Framework for SCI Recovery, part 1

This discussion + podcast is the sixth of a 10-part series that accompanies our book on SCI recovery, From the Ground Up: A Human-Powered Framework for Spinal Cord Injury Recovery. It will introduce the uninitiated reader to topics discussed in Chapter 6 of the book, but some vocabulary or context may not be fully defined.

How do you make lasting and impactful change in SCI recovery? Taking a closer look at how your body moves and feels, as a baseline, is an essential first step. We have to know what is going on in the body before we can even begin to address how to progress it.

By analogy, how difficult would it be to improve the design of a nuclear reactor if you had never studied nuclear science? How do you expect to change your body if you don’t understand how it works, and how it’s currently operating?

Building awareness is the process of determining what is happening in your body. Throughout the recovery process, constantly and consciously collect perceptual data so that you can interpret what it means, and assimilate these interpretations into usable pieces of information. All of this information helps inform where, when, and how to move.

Loss of sensation and proprioception make this process quite challenging, however. Building this perceptual database after paralysis requires even more attention – and intention – because sensory information below the level of injury is often dulled, distorted, or simply nonexistent. 

Here are some strategies for SCI trainers to stimulate sensory awareness in their clients:

• Lightly tap an area

• Squeeze a muscle firmly

• Scratch or tug on skin to “traction” it

• Brush fingers along a muscle to give a sense of motion or length

• Hold a textured object while doing arm exercises to give the body a sense of distal grounding

• Use textured mats under feet and hands

Building body awareness takes effort: time and attention to the details that you think might not matter down the road. While you may be eager to get to the part of recovery that includes innovative dynamic exercises, taking time to establish a sense of your body (and the skills/patience that come with that) will be worthwhile. 

For example, it may seem that a goal to soon walk requires simply hours of time on a treadmill. But through an awareness practice, you acquire the tools to inquire more specifically about where the disconnects are in your gait: why exactly am I unable to walk? How can I strengthen my connection to my torso, hips, and legs? Do those areas respond in some positions, but not others? How can I obtain the connection to those areas through any movement? 

Through this questioning, troubleshooting for more effective exercises and execution comes much easier. Awareness is a fundamental skill for refining your movement and rehab process: efforts spent there will pay off over and over again.

Explore body relationships through Bartenieff Fundamentals

In addition to understanding the body through traditional anatomy and biomechanics, consider how different areas of the body relate to one another. This awareness of relationships throughout the body can troubleshoot exercises for deeper integration. 

We found a lot of inspiration in the work of Irmgard Bartenieff, who practiced physical therapy in the mid-1900s with dancers, polio patients, and those with neurological challenges. She recognized that awareness of body relationships improved a dancer’s ability to fully express their choreography, and applied these concepts to those with neurological conditions who sought better movement efficiency as well (Hackney, Making Connections, 1998, pp. 1-8).

One of the first patterns Bartenieff recognized in injured individuals was how they used their upper body without support from the lower body (Hackney p. 7). This resonated deeply with us, of course, because this is an inherent challenge for almost all SCI athletes. Integration of the lower body into upper-body movements makes a big difference in the stability and power of the arms.

The six fundamental patterns as described by Bartenieff are the following:

• Breath establishes the difference between mere existence and the capability to participate in the world – it is the starting place for human life and movement, alike.

• Core-Distal emphasizes the relationship between our limbs and trunk (see image).

• Head-Tail establishes an upright posture and opens the possibility for various movements in the spine.

• Upper-Lower illustrates how the lower extremities can support trunk and arm movement, and how the upper extremities can support movements in the legs.

• Body-Halves focuses on the interplay between the left and right sides of the body.

• Cross-Lateral connects each arm to the opposite leg. It is the final and most complex relationship as it requires all prior relationships to be in place.

For those interested in more on this topic, we recommend the book Making Connections by Peggy Hackney: a dense read but one that brings up so many revelations for reconnecting the body after it has been dis-integrated from paralyzing injury.

We encourage all SCI athletes and trainers to analyze movement through the lens of these relationships. Ask yourself, “how can my lower body support this movement?” and you will be provided with a roadmap to further integrate the body in any situation.

Explore these concepts in greater detail in our book, From the Ground Up: A Human-Powered Framework for Spinal Cord Injury Recovery, available in print & e-book format.

Chapter / Episode 5 topics include:

• Our Framework for SCI rehab: awareness, connection, patterning, loading

• Why awareness is the key to long-term change

• Establish an internal baseline for your function NOW, so you can identify when changes happen as a result of your rehab process

• Why a parasympathetic, rather than sympathetic, nervous system state is best for doing exercises & healing

• Trainers should ask their SCI athletes for detailed feedback and analysis of their movement

• How anatomical knowledge can be used to amplify and compensate for incomplete or lost sensation

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