Facilitating Developmental Movement Patterns with the Use of a Body-Weight Supported Harness in Incomplete Spinal Cord Injury.
Kessler Institute for Rehabilitation, West Orange, NJ, United states
Title: Facilitating Developmental Movement Patterns with the Use of a Body-Weight Supported (BWS) Harness in Incomplete Spinal Cord Injury (iSCI).
Introduction: SCI can lead to secondary conditions that affect the overall health of the individual. These conditions include, but are not limited to, pain, spasticity, limitations in ROM, decreased bone mineral density, muscle weakness, 1,2 , and cardiovascular compromise 2. Physical rehabilitation, including weight bearing and standing activities, has been shown to be an effective intervention in individuals with SCI and other neurological conditions in managing the aforementioned conditions. 1,2,3,4.
While studies have confirmed the positive impact of activities such as tilt table 3, standing frame 4, and BWSTT 2,3 in those with SCI, few studies have investigated the effects of other load-bearing positions achieved through developmental movement patterns. These load-bearing patterns, promote core stability through strengthening trunk and pelvic muscles 5 and have traditionally been used by therapists for patients with neurologic conditions, including SCI.
Methods: Two individuals with iSCI, AIS C, participated in this intervention. Both individuals presented with spasticity, limitations in ROM, and impaired strength, postural control, and motor control. Objective measures taken included: MAS of hip/knee flexors/extensors, hamstring length, and PROM of hip extension in prone. Utilizing the BWS harness to support approximately 50% of their body weight, patients completed one session of manually facilitated developmental movement patterns, specifically transitioning from prone to other high level load bearing positions, while focusing on postural and pelvic control.
Results: Patients were able to maintain higher level load bearing positions for approximately 20 minutes, as compared to previous trials without the BWS, tolerating only up to 3 minutes. Patients were able to maintain the positions with only minimal assistance from the therapists, as compared to trials without the BWS, requiring total assistance to maintain. Changes were noted in MAS scores and hip extension ROM, pre and post intervention. Further research would be needed to determine if these results are statistically significant and whether there are any long term effects.
Conclusion: Studies have shown the positive effects of weight bearing in subjects with SCI. There is not adequate research investigating the effects of high level position changes in patients with iSCI. The tall kneel position may allow for the benefits of weight bearing without the limitations of hamstring ROM affecting the trunk and pelvic alignment. The use of a BWS harness may allow the patient to maintain the position for a longer period, without an increased burden on the therapist. This intervention may be an effective treatment that should be considered when working with iSCI in an acute rehabilitation setting. More research is needed to determine the effects of this intervention in the iSCI population.
Support: No external funding; this review is supported by the staff at Kessler Institute for Rehabilitation.
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