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Locomotor Training and SCI

Recovery of function can occur years after injury.

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For the first time, new research demonstrates that innovative rehabilitative treatments for individuals with spinal cord injuries can lead to significant functional improvements in patients and a higher quality of life. 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, a nonprofit organization dedicated to curing spinal cord injury and improving quality of life for people living with paralysis.

Eleven peer-reviewed studies published in the Sept. 2012 issue of Archives of Physical Medicine & Rehabilitation conclude that establishing a network of rehab centers for spinal cord injuries that standardizes treatment -- such as the NeuroRecovery Network (NRN), a national network of rehabilitative centers established by the Christopher & Dana Reeve Foundation -- can lead to significant functional improvements for chronically injured patients.

The NRN 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 patients living with SCI 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.

In addition, one NRN study published in the September issue of the Journal of Neurological Physical Therapy found that expenses associated with equipment, home renovations, and transportation decreased by up to 25 percent for both children and adult patients with motor incomplete spinal cord injury due to the function gained following intensive locomotor training intervention.

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 U.S. 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 responds to task-specific sensory cues and can result in recovery in walking," said Susan J. Harkema, PhD, director of NRN, University of Louisville professor of neurosurgery and rehabilitation, and research director of the University of Kentucky's Spinal Cord Research Center and Frazier Rehab Institute. "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," she explained.

"The research shows that locomotor training is beneficial to people living 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 patients living with spinal cord injury and that new sites are continuously added to the NeuroRecovery Network," she added.

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Employing this powerful intervention in the stroke and SCI settings.

Taken together, the papers suggest that locomotor training can be part of the reparative process after spinal cord injury and promotes improvements in the neuromuscular system. 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 living 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.

Multiple research teams headed by Dr. Harkema published the papers. Participating medical centers included the Frazier Rehab Institute in Louisville, KY; Boston Medical Center in Boston, MA; Kessler Foundation in West Orange, NJ; Magee Rehabilitation Hospital in Philadelphia, PA; Ohio State University Medical Center in Columbus, OH; Shepherd Center in Atlanta, GA; and The Institute for Rehabilitation and Research in Houston, TX.

Source: The Reeve Foundation
Photo Credit: Julie Lubinsky


 

very good site for all health professionals

sanjeev ranjanDecember 08, 2012
KANPUR




     

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