Activity-based Neural Recovery Programs
Medical research has shown the benefits of continued exercise after SCI, including improved overall health and wellbeing as well as improved abilities in daily activities. Continued exercise can also reduce or limit debilitating complications that individuals with SCI are at significant risk of including pain, spasticity, weight gain, and cardiovascular issues.
What are activity-based neural recovery programs?
In the last 10-15 years activity-based therapies or “activity based neural recovery programs” have become more common and some individuals with SCI seek out these programs following discharge from inpatient rehabilitation. Many clinics suggest their programs promote neural recovery by using tools and interventions to improve muscle activation. These programs often rely on the theory that repeated, vigorous, assisted exercise and locomotor training can help re-establish patterns of nerve activity within the brain and spinal cord that in turn may improve mobility and function below the level of injury. Many of these clinics give priority to standing and ambulation, whether clients have complete or incomplete injuries. Very few research studies have been done to test activity-based therapy programs, what amount, frequency and length of therapy is required and what specific types of therapies give the best results.
Any improvement following an exercise program can be important to a person’s life and wellbeing. Exercises such as assisted standing, walking, or moving muscles and joints may not help to regain lost function, but can benefit health and wellbeing by maintaining range of motion, managing spasticity, preserving bone health or limiting pain. Exercise can support the natural underlying recovery of the nervous system after an injury, however this in itself does not suggest neurological recovery, but may be a result of improved fitness, strength, endurance or the supportive environment they are in.
Research on activity-based therapy is limited, but the available scientific evidence shows some modest functional improvements for people with motor incomplete SCI (AIS C and D) but it is unclear how relevant it is based on level of injury and time since injury. The effectiveness of activity-based therapies on individuals with motor complete SCI (AIS A and B) has not been found yet. Individuals with SCI and their families should continue to stay in touch with their SCI clinicians (physiatrist and physiotherapist) and monitor research in this area in order to understand whether activity-based therapies are useful in their own unique case.
The Rick Hansen Institute recommends that people with SCI and their families carefully consider the cost, risks and benefits that may be involved before undertaking such therapies.
Rick Hansen Institute's position on activity-based neural recovery programs
Despite the benefits that activity-based exercise therapies may offer, independent research must be conducted to ensure such therapies offered outside the standard of care are effective and safe for people with SCI. Currently a large clinical trial is underway by the NeuroRecovery Network (funded by the Christopher & Dana Reeve Foundation) that is developing and expanding access to activity-based therapies and to determine their effectiveness on improving function, health, and quality of life. Further information about some therapies that are used in some activity-based programs, including functional electrical stimulation and locomotor (walking) training (both with and without body weight support) are summarized on SCIRE, Spinal Cord Injury Research Evidence.
When starting an exercise program, it is very important to ensure that staff at any centre you exercise at are trained and have expertise in the needs and risks of exercise for people with SCI. This includes an understanding of spasticity, low bone density, pressure ulcers and autonomic dysfunctions. This will ensure the safety of any individual attending such a program.
Ultimately, your decision to participate in an exercise-based rehabilitation therapy program should be part of a discussion with your SCI health care providers, enabling you to consider all of the benefits and risks that participation may involve with those who best understand your specific condition.
If you are considering participating in activity-based recovery programs, click here for additional resources.
Updated 17 February 2015 (version 1.0)
Systematic Review of Activity-based Interventions to Improve Neurological Outcomes After SCI January 1998 - 2009. Deborah Backus, Shepherd Centre, Atlanta. Accessed Online February 7 2015:
http://www.bu.edu/drrk/research-syntheses/spinal-cord-injuries/activity-based-interventions/ Boston University Centre for Psychiatric Rehabilitation Disability Research Right to Know.
Activity-based Therapies in Spinal Cord Injury: Clinical Focus and Empirical Evidence in Three Independent Programs. Michael L. Jones, PhD, Eric Harness, CSCS, CSRS III,2 Paula Denison, PT, OMPT, Candy Tefertiller, DPT, ATP, NCS, Nicholas Evans, MS, and Cathy A. Larson, PT, PhD Top Spinal Cord Inj Rehabil. 2012 Winter; 18(1): 34–42.doi: 10.1310/sci1801-34