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 Silva from WiredOn Development sits down with Dr Susan Hastings, Jen, and Casey to discuss their research paper, Neuromodulatory Strategies Overcome Multiple Inevitable Impairments of Cerebral Palsy, J. Neurophysiol. 2026, 136, 445–458,
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'v worked with.
00:00 Welcome and Paper Intro
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 and Midline
20:49 Hands On vs Hands Off
23:24 TheraTogs Reality Check
29:24 Eyes Closed Motor Learning
31:54 FES Before TSN and Weight Shifts
34:19 Pictures in the Brain
39:16 Barefoot Proprioception Tips
40:50 Ball Sitting Midline Test
42:19 Parenting Through TSN
45:22 Alignment Cues Tongue Trick
46:55 Vision Changes and CVI
52:10 Session Flow and Breaks
55:10 One Week Withdrawal Crash
01:04:11 Dialing Stim Too High
01:07:34 Slow Skill Ownership
01:10:21 Facial Expression Practice
01:11:16 Facial Expression Practice
01:13:21 Hidden Emotions in CP
01:15:50 TSN Changes Awareness
01:18:08 What the Paper Missed
01:22:55 Biggest TSN Improvements
01:24:21 Alignment and PDI Debates
01:29:14 How to Start Safely
01:35:45 Casey’s Future Path
01:38:04 Research Still Evolving
01:41:37 Wrap Up and Resources
