Introduction and overview

NeuroRecovery Network

The Reeve Foundation’s NeuroRecovery Network (NRN) supports cutting-edge clinical rehabilitation centers and Community Fitness and Wellness Facilities (CFWs) that make up two branches of care for people living with spinal cord injury and other physical disabilities.

The NRN moves science into clinical practice by developing and -- more importantly -- providing activity-based therapies that promote functional recovery and improve the health and overall quality of life for people living with paralysis. These therapies and exercise programs are based on new scientific knowledge about the remarkable plasticity of the brain and spinal cord (central nervous system).

The NRN is a perfect example of basic science being translated to the clinic and changing lives.

Its mission, to develop and expand access to activity-based therapies based on current scientific evidence, has lead to some of the most critical findings as it relates to the importance of rehabilitation following an injury.

Locomotor Training was the first method of physical therapy introduced by the NRN when it was founded in 2004. NeuroMuscular Electrical Stimulation (NMES) was introduced in 2014 to target upper extremities and trunk control.

Participants in the NRN become part of a network-wide database that documents comprehensive medical information about the progress of each patient. By collecting and analyzing this information, the NRN is able to accurately measure program outcomes and track the tangible impact of different therapies. Findings from the database are shared with the field at large through peer reviewed publications in scientific journals.

NRN clinical centers are staffed with dedicated professionals who have received highly specialized training. This includes center directors, physicians, administrative and clinical supervisors, data managers, physical therapists, occupational therapists and rehab technicians.

Personnel from the CFWs undergo rigorous training as well to enable clients to be “fit for life” and extend the continuum of care for people living with paralysis through personalized rehabilitation and exercise programs. CFWs enroll individuals with walking difficulties related to any cause. Their dynamic approach to rehabilitation focuses on Locomotor Training, electrical stimulation with cycling, and cardio/aerobic fitness and strength training therapies.

Originally conceived by Christopher Reeve, who dreamed of having an NRN facility in every major city, there are currently 12 sites nationwide with the Reeve Foundation working to expand to new locations as quickly as possible.

What we have achieved

The NRN is building a toolbox of therapies and interventions that leverages our new knowledge about how the brain and spinal cord work. This program has helped change the conversation about rehabilitation, which we now know is about so much more than just compensating for what was lost to paralysis. Now we talk about how certain kinds of activity-based rehabilitation can actually contribute to recovery after injury.

While results vary from one NRN participant to another, a range of functional and health improvements have been well-documented. Changes may include enhanced cardiovascular and pulmonary function, improved blood flow to arms and legs, as well as an increased bone density.

Functional results, such as improved trunk stability and recovery of standing and stepping, have also been reported by current and former participants. Improvements in trunk control, stepping, endurance and balance, may even lead to a better ability to perform daily activities and reduce dependence on caregivers.

Activating the dormant nervous system through activity-based therapies and exercise has led to improvements in every individual who has participated in NRN programs. That means 100% of participants have reported incremental or significant health and functional gains thanks to therapies provided by NRN sites. In fact, 94 participants who were unable to walk prior to entering the program are now able to walk.

All NRN participants have experienced well-documented changes that range from improved health and quality of life to standing and stepping.

Here’s a quick snapshot of NRN stats (as of December 31, 2015):

  • 963 people have completed or are currently enrolled in programs through the NRN clinical centers and NRN Community Fitness and Wellness Facilities
  • 94 participants are now walking in the home and community

Locomotor training and other emerging therapies

The principle therapy supported by the NRN is Locomotor Training. In fact, the genesis of this therapy dates back many decades ago to research funded by the Reeve Foundation.

Locomotor Training allows individuals living with paralysis to repetitively practice standing and stepping using body weight support. In a therapy session, the participant is suspended in a harness over a treadmill while specially trained therapists move his or her legs and body to simulate walking. As the person gains function, improvements in sitting, standing, reaching, grasping or walking occur.

The ultimate goal of Locomotor Training is to retrain the spinal cord to ‘remember’ the pattern of walking.

Locomotor Training emerged from recent advances in our understanding about neural plasticity, which is the ability of nerve cells in the central nervous system to develop new connections and learn new functions. It also provides additional insight and evidence into the important role the spinal cord plays in stepping and standing.

The spinal cord is smart. It can interpret sensory information below the level of injury and relay signals to generate a motor response. Locomotor Training works to awaken dormant nerve pathways by repetitively stimulating the muscles and nerves in the lower body.

NRN participants have experienced a number of functional and health improvements as a result of Locomotor Training. Some have regained trunk stability; others have recovered standing and stepping ability. Additionally, this therapy has contributed to enhanced overall health and wellness.

Potential benefits may include:

  • Improved cardiovascular and pulmonary function
  • Heightened bowel and bladder function
  • Increased blood flow to the upper and lower extremities
  • Enhanced strength and healing potential of skin to reduce pressure sores and other complications
  • Increased bone density
  • Overall improvements in sense of well-being (emotional and psychological)

NRN NeuroMuscular Electrical Stimulation (NMES) targets upper extremity function to increase movement, excite the central nervous system, and improve neuroplasticity. NMES use for the lower extremities is currently in the planning stages.

NMES is a non-invasive activity-based rehabilitation that uses pulses of electrical current to achieve muscle contractions and patterned muscle activity that enables a person to complete a specific task. Electrical stimulation activates muscles even though they may be weak or paralyzed as a result of neurological disease or injury.

Specialized training for clinicians and therapists

Beyond innovative therapies, the NRN’s other greatest hallmark is the rigorous training provided to clinicians, therapists, and trainers to standardize how treatments for paralysis are being deployed and administered.

NRN clinical centers partner with the NeuroRecovery Learning (NRL) to host regional training events around the country. These sessions are open to therapist and technician teams and to community fitness and wellness programs.

Using evidence gathered by NRN sites, NeuroRTI created the Locomotor Training course which provides the opportunity for clinicians, therapists, technicians all over the country to be trained in the activity-based techniques used within NRN sites.

CFWs also provide training programs across their respective local communities. Participants will learn the scientific basis, hands-on skills for providing Locomotor Training, electrical stimulation cycling, and cardiovascular and strengthening regimens.

By training hundreds of therapists, aides, sports exercise trainers in the principles, practices and scientific underpinning of activity-based therapies, we have expanded the number of individuals being treated outside of the NRN sites.

Current challenges

Given the state of healthcare in the U.S. and the federal imperative to rein in or cap outpatient therapy costs, reimbursement remains one of the biggest hurdles when it comes to broadening access or increasing enrollment in the NRN.

The Reeve Foundation continues to mobilize community leaders to educate legislators on the importance of rehabilitation.

However, your voice can make a difference.

Please visit our advocacy center to learn how you can support access to therapy programs like the NRN.

The National Paralysis Resource Center website is supported by the Administration for Community Living (ACL), U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $8,700,000 with 100 percent funding by ACL/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by ACL/HHS, or the U.S. Government.