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