Research isn’t only happening in scientific labs, it is now being carried out daily in Physical and Occupational Therapy Clinics. As technology and the understanding of the nervous system and its response to injury have advanced, so have rehabilitation options for people with spinal cord injuries.
The concept of neuroplasticity (the ability of the brain and spinal cord to adapt and change in response to stimulus and experiences) has been gaining speed over the past two decades and is the basis for newer rehabilitation techniques now being used in the clinic.
Two exciting and promising therapies worth watching are the use of electrical stimulation combined with intensive therapy to encourage standing and stepping and the use robotic upper extremity braces to improve strength and function of the elbow and wrist. In the article “Effect of epidural stimulation of the lumbosacral spinal cord on voluntary movement, standing, and assisted stepping after motor complete paraplegia: a case study” by Harkema, S. et al published in The Lancet online May 20, 2011, authors describe the use of electrical stimulation applied to the spinal cord (below the site of the injury) combined with supported and guided locomotor training on a treadmill to facilitate weight bearing and stepping motions. The muscle activity is possible because sensory and motor circuitry is intact below the level of the injury and can be activated with the electrical stimulation and sensory feedback provided to the bottom of the foot via the treadmill platform. Scientists and therapists are still evaluating the optimal pattern of electrical stimulation to use during the therapy, the carry over effects that the treatment may have when the electrical stimulation and guided locomotion are removed, and the actual neurophysiological changes that are happening in the nervous system as a result of the intensive therapy.
The other treatment option that is showing promising results in people who have had cerebrovascular accidents (strokes) that is now being evaluated on people with spinal cord injuries is the use of a powered brace called a myoelectric limb orthosis to help improve the use of the upper extremity following damage to the nervous system. This technology was developed decades ago at MIT and is now being used to improve function in people with neuromuscular disorders. The portable, lightweight robotic arm, or brace, is custom fit to the upper extremity. Non-invasive sensors detect muscle signals (even trace muscle signals) in the triceps and biceps when an active movement is initiated. The sensors allow the device to amplify the weak muscle signal to assist with the completion of the movement. The motion occurs at the elbow joint and the wrist and hand are held in a functional position by the brace, making it easier for the wearer to lift, reach, and eat. For more information about this device, please visit www.myopro.com.
The Travis Roy Foundation is not endorsing either of these therapies, but is excited to watch the progress in the clinic that is being made possible as a direct result of research that is happening in the labs supported by the TRF. Thank you for your donations to the TRF, it is with your help that we are able to provide funding for the advancement of knowledge of neuroplasticity and rehabilitation following damage to the nervous system.