Patient Insight Drives New Breakthroughs in Spinal Cord Injury Research

Published May 5, 2026

Contributed by: Anthony DiMarco, MD and Kris Kowalski, PhD / Center for Rehabilitation Research

Patient Insight Drives New Breakthroughs in Spinal Cord Injury Research

Anthony DiMarco, MD, principal investigator, and Kris Kowalski, PhD, senior co-investigator, and their team have spent decades advancing spinal cord injury (SCI) research at the MetroHealth System. What began as an effort to restore breathing has evolved into a broader approach that now targets cough and bowel function, two of the most serious and often overlooked challenges in SCI.

Now, their work is gaining new momentum, not only because a cough restoration system is moving closer to broader use, but also because patients themselves helped uncover a new application for the technology.

“It takes decades to move something like this forward,” says Dr. DiMarco, a staff scientist at MetroHealth “But the potential is enormous.”

From Breathing to Breakthroughs

In the 1990s, the team began exploring whether electrical stimulation could help activate muscles that no longer worked after spinal cord injury. They started in preclinical models, showing the stimulation could trigger the muscles needed for breathing. Then they translated these findings into clinical studies, refining the technology and procedure and making it safer and less invasive over time. Their work led to early advances in diaphragm pacing, including the treatment of patients such as Christopher Reeve, and helped establish MetroHealth as a leader in restoring respiratory function.

As the research progressed, the team turned its attention to another critical need: helping patients cough effectively. Even when patients could inhale, many could not generate the force needed to cough and clear their airways. By targeting the muscles in the abdomen and lower rib cage, the researchers showed they could restore that force. This work laid the foundation for the cough restoration system they continue to develop today.

“This is about more than function,” says Dr. Kowalski, a staff scientist at MetroHealth. “Without a strong cough, patients cannot clear secretions from their airways, which puts them at constant risk for infection. Respiratory complications are the major cause of death in people with spinal cord injury.”

Restoring a Life-Saving Function: Cough

Building on their respiratory research, the team developed an implanted system that uses spinal cord stimulation to activate the abdominal and lower rib cage muscles required for an effective cough. With the push of a button, patients can generate a controlled, forceful cough, on demand.

In two clinical studies involving 29 participants—the largest to date for this system—the team demonstrated the approach was safe and effective, significantly improving quality of life. Studies published in 2023 and 2024 also showed meaningful clinical benefits and reduced caregiver burden.

“For these users, this affects everyday life,” Dr. Kowalski says. “If they don’t have an effective cough, they have to rely on equipment or caregivers. When you restore the ability to cough independently, they can manage on their own.”

Now, the team is working with the U.S. Food & Drug Administration (FDA) to secure an investigational device exemption (IDE) to launch a multicenter trial involving approximately 40 patients across three sites. If successful, this step would pave the way for broader use of the technology, allowing physicians to prescribe the system beyond the research setting.

An Unexpected Discovery

The next breakthrough came from research participants. “During the cough studies, users told us they were using the system to help with bowel movements,” Dr. DiMarco says. “We hadn’t intended that, but once we recognized this other significant benefit, we evaluated it in another group of patients. In that assessment, bowel care time was significantly reduced from approximately two hours to as little as 15 to 20 minutes, relied less on medications and they gained much greater independence.”

That insight opened a new line of investigation into one of the most burdensome complications of SCI. For many people with spinal cord injury, bowel management can take hours and often requires substantial caregiver assistance. The main reason is that people with paralysis cannot generate the abdominal pressure needed for effective defecation. In severe cases, complications related to bowel dysfunction can become life-threatening.

Spinal cord stimulation addresses that issue. The system activates the abdominal muscles to create normal sustained pressure required for normal defecation. While the same muscles drive coughing, bowel function requires longer, controlled contractions rather than short bursts.

What’s Next

Now, Dr. DiMarco, Dr. Kowalski and their collaborators are working with the FDA to launch the next phase of clinical trials. Planned multicenter studies will move the bowel care technology closer to clinical availability.

“The potential for this technology is enormous,” Dr. DiMarco says. “We believe it could extend well beyond spinal cord injury to help patients with Parkinson’s disease, multiple sclerosis and other conditions that affect muscle control.”

Watch a news clip highlighting Dr. DiMarco’s research and its connection to Christopher Reeve.