2008 Estabrook Lecture

Dr. Harkema, national expert, discussed advances in recovery of mobility after spinal cord injury.

Regaining mobility after spinal cord injury is an important area of investigation for rehabilitation researchers. Dr. Susan Harkema, a renowned expert in neurorehabilitation, presented her perspective on this field at the Kessler Foundation Research Center’s annual Kenneth L. Estabrook Distinguished Research Scientist Lectureship on November 14, 2008. Dr. Harkema is based in Louisville, Kentucky, where she is associate professor in the Department of Neurological Surgery at the University of Louisville, Louisville, Kentucky, director of rehabilitation research at the Kentucky Spinal Cord Injury Research Center, and director of research at Frazier Rehabilitation Institute.

Dr. Harkema also serves as national director of the NeuroRecovery Network (NRN), a dynamic new joint initiative of the Christopher and Dana Reeve Foundation and the Centers for Disease Control. Through a network of seven research facilities, including Kessler Foundation Research Center, NRN promotes the recovery of walking and motor function through activity-based rehabilitation called locomotor training. This training has three components--step training on a treadmill, over ground walking and community ambulation.

During step training, the person is suspended in a body harness over the treadmill while specially trained physical therapists guide the person’s legs in a walking pattern. Dr. Harkema explained that the repetitive motion of the legs helps the nervous system relearn the motor patterns needed for walking. Each training session is one and one half hours long. The person trains three to five times week for three to four months. As step training progresses, the amount of load is increased, as well as walking speed. As the person regains function, the training progresses from the treadmill to assisted walking over ground. The goal is to recover sufficient mobility to function as independently and safely as possible in the home and community.

In the NRN study, researchers are looking at how to achieve optimal results and how locomotor training can best be used in patients with different types of paralysis. At present, they are focusing on individuals with incomplete injuries of the thoracic and cervical spinal cord. Comprehensive data on each patient is collected and analyzed in the NRN database. The goal to establish evidence-based interventions that help patients regain motor function after disabling injuries. Dr. Harkema emphasized that standardization of locomotor training is needed in order to translate research findings into clinical rehabilitation interventions that are widely accepted and reimbursable by insurers.

While recovery of walking and motor function is the goal, even incremental gains in mobility can have major impact on an individual’s quality of life, Dr. Harkema pointed out. Regaining the ability to transfer independently from bed to chair, for example, can markedly increase a person’s options for self care and mobility. So far, results vary from person to person. Some people realize other benefits as well, such as better heart and lung function, improved skin healing, better bladder and bowel control, and improved emotional well being.

Dr. Harkema’s research has sparked interest in applying activity-based strategies to the rehabilitation of people with mobility deficits caused by traumatic brain injury or stroke. These could be promising studies, according to Dr. Harkema, because in these conditions, the spinal cord is intact which could mean even better results than in individuals with spinal cord damage.