Recent Presentations

Brooke Bamford, PT, DPT, "Neurological and Functional Recovery Following Long-Term Activity-Based Restorative Therapy in a Patient with Chronic Cervical Incomplete Spinal Cord Injury"

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Background and Purpose:

Rehabilitation following spinal cord injury (SCI) has previously focused on compensatory strategies for loss of function below the level of injury due to the fact that significant functional recovery was not expected. More recently, new techniques for rehabilitation after SCI have emerged, including activity-based restorative (ABR) therapies. The purpose of this case report is to describe the neurological and functional recovery which occurred in a patient with chronic cervical incomplete spinal cord injury following a long-term bout of activity-based restorative therapy.

Case Description:

This case report describes a 48 year-old female who sustained a traumatic SCI in 2004 due to a fall off of a horse, who underwent intensive ABR therapies on a clinical and home basis over the course of approximately two and a half years. Therapy began 8 months after the injury occurred. Interventions consisted of both patterned and non-patterned activity. Patterned activity included functional electrical stimulation (FES) leg cycle ergometry, reciprocal upper and lower extremity movement in a stander with glider component, gait training with body weight support (overground and over treadmill), and gait training overground without body weight support. Non-patterned activity consisted of strengthening with and without use of FES, functional mobility training and balance activities.

Outcomes:

The patient experienced consistent, clinically meaningful neurological and functional recovery over the two and a half year time period. The patient was originally classified as having a C4 ASIA A (complete) SCI after her injury. At the time of discharge from clinically-based ABR therapies, the patient was classified as having a C4 ASIA D (incomplete) injury, an improvement of 3 ASIA grades. ASIA scores at discharge were improved as follows: light touch score increased from 40/112 to 77/112, pinprick score increased from 20/112 to 45/112, and motor score improved from 5/100 to 68/100. Functionally, the patient went from a non-ambulatory status to ambulating with a platform rolling walker and ankle-foot orthosis (AFO) with assistance only to advance the left lower extremity. The patient’s score on the Walking Index for Spinal Cord Injury (WISCI II) went from 0/20 to 6/20. She also decreased the amount of assistance needed for functional mobility from requiring dependence or maximum assistance to requiring minimal assistance or less.

Discussion:

This case report demonstrates clinically meaningful neurological and functional recovery following intensive clinical and home application of long-term ABR therapies in a patient with chronic cervical spinal cord injury. Given the potential for late onset of neurological and functional improvement, more research is warranted to determine the optimal frequency, intensity, and duration to maximize recovery following spinal cord injury.