{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"medRxiv"}],"indexed":{"date-parts":[[2026,11,2]],"date-time":"2026-11-02T17:58:32Z","timestamp":1793642312760,"version":"4.5.1"},"posted":{"date-parts":[[2026,6,9]]},"group-title":"Rehabilitation Medicine and Physical Therapy","reference-count":72,"publisher":"openRxiv","license":[{"start":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T00:00:00Z","timestamp":1780963200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.medrxiv.org\/about\/FAQ#license"}],"funder":[{"name":"Minnesota Spinal Cord Injury and Traumatic Brain Injury Research Grant Program 2022","award":["214550"],"award-info":[{"award-number":["214550"]}]},{"DOI":"10.13039\/100006108","name":"National Center for Advancing Translational Sciences","doi-asserted-by":"crossref","award":["UM1TR004405"],"award-info":[{"award-number":["UM1TR004405"]}],"id":[{"id":"10.13039\/100006108","id-type":"DOI","asserted-by":"crossref"}]},{"name":"Biotechnology Research Center","award":["P41EB015894"],"award-info":[{"award-number":["P41EB015894"]}]},{"name":"National Institute of Neurological Disorders & Stroke Institutional Center Core Grants to Support Neuroscience Research","award":["P30 NS076408"],"award-info":[{"award-number":["P30 NS076408"]}]},{"name":"High-Performance Connectome Upgrade for Human 3T MRI scanner","award":["1S10OD017974"],"award-info":[{"award-number":["1S10OD017974"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2026,6,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                <jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>\n                    Reduced or lost sensation and movement after a spinal cord injury (SCI) impairs the brain\u2019s ability to accurately localize paralyzed body parts, causing deficits in its internal body map, or \u201cmental body representations\u201d (MBR). These deficits hinder functional recovery and contribute to neuropathic pain. Medications for neuropathic pain are often ineffective and carry side-effects. Our pilot trials found that\n                    <jats:italic>in-person<\/jats:italic>\n                    Cognitive Multisensory Rehabilitation (CMR), a physical therapy restoring MBR, led to prolonged pain reduction, improved sensorimotor function, and enhanced brain function, to greater extent than adaptive fitness.\n                  <\/jats:p>\n                  <jats:p>\n                    To explore more accessible interventions for those in rural areas or with transportation challenges, we examined whether 12 weeks of\n                    <jats:italic>remotely delivered<\/jats:italic>\n                    CMR or exercise would (1) improve function and reduce pain; (2) increase brain activity and connectivity related to sensorimotor function and MBR in adults with SCI.\n                  <\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Of 19 adults with SCI who consented, 15 (51\u00b115 years old, 8\u00b110 years post-SCI) were randomized to 12 weeks of remotely delivered CMR or exercise (45min, 3x\/week). Eight reported neuropathic pain \u22653\/10. The Numeric Pain Rating Scale (NPRS), ASIA Impairment Scale (AIS), and Neuromuscular Recovery Scale (NRS) assessed pain and sensorimotor function at baseline, post-intervention, and 6-month follow-up. Functional MRI included resting-state and four tasks: imagining feeling the left leg, imagining moving the left leg, whole-body movement imagery, and a sensation task.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>After CMR (n=8), participants improved on AIS (large effect sizes: touch: d=1.30; pinprick: d=1.21; lower limb motor function: d=1.83). Exercise (n=7) produced smaller improvements (touch: d=0.35; pinprick: d=0.36; lower limb motor function: d=0.80). CMR showed greater NRS effect sizes (core: d=1.48; upper limb: d=0.69; lower limb: d=1.25) than exercise (core: d=0.31; upper limb: d=0.74; lower limb: d=0.83). Benefits persisted at follow-up for both AIS and NRS, especially in the CMR group. Highest neuropathic pain intensity decreased in both groups post-intervention (CMR: d=-0.61; exercise: d=-0.73) and at 6-month follow-up (CMR: d=-0.55; exercise: d=-0.55). Unlike previous studies, group effects for CMR were not found due to high heterogeneity. Increased task-based activation, including in the lateral occipital cortex involved in visual body perception and spatial awareness, was seen for the exercise group (n=5).<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Discussion<\/jats:title>\n                  <jats:p>These preliminary results support the potential of remotely delivered CMR and exercise to improve function and reduce neuropathic pain in adults with SCI, highlighting the need for larger trials.<\/jats:p>\n                  <jats:p>\n                    Clinicaltrial.gov:\n                    <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" xlink:href=\"NCT05870189\">NCT05870189<\/jats:ext-link>\n                  <\/jats:p>\n                <\/jats:sec>","DOI":"10.64898\/2026.06.02.26354574","type":"posted-content","created":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T22:55:12Z","timestamp":1781045712000},"source":"Crossref","is-referenced-by-count":1,"title":["Sensorimotor recovery and neuropathic pain reduction after remotely delivered cognitive multisensory rehabilitation or remotely delivered exercise in adults with spinal cord injury: a pilot clinical trial"],"prefix":"10.64898","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8400-3177","authenticated-orcid":false,"given":"Ann","family":"Van de Winckel","sequence":"first","affiliation":[{"name":"Division of Physical Therapy and Rehabilitation Science, Department of Family Medicine and Community Health, Medical School, University of Minnesota, Minneapolis, MN 55455, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amanda A.","family":"Herrmann","sequence":"additional","affiliation":[{"name":"HealthPartners Institute Neuroscience Research Center, St. Paul, MN 55130, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sydney T.","family":"Carpentier","sequence":"additional","affiliation":[{"name":"Rehabilitation Science Graduate Program, Department of Family Medicine and Community Health, Medical School, University of Minnesota, Minneapolis, MN 55455, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Bottale","sequence":"additional","affiliation":[{"name":"Centro Studi di Riabilitazione Neurocognitiva \u2013 Villa Miari (Study Center for Cognitive Multisensory Rehabilitation), Santorso VI, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ricky L.","family":"Lopez","sequence":"additional","affiliation":[{"name":"HealthPartners Neuroscience Center, St. Paul, MN 55130, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew D.","family":"Rapacz","sequence":"additional","affiliation":[{"name":"HealthPartners Neuroscience Center, St. Paul, MN 55130, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samantha J.","family":"Larson","sequence":"additional","affiliation":[{"name":"HealthPartners Institute Neuroscience Research Center, St. Paul, MN 55130, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei","family":"Deng","sequence":"additional","affiliation":[{"name":"Rehabilitation Science Graduate Program, Department of Family Medicine and Community Health, Medical School, University of Minnesota, Minneapolis, MN 55455, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lin","family":"Zhang","sequence":"additional","affiliation":[{"name":"Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN 55414 USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timothy J.","family":"Hendrickson","sequence":"additional","affiliation":[{"name":"Masonic Institute for the Developing Brain, University of Minnesota; 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