Spinal Neuromodulation in Cerebral Palsy - Research
- 4 hours ago
- 4 min read
Dr Susan Hastings, with Casey and Jen Gonnella
Casey Gonnella was 11 years old when he started Transcutaneous Spinal Neuromodulation (TSN). Fast forward a few years and he now a published co-author on an academic publication discussing his case study in the Journal of Neurophysiology, along with the grandfather of Spinal Neuromodulation, the late Dr Reggie Edgerton, Dr Susan Hastings and his mother, Jennifer Gonnella.
In this conversation, Mindy sits down with Susan, Jen, and Casey to discuss their research paper, "Neuromodulatory Strategies Overcome Multiple Inevitable Impairments of Cerebral Palsy," in J. Neurophysiol. 2026, 136, 445–458,
"We're at a very new place in the research. Anyone who thinks they've got it all figured out, including myself - No!"
- Susan Hastings -
They address skepticism about Casey’s diagnosis and detail his pre- versus post-TSN changes, including major gains in tactile sensation, easier movement, and new visual, auditory, cognitive, swallowing, and facial-expression awareness.
The discussion emphasizes that the paper’s key clinical contribution is proprioceptive-derived intervention (PDI): training midline, alignment, head/neck control, weight shifts, and eyes-open/eyes-closed strategies to uncouple vision from movement, often using unstable surfaces. They also cover FES and TheraTogs, hands-on versus hands-off guidance, risks of reinforcing wrong patterns, individualized dosing, and the need for experienced clinicians who have evidence of long-term outcomes from children they've worked with.
For handy links to things we've discussed in this interview, scroll down to the Resources Section at the bottom of the page.
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Podcast Highlights
00:49 Honoring Reggie Edgerton
01:39 How the Paper Came Together
02:50 Did Casey Really Have CP
05:46 Life Before and After TSN
08:04 Early Choices and Surgery Pressure
11:02 PDI Explained
20:49 Hands On vs Hands Off
23:24 TheraTogs Reality Check
29:24 Eyes Closed - Motor Learning
31:54 FES Before TSN
34:19 Pictures in the Brain
39:16 PDI
42:19 Parenting Through TSN
46:55 Vision Changes and CVI
52:10 Session Flow
55:10 Dosing
01:07:34 Hidden Emotions in CP
01:18:08 What the Paper Missed
01:29:14 How to Start Safely
01:38:04 Research Still Evolving
01:41:37 Wrap Up and Resources
BIO
Susan Hastings, PT, DPT, PCS is a board-certified Pediatric Certified Specialist who earned her tDPT from Rocky Mountain University of Health Professions in 2010. She opened her own practice shortly after, built around functional electrical stimulation (FES) and whole body vibration (WBV), and has spent 25+ years developing new applications of stimulation for children with cerebral palsy, with a focus on motor learning. She has taught and presented at the Combined Sections Meeting, APTA SoPAC (alongside Beverly Cusick), AACPDM, and in cities as far afield as Rio de Janeiro, and has worked for years as a co-instructor with Judy Carmick on pediatric electrical stimulation courses.
For the last several years of his life, Susan collaborated closely with Dr V. Reggie Edgerton and Dr Parag Gad at the Edgerton Research Lab at UCLA, applying transcutaneous spinal neuromodulation (TSN) to new pediatric CP cases. That collaboration, and Susan's long-running focus on proprioception-derived intervention (PDI) as the piece that makes stimulation-driven gains stick, led directly to the case study discussed in this episode.
Casey and Jen Gonnella are, respectively, the case study's subject and his mother. Casey was born at 26 weeks and has cerebral palsy spastic diplegia. He began TSN at age eleven, paired with PDI under Susan's direction, and is now a young adult and a named co-author on the resulting paper.
Terms Used in This Episode (for readers unfamiliar with them)
TSN (transcutaneous spinal neuromodulation): non-invasive stimulation applied over the spine, used in this case alongside PDI.
PDI (proprioceptive-derived intervention): the structured practice work (finding midline, alignment, weight shift) that Susan and Casey describe as the harder, slower, and in Susan's view more important half of the intervention.
The "Continuum": a stimulation device Susan references directly, distinguishing it from the unit used in this case, particularly around seizure control in some patients.
Resources
Clickable links will take you right to the information you're looking for.
Neuromodulatory strategies overcome multiple inevitable impairments of cerebral palsy 
Clinical Advances in Spinal Neuromodulation 
The Broccoli Impossible to Possible Lab
Neuromodulatory Strategies Overcome Multiple Inevitable Impairments of Cerebral Palsy Journal of Neurophysiology (Articles in Press) · DOI: 10.1152/jn.00518.2025 Authors: Susan D. Hastings, Hui Zhong, Ken Kijima, Casey Gonnella, Jen Gonnella, Darrin J. Lee, Charles Liu, Yury P. Gerasimenko, V. Reggie Edgerton, and Christopher A. Johnson
The paper is a two-year longitudinal case study of one adolescent with spastic diplegic cerebral palsy, pairing TSN with PDI. It reports changes across posture, walking, fine motor control, speech, vision, hearing, sleep, endurance, executive function, and social engagement, and argues that some of what appears to be a fixed motor disorder in CP is actually reversible with the right combination of interventions. Mindy notes in the interview that the paper is open access.
Clinical Advances in Spinal Neuromodulation: A Mini Summit https://spinal-neuromodulation.heysummit.com/
Susan and the late Dr Reggie Edgerton were the driving force behind this mini-summit, a fundraiser for spinal neuromodulation research at the Broccoli Impossible-to-Possible Lab. The replays walk through the science and clinical results behind TSN, and include a live panel featuring Edgerton, Hastings, and Casey himself. If this episode left you wanting the fuller research picture, this is where to go next.
The Broccoli Impossible to Possible Lab https://www.impossibletopossiblelab.org/
This is the research lab itself, part of the Rancho Research Institute at Rancho Los Amigos National Rehabilitation Center, the same institution listed on the published paper. Its focus is on restoring independence and quality of life for people with spinal cord injury and cerebral palsy, and the site includes sections on the lab's research on cerebral palsy and neuromodulation, its people, and a donation page for anyone who wants to support the work directly. Unlike the summit replay, this is free to browse.
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