NISE-Stim: How Spinal Stimulation Can Support Children with Down Syndrome

Parents of children with Down syndrome often ask about new therapies that can help their child build strength, coordination, and independence. One option that is gaining

attention is NISE-Stim, short for Non-Invasive Spinal Electrical Stimulation.

This innovative approach uses safe, gentle electrical currents to stimulate the spinal cord and muscles, supporting both movement and overall nervous system function. Let’s explore what NISE-Stim is, how it works, and why it may benefit children with Down syndrome.

What is NISE-Stim?

NISE-Stim was developed in 2017 by physical therapist Gerti Motavalli, PT, MPT, alongside Dr. Gad Alon, PT, Ph.D., a world-renowned researcher in electrical stimulation.

It uses surface electrodes (small pads placed on the skin) to deliver mild electrical currents over the spinal cord and targeted muscles. This stimulation helps the nerves and muscles “talk” to each other more effectively, which can lead to improvements in:

• Muscle strength and coordination

• Motor skills like sitting, crawling, standing, or walking

• Sensory awareness

• Autonomic functions such as breathing, digestion, circulation, and bladder/bowel control

How Does It Work?

During NISE-Stim, electrodes are placed over the spinal cord and specific muscles. The electrical impulses mimic natural nerve signals, which:

• Activate muscle contractions

• Stimulate pathways between the brain, spinal cord, and muscles

• Encourage neuroplasticity (the brain and nervous system’s ability to form new connections)

Children don’t need to sit still for long therapy drills during sessions. Instead, stimulation can be paired with everyday activities like:

• Playing with toys

• Reading a book

• Watching TV

• Standing in a stander

This makes it child-friendly, comfortable, and easy to integrate into daily life.

Why Might It Help Children with Down Syndrome?

Children with Down syndrome often face low muscle tone, muscle weakness, and motor delays. NISE-Stim may provide:

• More effective muscle activation to support movement and posture

• Improved trunk control and balance for sitting and standing

• Increased coordination to help with walking and gross motor skills

• Better circulation and digestion, which are sometimes affected in children with low tone

While more research is still being done, many families and therapists have reported noticeable improvements within just a few weeks.

Proven Benefits and Safety

May children have already been treated directly with NISE-Stim, and many have shown improvements in:

• New movements or stronger existing muscles

• Trunk and core stability

• Better use of hands

• Improved bladder and bowel control

• Enhanced breathing and circulation

NISE-Stim is considered safe for most children. The stimulation feels like a light tingling or tapping, not painful. However, it is not recommended for children with:

• Pacemakers or implanted electronic devices

• Active cancer

Family-Friendly and Empowering

One of the biggest advantages of NISE-Stim is that it can be used both in therapy and at home. Parents are trained to place the electrodes and supervise sessions, starting with short 20-minute sessions and building up to 30 minutes, 1–3 times daily.

This makes NISE-Stim not just a clinic-based therapy, but a home program families can confidently use to reinforce progress between therapy visits.

Takeaway

NISE-Stim is an innovative, non-invasive therapy that can be a powerful addition to traditional physical therapy for children with Down syndrome. By stimulating the spinal cord, muscles, and nervous system, it supports strength, coordination, and overall development ,while also being safe, gentle, and family-friendly.

If you’d like to learn more about whether NISE-Stim might benefit your child, I’d be happy to connect with you and explore how this approach could fit into your therapy plan.

Published articles about the use and safety of electrical stimulation

1. Samejima, S. Caskey, C. D. Inanici, F. Multisite Transcutaneous Spinal Stimulation for Walking and Autonomic Recovery in Motor-Incomplete Tetraplegia: A Single-Subject Design. Phys Ther 2022;102: DOI10.1093/ptj/pzab228. CONCLUSION: These results suggest that noninvasive spinal cord stimulation might promote recovery of locomotor and autonomic functions beyond traditional gait training in people with chronic incomplete cervical SCI. IMPACT: Multisite transcutaneous spinal stimulation may induce neuroplasticity of the spinal networks and confer functional benefits following chronic cervical SCI.

2. Anastasia Keller1,2, Goutam Singh 1,2, et al. Noninvasive spinal stimulation safely enables upright posture in children with spinal cord injury NATURE COMMUNICATIONS | https://doi.org/10.1038/s41467-021-26026-z

3. Solopova IA, Sukhotina IA, Zhvansky DS, et al. Effects of spinal cord stimulation on motor functions in children with cerebral palsy. Neurosci Lett. 2017;639:192-198.

4. Krucoff MO, Rahimpour S, Slutzky MW, Edgerton VR, Turner DA. Enhancing Nervous System Recovery through Neurobiologics, Neural Interface Training, and Neurorehabilitation. Front Neurosci. 2016;10:584.

5. Gerasimenko Y, Gad P, Sayenko D, et al. Integration of sensory, spinal, and volitional descending inputs in regulation of human locomotion. J Neurophysiol. 2016;116(1):98-105.

6. Lee NG, Andrews E, Rosoklija I, et al. The effect of spinal cord level on sexual function in the spina bifida population. J Pediatr Urol. 2015;11(3):142 e141-146.

