Activity-Based Restorative Therapies after Spinal Cord Injury: Inter-institutional conceptions and perceptions

David R Dolbow, Ashraf S Gorgey, Albert C Recio, Steven A Stiens, Amanda C Curry, Cristina L Sadowsky, David R Gater, Rebecca Martin, John W McDonald, David R Dolbow, Ashraf S Gorgey, Albert C Recio, Steven A Stiens, Amanda C Curry, Cristina L Sadowsky, David R Gater, Rebecca Martin, John W McDonald

Abstract

This manuscript is a review of the theoretical and clinical concepts provided during an inter-institutional training program on Activity-Based Restorative Therapies (ABRT) and the perceptions of those in attendance. ABRT is a relatively recent high volume and intensity approach toward the restoration of neurological deficits and decreasing the risk of secondary conditions associated with paralysis after spinal cord injury (SCI). ABRT is guided by the principle of neuroplasticity and the belief that even those with chronic SCI can benefit from repeated activation of the spinal cord pathways located both above and below the level of injury. ABRT can be defined as repetitive-task specific training using weight-bearing and external facilitation of neuromuscular activation. The five key components of ABRT are weight-bearing activities, functional electrical stimulation, task-specific practice, massed practice and locomotor training which includes body weight supported treadmill walking and water treadmill training. The various components of ABRT have been shown to improve functional mobility, and reverse negative body composition changes after SCI leading to the reduction of cardiovascular and other metabolic disease risk factors. The consensus of those who received the ABRT training was that ABRT has much potential for enhancement of recovery of those with SCI. Although various institutions have their own strengths and challenges, each institution was able to initiate a modified ABRT program.

Keywords: Activity-based Restorative Therapies; Locomotor Training; Massed practice; Neuroplasticity; Task-specific Practice.

Figures

Figure 1.
Figure 1.
Spinal cord lesion with glia scarring and axon demyelination.

