The impact of activity-based rehabilitation

In September 2012, research published in the Archives of Physical Medicine & Rehabilitation reported that recovery of walking and balance can occur even years after injury in people with incomplete spinal cord injury who participate in locomotor training. This research was based on data and findings from the Christopher & Dana Reeve Foundation NeuroRecovery Network (NRN).

The NRN is a national network of rehabilitation centers that translate scientific advances into treatments for spinal cord injury and other physical disabilities. It is funded through a cooperative agreement with the Administration for Community Living (ACL) to develop and expand access to activity-based therapies that promote functional recovery, health and quality of life for individuals living with paralysis.

One of the principal interventions supported by the NRN is Locomotor Training, an intensive, activity-based therapy that involves suspending patients in harnesses over treadmills while therapists move their legs to simulate walking.

Eleven peer-reviewed papers published in the Archives of Physical Medicine & Rehabilitation confirmed that therapies like Locomotor Training trigger the body’s repair process, leading to enhanced mobility and health. These findings were based on data from 296 participants at seven NRN sites. The key topics addressed in the papers include:

  • Analysis of the basic scientific concepts of activity-based therapies
  • Organizational strategies for the NeuroRecovery Network
  • Assessing functional outcomes for balance, ambulation, cardiovascular health and quality of life measures

Highlights from NRN research

Prior to recent research on activity-based therapies, rehabilitation was thought to be compensatory, teaching the body to work around the functions lost due to injury or disease. However, we now understand that rehabilitation is a critical part of recovery with well-documented changes from former and current NRN participants that range from standing and stepping to improved wellness and quality of life.

Beyond addressing the impact of locomotor training, the research also highlighted the importance of standardizing protocols across all NRN centers to further study the role of rehabilitation in both acute and chronic cases of spinal cord injury.

"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., co-director of the NRN. "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."

In addition, one NRN 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 children and adult patients with incomplete spinal cord injury due to the function gained following intensive locomotor training:

  • 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.