Friday’s final presentation was called Activity-dependent Plasticity for Neuromuscular Recovery: Use of Classifications to Drive Therapies and Outcomes and given by Andrea Behrman.
The majority of Andrea’s presentation focused on 3 clinical cases, which I won’t go into too much detail on that here, but I did want to discuss the nuggets of overall physical therapy Biblical truth that I gleaned from her presentation.
“Kids need to be moving. ” Andrea stated that current practice in a child post SCI is to strap them down with braces and provide lots of supportive type devices. This is done because almost 100% of children who are injured before age 5 develop scoliosis and the same almost 100% develop hip dysplasia if injured before age 10. Andrea wanted to promote the idea that perhaps current practice is not best practice as children are natural born movers and we are interfering with nature. Perhaps instead (or in a scaled down combination), we should be focusing on core strengthening in sitting and standing.
In reaction to spasticity management with Botox or Baclofen meds/pump, Andrea stated, “We’re going to take a paralyzed muscle and make sure it doesn’t move.” Again, perhaps these meds aren’t best practice. Yes, they do a marvelous job of decreasing spasticity, but one of the side effects is decreased strength. I’ve often wondered about the trade off here too. Is it really worth it? Andrea also mentioned that the spasticity/hypertonicity may also be beneficial in allowing synergistic patterns to appear that may be useful for the patient to use for mobility.
A new “lens” for prediction and assessment of this population was also proposed, which included the pedi Neuromuscular Recover Scale (as discussed in previous post, not yet available or at least not that I can find), the Segmental Assessment of Trunk Control and utilizing activity in weight-bearing environment (can’t find the article).
“I never really understood why the therapists had me strengthening the parts of my body that worked and did not focus on the parts of my body that didn’t work.”– Marilyn Hamilton, SCI. It seems stupid and obvious here in retrospect, but she’s right. We focus so much on compensatory strategies with SCI that we don’t hardly address recovery strategies at all. If we completely ignore the paralyzed parts, there’s no way they’ll move again. But it we force them to move (again, assuming the “smart” spinal cord), then there’s a change they will move again. And by doing so we will “turn on” the potential of the neuromuscular system.
So that’s what I gleaned from Andrea’s talk, which was the final lecture session on Friday.