What is activity-based rehabilitation (ABR)?  This is one of the most common questions asked and the answer is never a short and snappy one.  In this blog we attempt to break it down to help understand what it is and how it can be beneficial for individuals living with paralysis. 

In the context of spinal cord injury (SCI), Sadowsky & McDonald describe it as: 

the implementation of physical activity and exercise as a therapeutic tool in the management of chronic spinal cord-related neurological paralysis”.  

They also add: 

the goal of this approach is to achieve activation of the neurological levels both above and below the injury level using rehabilitative therapies”.

Alternatively, we could simplify that to following:

Activities that are crafted to -:

•  challenge both above and below the level of injury/impairment
•  at an appropriate intensity
•  for an appropriate duration
•  at an appropriate frequency

What kinds of activities are involved?  Typically, ABR programmes include a variety of active-assisted movement patterns, weight-bearing activities, balance training exercises, strength and conditioning, functional electrical stimulation, gait and locomotor training.  Whether it’s upper or lower limb, complete or partial paralysis – activities are tailored to target the functional and the non-functional areas of the body.

What are the benefits?  Physical activity is an area that is currently gaining a lot of traction among researchers, health economists and governing health bodies.  The soaring healthcare cost attributed to the long-term health of an aging population is an extremely important topic and a challenge for our global leaders. 

For the interest of the paralysis community in particular, many of the benefits of ABR can easily be translated from research conducted in the able-bodied population.  It is well known that exercise is a form of medicine which offers a multitude of physiological and psycho-social benefits such as cardiovascular and metabolic health, muscular strength, function and conditioning as well as improved energy levels, appetite and psychological wellbeing. 

So what’s different about ABR?  Due to the complex nature of neurological conditions and the variety of physical outcomes among those living with paralysis, physical activity and exercise is not as accessible as it should be.  Although options do exist such as IFI accredited gymnasiums, disability sports clubs or popular outdoor activities like handcycling, these options tend to rely heavily (often to the extreme) on what little function is preserved rather than the health of the paralysed parts of the body. 

This is where ABR stands out.  With the aid of specialised exercise trainers and a variety of equipment, exercises are specifically tailored to impact the whole body, no matter the degree of paralysis.  This additional dimension to exercising after paralysis also serves as a preventative measure for the common secondary issues faced by individuals living with paralysis such as pressure sores, bone fractures, muscle contractures, medicinal dependency and poor metabolism or appetite.  Participants in ABR programmes often experience improved muscle mass, skin quality, bone health, range-of-motion and energy expenditure.  Also, participants are often able to reduce their medicinal intake, recover appetite, increase energy levels and improve quality of sleep.  

Lastly, it has been well-documented that the central nervous system is 'plastic' and is capable of forming new neural connections throughout its lifetime.  This is still an area that is being investigated but research has shown that physical activity can promote plasticity after a neurological loss.  With this in mind, ABR programmes tailor activities to promote this possibility.  

It's important to understand that ABR cannot claim return of neurological function as an outcome.  However exercise trainers do provide active-assisted input to movement patterns and feedback to and from paralysed areas throughout the training sessions to capitalise on this probability.  Neurological changes can and do occur.  Whether these are as a result of ABR, natural recovery or just previously undetected function is still a matter for debate and further examination and research.  

As the debates continue ABR will continue to offer a feasible platform for maximising physiological, neurological and psychological outcomes in individuals living with a variety of forms of paralysis.

Sadowsky & McDonald http://www.ncbi.nlm.nih.gov/pubmed/19489091

Rehabilitation is a serious part of who made me the person that I am today. If I did not attend a rehabilitation center, then I would never have been able to reach the heights that I have reached. During my earlier life, I was a stupid young kid. I did a lot of things that I regret, but that is not something that I wish to share. If you ask me, we can all change, that is an opportunity that life gives us.


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