NRN Studies: Improved Health and Function
Intensive, activity-based rehabilitation therapy can lead to significant functional improvements in patients with spinal cord injuries. New research, based on studies from the Christopher & Dana Reeve Foundation NeuroRecovery Network (NRN), shows that recovery of walking and balance can occur even years after injury in people with incomplete spinal cord injury who participate in locomotor training.
The NRN is a national network of rehabilitative centers that translate scientific advances into rehabilitation treatment for individuals with neurological disorders; it is funded by a cooperative agreement between the Reeve Foundation and the U.S. Centers for Disease Control and Prevention (CDC).
The new research comprises 11 peer-reviewed studies published in the September 2012 issue of Archives of Physical Medicine & Rehabilitation. Using rigorous evaluation and analysis, data from 296 spinal cord injury (SCI) patients at seven centers across the country 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 an intensive, activity-based intervention therapy that seeks to re-train the nervous system by simulating stepping and walking. The training is 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 sent to the spinal cord, which can initiate functional movement.
"These results support the concept that human spinal cord circuitry can respond to task-specific sensory cues, which can result in recovery in walking," said Susan J. Harkema, Ph.D., Director of the NRN, University of Louisville professor of neurosurgery and rehabilitation, and research director of the University of Kentucky’s Spinal Cord Research Center. "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."
Studies in the Archives collection include analysis of the basic scientific concepts of activity-based therapies, organizational strategies for establishing the NeuroRecovery Network and several papers assessing functional outcomes for balance, ambulation, cardiovascular health and quality of life measures.
In addition, one NRN study published in the September issue of Journal of Neurological Physical Therapy found that intensive locomotor training enabled both an adult and pediatric patient with incomplete spinal cord injuries to significantly reduce expenses associated with equipment, home renovations, and transportation. A four year old male had a decrease of expected lifetime expenses between $437,790 and $571,618 due to newly gained function following locomotor training; a 61 year old female had a decrease of expected lifetime expenses between $148,237 and $197,208 due to function she recovered following the training.
These findings suggest that a shift in both protocol and policy is needed to standardize rehabilitation across multiple centers.