Walk Again Post Spinal Cord Injuries
Recovery is Possible
Design Features & Benefits
Use the Gait Harness System to Walk Again Post Spinal Cord Injury
People who stand & walk after SCI live longer, live better, live healthier.
What is a spinal cord injury?
Spinal cord injuries result from damage to the vertebrae, ligaments or disks of the spinal column or to the spinal cord itself.
A traumatic spinal cord injury may stem from a sudden, traumatic blow to the spine that fractures, dislocates, crushes, or compresses one or more vertebrae. It also may result from any penetrating object which cuts the spinal cord.
Additional damage usually occurs over days or weeks because of bleeding, swelling, inflammation and fluid accumulation in and around the spinal cord.
A nontraumatic spinal cord injury may be caused by arthritis, cancer, inflammation, infections or disk degeneration of the spine.
A spinal cord injury (SCI)— damage to any part of the spinal cord or nerves at the end of the spinal canal — often causes permanent changes in strength, sensation and other body functions below the site of the injury.
SCI affects many aspects of life. Scientists are optimistic that advances in research will someday make the repair of spinal cord injuries possible. Research studies are ongoing around the world.
In the meantime, treatments and rehabilitation allow many people with a spinal cord injury to lead productive, independent lives. There’s almost always hope of recovering some function after a spinal cord injury.
Ability to control the limbs after spinal cord injury depends on two factors: the place of the injury along the spinal cord and the severity of injury to the spinal cord.
The lowest part of the spinal cord that functions normally after injury is referred to as the neurological level of the injury. The severity of the injury is often called “the completeness” and is classified as either of the following:
- Complete. If almost all feeling (sensory) and all ability to control movement (motor function) are lost below the spinal cord injury, the injury is called complete.
- Incomplete. If there is some motor or sensory function below the affected area, the injury is called incomplete. There are varying degrees of incomplete injury.
Additionally, paralysis from a spinal cord injury may be referred to as:
- Tetraplegia. Also known as quadriplegia, this means the arms, hands, trunk, legs and pelvic organs are all affected by the spinal cord injury.
- Paraplegia. This paralysis affects all or part of the trunk, legs and pelvic organs.
A health care team will perform a series of tests to determine the neurological level and completeness of the injury.
Individuals with SCI often experience a complex blend of physical, sensory, and psychological challenges. A person with a SCI will need to be hospitalized and may have long-term problems affecting things such as:
- Loss of movement
- Loss of sensation, including the ability to feel heat, cold and touch
- Loss of bowel or bladder control
- Exaggerated reflex activities or spasms
- Changes in sexual function, sensitivity and fertility
- Pain or an intense stinging sensation caused by damage to the nerve fibers in the spinal cord
- Difficulty breathing, coughing or clearing secretions from lungs
- Psychological health
- Systemic issues
Often, the devastating effects of a SCI are not fully understood until after the patient has completed medical treatment in an ICU and has entered rehabilitation.
Long-term disability is a frequent sequel of SCI and takes the form of persisting motor impairments that impact walking and autonomous movement. To improve environmental negotiation and basic care skills, encouraging independent standing and gait is an essential therapy goal for SCI patients.
For a SCI survivor, learning to stand and walk again should be a top priority.
Walking After a SCI: Recovery is Possible
Most people who have had a significant SCI injury will require long-term rehabilitation. They may need to relearn many or all basic skills. The goal is to improve their abilities to perform daily activities.
Therapy usually begins in the hospital and continues at an inpatient rehabilitation unit, a residential treatment facility or through outpatient services. The type and duration of rehabilitation varies by individual, depending on the severity of the SCI and what part of the spine was injured.
Ambulation is a crucial component to recovery and lifetime health. Movement keeps joints lubricated and stimulates the survivor’s brain, encouraging brain plasticity repair. Stronger muscles and bones provide the strength and balance the SCI survivor needs to be active.
Physical therapy programs should be designed to help with mobility and relearning movement patterns, balance and how to stand and walk again. SCI survivors may need to go slowly.
Walking ability has important health implications, providing protective effects against secondary long-term complications after SCI, including respiratory, cardiovascular and urinary and bowel complications; spasticity; pain syndromes; pressure ulcers; osteoporosis and bone fractures.
SCI can exacerbate the physical and physiologic declines brought on by the aging process. Many long-term follow-up studies and authors have documented the tendency for individuals with SCI to age faster than the able-bodied population does.
While SCI survivors heal and progress at different rates, virtually all survivors can relearn to improve health by practicing standing and walking again. Even if someone has been primarily wheelchair or bed-bound for years (with little intervention), they can achieve significant results and greater quality of life with the proper program, and with proper equipment.
Many of our GHS clients see consistent standing and walking progress in the years and life span of SCI recovery.
Why is Walking Affected by SCI Injury?
Your brain and central nervous system
The central nervous system comprises the brain and spinal cord. The spinal cord, made of soft tissue and surrounded by bones (vertebrae), extends downward from the base of the brain and is made up of nerve cells and groups of nerves called tracts, which go to different parts of the body.
