Our Methods

The treatment program at the ICSCI emphasizes advanced restoration therapies (RT). RT relies on the principle that neural cells need patterned activity to grow and work optimally. When a person experiences a spinal cord injury, the connection between the brain and body is lost-the brain can no longer tell the body to move, and the neural cell’s no longer have the patterned activity they need to grow and differentiate. With RT, physicians and therapists help patients with spinal cord injuries perform activities that encourage the growth of new nervous system cells as well as prompt remaining cells to "remember" how to move. In addition to possibly encouraging recovery of function, these therapies are known to improve patients’ overall health and quality of life by reducing the incidence of osteoporosis, skin breakdown, infection, cardiovascular decline and other signs of premature aging often associated with spinal cord injuries.

What’s more, although most people associate spinal cord injuries with trauma such as automobile or sports accidents, our therapies also show promise in people whose paralysis stems from cerebral palsy, spina bifida, adrenoleukodystrophy, AV malformations, neurofibromatosis, stroke, hemangiomas, connective tissue disorders and degenerative disorders such as Freidrich’s ataxia.

The ICSCI’s RT program focuses on Functional Electric Stimulation (FES). With FES, a computer sends electrical messages telling a person’s legs to contract and relax, just as the brain does normally. For example this process allows a person with paralysis to "pedal" a specially designed bike.

Another common form of RT is aquatherapy. Because pools are the closest thing to a gravity-free environment here on earth, people with paralysis can perform activities in them that would be impossible in other conditions. Again, engaging in these activities can provide the stimulation needed to generate neural cells.

Other advanced rehabilitative strategies used at the ICSCI include tendon transfers, partial body weight supported walking/robotic walking, peripheral nerve transfers and nerve reconstruction for brachial and lumbosacral plexus repair and FES implants for hand and bladder function.

Tendon transfer is a surgical procedure in which the tendon of a normally functioning muscle is detached or split and reattached to a weak or paralyzed muscle. With retraining of the transferred muscle, function can be enhanced in the previously weak or paralyzed muscle. For example, a patient with tetraplegia and good proximal/forearm muscles can regain elbow/wrist control and achieve a pinch/grasp/release function. Tendon transfer is a relatively simple and safe procedure that allows spinal cord injury patients to regain independence in self-care skills such as feeding, grooming, dressing, transfers and, for some, driving.

Partial weight supported walking involves suspending the patient in a harness and allowing him to ambulate over an electric treadmill at a very low speed. For individuals unable to initiate stepping, two therapists will help advance the lower extremities and ensure an efficient and technically correct gait pattern. As gait pattern is established, the individual is allowed to bear progressively more weight through the lower extremities. In the case of incomplete SCI, the PWSW is followed/complemented by traditional over-ground ambulation.

Peripheral nerve transfers are often performed on children with brachial plexus injury suffered at birth and others that experience traumatic avulsions as a consequence of accidents. Individuals with a certain kind of spinal cord injury, cauda equina, might benefit from similar type surgery to help restore bowel or bladder function.

FES in tetraplegic patients has focused primarily on restoring grasp and pinch function. The best candidates are patients with C5/C6 level of injury who have preserved peripheral innervation to the muscles that are considered for electrical stimulation. These muscles should also be able to generate sufficient strength and be fatigue-resistant.

To improve function of a paralyzed hand in a C6 tetraplegic patient, the most common approach of traditional rehabilitation has been to use an orthotic device to translate wrist extension motion into passive finger flexion motion to achieve grasp function. These orthoses are not always effective, are cumbersome to use, require assistance to apply and only marginally improve hand function. For patients with injuries causing loss of function at C4 level, orthoses are not usually effective, and other treatment options to restore hand function are very limited. Use of FES systems in persons with injuries at C5/C6 levels offers a unique opportunity for restoring hand function.

Voluntary and conscientious control of bladder and bowel function is lost or significantly impaired after SCI depending on the severity and degree of incompleteness of injury. FES technology offers new solution in this arena as well. One implantable system operates by using a radio frequency signal to activate electrodes placed on the sacral spinal nerve roots leading to the bladder/large bowel and controlling urethral/ anal sphincter contraction.