References

    1. Sadowsky CL, McDonald JW. Activity-based restorative therapies: concepts and applications in spinal cord injury-related neurorehabilitation. Dev Disabili Res Rev. 2009;15(2):112–116.
    1. Martin R, Sadowsky C, Obst K, Brooke M, McDonald J. Functional Electrical Stimulation in Spinal Cord Injury: From Theory to Practice. Top Spinal Cord Inj Rehabil. 2012;18(1):28–33. 18(1)
    1. Bear MF, Connors BW, Paradiso MA. Neuroscience: past, present, and future In Neuroscience: Exploring the Brain. 3rd ed. Lippincott Williams & Wilkins; 2007. p. P19.
    1. Fitch MT, Silver J. CNS injury, glial scars, and inflammation: Inhibitory extracellular matrices and regeneration failure. Exp Neurol. 2008;209(2):294–301.
    1. Becker D, Gary DS, Rosenzweig ES, Grill WM, McDonald JW. Functional electrical stimulation helps replenish progenitor cells in the injured spinal cord of adult rats. Exp Neurol. 2010;222(2):211–8.
    1. Sherrington CS. Flexion-reflex of the limb, crossed extension-reflex, and reflex stepping and standing. J Physiol. 1910;40(1–2):28–121.
    1. Grillner S, Rossignol S. On the initiation of the swing phase of locomotion in chronic spinal cats. Brain Res. 1978;146(2):269–277.
    1. Lovely RG, Gregor RJ, Roy RR, Edgerton RV. Effects of training on the recovery of full-weight-bearing stepping in the adult spinal cat. Exp Neurol. 1986;92(2):421–435.
    1. Harkema SJ, Hurley SL, Patel UK, Dobkin BH, Edgerton VRT. Human lumbrosacral spinal cord interprets loading during stepping. J Nuerophysiol. 1997;77(2):797–811.
    1. Dietz V, Mueller R, Colombo G. Locomotor activity in spinal man: significance of afferent input from joint and load receptor. Brain. 2002;125:2626–2634.
    1. Hodgson JA, Roy RR, De Leon R, Dobkin B, Edgerton VR. Can the mammalian lumbar spinal cord learn a motor task. Med Sci Sports Exerc. 1994;26:1491–1497.
    1. Hubli M, Dietz V. The physiological basis of neutorehabilitation-locomotor training after spinal cord injury. J Neuroeng Rehabil. 2013 Jan 21;10:5.
    1. Dietz V. Body weight supported gait training: from laboratory to clinical setting. Brain Res Bull. 2008 Jul 30;76(5):459–463.
    1. McDonald JW, Becker D, Sadowsky CL, Jane JA, Sr, Conturo TE, Schultz LM. Late recovery following spinal cord injury; case report and review of the literature. Journal NeurosurgerySpine. 2002;(97):252–265.
    1. Behrman AL, Bowden MG, Nair PM. Neuroplasticity after spinal cord injury and training: an emerging paradigm shift in rehabilitation and walking recovery. Phy Ther. 2006;86(10):1406–1425.
    1. Sanders M, Sanders B. In: Principles of Resistance Training in Therapeutic Exercise: Techniques for Intervention. Bandy WD, Sanders B, editors. Lippincott Williams & Wilkins; Philadelphia PA: 2001. p. 91.
    1. Frost HM. Bone “mass” and the “mechanostat”: A proposal. Anat Rec. 1987;219(1):1–9.
    1. Castro JM, Apple DF, Jr, Hillegass EA, Dudley GA. Influence of complete spinal cord injury on skeletal muscle cross-sectional area with the first 6 months of injury. Eur J Appl Physiol Occup Phsyiol. 1999;80:373–378.
    1. Broholm B, Podenphant J, Biering-Sorensen F. The course of bone mineral density and biochemical markers of bone turnover in early postmenopausal spinal cord-lesioned females. Spinal Cord. 2005;43:674–677.
    1. Dauty M, Perrouin Verbe B, Maugars Y, Dubois C, Mathe JF. Supralesional and sublesional bone mineral density in spinal cord-injured patients. Bone. 2000;27(2):305–309.
    1. Dudley-Javoroski S, Shields RK. Muscle and bone plasticity after spinal cord injury: Review of adaptations to disuse and to electrical muscle stimulation. J Rehabil Res Dev. 2008;5(2):283–296.
    1. Eser P, Frotzler A, Zehnder Y, Wick L, Knecht H, Denoth J, Schiessl H. Relationship between the duration of paralysis and bone structure: a pQCT study of Spinal cord injured individuals. Bone. 2004;34(5):869–880.
