Face Into The Future
The Kennedy Krieger International Center for Spinal Cord Injury keeps patients moving toward their goals.
By Frank Long, Editorial Director, Rehab Management
Looking up the road to functional recovery can be particularly challenging for individuals affected by spinal cord injury (SCI). The International Center for Spinal Cord Injury (ICSCI) at Kennedy Krieger Institute has expertise in treating this population of pediatric and adult patients, and guiding the process of learning to live with a mobility impairment. This focus has helped to develop programs designed to deliver on a core belief that patients can achieve significant improvement more than 6 months post-injury, and work toward ongoing substantive recovery more than 2 years post-injury.
The ICSCI and the interdisciplinary healthcare professionals who comprise its staff emphasize restoration and recovery for those whose injuries or related disorders have resulted in paralysis. Unlike some conventional thinking, “rehabilitation” at ICSCI is not practiced as a limited series of services that simply teaches patients compensatory strategies for living with injuries from which it was presumed there could be no improvement. Instead, the center uses an approach to treating patients built on a natural physiological tendency for bodies to grow and repair. By leveraging this natural asset, ICSCI staff tailors strategies designed to produce lasting benefits from intense rehabilitation.
ADVANCED RESTORATION THERAPIES
At the core of ICSCI’s focused rehab is a technique defined as Activity-Based Restorative Therapy (ABRT). ABRT leverages the use of several therapy modalities including functional electrical stimulation (FES), partial weight supported walking (PWSW), function specific motor tasks, and exercise as a way to continue making gains in recovery long after the original injury has occurred.
Among the benefits this combined approach aims to provide are improved overall health and quality of life, improved function, improvement in bone density, and reductions in complications, such as cardiovascular disease, spasticity, and skin breakdown. Some patients who have been treated using ABRT also are reported to have recovered the ability to walk.
What is behind these achievements? One factor at play, according to the experts at ICSCI, may be the therapeutic use of FES ergometry, which evokes muscle activity and allows an individual to perform a repetitive activity, such as cycling or stepping, which replicates normal activity patterns with the nervous system. This therapy has been a component of studies that demonstrate nerve regeneration and function can be stimulated by this patterned activity. Other possibilities include the results of aquatic therapy and partial weight supported walking. Aquatic therapy benefits from the buoyancy of water to allow patients with paralysis to perform tasks that would be impossible on land, which, like FES ergometry, also provides patterned stimulation to the nervous system. Partial weight supported walking involves suspending patients in a harness and allowing them to walk over an electric treadmill at a low speed. This type of gait training allows a person to re-learn natural walking while recovering mobility.
In the larger view, these therapeutic approaches have logged many successes, and the researchers at ICSCI continue to study ABRT—and its use of FES—to understand how it promotes nerve regeneration and recovery. Perhaps one of the best-known beneficiaries of this type of therapy was actor Christopher Reeve, who received therapy after he sustained an SCI in 1995.
RECOVERY: BEYOND SPINAL CORD INJURIES
Though ICSCI has a unique expertise in treating pediatric spinal cord injury, they also specialize in treating adults with chronic injuries. Movement disorders can have a variety of causes, therefore ICSCI has developed programs for a range of conditions that cause paralysis such as transverse myelitis, multiple sclerosis, spinal tumors, or AV malformations.
The benefits of this approach are underscored by the case of 4-year-old Pfeiffer Whiteley, who was treated at ICSCI recently for transverse myelitis. This condition can run an unpredictable course, and there are no surgical interventions available. Thus, Whiteley’s recovery was largely dependent on the outcome of ABRT. Her treatment included an initial inpatient stay, followed by 2-week courses of intense therapy conducted three times a year. The program utilized specially adapted equipment including a body-weight support system with harness and treadmill, an FES bike, a device to provide electrical stimulation to muscles, and a special ankle-foot orthosis designed to hold her feet in alignment and build strength in her lower extremities. Over the course of her treatment, Whiteley has progressed from walking with assistive devices such as a walker, forearm crutches, and a cane to unassisted ambulation over short distances.
Pediatric programs administered by the ICSCI were not developed originally for adults then scaled or modified for children. Rather, these programs feature activity protocols and rehabilitation equipment designed from the ground up for adolescents and children. This strategy is complemented by an interdisciplinary spectrum of talent capable of supporting the particular medical, physical, developmental, social, and educational needs associated with the spinal cord injured population.
CHRONIC SPINAL CORD INJURY
Chronic spinal cord injury is, of course, an area of specialization at ICSCI. And though the center is designed to provide care in the acute phases of rehabilitation, it also puts a critical focus on designing long-term therapy programs for patients to follow after discharge. As part of this focus, the center offers training to caregivers so that the caregivers themselves may deliver therapies to a loved one who is affected by SCI. Being able to deliver this training at home makes it easier to adapt to individual family lifestyles compared to inpatient rehabilitation. Over time, this is also a less costly way to provide therapy.
QUEST FOR QUALITY OF LIFE
Underlying the range of services delivered by ICSCI is an aim to provide a high quality of life. The pursuit of this objective requires the center to think beyond the immediate scope of care, and beyond efforts to help patients recover mobility and independence. The center’s overall approach aims to help patients improve health and quality of life and avoid complications from such conditions by promoting movement.
Mobility impairment can significantly impact everyday life, but ICSCI’s continuous focus on rebuilding function and promoting independence can help set people back on a path and face their futures with an optimized level of function and independence. RM
Frank Long is Editorial Director for Rehab Management. For more information, contact RehabEditor@nullallied360.com.