation. These results underscore the potential of technology-driven strategies to overcome barriers to care.