    1. Garland DE, Stewart CA, Adkins RH, Hu SS, Rosen C, Liotta FJ, Weinstein DA. Osteoporosis after spinal cord injury. J Orthop Res. 1992;10(3):3871–3878.
    1. Sheilds RK. Muscular, skeletal, and neural adaptations following spinal cord injury. J Orthop Sports Phys Ther. 2002;32(2):65–74.
    1. Sniger W, Garshick E. Alendronate increases bone density in chronic spinal cord injury: A case report. Arch Phys Med Rehabil. 2002;83(1):139–140.
    1. Furlan JC, Fehlings MG. Cardiovascular complications after spinal cord injury: pathophysiology, diagnosis, and management. Neurosurg Focus. 2008;25(5):E131.
    1. Bauman AW, Spungen AM. Coronary heart disease in individuals with spinal cord injury: assessment of risk factors. Spinal Cord. 2008;46(7):466–76.
    1. Groah SL, Weitzenkamp D, Sett P, Soni PB, Savic G. The relationship between neurological level of injury and symptomatic cardiovascular disease risk in the aging spinal injured. Spinal Cord. 2001;39(6):310–317.
    1. Myers J, Lee M, Kiratli J. Cardiovascular disease in spinal cord injury: an overview of prevalence, risk, evaluation, and management. Review Am J Phys Med Rehabil. 2007;86(2):142–152.
    1. Bauman WA, Raza M, Chayes Z, Machac J. Tomographic thallium-201 myocardial perfusion imaging after intravenous dipyridamole in asymptomatic subjects with quadriplegia. Arch Phys Med Rehabil. 1993;74(7):740–4.
    1. Bauman WA, Spungen AM. Disorders of carbohydrate and lipid metabolism in veterans with paraplegia or quadriplegia: a model of premature aging. Metabolism. 1994;43(6):749–56.
    1. Edwards LA, Bugaresti JM, Bucholtz AC. Visceral adipose tissue and the ratio of visceral to subcutaneous adipose tissue are greater in adults with spinal cord injury than those without spinal cord injury, despite matching waist circumferences. Am JClin Nutr. 2008;87(3):600–607.
    1. Sorensen FB, Bohr H, Schaadt O. Bone mineral content of the lumbar spine and lower limbs years after spinal cord lesion. Paraplegia. 1998;26:293–301.
    1. Maynard FM, Karunas RS, Adkins RH. Management of the neuromuscular system. In: Stover SL, Delisa JA, Whiteneck GG, editors. Spinal cord injury: clinical outcomes of the model systems. Aspen; Gaitersburg, MD: 1995. pp. 163–169.
    1. Bauman WA, Spungen AM, Wang J, Pierson RN., Jr The relationship between energy expenditure and lean tissue in monozygotic twins discordant for spinal cord injury. J Rehabil Res Dev. 2004;41(1):1–8.
    1. de Bruin ED, Frey-Rindova P, Herzog RE, Dietz V, Dambacher MA, Stussi E. Changes of tibia bone properties after spinal cord injury: effects of early intervention. Arch Phys Med Rehabil. 1999;80(suppl 2):214–220.
    1. Adams MM, Hicks AL. Comparison of effects of body-weight-supported treadmill training and tilt-table standing on spasticity in individuals with chronic spinal cord injury. J Spinal Cord Med. 2011;34(5):488–94.
    1. Dolbow DR, Gorgey AS, Ketchum JM, Moore JR, Hackett LA, Gater DR. Exercise adherence during home-based functional electrical stimulation cycling by individuals with spinal cord injury. Am J Phys Med Rehabil. 2012;91(11):922–930.
    1. Walter JS, Sola PG, Sacks J, Lucero Y, Langbein E, Weaver F. Indications for a home standing program for individuals with spinal cord injury. J Spinal Cord Med. 1999;22(3):152–158.
    1. Frotzler A, Coupaud S, Perret C, Kakebeeke TH, Hunt KJ, Donaldson Nde N, Eser P. High-volume FES-cycling partially reverses bone loss in people with chronic spinal cord injury. Bone. 2008;43:169–176.
    1. Gorgey AS, Mather KJ, Cupp HR, Gater DR. The effects of resistance training on adiposity and metabolism after spinal cord injury. Med Sci Sports Exerc. 2012;1:165–174.
    1. Dolbow JD, Dolbow DR, Gorgey AS, Adler RA, Gater DR. The effects of aging and electrical stimulation exercise after spinal cord injury. Aging Dis. 2013;4(3):141–153.
