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

Aging and Disease, 2015 · DOI: http://dx.doi.org/10.14336/AD.2014.1105 · Published: August 1, 2015

Spinal Cord Injury Neuroplasticity Rehabilitation

Simple Explanation

Activity-Based Restorative Therapies (ABRT) is a high volume and intensity approach to restore neurological deficits and decrease secondary conditions after spinal cord injury (SCI). ABRT uses neuroplasticity to benefit even those with chronic SCI by activating spinal cord pathways above and below the injury. ABRT involves repetitive task-specific training with weight-bearing and external facilitation of neuromuscular activation. Key components include weight-bearing activities, functional electrical stimulation, task-specific practice, massed practice, and locomotor training such as treadmill walking and water treadmill training. ABRT's various components improve functional mobility and body composition after SCI, reducing cardiovascular and metabolic disease risks. Attendees of ABRT training believed it has potential to enhance recovery, and despite institutional differences, each initiated a modified ABRT program.

Study Duration

Not specified

Participants

Representatives from three rehabilitation centers

Evidence Level

Review Article

Key Findings

1
ABRT components improve functional mobility and reverse negative body composition changes after SCI, reducing cardiovascular and metabolic disease risk factors.
2
Individuals with incomplete SCI have shown substantial benefit from ABRT training, highlighting the potential for activating spinal locomotor centers.
3
The consensus of those who received the ABRT training was that ABRT has potential for enhancing the recovery of those with SCI, despite challenges in matching resources.

Research Summary

This review discusses the theoretical and clinical concepts of Activity-Based Restorative Therapies (ABRT) presented during an inter-institutional training program, along with the perceptions of the attendees. ABRT, guided by neuroplasticity, is a high-intensity approach to restore neurological deficits and reduce secondary conditions post-SCI by activating spinal cord pathways through repetitive task-specific training and external facilitation. The consensus from the training program was that ABRT has significant potential for enhancing recovery in SCI patients, and despite institutional limitations, modified ABRT programs were successfully initiated.

Practical Implications

Enhanced Rehabilitation Programs

ABRT can be integrated into existing rehabilitation programs to improve functional mobility and overall health outcomes for SCI patients.

Improved Patient Outcomes

ABRT's emphasis on neuroplasticity and repetitive training may lead to significant restoration of function and improved quality of life for individuals with SCI.

Resource Allocation

Medical centers should consider allocating resources to support ABRT programs, including staffing and equipment, to maximize patient recovery potential.

Study Limitations

1
Most medical centers are unable to match the trained staffing and equipment resources of the host facility.
2
Staffing in most rehabilitation programs is not adequate to provide three to five hours of skilled therapy for each patient.
3
The average age of the individuals with SCI enrolled in rehabilitation is typically older, with many in their fifth through eighth decades of life and often with co-morbidities.

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