Restorative rehabilitation entails a paradigm shift in pediatric incomplete spinal cord injury in adolescence: An illustrative case series

Issue title: Spinal Cord Injury

Article type: Research Article

Authors: Behrman, Andrea L. | Watson, Elizabeth | Fried, Guy | D'Urso, Kelly | D'Urso, Denise | Cavadini, Natalie | Brooks, Monifa | Kern, Marcie | Wenzel, Lisa | Taylor, Heather | Ardolino, Elizabeth

Affiliations: Department of Neurological Surgery and Kentucky Spinal Cord Injury Research Center, University of Louisville, Kentucky, Louisville, KY, USA | Magee Rehabilitation Hospital, Philadelphia, PA, USA | Kessler Institute for Rehabilitation, Outpatient Department, West Orange, NJ, USA | Kessler Institute for Rehabilitation, West Orange, NJ, USA | TIRR Memorial Hermann, Houston, TX, USA | University of St. Augustine, Austin, TX, USA

Note: [] Corresponding author: Andrea L. Behrman, PhD, PT. Professor, Department of Neurological Surgery, Frazier Rehab Institute. 220 Abraham Flexner Way #1506, Louisville, KY 40202, USA. Tel.: +1 502 582 7451; Fax: +1 502 582 7605; E-mail: Andrea.Behrman@jhsmh.org

Abstract: Physical rehabilitation after spinal cord injury (SCI) in adult and pediatric populations has traditionally compensated for paralysis and weakness using wheelchairs, assistive devices, and braces to achieve seated mobility, upright standing, or bracewalking. Recent evidence indicates efficacy of activity-based therapies in adults with SCI, specifically locomotor training (LT), to activate the neuromuscular system below the injury level and improve walking and postural control by restoring pre-morbid movements. The purpose of this paper is to demonstrate the feasibility of LT, using repetitive stepping practice on a treadmill and translated to over ground and the community, to meet the unique needs and demands of pediatric, adolescent rehabilitation. Three outpatient adolescents, T5 AIS D, age 15 (primary wheelchair user), T5 AIS C, age 14 (primary wheelchair user), and C2, AIS D, 14 years (primary ambulator), received a standardized protocol of LT 4–5 times per week for 75, 293, and 40 total sessions, respectively, across 1–3 episodes of care. Two adolescents became full-time ambulators, and one adolescent improved locomotor skills, kinematics, and endurance with two individuals lacking significant increases in strength to account for the benefits. Motivational strategies were developmentally specific, parental involvement critical for carryover, and musculoskeletal considerations paramount with growth and maturation. In comparison to adults, adolescents' continued musculoskeletal, cognitive, and social growth and maturation necessitate repeated episodes of therapy and bi-annual re-evaluations to identify needs and address new goals. The use of activity-based therapies, i.e. LT, represents a paradigm shift in pediatric rehabilitation towards activation of the neuromuscular system below the lesion via task-specific training and experience, minimizing compensation strategies, and targeting recovery of function achieved via use of pre-morbid movement patterns.

Keywords: Activity-based therapies, spinal cord injury, recovery, pediatrics, walking, rehabilitation

DOI: 10.3233/PRM-2012-00225

Journal: Journal of Pediatric Rehabilitation Medicine, vol. 5, no. 4, pp. 245-259, 2012