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Thread: Need some explanation

  1. #1
    Join Date
    Dec 2009
    Johannesburg, South Africa

    Need some explanation

    When one is told that the best recovery normally happens in the first 12 to 18 months, do they mean that what has returned can get stronger with exercise but what has not returned won’t return?

  2. #2
    This means that most of the naturally occurring recovery is seen in the first 18-24 months, but many people will continue to see small improvements even after that. Christopher Reeve is an example...he got some return as long as 10 years post injury.

    Any return that does occur can be maximized as far as function by continuing exercise and therapy, but exercise in and of itself probably does little to make recovery occur.


  3. #3
    Let me add a caveat.

    In my experience, if a person does not try use the paralyzed parts of the body and does not exercise after injury, motor recovery is often suppressed and does not occur as much or as fast. There is strong evidence that both muscle and nervous system undergo atrophy if those parts of the body are not used. Repetitive exercise can reverse the atrophy and restore function.

    The question is how much and what kind exercise should people get for how long. These is simply not enough data to provide a credible answer. In the Chengdu Army General Hospital in Kunming, they encourage the patients to do intensive locomotor exercises, doing overground walking up to 6 hours a day and 6 days a week, often for 6 months. I have seen people regain substantial motor function from such training but not everybody recovers. I think that if the more a person is "incomplete", the greater the likelihood that intensive locomotor training will restore locomotor function.

    There are some centers that focus on other parts of the body. For example, when I was in Firenze, I visited the Sanitario Centro Giusti, headed by Doctor Carlo Alberto Arcangeli. This Center has a very intensive rehabilitation program that focuses on all the different muscle groups affected by the spinal cord injury. They do one-on-one rehabilitation with muscle strengthening routines for shoulder, arms, hand, thoracic postural, hip, legs, and other muscles. I was really quite impressed by how thorough their training program is. They do 6 hours a day 5 days a week. Of course, I don't know how effective their program is but the patients seem to be very happy and satisfied.

    These types of therapies are obviously labor-intensive and require specialized knowledge and experience. The medical model is too expensive and many non-medical training centers have cropped up all over the United States. Project Walk in San Diego is one such program. There are other programs in the Chicago, New Jersey, and other places that offer training. Many of these places arose because of families who want such training for their sons and daughters but were unable to get it close to home. So, they set up these facilities that are available to others in the community.

    In the 1980's, a woman by the name of Barbara Divine ran an intensive exercise program in Cottonwood, Alabama. The program later moved to Texas. I knew many of the people in this program. They were convinced that they were going to get function back from walking and I think that some did. However, many people got only limited function back after having done the program for many months and sometimes even years. From that experience, I have been recommending to people that they don't do years of training but that it may be better for them to train for 3 months per year, if it is helping them, and then maintain the progress by doing an hour a day.

    In any case, I believe that if we do not include intensive rehabilitation with regenerative therapies, we will only see limited motor recovery. This is not true of sensory recovery. That may be why treatments such as the olfactory ensheathing glia by Hongyun Huang and other places is producing only sensory improvement but limited motor recovery. Almost none of these places are including intensive training with their treatments. Carlos Lima recently presented some interesting data suggesting that patients with the nasal mucosal transplants are showing late improvements associated with intensive locomotor training. Perhaps this is another example of how training can restore function after regenerative therapies. I don't know.


  4. #4
    Join Date
    Dec 2009
    Johannesburg, South Africa
    Many thanks Dr Wise – I have been told by some neurologists here in SA that no amount of exercise will fasten the recovery period of a spinal cord injury although the physiotherapists argue this point vigorously. From what I have observed during my recovery is that the vast amount of exercise I carried out did not really assist with the speed at which recovery occurred but rather just strengthened that which I already had.

    At the time of injury, my Quads were 5/5 – gluts and hamstrings 2/5 – no movement below my knees although I could feel everything – my sensation was very good. 4 weeks later I was able to move my toes. I have been training hard and it seems that I have just experienced and increase in strength in those areas that I had function from the onset. I am able to work hard in the gym and able to do a variety of exercises but those areas where I’m needing improvement just seem to remain weak indicating that until I get some motor function or an increase in motor function in those areas no amount of exercise will hasten the recovery in these areas.

    Muscle atrophy can be reversed if there is some motor function in that specific area. If you cant exercise a specific area would muscle atrophy not occur naturally until some form of motor function returns?

  5. #5
    Generally the rule of thumb is that you need a muscle grade of 3 or better to do resistive exercises, but in pool therapy this may still be possible due to the gravity reducing effect of water. Also, if you have a grade 1 or 2 muscle often electrical stimulation can be used to get it up to a 3 grade so that you can then do those exercises.


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