Sunday, June 22, 2014

Locomotor Training

Dennis is about a month in on locomotor treadmill therapy as part of the Nuerorecovery Network (NRN) run by the Christopher and Dana Reeve Foundation. It’s not a cure, but it is the best rehabilitation therapy out there, often giving better outcomes than other approaches.

It requires a commitment of 90 minutes a day, five days a week. There are only a handful of centers in the country that offer NRN. We’re fortunate that one of those centers is Kessler, which is practically in our backyard, only 25 minutes from our home.

We are also fortunate that Dennis has access to this progressive therapy at all. Taking into account the limited number of NRN locations in the US and the amount of time dedicated to each patient in the program, we estimate about 100 people in the country are a part of the program at any given time. There are 1.28 million people in the US who suffer paralysis from spinal cord injury (with the full paralysis community spanning 6 million people). That translates into less than 1% of the of the spinal cord injury population enrolled in the program at any given moment.

It takes four therapists to provide NRN, one moving each leg, one providing support behind the person receiving the therapy and one person to work the machine to vary the settings and read the inputs during the session.

The first hour of the 90 minutes is spent on the treadmill, with the therapists moving each leg. The session alternates between providing a higher level of support for Dennis to get a more intense bout of repetition and sensory cues, rotations of providing the least amount of support needed to see how much he can do on his own and encourage deeper engagement, and periods of trying to stand with varying levels of support. The idea is to inspire muscle memory and retraining. The last 30 minutes is spent off the treadmill doing assisted stepping, standing, or core exercises to strengthen trunk control and further push potential muscle memory while the nervous system is "excited" by the sensory inputs from the locomotor training.
Whether and how much NRN will work for Dennis is yet to be seen. Any substantial success is uncertain and measured by years versus days or weeks. Regardless of what recovery comes, it is also the best way to stay healthy, offer Dennis exercise, help keep his bones strong and his muscle mass up and for that we are ever grateful.

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