FROM TODDLERS TO TEENS…
We Are Actively Screening Children with Spinal Cord Injuries for Participation in RECOVERY-BASED Therapies and Research
ACTIVITY-BASED THERAPY – LOCOMOTOR TRAINING
An activity-based therapy is a physical rehabilitation therapy that’s purpose is to “activate” or “turn on” the nerves and muscles affected by a neurological impairment. The activity refers to the specific type and amount of practice and input that is necessary to illicit an improvement in a motor skill. The type of activity is task-specific such that we “train like you walk” and “train like you stand”. The amount of activity refers to the intensity of practice and input necessary for the child’s abilities to improve. Therapy sessions occur daily (5 times/week) for 1.5 hours/day for a minimum of 60 sessions. Additional sessions may be indicated based on your child’s progress and need.
Just like a child who practices soccer every day of the week to hone their skills, children who have suffered a severe insult to their nervous systems also require intense training to see results.
Locomotor training is an intense, activity-based therapy designed to activate the neuromuscular system below the level of a spinal cord injury or neurological impairment and restore function in weak or paralyzed muscles. During locomotor training, the child is suspended in a harness over a treadmill and facilitated by therapists to step and stand with the timing and movements similar to those used prior to injury or that are age-appropriate, i.e. “train like you walk”.
Specific sensory cues are used along with a body weight support system on a treadmill to activate age-expected movement patterns for standing, walking and trunk control. These specific cues provide a “picture” of walking or standing to the nervous system and promote “turning on” the system, thought to be inactive or paralyzed after injury. Newly developed motor skills are then applied to the child’s everyday activities (off the treadmill). This combined with increased specific activities at home and in the community allows for the emergence of motor and other functions not seen since injury. In the case of some children injured prior to the development of sitting, standing, or walking, these functions may never have been seen before.
This approach is in stark contrast to traditional approaches, such as the primary use of wheelchairs, standing frames, braces, and assistive devices, which focus on compensation for injury-induced weakness and paralysis.
- If your child is enrolled in our program, a physician specialized in working with children with spinal cord injury (SCI) will conduct an initial evaluation.
- If you are not a local resident, our pediatrician will see your child for an initial evaluation and provide on-going medical care as needed while enrolled in locomotor training.
- Every family participating in our program will undergo a child and family interview with our pediatric psychologist.
- Additionally, a set of comprehensive assessments customized to your child’s specific needs will be performed. All children will be evaluated by a Physical Therapist (PT) using a series of tests, or outcome measures, to determine baseline function upon entering the program. This will include, but is not limited to, assessments of trunk control, movement, basic physiological function (e.g. blood pressure/heart rate), some simple orthopedic measures and assessment of standing and stepping on a body-weight supported treadmill system. The initial PT assessment generally takes two hours the first day and may extend into the second day’s session.
Some of these assessments your child may be familiar with, others may be completely new. We strive to make the assessments “child-friendly” and use age-appropriate behavior techniques to engage the child and maximize participation.
Your child’s progress will be assessed by on-going re-evaluations performed after every 20 sessions of locomotor training.
Upon completion of an episode of locomotor training (60 sessions or greater), a discharge evaluation will be completed by the physician and the physical therapist.
ANNUAL FOLLOW-UP EVALUATIONS
Our rehabilitation and medical team conducts comprehensive clinical evaluations viewing your child’s health and well-being through a lens of “recovery” and development. Annual evaluations are important to assess the impact of growth and development on your child’s long-term recovery and quality of life. Our team meets with parents to discuss child progress and state of recovery and develop the next steps for therapy and home. We expect that after completing an initial episode of locomotor training (minimum 60 sessions), that a child will return yearly for “booster” sessions to address new potential, developmental changes, physical growth, and differences in environmental stresses. We anticipate with certain life transitions, such as moving from elementary to middle school, the child may face new neuromotor demands and require additional intervention to foster continued recovery. A child’s annual evaluation is scheduled six months to a year in advance.
Because activity-based therapies are most successful when the principles are incorporated throughout the day, what happens at home, school and in community settings is very important to your child’s continued recovery. Therefore, we value ongoing communication with families to address issues, concerns, and needs related to recovery as they arise.
While your child is enrolled in the Locomotor Training program, a team member will meet with you weekly to discuss your child’s progress and address any concerns.
Families may contact us at any time with questions and concerns in regard to their child’s recovery, and we will pursue answers and provide evidence-based information as appropriate.
At time of discharge, we will meet with the family to discuss the outcomes of our discharge evaluation, finalize a plan for continuation of principle-based activities in the home and community specific to your child’s progress and needs, and plan for your next visit (e.g. schedule follow-up date).
After discharge from an episode of out-patient therapy, we will schedule and conduct quarterly phone communications to gather information regarding your child’s continued progress with recovery and any factors affecting progress. This information assists us in identifying steps forward and challenges that your child and you may face so that they may be productively addressed.
KENTUCKY SPINAL CORD INJURY RESEARCH CENTER
Our partnership with the Kentucky Spinal Cord Injury Research Center is a primary reason that the Kosair Charities Center for Pediatric NeuroRecovery is able to fast-track scientific evidence into practice.
KSCIRC was opened in 2001 and is located in the Medical Dental Research Building close to the three major hospitals of the University of Louisville Health Science Center. The Center is led by Scientific Director Scott R. Whittemore, Ph.D., who is committed to further developing it into a world-class scientific and clinical research center. The Center, one of 12 spinal cord injury research centers in the United States, is in a rapid growth phase, made possible by funding and excellent cooperation between the State of Kentucky, University of Louisville and Norton Healthcare, and a recent $5.5 million grant from NIH. It is in a unique position to conduct research that, through its close association with clinical colleagues in the Department of Neurological Surgery, is expected to ultimately lead to effective treatments for spinal cord injury. This goal is guided by its mission: “to develop successful spinal cord repair strategies in the laboratory that can be taken to the clinic in a timely and responsible fashion”.
REEVE FOUNDATION NEURORECOVERY NETWORK
The NeuroRecovery Network (NRN) is a cooperative network of cutting-edge rehabilitation centers designed to provide and develop therapies, activity-based therapies, to promote functional recovery and improve the health and quality of life for people of all ages living with paralysis. The majority of the six clinical sites in the United States provide activity-based therapies for adults post spinal cord injury. At Frazier Rehab Institute in Louisville, KY, a program has been specifically developed for children under 12 years of age.
Our partnership with the NRN enhances our ability to fast-track scientific evidence into daily, clinical practice and therapies to promote recovery in children.