LAURANCE JOHNSTON, PH.D.
In recent years, a variety of aggressive physical Rehabilitation programs have emerged that seem to restore significant function for many people after spinal cord injury (SCI), even years after injury. This article discusses several of the programs, as well as key issues surrounding their use.
Introduction
Increasingly, such aggressive rehabilitation is being used to maximize restored function after cell-transplantation or other innovative surgeries that are surfacing throughout the world, including those discussed in previous articles. Often videos are produced to document improvement, and given the impressive nature of the physical activities that could be done after but not before surgery, it is assumed that the new-found abilities prove the intervention’s efficacy.
However, this assumption may not be valid; in fact, in some cases, perhaps little of the restored function is due to the surgery but rather to the rehabilitation aggressively pursued after the intervention but not before. If post-surgical Functional recovery depends upon slowly regenerating neurons reaching an anatomically distant target site, it will take a relatively long time for improvements to appear. If during that period, the patient is enthusiastically working out, the true cause of any ensuing improvement is questionable. As such, some surgical interventions now require patients to aggressively rehabilitate before, as well as after, surgery.
Furthermore, if patients believe with heart-and-soul conviction that the surgery will help him, it will shift their consciousness from the prior “you-will-never-walk-again” attitude that is often imprinted on the patient’s consciousness by our medical authorities to a self-fulfilling belief of what may be truly possible through hard work. Their will propels them to new functional levels, perhaps only a small amount of which is actually due to the surgery.
Even by itself, aggressive physical rehabilitation is a complicated area in which improvements may be due to many causes and mediating physiological mechanisms. First, such rehabilitation most likely stimulates some function-restoring neuronal Regeneration, adaptation, and/or reconfiguration (i.e., Plasticity); and also may activate dormant but intact neurons that transverse most injury sites, even injuries clinically classified as complete. Studies suggest that only a small percentage of “turned-on” neurons are needed to regain significant function.
Second, the spinal cord by itself possesses intelligence and is not completely subservient to brain oversight. Specifically, the spinal-cord’s “central-pattern generator” can sustain lower-limb repetitive movement, such as walking, independent of direct brain control. With training and braces, impressive Ambulation may be observed through physically stimulating this neural network.
Third, many muscles above the injury site indirectly affect ambulation, especially through the use of leg braces. For example, the latissimus dorsi (i.e., the lats), which are innervated from the cord’s Cervical region, influence pelvic-area movement and, in turn, ambulation.
Fourth, aggressive physical rehabilitation is often initiated in the first year after injury, a period in which appreciable recovery potential exists. As such, critics have suggested that any functional recovery, no matter how dramatic, would have happened anyway.
Finally, in paradigm-expanding speculations, experts knowledgeable in Eastern and esoteric-healing traditions believe that it is possible for brain-directed function below an anatomically complete injury site. Specifically, a sophisticated interaction takes place between our body’s electromagnetic energy meridians, systems, and fields and neurological systems that can bypass the injury site. As such, it has been suggested that martial-arts or qigong study, which emphasize energy-flow and control, facilitates this potential.
