NeuroRecovery Network provides standardization of locomotor training for persons with incomplete spinal cord injury.

OBJECTIVE: To illustrate the continuity of care afforded by a standardized locomotor training program across a multisite network setting within the Christopher and Dana Reeve Foundation NeuroRecovery Network (NRN). DESIGN: Single patient case study. SETTING: Two geographically different hospital-based outpatient facilities. PARTICIPANTS: This case highlights a 25-year-old man diagnosed with C4 motor incomplete spinal cord injury with American Spinal Injury Association Impairment Scale grade D. INTERVENTION: Standardized locomotor training program 5 sessions per week for 1.5 hours per session, for a total of 100 treatment sessions, with 40 sessions at 1 center and 60 at another. MAIN OUTCOME MEASURES: Ten-meter walk test and 6-minute walk test were assessed at admission and discharge across both facilities. For each of the 100 treatment sessions percent body weight support, average, and maximum treadmill speed were evaluated. RESULTS: Locomotor endurance, as measured by the 6-minute walk test, and overground gait speed showed consistent improvement from admission to discharge. Throughout training, the patient decreased the need for body weight support and was able to tolerate faster treadmill speeds. CONCLUSIONS: Data indicate that the patient continued to improve on both treatment parameters and walking function. Standardization across the NRN centers provided a mechanism for delivering consistent and reproducible locomotor training programs across 2 facilities without disrupting training or recovery progression.

Restorative rehabilitation entails a paradigm shift in pediatric incomplete spinal cord injury in adolescence: an illustrative case series.

Physical rehabilitation after spinal cord injury (SCI) in adult and pediatric populations has traditionally compensated for paralysis and weakness using wheelchairs, assistive devices, and braces to achieve seated mobility, upright standing, or bracewalking. Recent evidence indicates efficacy of activity-based therapies in adults with SCI, specifically locomotor training (LT), to activate the neuromuscular system below the injury level and improve walking and postural control by restoring pre-morbid movements. The purpose of this paper is to demonstrate the feasibility of LT, using repetitive stepping practice on a treadmill and translated to over ground and the community, to meet the unique needs and demands of pediatric, adolescent rehabilitation. Three outpatient adolescents, T5 AIS D, age 15 (primary wheelchair user), T5 AIS C, age 14 (primary wheelchair user), and C2, AIS D, 14 years (primary ambulator), received a standardized protocol of LT 4-5 times per week for 75, 293, and 40 total sessions, respectively, across 1-3 episodes of care. Two adolescents became full-time ambulators, and one adolescent improved locomotor skills, kinematics, and endurance with two individuals lacking significant increases in strength to account for the benefits. Motivational strategies were developmentally specific, parental involvement critical for carryover, and musculoskeletal considerations paramount with growth and maturation. In comparison to adults, adolescents' continued musculoskeletal, cognitive, and social growth and maturation necessitate repeated episodes of therapy and bi-annual re-evaluations to identify needs and address new goals. The use of activity-based therapies, i.e. LT, represents a paradigm shift in pediatric rehabilitation towards activation of the neuromuscular system below the lesion via task-specific training and experience, minimizing compensation strategies, and targeting recovery of function achieved via use of pre-morbid movement patterns.