Activity-Based Therapy Targeting Neuromuscular Capacity After Pediatric-Onset Spinal Cord Injury

Top Spinal Cord Inj Rehabil, 2019 · DOI: 10.1310/sci2502–132 · Published: April 1, 2019

Spinal Cord Injury Pediatrics Rehabilitation

Simple Explanation

Activity-based therapies (ABT) are neurotherapeutic interventions aimed at activating the neuromuscular system below the SCI as well as above and across the lesion. Activation promotes activity-dependent plasticity of the nervous system circuitry resulting in improved neuromuscular capacity underlying performance. Capacity is the demonstrated sensorimotor control in the context of functional tasks for the arm/hand (eg, reach and grasp), trunk (eg, sitting, sit-up, lying down, standing), and lower limb (eg, standing up, standing, walking) without compensation. The treating therapist encouraged integration of the training principles into daily activities in the home and community, with the parent and/or caregiver(s) promoting self-training outside of therapy, for example, providing the opportunity to bear weight or to initiate movement.

Study Duration

Not specified

Participants

26 pediatric patients with SCI

Evidence Level

Prospective, observational study

Key Findings

1
Sixty AB-LT sessions significantly improved trunk and neuromuscular capacity in children with SCI, regardless of age or chronicity at enrollment.
2
The greatest improvement was observed from the initial to fourth evaluation (adjusted mean of 11.4, p < .05).
3
We found that the initial score was negatively correlated with both the Pediatric NRS and SATCo score changes (p < .05).

Research Summary

This is the first report of neuromuscular capacity as a primary outcome measure and indicates statistically significant score changes, large effect sizes, and meaningful impact in children with acquired SCI after 60 sessions (5x/week) of AB-LT, as measured with the SATCo and Pediatric NRS total scores. Children benefited from ABTs, resulting in significant score changes regardless of chronicity. Whether children were treated during the acute phase or the chronic phase post SCI, positive changes in the SATCo and Pediatric NRS were deemed significant and similar. Together, these two aspects offer additional evidence for a recalibration of expectations for gains and improvements when children with severe injury and/or those with chronic injuries (>1 year and <6 years post-SCI) receive AB-LT.

Practical Implications

Clinical Practice

AB-LT can significantly improve trunk and neuromuscular capacity in children with SCI, regardless of age or chronicity, supporting its use in clinical practice.

Rehabilitation Expectations

Healthcare professionals should recalibrate their expectations for gains and improvements in children with severe or chronic SCI who receive AB-LT.

Further Research

Future studies should investigate the long-term benefits of improved neuromuscular capacity, engagement, and health, as well as the potential cost-benefit of AB-LT.

Study Limitations

1
Blinding was not used as all of the outcome measures and session data were collected from the medical records and from usual care.
2
One potential critique of this data is that neuromuscular capacity does not necessarily correspond with functional changes in the real world that are relevant to a child or family’s quality of life.
3
The inability to designate the level of injury or AIS classification for children <6 years of age is a limit in all pediatric SCI documentation, whether in the clinic or in research.

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