Summaries are provided below on various aggressive, function-restoring Rehabilitation programs:

Neuro Institute

Arnie Fonseca was the driving force behind the creation of the Neuro Institute in Tempe, Arizona (www.theneuroinstitute.com). An exercise physiologist and former coach, Fonseca motivates clients with SCI and other neurological disorders to regain sometimes amazing function. I met Fonseca and was impressed with his drive, can-do spirit, and commitment to his rehabilitation mission, which became personal after his son Brandon sustained a serious head injury from an auto accident.  (Photo: Arnie and Cari Fonseca, with son Brandon, co-founded the Neuro Institute)

Fonseca describes his program as immersion therapy. He believes that the best way for a neurologically compromised patient to get positive results is to be immersed in goal-oriented rehabilitation therapy for at least three hours a day for 3-5 days a week. There is no magic technique; the program uses a variety of rehabilitation approaches ranging from electronic equipment (e.g., FES bikes) to old-fashioned, low-tech weight training. Through his “just-do-it” motivational prowess, Fonseca encourages patients to replace entrenched defeatist attitudes with a new conviction of what is possible if they work hard.

Several impressive success stories are documented on his Web site. One of the more notable involves Andrea, whose experience represents a good example of how function-restoring surgeries are being combined with aggressive rehabilitation. Briefly, an omental/collagen bridge was used to bridge a 4-cm gap in Andrea’s cord that resulted from a skiing accident (see Neurological Research 27, 2005). Since starting Fonseca’s program, Andrea regained considerable function, including some Ambulation. Time-sequential MRIs indicate ongoing development of axonal structure through the once huge, spinal-cord gap. Although we cannot distinguish surgical from rehabilitation contributions, this is the sort of synergistic programs that we are going to see much more of in the future.

Project Walk

Many people with SCI who have committed to Project Walk (www.projectwalk.org) have accrued function much beyond what was considered possible after injury. The intensive exercise-based recovery program, developed by Ted and Tammy Dardzinksi in Carlsbad, California, attempts to re-educate the damaged nervous system through physical stimulation. Because each injured system is unique and each patient has different capabilities, the program is tailored to individual clients.

Briefly, Project Walk focuses on developing muscle potential below the injury level. The Dardzinksis believe standard rehabilitation programs not only ignore this potential but contribute to its extinction by “tossing-in-the-towel” focusing on non-paralyzed body parts needed for adaptation to wheelchair living instead of ambulation.

They also believe the extensively administered anti-Spasticity medications are the equivalent of pouring water on the flickering embers of Regeneration that often still exist after injury. In contrast, Project Walk’s goal is to fan these embers into a phoenix-like reemergence of functionality.

Underscoring their reservations with prevailing rehabilitation thinking, the Dardzinksis note: “If you were to place an able-bodied person in a reduced gravity Environment, tell them they can’t move for a year, heavily medicate them, and give them no hope, what do you think the outcome would be? Bone density, muscle mass, and nervous system activity would begin to shut down and disappear. That able-bodied person would have the same symptoms of a paralyzed person. So, is it just the injury or the treatment that keep some SCI paralyzed?”

Believing there is a post-injury therapeutic window in which the recovery potential is greatest, Project Walk ideally would like to start treating patients relatively soon after injury. The program believes that without proper stimulation and load bearing, a newly injured person will soon start losing bone density, muscle mass, and CNS functioning, which makes future recovery even more difficult. Although the program has treated many after this window, sometimes with dramatic improvements, much more effort is needed.

Although the training schedule depends upon a person’s function, the average client works out three hours every other day.  For people returning home, individually tailored, home-based programs are designed. Although intensive, the program encourages clients not to embrace it exclusively at the expense of overall life balance achieved through involvement in areas such as career, school, social life, etc.

The program combines strengthening activities for all muscles in the extremities and core (abdominal, back, and pelvic), balance work, and coordination drills. Exercises are structured to activate paralyzed areas and strengthen weak muscles. Specialists facilitate active and passive motions in various planes of motion to reactivate and reorganize the nervous system. This includes floor exercises, assisted or unassisted work on Total Gyms^®, and body-weight-supported ambulation. The common component is weight bearing through the body’s long bones.

Functional improvements include increased muscle mass, CNS activity, health and well being, sensation and function below the injury level, occupational skills, and sweating, as well as decreased drug dependence and pain.

Project Walk encourages the use of synergistic healing modalities, including acupuncture, hyperbaric oxygen therapy, standing frames, FES bikes, and other electrical stimulation that helps to maintain muscle mass and circulation; and emphasizes good nutrition.

Additional aggressive physical rehabilitation programs will be discussed in Part 2.

Adapted from article appearing in February 2006 Paraplegia News (For subscriptions, call 602-224-0500) or go to www.pn-magazine.com).