Activity Based Restorative Therapy (ABRT) in Myelopathies

Treatment of myelopathies, a vastly inclusive term referring to neurologic changes related to spinal cord dysfunction, requires both etiology specific and deficit specific interventions, as the initial damage to the spinal cord frequently results into long standing neurologic deficits. Over the past 1.5 decades, there has been a paradigm shift in the field of neuro-rehabilitation, moving the focus from compensation to restoration in order to achieve functional goals. This shift was prompted by ever accruing evidence that the nervous system is capable of plastic changes and repair and the process is activity dependent. Activity based restorative therapy (ABRT) is defined as a life-long intervention where changes in the nervous and muscular system are driven by repetitive activation of the neuromuscular system above and below injury level. ABRT addresses impairments, activity and participation as defined by the Classification of Functioning, Disability and Health (ICF), the World Health Organization’s (WHO) framework designed to measure health and disability at both individual and population levels. Key components of ABRT are: (1) Functional Electrical Stimulation (FES); (2) Locomotor Gait Training (LT); (3) Weight Loading/Bearing; (4) Massed Practice and (5) Task-Specific Practice. While much remains to be studied regarding the application and benefits of utilizing an activity based restorative rehabilitation program when addressing consequences related to neurologic insults like those induced by myelopathies, the substantial knowledge supporting activity dependent neuro-plasticity behooves re-structuring the traditional approach to change neurologic and day to day function, moving firmly from compensation to restoration.