    1. Griffin L, Decker MJ, Hwang JY, Wang B, Kitchen K, Ding Z, Ivy JL. Functional electrical stimulation cycling improves body composition, metabolic and neural factors in persons with spinal cord injury. J Electromyogr Kinesiol. 2009;19(4):614–622.
    1. Gater DR., Jr Obesity after spinal cord injury. Phys Med Rehabil Clin N Am. 2007;18(2):333–351.
    1. Hooker SP, Figoni SF, Rodgers MM, Glaser RM, Mathews T, Suryaprasad AG, Gupta SC. Physiologic effects of electrical stimulation leg cycle exercise training in spinal cord injured persons. Arch Phys Med Rehabil. 1992;73(5):470–476.
    1. Nash MS, Bilsker S, Marcillo AE, Isaac SM, Botelho LA, Klose KJ, Green BA, Rountree MT, Shea JD. Reversal of adaptive left ventricular atrophy following electrically-stimulated exercise training in human tetraplegics. Paraplegia. 1991;29(9):590–599.
    1. Andersen JL, Mohr T, Biering-Sorensen F, Galbo H, Kjaer M. Myosin heavy chain isoform transformation in single fibres from m. vastus lateralis in spinal cord injured individuals: effects of long-term functional electrical stimulation (FES) Pflugers Arch. 1996;431(4):513–518.
    1. Brurok B, Torhaug T, Karlsen T, Leivseth G, Helgerud J, Hoff J. Effect of lower limb functional electrical stimulation pulsed isometric contractions on arm cycling peak O2 uptake in spinal cord injury individuals. J Rehabil Med. 2013;45(3):254–259.
    1. Mohr T, Andersen JL, Biering-Sorensen F, Galbo H, Bangsbo J, Wagner A, Kjaer M. Long-term adaptation to electrically induced cycle training in severe spinal cord injured individuals. Spinal Cord. 1997;35(1):1–16.
    1. Barstow TJ, Scremin AM, Mutton DL, Kunkel CF, Cagle TG, Whipp BJ. Changes in gas exchange kinetics with training in patients with spinal cord injury. Med Sci Sports Exerc. 1996;28(10):1221–1228.
    1. Crameri RM, Cooper P, Sinclair PJ, Byrant G, Weston A. Effect of load during electrical stimulation training in spinal cord injury. Muscle Nerve. 2004;29(1):104–111.
    1. Pollack SF, Axen K, Spielholz N, Levin N, Haas F, Ragnarsson KT. Aerobic training effects of electrically induced lower limb exercises in spinal cord injured people. Arch Phys Med Rehabil. 1989;70(3):214–219.
    1. Thijssen DH, Heesterbeek P, van Kuppevelt DJ, Duysens J, Hopman MT. Local vascular adaptations after hybrid training in spinal cord-injured subjects. Med Sci Sports Exerc. 2005;37(7):1112–1118.
    1. Dolbow DR, Gorgey AS, Dolbow JD, Gater DR. Seat pressure changes after eight weeks of functional electrical stimulation cycling: A pilot study. Top Spinal Cord Inj Rehabil. 2013;19(3):222–228.
    1. Petrofsky JS. Functional electrical stimulation, a two year study. J Rehabil. 1992;58(3):29–34.
    1. Hjeltnes N, Aksnes AK, Birkeland KI, Johansen J, Lannem A, Wallberg-Henriksson H. Improved body composition after 8 wk of electrically stimulated leg cycling in tetraplegic patients. Am J Physiol. 1997;273(3 Pt 2):R1072–1079.
    1. Li Q, Brus-Ramer M, Martin JH, McDonald JW. Electrical stimulation of the medullary pyramid promotes proliferation and differentiation of oligodendrocyte progenitor cells in the corticospinal tract of the adult rat. Neurosci Lett. 2010;479(2):128–133.
    1. Dolbow DR, Gorgey AS, Ketchum JM, Gater DR. Home-based functional electrical stimulation cycling enhances quality of life in individuals with spinal cord injury. Top Spinal Cord Inj Rehabil. 2013;19(4):324–329.
    1. Dietz V. Neuronal plasticity after a human spinal cord injury: positive and negative effects. Exp Neurol. 2012;235(1):110–115.
    1. Gorgey AS, Poarch H, Harnish C, Miller JM, Dolbow D, Gater DR. Acute effects of locomotor training on neuromuscular and metabolic profile after incomplete spinal cord injury. NeuroRehabilitation. 2011;29(1):79–83.

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