PTOTNarrative ReviewJournal of neurologic physical therapy : JNPT2017

Activity-Based Therapy: From Basic Science to Clinical Application for Recovery After Spinal Cord Injury.

Andrea L Behrman, Elizabeth M Ardolino, Susan J Harkema

PMID 28628595

WHAT IT FOUND

Intense, task-specific movement below the spinal cord injury is the core of activity-based therapy.

The review also describes a movement-quality scale and three children with chronic SCI reported to change following locomotor training.

Key findings

01Activity-based therapy is described as intense, task-specific movement below the injury, with daily 1.5-hour sessions and typically more than 60 sessions.

02The Neuromuscular Recovery Scale scores how a person performs functional tasks without compensation, and the article says it reduces performance variability compared with the ISNCSCI.

03Three children with chronic spinal cord injury were reported to change in walking, sitting, standing, stepping, or wheelchair propulsion following participation in standardized locomotor training, and the article says no change in AIS score or voluntary movement accounted for the improvements.

STILL TO COME

How it was doneWhat they foundWhat it means for PTsWhat it means for OTs

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What it does not show

This is a narrative review and clinical commentary, not a controlled trial of activity-based therapy. The pediatric improvements are observations in three children, so they cannot show that locomotor training caused the changes. The article says the pediatric outcomes are only clinical report, and no change in AIS score or voluntary movement accounted for them. The pediatric inter-rater reliability results for the Peds NRS are described as forthcoming. Epidural stimulation is described as an experimental model, not a therapy that clinicians can deliver.

Declared interests

The article states that Drs. Behrman and Harkema are founders of NeuroRecovery Education Inc., and Dr. Harkema is a co-founder of Power NeuroRecovery.

The easy way to misread this

Do not conclude that activity-based therapy is proven to restore walking or function in chronic spinal cord injury. The article is a review and presents the pediatric outcomes as clinical report rather than a controlled comparison, and it states that no person with AIS A or B has recovered walking even with intense locomotor training.

Read it on PubMed →