Physiatry Progressions: Spinal Cord Injury Recovery Advances

Sandeep Singh, MD

Historically, physicians have been taught that the damage from a spinal cord injury is irreversible and that in most cases any resultant non-ambulatory status is permanent. While biological repair of the damage through restorative medical and surgical management is still an elusive research goal in post-injury care, the adaptive and assistive technology currently available should change the way providers think about spinal cord injury recovery. Through the use of personal robotic assistive walking devices, seeing patients standing upright — even following high-spine damage — is no longer considered impossible.

Good Shepherd Rehabilitation Network’s aggressive approach to spinal cord injury rehabilitation incorporates these technologies early in the recovery process for both inpatients and outpatients. Our Locomotor Training Program is centered on a device called EKSO, a wearable robotic exoskeleton that allows paralyzed individuals with varying degrees of limitation to obtain upright positioning and to walk with a reciprocal gait. Good Shepherd has used the device successfully with those with high-spinal cord injury or hemiparesis due to traumatic injury, stroke or medical disease. 

Good Shepherd first became involved in EKSO’s development in 2011 through investigational trials. Since that time, we have seen our EKSO-based rehabilitation services grow to include inpatients and outpatients.

When first utilizing the EKSO, patients use button-triggered step control. As they improve their core-strength, stability and coordination, patients can progress to self-triggered EKSO assisted steps.

EKSO with Variable Assist is equipped so that as a patient progresses, the degree of support can be adjusted. EKSO with Variable Assist allows individuals to become increasingly more independent in their gait training therapy.

There are other quantifiable improvements in health for patients who use EKSO, including: strength and conditioning, pulmonary function, bone density, cardiovascular health, metabolic status and psychological and mental health. Still, some of the most compelling arguments for use of the EKSO assistive walking device center around the immeasurable impact of standing for the first time since an injury and taking steps.

At Good Shepherd, we work to address other ongoing needs of our spinal cord patients through a multidisciplinary team of physicians, nurses, physical and occupational therapists, social workers and care managers. The care of the whole patient may include: ventilator weaning; pulmonary rehab; speech, language and swallowing evaluation and therapy; driver training and adaptations; home and work evaluation; recreational opportunities; bowel and bladder management; sexual health management; and support groups.

For patients with a spinal cord injury, this multidisciplinary care team is with them for primary and specialty care during every stage of their recovery.