Tracts in the spinal cord carry messages between the brain and the rest of the body. Motor tracts carry signals from the brain to control muscle movement. Sensory tracts carry signals from body parts to the brain relating to heat, cold, pressure, pain and the position of limbs.
Damage to nerve fibers
Whether the cause is traumatic or nontraumatic, the damage affects the nerve fibers passing through the injured area and may impair part or all corresponding muscles and nerves below the injury site.
The ability to maintain balance is determined by many factors, including level and nature of spinal cord damage, sensation, physical strength and coordination. Adjusting posture or taking a step to maintain balance before, during, and after movement is a complex process that is often affected after SCI.
How Does a SCI Survivor Learn to Walk Again?
A patient’s rehabilitation should start as soon as he or she is medically stable. Established guidelines, as well as a huge body of literature, insist that the earlier therapy is initiated the better.
Before walking begins, a practitioner may guide the patient through standing and pre-walking exercises to ready other pertinent muscles. If a patient’s trunk muscles were affected, causing him or her to lean to one side or to the front, therapy may start with core strengthening exercises in a sitting position, and assess need for bracing. The practitioner should also consider use of supportive long leg braces and integration of functional electrical stimulation (FES).
The next step might be to work on standing until the patient feels anchored and secure. Learning to stand walk again involves scores of muscles and many isolated movements. Caregiver/practitioner and patient should approach the complex act of learning to stand and walk again in a safe, supported manner.
Physical activity remains a cornerstone in risk-reduction therapies for the treatment of SCI. Regardless of how a SCI survivor learns to stand and walk again, one thing is certain: the survivor needs to get up, and safely moving.
The years of recovery may seem overwhelming, but SCI survivors, caregivers, and practitioners need to keep in mind that the potential for progress is always there.
SCI survivors (and the caregivers who help them) are often concerned about learning to walk or exercise due to loss of motor control, and related fears of falling — a fear that can lead to them being stuck in the house, and confined to bed or wheelchair. The risks of falling, experiencing a fracture are increased for the SCI survivor.
Impairments resulting from SCI, such as mental health issues, muscle weakness, pain, contracture, spasticity and poor balance can lead to a reduced tolerance to activity and further a sedentary lifestyle.
Immobility-related complications are very common in the first months and years after a severely disabling SCI. Patients who are more functionally dependent in self-care are likely to experience a greater number of complications than those who are less dependent.
To reduce risk of falls, individuals are encouraged to exercise regularly, focus on leg strength, weight bearing exercises, and improving balance.
Osteoporosis, a condition characterized by low bone mass and deterioration of the skeletal microarchitecture, is a well-known complication of SCI. It occurs rapidly in the first 12-18 months post injury, but continues for several years. A significant decrease in bone mineral density has been reported in chronic SCI patients. Bone loss after SCI leads to increased risk of low impact fractures.
Sitting for more than 8 hours a day has been shown to negatively impact health and mortality. Standing and walking again are the recommended healthier alternatives.
Early Intervention is Key
By necessity, early gait intervention comes second to the other complications and concerns of a healing body.
A recent study at Cleveland Clinic found that patients participating in early mobility routines after neurological injury recovered quicker and went home earlier than those receiving standard care.
There is growing evidence showing the provision of early ambulation support to critically ill and injured patients result in more favorable recovery outcomes as compared to less aggressive approaches.
The magnitude of bone lost in the lower limbs following SCI is substantial. Early weight-bearing after acute SCI by standing or treadmill walking (5 times weekly for 25 weeks) resulted in no loss or only moderate loss in trabecular bone compared with immobilized subjects. 6 weeks after SCI, there begins a rapid and dramatic loss of muscle mass below the level of the lesion.
Early rehabilitation is important to prevent disability and complications. Literature shows that the best time for starting independent gait recovery for an incomplete SCI occurs as soon as it is safe to do so, once the survivor is medically stable, hopefully within the months after injury. The sooner muscles start working again after SCI, the better the chances are of additional recovery-especially for standing and walking again.
Initially, a therapist practitioner may start the SCI survivor with passive standing (and consider use of long leg bracing and FES). Passive standing is a relatively easy physical activity that may reduce the risk of secondary medical complications after SCI, such as pressure ulcers and has been shown to improve the perception of well-being in those with SCI.
Standing has been shown to counteract many of the effects of chronic immobilization and spinal cord injury, including bone demineralization, urinary calculi, cardiovascular instability, and reduced joint range of motion and muscular tone. Standing has been used as a treatment for spasticity as well as an intervention to prevent contractures and reduce bone loss in SCI.
Over-ground therapy is more effective than robotic BWSTT
Over-ground walking is an effective means to regain greater independence of gait. The Gait Harness System provides a secure, comfortable, safe environment for the SCI client to practice functional standing and walking again.
Body weight support treadmill training (BWSTT), which relies on total guidance of robotics, leaves little room for active effort on the part of the client, a key aspect in motor learning and functional gains.
Research shows that for most participants, BWSTT is not sufficient to induce long-term improvements in balance and balance confidence.
