January 1, 2013
“John McDonald practices motor skills with patient Diego Mendoza. Cristina Sadowsky, right, and McDonald have developed a program to rekindle neural patterns that drive movement.”
With its emphasis on the development of compensatory skills, traditional physical rehabilitative therapy often concentrates on teaching patients with spinal cord injury-related paralysis how to compensate for the loss of functions such as walking or drinking from a cup. But thanks to a novel form of rehabilitation therapy, spinal cord injury patients will tell you that much more is possible than the medical community once thought.
For scores of patients introduced to activity-based restorative therapy (ABRT), a spinal cord injury diagnosis doesn’t have to signal the end of an active life. ABRT aims for nothing less than the restoration of mobility in patients with transverse myelitis, spinal cord tumors or other neurological injuries that cause paralysis.
ABRT taps the central nervous system’s ability to spontaneously regenerate after injury in response to patterned activities, like cycling, treadmill training and aquatic exercises. The therapy, says Johns Hopkins School of Medicine Assistant Professor Cristina Sadowsky, has “life-long applications for preventing and combating the effects of paralysis and improving neurological and day-to-day function.” Sadowsky, along with fellow Johns Hopkins faculty member John McDonald, leads the International Center for Spinal Cord Injury at Hopkins’ neighboring institution, the Kennedy Krieger Institute.
The weight-bearing exercises, motor skills training and occupational therapy that comprise ABRT are designed to decrease spasticity and rekindle the neural patterns that drive movement. “Everything people without injuries do on a day-to-day basis involves a sequence of motor events,” Sadowsky says. “We apply the same principle when we try to optimize the neurological activity of patients.”
ABRT targets the nervous system above and below the level of the injury. Patients with higher levels of paralysis may also require functional electrical stimulation (FES) to kick-start the spine’s central pattern generator as they train on a treadmill or stationary bicycle.
As ABRT helps patients to regain mobility, it also helps them avoid the hazards of physical inactivity, including osteoporosis, cardiovascular disease, incontinence and all different kinds of overuse injuries.
Increasing evidence of ABRT’s beneficial effects has drawn spinal cord injury patients of all ages to the center from across the country and around the world. To reap the maximum benefits of ABRT, though, patients must commit to a daily, two-to-three-hour regimen of high-intensity physical activity. They also set a reasonable goal for their recovery that takes into consideration “what we know can be achieved,” Sadowsky says.
As one patient expressed it, “my life’s goals are more attainable now because I can tell the producer of a film that I can travel to location to direct, which is my profession.”
Sustaining physical gains depends on the life-long practice of ABRT at home, as well as in a clinical setting, Sadowsky says. Even patients who begin ABRT years after an injury can make remarkable strides, she says. “Of course, the earlier they come in, the better.”