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What is National SCI Care Strategy?
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A national care strategy will ensure a system of care built on evidence and practices that support people with spinal cord injury (SCI) to live their best life in the community.
To support this initiative, Praxis is sharing best practices drawn from across Canada that showcase excellence in SCI research, care and innovation in action.
We hope you find these stories enlightening.
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In this month's theme learn about
Getting the Balance Right:
Rehabilitation
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Each month the National SCI Care Strategy newsletter shares examples of excellence and best practices in action, introducing practitioners and experts at their work.
This month, physical therapist Kristin Musselman guides us through the rehabilitation experience, introduces us to perturbation training and how therapists are establishing a community of care.
Kristin, who is an Assistant Professor in the Department of Physical Therapy at the University of Toronto, runs her research from a rehab hospital dedicated to spinal cord injury (SCI). She and her team focus on helping individuals regain their balance control to enable walking again after SCI. You can hear Kristin talk about her work here.
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Tapping Into Neural Circuits to Learn to Walk Again
...if you’re not paying attention to things like your balance while walking then you won’t be able to use your stepping movement in real life...
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Learning to walk again following a spinal cord injury is a complex process. Kristin describes how rehab tools and approaches have changed over the years, combining better understanding of both how to relearn and also what people with SCI prioritize.
In the last thirty years, rehab has moved on from offering very little time spent on getting patients back on their feet. According to Kristin, working on skills beyond setting one foot in front of another is key. Rehab practitioners realized that supporting patients on a moving treadmill helped move their legs backwards. This tapped into neural circuitry in the spinal cord for the basic stepping movement.
Moving on from this, research focuses on other key factors vital to locomotion such as balance. As Kristin says, if you’re not paying attention to things like your balance while walking then you won’t be able to use your stepping movement in real life.
"If I’m walking outside and I slip on some ice there are some postural reactions that I automatically use to prevent myself from hitting the ground...”
“Sometimes we take a reactive step that increases our base support and helps us get balanced again so we can continue on with our walk.”
Identifying and reactivating these reactive movements brings success as they mean you’re able to adapt your walking to accommodate new situations in your walking environment.
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Push and Pull to Walk Again
Being a pushover is all part of learning to walk again.
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Kristin describes how perturbation balance training helps people avoid falls post SCI in a safe environment and regain their balance lost following injury.
“Perturbation-based balance training is basically just a fancy way to say pushing and pulling people,” she explains. Her team brings patients into the clinic to practice walking and standing movements in a safe environment. Using a safety harness as support, the therapists then literally push and pull patients off balance. This then triggers the reactive movements that help people adapt to the environment and manage interruptions such as a dog running out into their path or dealing with ice on a sidewalk safely. Suspended by the safety harness, patients won’t fall over so they can practice and acquire the kind of balance movements relied on pre-SCI.
Kristin and the rehab team also use another therapeutic option to help patients walk again. Electrical stimulation helps train and regenerate the stepping response while patients practice walking movements. Combining this with perturbation training helps establish a strong base for patients to practice so they can learn to walk and also stop themselves from falling.
“One thing that we’re really interested in is trying to help people be able to keep their balance once it’s been lost."
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Rehab is a Very Personal Experience
What’s meaningful to one person with SCI may be totally different to another.
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As Kristin notes however, rehab is a very personal experience. Not only is the rehab program best tailored to individual needs, but it’s important to realize that each patient benefits in a way that is unique to them. What’s meaningful to one person with SCI may be totally different to another. Getting frequent and ongoing feedback is important so that the program can be adjusted during the rehab process for meaningful benefit.
And this is also important when determining priorities. To the general public without direct knowledge or experience of SCI, it’s easy to assume that the most important goal for any person in a wheelchair is to be able to walk again. However, feedback from the SCI community shows otherwise. Depending on the level of injury, regaining hand function might be much more important.
“...rehab is very personal experience; each individual may notice a different meaningful benefit that’s very unique to them”
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ABT Community of Practice
Activity-Based Therapy (ABT) involves repetitive neuromuscular activation below the level of spinal injury, typically achieved through intensive, task-specific movement practice.
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Looking after the SCI community includes supporting practitioners. This is especially important for those who work outside the big centres of excellence and may not have easy exposure to best practices or cutting-edge research.
The Activity-Based Therapy (ABT) Community of Practice (CoP) is open to everyone with an interest in ABT—people with lived experience, researchers, clinicians, administrators, policy makers, advocates, and family members are all very welcome to join. With resources such as the podcast, Spinal Moves, practitioners and others can learn more about this rehab option.
What is ABT? Therapeutic activities that involve repetitive neuromuscular activation below the level of spinal injury, typically achieved through intensive, task-specific movement practice.
“This [community of practice] is a group of people with lived experience, researchers, clinicians, administrators, policy makers, advocates, family members – anybody who has an interest in activity based therapy is welcome to join.”
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Coming Up Next!
Next month, we are continuing our exploration of best practices in action as we move towards a National SCI Care Strategy. Returning to Barry Munro, we're hearing about the NASCIC advocacy course and how the SCI community can train to be advocates in research, policy and beyond.
We're also interested in what you would like to share too; how are you putting best practices into action in your clinical practice and community? Please let us know.
You can leave your feedback or share your story.
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ABOUT: Praxis started an engagement process in 2019 to create a national care strategy aimed at building on the strengths and collective wisdom of the spinal cord injury (SCI) community across Canada. Based on community consultation, this process led to Being Bold: Toward a National Spinal Cord Injury Care, Health & Wellness Strategy Discussion Document & Consultation Report, a discussion document, and then to the follow up community report, SCI Care for Canada: A Framework for Strategy and Action, which lays out a framework for an actionable National SCI Care Strategy.
The ongoing vision will ensure a national system of care built on evidence and practices that support people with SCI to live their best life in the community. As the ‘backbone’ organization in this initiative, Praxis is sharing best practices drawn from across Canada; instead of searching for solutions in isolation, the national strategy will give people access to peer experiences and stories of excellence that show best practices in action and their impact daily life.
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