Impact of Activity-Based Therapy on Respiratory Outcomes in a Medically Complex Child

Abstract

Introduction: Activity-based therapies (ABTs) focus on activating the neuromuscular system below the level of spinal cord injury (SCI) promoting neuromuscular capacity. Case description: A 2 year 7 month old with history of prematurity at 29 weeks, neonatal epidural abscess, resultant cervical SCI, respiratory failure, and global developmental delays presented for enrollment in an outpatient activity-based therapy program. Upon presentation to this program, he required nighttime mechanical ventilation via tracheostomy and daytime suctioning. He could not perform any age-appropriate activities and was described by his mother as ‘present’, neither engaged nor attentive. During and after 7 months of participation in ABTs including locomotor training and neuromuscular electrical stimulation, the patient demonstrated unexpected changes in his respiratory status leading to ventilator weaning with concomitant improvements in head and trunk control, participation, development, and quality of life. Discussion: ABT was not only safe for a medically complex child, but also this intervention had a remarkable effect on unresolved respiratory capacity and a more widespread impact on other functions as well as development. A child with a chronic, severe SCI demonstrated positive and impactful improvements in health, functional status, and quality of life during an episode of ABT.

Recovery of walking in nonambulatory children with chronic spinal cord injuries: Case series

“…This association between postural control, gross motor function, and mobility as scored on the GMFM is consistent with observations in children with cerebral palsy (Butler et al, 2010) and gains in trunk control likely contributed to gains in GMFCS level. Recent studies show that children with SCIs who received 60 ABLT sessions or more showed improved trunk control based on Segmental Assessment of Trunk Control scores (Argetsinger et al, 2019, 2020; Behrman et al, 2019; Goode‐Roberts et al, 2021). Mechanisms for improved trunk control align with those activating the neuromuscular system below the lesion via sensory input during ABLT (Angeli et al, 2014; Rejc & Angeli, 2019), as well as potential activation of trunk musculature above, across, and below the lesion.…”

“…Broken line arrow indicates onset of sound stimulus. Scale bars = 500 ms. Bi, biceps brachii; MG, medial gastrocnemius; sound, recorded train blast; TA, tibialis anterior.showed improved trunk control based on Segmental Assessment of Trunk Control scores(Argetsinger et al, 2019(Argetsinger et al, , 2020Behrman et al, 2019;Goode-Roberts et al, 2021). Mechanisms for improved trunk control align with those activating the neuromuscular system below the lesion via sensory input during ABLT(Angeli et al, 2014;Rejc & Angeli, 2019), as well as potential activation of trunk musculature above, across, and below the lesion.…”