Activity-Based Therapy in a Community Setting for Independence, Mobility, and Sitting Balance for People With Spinal Cord Injuries

Abstract

Introduction: Activity-based therapy (ABT) aims to activate the neuromuscular system below the level of the spinal cord lesion and promote recovery of motor tasks through spinal reorganisation, motor learning and changes to muscles and sensory system. We investigated the effects of a multimodal ABT program on mobility, independence and sitting balance in individuals with spinal cord injury (SCI). Methods: Retrospective clinical data from 91 adults who independently enrolled in four community-based ABT centres in Australia were analysed. The multimodal ABT program was delivered for 3 to 12 months, one to four times per week. Assessments were undertaken every 3 months and included the Modified Rivermead Mobility Index (MRMI), Spinal Cord Independence Measure (SCIM) and seated reach distance (SRD). A linear mixed model analysis was used to determine time-based and other predictors of change. Results: There was a significant improvement after 12 months for all outcome measures, with a mean change score of 4 points in the SCIM (95% confidence interval [CI]: 2.7-5.3, d = 0.19), 2 points in the MRMI (95% CI: 1-2.3, d = 0.19) and 0.2 in the SRD (95% CI: 0.1-2.2, d = 0.52). Greater improvements occurred in the first 3 months of intervention. There were no interaction effects between time and the neurological level of injury, American Spinal Injury Association Impairment Scale classification, or duration post-injury for most outcomes. Conclusions: A community-based ABT exercise program for people with SCI can lead to small improvements in mobility, independence and balance in sitting, with greater improvements occurring early during intervention.

Home-based arm cycling exercise improves trunk control in persons with incomplete spinal cord injury: an observational study

“…Our participants with chronic incomplete SCI improved reaching distance by ~ 13%, which is comparable to what has been reported after 30 sessions of supervised, laboratory-based kayak ergometers training in people with SCI 37 . Additionally, our results are consistent with the effect of activity-based therapy in the community in a similar population 39 , 40 . Conversely, two previous studies reported no improvement in reaching distance after a similar exercise program involving the upper body in people with chronic SCI; one study delivered 15 sessions of group-based arm-crank exercise 17 , while the other study conducted 8 sessions of indoor wheelchair curling training 41 .…”

Characteristics of activity-based therapy interventions for people living with spinal cord injury or disease across the continuum of care: a scoping review protocol

“… 6 12–16 Participation in ABT may prove beneficial across all degrees of severity and stages of injury (ie, acute, subacute and chronic stages), however, little is known about the characteristics and delivery of ABT across the continuum of care (ie, acute care, rehabilitation and community living). 16 Although ABT are gaining in popularity, there remain a number of challenges to their implementation in clinical practice. A lack of consensus regarding programme delivery and standardised guidelines, as well as available tools to effectively document participation and performance in ABT, limit the use of ABT in acute care, neurorehabilitation and community settings.…”

Congenital exercise ability ameliorates muscle atrophy but not spinal cord recovery in spinal cord injury mouse model

“…Previous studies have showed that animals with a complete spinal cord transection (SCT) can step and stand with practice 16, 17. Activation of the neuromuscular system below the level of the spinal cord lesion by activity-based therapy (ABT) can lead to small improvements in mobility 18. Therefore, the performance of a motor task is improved by practicing a specific task with “challenges” added to a training regimen.…”