Effective management of orthostatic hypotension in a patient with complete spinal cord injury using a portable transcutaneous spinal cord stimulation device: A case report

Orthostatic hypotension (OH) is a debilitating condition in spinal cord injury (SCI) patients, characterized by impaired autonomic regulation and significant drops in blood pressure (BP) upon upright positioning. Despite pharmacological and non-pharmacological interventions, OH often persists, limiting rehabilitation progression and daily functional activities. Transcutaneous spinal cord stimulation (tSCS), is a non-invasive modality that has shown promise in addressing cardiovascular dysregulation. However, clinical application of tSCS is often constrained by availability. This case report describes a novel application of a commercially available neuromuscular electrical stimulation (NMES) device, adapted for transcutaneous spinal cord stimulation, in a 49-year-old male with C5 complete SCI and severe OH refractory to conventional treatments. The intervention demonstrated immediate stabilization of BP and symptom resolution during upright positioning, enabling significant functional gains, including improved sitting tolerance and enhanced quality of life. These findings suggest that NMES can be a cost-effective and portable alternative to traditional tSCS, and may broaden therapeutic options for managing OH in SCI patients. Further research is warranted to validate these results and optimize its clinical application.