7. Sayenko DG, Atkinson DA, Floyd TC, et al. Effects of paired transcutaneous electrical stimulation delivered at single and dual sites over lumbosacral spinal cord. Neurosci Lett. 2015;609:229-234.

8. Shideler, B.L., et al., Toward a hybrid exoskeleton for crouch gait in children with cerebral palsy: neuromuscular electrical stimulation for improved knee extension. J Neuroeng Rehabil, 2020. 17(1): p. 121.

9. Elnaggar, R.K., B.A. Alqahtani, and M.F. Elbanna, Functional outcomes of botulinum neurotoxin-A injection followed by reciprocal electrical stimulation in children with cerebral palsy: A randomized controlled trial. Restor Neurol Neurosci, 2020.

10. Salazar, A.P., et al., Neuromuscular electrical stimulation to improve gross motor function in children with cerebral palsy: a meta-analysis. Braz J Phys Ther, 2019. 23(5): p. 378-386.

11. Oshima, O., et al., Effects of hybrid assistive neuromuscular dynamic stimulation therapy for hemiparesis after pediatric stroke: a feasibility trial. Disabil Rehabil, 2019: p. 1-5.

12. Marcus, S., et al., Neuromuscular electrical stimulation for treatment of dysphagia in infants and young children with neurological impairment: a prospective pilot study. BMJ Paediatr Open, 2019. 3(1): p. e000382.

13. Magalhaes, P., et al., Is transcutaneous electrical muscle stimulation an alternative for preventing acquired muscle weakness in the pediatric intensive care unit? A scoping review. Pediatr Pulmonol, 2019. 54(8): p. 1108-1116.

14. Elnaggar, R.K. and M.F. Elbanna, Evaluation of independent versus integrated effects of reciprocal electrical stimulation and botulinum toxin-A on dynamic limits of postural stability and ankle kinematics in spastic diplegia: a single-blinded randomized trial. Eur J Phys Rehabil Med, 2019. 55(2): p. 241-249.

15. Andreoli, S.M., B.L. Wilson, and C. Swanson, Neuromuscular electrical stimulation improves feeding and aspiration status in medically complex children undergoing feeding therapy. Int J Pediatr Otorhinolaryngol, 2019. 127: p. 109646.

16. Alrwaily, M., et al., Stabilization exercises combined with neuromuscular electrical stimulation for patients with chronic low back pain: a randomized controlled trial. Braz J Phys Ther, 2019. 23(6): p. 506-515.

17. Qi, Y.C., et al., Therapeutic Effect Evaluation of Neuromuscular Electrical Stimulation With or Without Strengthening Exercise on Spastic Cerebral Palsy. Clin Pediatr (Phila), 2018. 57(5): p. 580-583.

18. Elbasan, B., et al., Effects of neuromuscular electrical stimulation and Kinesio Taping applications in children with cerebral palsy on postural control and sitting balance. J Back Musculoskelet Rehabil, 2018. 31(1): p. 49-55.

19. Serel Arslan, S., et al., Effect of Swallowing Rehabilitation Protocol on Swallowing Function in Patients with Esophageal Atresia and/or Tracheoesophageal Fistula. Eur J Pediatr Surg, 2017. 27(6): p. 526-532.

20. Pool, D., et al., Neuromuscular electrical stimulation-assisted gait increases muscle strength and volume in children with unilateral spastic cerebral palsy. Dev Med Child Neurol, 2016. 58(5): p. 492-501.

21. Neyroud, D., et al., Wide-pulse-high-frequency neuromuscular electrical stimulation in cerebral palsy. Clin Neurophysiol, 2016. 127(2): p. 1530-1539.

22. Karabay, I., et al., Training postural control and sitting in children with cerebral palsy: Kinesio taping vs. neuromuscular electrical stimulation. Complement Ther Clin Pract, 2016. 24: p. 67-72.

23. Elnaggar, R.K., Shoulder Function and Bone Mineralization in Children with Obstetric Brachial Plexus Injury After Neuromuscular Electrical Stimulation During Weight-Bearing Exercises. Am J Phys Med Rehabil, 2016. 95(4): p. 239-47.

24. McCain, K.J., M. Farrar, and P.S. Smith, Gait recovery in a girl with ischemic spinal cord stroke. Pediatr Phys Ther, 2015. 27(2): p. 190-9.

25. Karabay, I., et al., Short-Term effects of neuromuscular electrical stimulation on muscle architecture of the tibialis anterior and gastrocnemius in children with cerebral palsy: preliminary results of a prospective controlled study. Am J Phys Med Rehabil, 2015. 94(9): p. 728-33.

26. Coskun-Benlidayi, I., et al., Early rehabilitation of a child with intensive care unit acquired weakness secondary to membranoproliferative glomerulonephritis: A case report. Turk J Pediatr, 2015. 57(4): p. 422-425.

27. Yildizgoren, M.T., et al., Effects of neuromuscular electrical stimulation on the wrist and finger flexor spasticity and hand functions in cerebral palsy. Pediatr Neurol, 2014. 51(3): p. 360-4.