Neuromodulatory strategies overcome multiple inevitable impairments of cerebral palsy

Cerebral palsy (CP) is traditionally characterized as a disorder of motor impairment; however, growing evidence suggests it reflects broader dysregulation across multiple physiological systems. We present a longitudinal case study examining whether pairing transcutaneous spinal neuromodulation (TSN) with a proprioceptive-derived intervention (PDI) can engage systems-level functional adaptation in an adolescent with CP spastic diplegia, whose progress had plateaued after years of conventional therapy. Across 2 years of the intervention, structured clinical observations revealed progressive and reversible improvements spanning posture, locomotion, fine motor control, speech, vision, hearing, sleep, endurance, executive function, and psychosocial engagement. Motor coordination often changed rapidly with stimulation, autonomic functions evolved over intermediate timescales, and longer-lasting changes consistent with support of physiological capacity and recovery emerged more gradually. The task specificity, state dependence, and reversibility of these effects are consistent with activity-dependent processes guided by enhanced proprioceptive signaling during TSN + PDI. Importantly, these adaptations did not emerge uniformly across domains. These findings support a reconceptualization of CP not solely as an isolated motor disorder, but as a condition of maladaptive multisystem regulation that may be amenable to noninvasive, proprioceptively derived neuromodulatory rehabilitation strategies. Although limited to a single case, this work highlights underappreciated neuroadaptive potential in CP and motivates future controlled studies targeting systems-level recovery.NEW & NOTEWORTHY This 2-year longitudinal case report extends beyond motor outcomes to examine systems-level changes in cerebral palsy (CP). Using combined qualitative and quantitative evidence, we show that pairing transcutaneous spinal neuromodulation with proprioceptive-derived intervention can engage activity-dependent neuroplasticity across multiple physiological domains. Coordinated improvements in motor, autonomic, and cognitive function, with distinct temporal dynamics and reversibility, suggest that enhancing proprioceptive signaling may modulate and improve distributed physiological networks and reveal clinically relevant targets for future study.