Research studies from teams headed by a University of Louisville/Frazier Rehab Institute neuroscientist published online this week demonstrate for the first time that innovative rehabilitative treatments for individuals with spinal cord injuries (SCI) can lead to significant functional improvements in patients and a higher quality of life.
Eleven studies published in the September issue of the Archives of Physical Medicine and Rehabilitation conclude that establishing a network of rehab centers for SCI that standardizes treatment can lead to significant functional improvements for chronically injured patients. An additional study published in the September issue of Journal of Neurological Physical Therapy found that expenses associated with equipment, home renovations and transportation decreased by up to 25 percent for both pediatric and senior patients with motor incomplete SCI due to the function gained following intensive locomotor training intervention.
The principal author is Susan J. Harkema, Ph.D., the Owsley Brown Frazier Chair in Clinical Rehabilitation Research at the UofL School of Medicine’s Department of Neurological Surgery and director of the Spinal Cord Medicine Program at Frazier Rehab Institute, part of KentuckyOne Health.
These treatments are provided through the Christopher & Dana Reeve Foundation NeuroRecovery Network (NRN), a national network of activity-based rehabilitation centers for spinal cord injury. The findings suggest that a shift in both protocol and policy is needed to standardize rehabilitation across multiple centers. The studies were funded by the Reeve Foundation, the nation’s leading non-profit organization dedicated to curing spinal cord injury and improving quality of life for people living with paralysis.
The NRN is a national network of rehabilitative centers established by the Christopher & Dana Reeve Foundation to translate scientific advances into activity-based rehabilitation treatment for individuals with neurological disorders, and is funded by a cooperative agreement between the Foundation and the U.S. Centers for Disease Control and Prevention (CDC).
Using data from a total of 296 SCI patients at seven centers across the country, researchers found that the NRN succeeds because of overarching conditions, including:
- The deployment of standardized activity-based rehabilitation based on and supported by scientific and clinical evidence across the seven centers.
- The rigorous evaluation of all NRN interventions across the seven centers using measures of function, health, and quality of life. These rehabilitation interventions are continually assessed in light of newly emerging knowledge from basic science laboratories.
- The creation of NRN teams that include scientists, physicians, physical and occupational therapists and hospital administrators. Their varied perspectives enable the most effective and cost-efficient clinical model for the NRN.
Locomotor training is an intensive, activity-based intervention therapy that seeks to re-train the nervous system by simulating stepping and walking for those with spinal cord injuries. More than one million people in the United States are living with paralysis due to a spinal cord injury according to the Reeve Foundation.
“These results support the concept that there exists an intrinsic capacity of the human spinal cord circuitry that response to task-specific sensory cues can result in recovery in walking,” said Harkema, who also is NRN director. “The existence of the NRN and standardization of locomotor training protocols are crucial to determining the outcomes of these and future studies. By standardizing protocols across all NRN centers, we have an improved ability to understand the capacity for recovery in a chronic SCI population.”
“The research speaks for itself—the science shows that locomotor training is beneficial to people with spinal cord injury, even in those who have been injured for quite some time,” said Susan Howley, executive vice president of research at the Christopher & Dana Reeve Foundation. “For the first time, conclusive evidence has proven that standardized rehabilitation across multiple centers can result in positive patient recovery. Policies are needed to ensure that access to these centers is provided to all spinal cord injury patients and that new sites are continuously added to the NeuroRecovery Network.”
Taken together, the Archives papers suggest that locomotor training can be part of the reparative process after spinal cord injury and promotes improvements in the neuromuscular system. The studies provide evidence that rehabilitation is more than just compensatory—it is part of the repair process.
Locomotor training is used for people with brain and spinal cord injury, stroke and other neurological disorders. Many people with SCI, regardless of time elapsed since their injury, have improved their ability to walk after receiving locomotor training in research programs and clinics in Germany, Canada, Switzerland and the United States.
Locomotor training consists of a continuum of training principles that are applied across the three training environments: step training using body weight support on a treadmill (BWST) and manual assistance; over-ground walking training; and community ambulation training. Sensory information from the legs and trunk during walking is repetitively sent to the spinal cord using BWST. The sensory input comes from the actual stepping, from the manual contact of the therapist on the patient, and from the contact of the sole of the foot on the ground. The therapist ensures that the patient is optimizing standing and walking, although as the patient improves, the assistance of the therapist is reduced.
Participating medical centers included: Frazier Rehab Institute in Louisville; Boston Medical Center in Boston; Kessler Medical Rehabilitation Research and Education Center/Kessler Institute for Rehabilitation in West Orange, N.J.; Magee Rehabilitation Hospital in Philadelphia; Ohio State University Medical Center in Columbus; Shepherd Center in Atlanta; and The Institute for Rehabilitation and Research in Houston.
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