Comparing over-ground training to the robotic treadmill training suggests that it is not the length of time spent in training, but rather how an individual engages in the activity that produces the results. Or, that a greater number of step repetitions produces greater functional change in walking ability, but only when transferring the skill to a natural walking environment.
Studies also show that walking on a treadmill does not carry over well to over-ground walking. The active motor requirements in over-ground walking appear to be an important factor for promoting spatial symmetry in gait.
Compared to BWSTT, a recent study showed that step-length symmetry ratio improved only with the over-ground therapy gait group. Reduced step length symmetry ratio has been found to increase fall risk. Improving step length symmetry through over-ground gait training has the potential to decrease fall risk.
Improving gait symmetry through over-ground practice, in the “real world,” contributes to a goal of more “normal” walking patterns.
The Second Step GHS encourages client-centered, supported, faster walking and more functional, natural movement. The System provides a novel, optimal gait training strategy for SCI survivors, enabling goal-directed recovery and maintenance of walking ability.
Ready, Set, Walk!
Rehabilitation after SCI has traditionally involved teaching compensatory strategies for identified impairments and deficits to improve functional independence. However, optimal independence is achieved by overcoming learned non-use patterns, regaining standing and walking abilities.
Walking speed predicts the level of disability. Regaining independent ambulation, and increasing walking capacity, is a top priority for individuals recovering from SCI. Thus, physical rehabilitation post-SCI should focus on improving standing and walking function and endurance.
The best way to improve coordination, balance, and learning to stand and walk again, is by practicing regularly. Too often patients only do their exercises in physical therapy.
Some days putting in the hard work for SCI recovery can be difficult. Maintaining those exercises long term, for as many years as is needed, is often needed to maintain the gains made in therapy.
With proper practitioner/caregiver support and safe therapy equipment, SCI survivors can reduce high risks for falls, fractures, learned non-use behavior, and further declines in mobility.
Beginning to walk again, even long after a SCI, has been associated with functional gains.The future for people recovering from SCI is more optimistic than it has ever been.
Repetition, Intensity, Practice: it Takes Commitment
Research shows that SCI recovery is boosted by longer and more intense rehabilitation. Care and treatment for SCI may be required across the life span.
Research proves the effectiveness and importance of aggressive inpatient rehabilitation following spinal cord injury. Evidence based practice also proves the importance of intensive, aggressive outpatient rehab on a long-term basis.
How do SCI survivors move beyond the obstacles of learning to stand and walk again? Through caregiver and practitioner support, sheer determination, and a mindset of never giving up, no matter how long it takes: repetition, intensity, and practice.
Studies show a daily commitment to standing and walking therapy practice (or ideally multiple therapy sessions daily) yields the best outcomes.
GHS Standing & Walking Frame equipment can help
Non-pharmacological treatment methods such as standing-up, orthotically aided walking, weight – bearing physical exercises, functional electrical stimulation and pulsed electromagnetic fields have been studied in the literature. In various studies standing-up and orthotically-aided walking seem to have a favorable effect during the early phase of SCI.
Evidence based practice also confirms that ambulation spanning the long-term SCI recovery phases using an over-ground, all-in-one standing frame and walking frame support system, such as the Gait Harness System, should be encouraged.
The SCI survivor may begin using the GHS as a body weight supported, passive standing frame, then move on to ambulation via walking frame support when they are ready to do so. Functional recovery progress thus can be made for the years to come.
GHS Allows for Therapy in the Clinic, and in the Home
Typically, the amount of walking completed by post SCI individuals attending rehabilitation is far below that required for independent community ambulation. Increased standing and walking activity after discharge from rehab will improve walking function, physiological condition, psychological health, psychosocial connection, and community re-integration.
If you’ve worked with a rehab therapist, you’ve likely heard them emphasize the value of home carryover exercises in between sessions, and the importance of quality, consistent, focused practice at home once therapy is finished.
Treatment intensity and duration in hospital and skilled-nursing facilities cannot be maximized to the point required for optimal recovery, nor do these environments provide appropriate demand or context to allow efficient and effective learning or generalization of learning. Researchers have not been able to identify a ceiling for treatment intensity. More therapy is generally better than less.
Safe, supported standing frame and walking frame equipment is important to provide chronic stage ambulation. Advances in therapy equipment, such as provided by the Gait Harness System for Home Users (especially when used in conjunction with bracing, long leg bracing, or RGO, and/or FES, as deemed medically appropriate by medical provider) allows clients to actively participate in therapy in their homes at their convenience, empowering them to take control of standing and walking again therapy, instead of being passive consumers.
Evidence supports the impact of home-based supported standing and walking programs on range of motion and exercise activity. 60 min of standing and walking practice daily is suggested for mental function and bone mineral density. The Second Step GHS provides a unique, safe combination of standing frame and walking frame benefits for SCI survivors who need the extra support while learning to safely stand and walk again.
Many people think after a certain number of years, they’re not going to make progress. Research shows that is simply not true. With hard work, people with SCI can continue to improve functional outcomes for many years after injury.
Walking again enhances life quality. Every step forward is progress.
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