In recent years, aggressive physical rehabilitation programs have emerged that seem to restore significant function in many with SCI, even years after injury. Sophisticated devices and technology have been developed to catalyze such function-restoring rehabilitation, such as GIGER-MD® locomotion system (www.gigermd.com) or the Locomat® robotic treadmill training (photo) (www.hocoma.com).
Frequently, these programs are used to maximize restored function after an innovative surgical procedure or other intervention. Often videos are created to document the patient’s functional improvement, and given the impressive nature of the physical activities that could be done after but not before treatment, it is assumed that the recovered ability documents efficacy.
However, this assumption may or may not be valid. It is possible that little of the restored function is due to, for example, a $50,000 surgery but rather attributed to the rehabilitation aggressively pursued after the surgery but not before. If functional recovery after a surgical intervention depends upon a slowly regenerating neuron reaching an anatomically distant target site, it will take a relatively long time for new functional improvements to appear. If during that period, the patient has sustained an aggressive physical rehabilitation program, it is not unreasonable to question, as many scientists, indeed, do, what is the true cause of the improvement. Because of this concern, some surgical interventions are now requiring patients to aggressively rehabilitate before the surgical intervention as well as after.
Furthermore, if a patient believes with heart-and-soul conviction that the surgery/intervention will help him recover some function, it will shift his consciousness from the pre-surgical “you-will-never-walk-again” attitude that is often imprinted on patients by medical authorities to a self-fulfilling belief of what may be truly possible if he works hard . The patient’s will propels him to new levels of function, much of which, in fact, may have little to do with the surgery/intervention.
Even considering it alone without any potentially confounding intervention, physical rehabilitation is a complicated area in which observed improvement may be due to a number of causes separately or in combination. First, through a variety of physiological mechanisms, including growth-factor stimulation, aggressive physical rehabilitation in many individuals with SCI probably does trigger some neuronal regeneration.
Second, it may activate dormant but intact neurons that transverse most injury sites, even in injuries clinically classified as complete. Studies suggest that only a small percentage of “turned-on” neurons are needed to regain significant function.
Third, the spinal cord in itself possesses intelligent and 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 appropriately designed leg braces, impressive ambulation may be observed with minimal if any neuronal regeneration.
Fourth, many muscles above the injury site affect ambulatory potential, especially when using appropriately designed leg braces. For example, the latissimus dorsi, a muscle innervated from the spinal-cord’s cervical region, can influence pelvic-area movement and, in turn, ambulatory-associated motions (Anton Wernig, private communication).
Fifth, increasingly, many scientists believe that there are intriguing possibilities about the integration of different neurological systems above and below the injury site, which, although making our understanding of the nervous system more complicated than once assumed, generate rehabilitation opportunities.
Sixth, aggressive physical rehabilitation programs are often initiated relatively soon after injury in a period in which there is already appreciable recovery potential. Once again, it is often difficult to determine how much recovery is due to a specific program and how much would have occurred anyway. Advocates of the status quo and critics of the innovative tend to be skeptical of the results produced by innovative rehabilitation programs as phenomena that may have occurred anyway. The growing base of both scientific and anecdotal evidence suggests that aggressive rehabilitation programs magnify recovery potential.
Finally, confounding understanding even further, in paradigm-expanding speculations, some scientists believe that it is possible for brain-directed function below an anatomically complete injury site. For example, Albert Bohbot, whose laserpuncture work was described previously, believes that there is a sophisticated interaction between our body’s electromagnetic energy channels/systems/fields and our nervous system that can bypass the injury site . Although beyond mainstream biomedical thinking, this is entirely possible under Eastern- and other esoteric-healing philosophies, and, as such, it has been suggested that martial-arts study, which emphasize energy-flow and control, would facilitate this potential.
Summaries are provided below on various private-clinic and university-based rehabilitation programs that may restore some function after SCI. The agendas and priorities of the programs in these two settings often vary greatly. The latter is often research driven with the goal of publishable professional papers and awarded grants, and with the former, research by itself is not the goal but the production of real-world results that economically sustain the program.
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