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Published on: July 19, 2013
Spinal Cord Injury at Birth, Expected Medical and Health Complexity in Chronic Injury Guided Anew by Activity-Based
Laura Leon Machado1, Kathryn Noonan1, Scott Bickel2,3
1UofL Health, Frazier Rehab Institute, Kosair Charities Center for Pediatric NeuroRecovery, Louisville, KY, United States.
Insights
Activity-based restorative therapies (ABRT) improved physical function and development in an infant with a severe cervical spinal cord injury (SCI). This therapy enhanced trunk control, arm function, and social-emotional growth, demonstrating positive impacts despite injury chronicity.
Area of Science:
- Pediatric neurology
- Developmental pediatrics
- Rehabilitation medicine
Background:
- Infancy is a period of rapid growth and development, making infants vulnerable to disruptions like spinal cord injury (SCI).
- Neonatal SCI has profound and lasting effects on physical and developmental trajectories.
- Activity-based restorative therapies (ABRT) leverage neuroplasticity to improve outcomes in children with SCI.
Observation:
- A case report details an infant with a congenital cervical SCI affecting leg, trunk, arm, and hand function.
- The child initiated an ABRT program at three years of age.
- The injury resulted in paralysis of leg and trunk muscles and paresis of arm and hands.
Findings:
- After 59 ABRT sessions, the child showed significant improvements in trunk control and arm function.
- The therapy also positively impacted social and emotional development.
- These benefits were observed despite the chronic nature of the injury.
Implications:
- ABRT can yield substantial benefits for infants with chronic SCI, even with initially low expectations for recovery.
- This approach positively influences physical capacity and broader developmental domains.
- Activity-based interventions offer a promising avenue for improving quality of life in pediatric SCI patients.
Abstract:
As infancy is characterized by rapid physical growth and critical periods of development, disruptions due to illness or disease reveal vulnerability associated with this period. Spinal cord injury (SCI) has devastating consequences at any age, but its onset neonatally, at birth, or within the first year of life multiplies its impact. The immediate physical and physiological consequences are obvious and immense, but the effects on the typical trajectory of development are profound. Activity-based restorative therapies (ABRT) capitalize on activity-dependent plasticity of the neuromuscular system below the lesion and when provided to children with SCI aim to improve the child's neuromuscular capacity, health and quality of life. This is a report of an infant with a cervical SCI at birth resulting in paralysis of leg and trunk muscles and paresis of arm and hands who was enrolled in an ABRT program at 3 years of age. After 59 sessions of ABRT, the child demonstrated significant improvements in trunk control and arm function, as well as social and emotional development. Despite the chronicity of injury and low expectations for improvement with therapeutic interventions, ABRT had a positive impact on the child's physical capacity and provided benefits across multiple developmental domains.
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