Chapter 1: Opportunities for Optimization in SCI Rehab

Sep 7

This discussion + podcast is the first 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 1 of the book (free download below), but some vocabulary or context may not be fully defined.

Download chapter 1 [free]- click here

Every SCI athlete (our term for ‘individual who has sustained a spinal cord injury') and neuro rehab trainer has asked the eternal questions:

What are the best exercises after spinal cord injury?
How long does spinal cord injury recovery take?
Is recovery after spinal cord injury possible?

By shifting focus on fundamental aspects of recovery – such as organizing the progression of neurological healing, the importance of an SCI rehab home program, and exercising independently – the answers to the questions above become more apparent.

With all the attention on SCI recovery turning to robotics, stem cells, and stimulation, we must remember that self-generated movement will always be part of learning to move again after SCI. While we wait for science to bring us the cure to paralysis, we should also focus on optimizing the process of motor learning and leveraging human-powered healing potential.

Read on for few ways we can do that.

Exercise programming for SCI

Many recently-injured individuals turn to robotic-assisted and body-weight supported treadmill training as a primary rehab tool to return to walking after SCI. After all, it does get the body to perform the desired movement lost after paralysis - however passive it may be.

When used in isolation, this rehab tool doesn’t teach the fundamental “movement skills” that must be acquired before an athlete is “ready” for walking exercises.

Based on the motor development progression - the series of movements and skills developed in the first couple of years of life - it is clear that there are “checkpoints” of skills that must be obtained before one can effectively walk around. We can use this model even as adults learn to walk again after spinal cord injury. The motor development progression works through the following positions and corresponding stability/mobility demands for each:

Supine (on your back)
Prone (on your front)
Side-lying
Seated
Kneeling
Quadruped
Standing
Walking

motor development progression in SCI rehab programming

Develop a comprehensive home exercise program for SCI rehab using the motor development progression by:

Simply holding the body in each position (ie. sitting upright)
Adding balance or movement challenge variables in each position (ie. sitting upright while lifting an arm)
Coordinate the smooth self-generated transition between each position/stage (ie. the transition from seated to quadruped)

When creating an SCI exercise program with this natural motor learning template in mind, we have a clear picture of what types of exercises and positions are an appropriate challenge at this time. Integrated skills and strength development in a systematic way, from the ground up, allowing the athlete to address every necessary piece by simply working through the progression. After all, the body is meant to build one skill upon the next.

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

Learn more about the book

Sustainable long-term SCI rehabilitation

Many individuals pour themselves into their recovery for the first couple of years: hours and hours every week of therapy, trying every modality possible - no matter the distance or cost. But how is this SCI recovery plan sustainable for the long term? What if recovery isn’t achieved after this intensive effort? What happens then?

The answers to the questions above – How long is SCI recovery? Is healing possible after spinal cord injury? – are highly individual, but it might help to consider what we call the healing environment.

The essential idea is that any work done in the gym or PT clinic must become assimilated into the individual’s daily routine. Rather than relying solely on a physical therapist or trainer to make progress in healing, make an effort to create environments in the home/office that facilitate productive motor learning. For example:

Warm up for the day with stretches on the floor; getting onto and off the floor (floor transfers) is functional but also valuable movement in itself
Take time to properly configure a desk chair or wheelchair for tall seated posture while at the computer
Fold laundry or cook meals to exercise dexterity, arm mobility, and trunk stability
Organize accessible, active social activities, like kayaking or hand-cycling

Formal SCI therapy and structured exercise can only go so far toward being functional. These skills must be implemented and practiced in real life (where conditions may not always be perfect!) in order to become usable.

The ability to functionally use the skills learned in the clinic is a good indicator that the recovery program is appropriate and sustainable. If there is little to implement and practice immediately, you may be skipping over the valuable lesson of independent movement re-discovery in the healing process.

Sustainable SCI recovery programs all boil down to the individual’s ownership of the process. It is the responsibility of the rehab professional to facilitate this kind of movement curiosity which builds confidence in the individual to try things on their own. But it is, more importantly, the responsibility of the individual to be curious about their own movement possibilities and practice on their own.

While there is no defined answer to how long SCI recovery takes, we encourage you to audit every part of your recovery process for optimization.