Poster 8: The Effects of Intensive Activity-Based Restorative Therapy on Function in Chronic Spinal Cord Injury (American Spinal Injury Association Grade D)

Abstract

Objective: To demonstrate the impact of intensive activity-based restorative therapies on functional limitations in a highly functioning patient with chronic American Spinal Injury Association (ASIA) grade D spinal cord injury (SCI). Design: Single case study. Setting: Outpatient SCI rehabilitation program. Participant: The subject was an employed 26-year-old who sustained an SCI as a child and had not participated in formal rehabilitation for the past 20 years. He ambulated in the community with Lofstrand crutches, demonstrated decreased activity tolerance, and had limited participation in strenuous activities. Interventions: A 6-month program of clinical-based therapy and home exercise program with an activity log was prescribed, with treatment including: partial body weight–supported gait training, strengthening, electric stimulation, and manual stretching. Main Outcome Measures: Standardized measures include: Timed Up & Go (TUG), Berg Balance Scale (BBS), timed single-leg stance, six-minute walk test (6MWT), Biodex isokinetic knee and ankle strength measurements, spatiotemporal gait parameters (GAITRite mapping), Spinal Cord Independence Measure, version III (SCIM III), ASIA scores, manual muscle testing (MMT), and 36-Item Short-Form Health Survey (SF-36). Measurements were taken at initial evaluation and repeated monthly throughout a 6-month intensive physical therapy bout, with the exception of Biodex scores, ASIA, and SF-36, which were taken at initial evaluation and at discharge. Results: Preliminary results showed an improvement from baseline by 8 points in BBS, 33% increase in 6MWT, 1 MMT score in hip and knee muscles bilaterally, 22% increase in velocity, and 8% increase in cadence on 10m walk for time, and 5 points on SCIM III after 5 months of therapy. The study is ongoing; select measures were chosen for long-term follow-up and will be presented. Conclusions: Intense, individualized activity-based restorative therapy can produce a meaningful increase in function in an already high-functioning patient with long-standing, chronic SCI.