Activity Based Training for Spinal Cord Injuries

touchdown-2-danceAverage Yearly Spinal Cord Injury Costs   

The average yearly expenses (health care costs and living expenses) and the estimated lifetime costs that are directly attributable to Spinal Cord Injury (SCI) vary greatly based on age, education, neurological impairment, and pre-injury employment history.    

Yearly expenses for a catastrophic spinal cord injury, can exceed $1 million.

Even with high-end insurance coverage there can be significant, long-term out-of-pocket costs to consider.
The lifetime cost of becoming a quadriplegic can reach nearly $5 million dollars when injured as a teenager.

Initial costs like ambulance, surgery, hospital stay, inpatient rehab, mobility equipment are typically covered in part by one’s health insurance.  However, the uninsured expenses begin to mount upon discharge as returning home in a wheelchair requires many accommodations and modifications.  From new transportation needs, home renovation and nursing care to maintaining optimum health to avoid life threatening setbacks, these uninsured costs escalate quickly.

The hidden costs of wellness through exercise can be daunting.  Activity-Based Training (ABT) is not covered by insurance and cost on average $100/hour.  The most optimized commitment to regain neurological connection for those with an SCI is 2-4 hours of training/day.  One can see how costs can escalate quickly for those dedicated to improving their paralysis.

Some believe that Stem Cell injections can reverse paralysis, but that is not considered a cure and is still undergoing extensive trials here in the US.  With the non-invasive benefits of ABT, there is much to celebrate with improved circulation, muscle tone, spasm reduction, and even reigniting neurological connections.   The only caveat is the cost as it is out of pocket / self pay.


  Activity Based Training Is Not
Currently Covered By Insurance  

SCI treatment currently focuses on preventing further injury and empowering people with a spinal cord injury to return to an active and productive life.  Rehabilitation and exercise are key to enhancing a person’s health and quality of life.     

Activity-based therapies (ABTs) also referred to as activity-based restorative therapy (ABRT) includes any exercise therapy activity, rehabilitation, or intervention. It is focused on improving muscle function and sensory perception for the paralysis and sensory loss due to spinal cord injury (SCI), to improve overall function after SCI. With ABTs, spinal cord injury patients can first regain feeling and over time, movement in the areas affected by the injury.

Currently, over 1,462,220 people suffer from spinal cord injury paralysis in the United States with only an average of 36 days spent in rehab before being discharged home.

ABTs work by assigning task-specific movements to improve activation of the neuromuscular system below the injury level. This treatment helps to stimulate the central state of excitability, also known as your spine. Therapies are also repetitive which is important in neurological rehab. The more times you practice doing an activity correctly, the more likely you will do this same activity with ease in real life. When the injury has produced a higher level of paralysis, patients may also undergo functional electrical stimulation therapy (FES) to kick-start the spine’s central pattern generator as the person with spinal cord injury trains on a treadmill or stationary bike.  

Important to note Third-party payers which include private Insurance companies and Medicaid currently do not cover, pay, or reimburse for these crucial services.

   Activity Based Training Methods 

The activity-based training programs focus on using specific exercises that are related to the same movement patterns that occur during human development. Through these movements, they are attempting to re-establish patterned neural activity within the central nervous system–activity that is the instinctive pattern of movement we’ve developed from childhood. Many of the exercises they use are based on patterned neural activity. This method is the process through which it is thought the central nervous system develops its structure and function in the growing human being. The continuous repetition of movement may help to create this neural pattern in the brain and spinal cord. Also, relearning a specific motor task may be highly dependent on the repetitive stimuli provided when input from the brain is limited. Specialists are trained to create the proper stimulation not just to increase a client’s health, but help them regain function below their level of injury. The weight-bearing exercises, motor skills training and occupational therapy that comprise ABT are designed to decrease muscle contraction–stiffness or tightness in the muscles and rekindle the neural patterns that drive movement.

Activity-based therapies focus on the repetition of movement to promote neuroplasticity, load bearing to promote bone health as well as core and trunk control.

The ultimate goal of facilities using active based therapy programs is to help their spinal cord injury victims regain function and improved health through exercise and to walk again eventually. To reap the maximum benefits of ABT, though, patients must commit to a daily, two-to-three-hour regimen of high-intensity physical activity.       

Locomotor Training  


Locomotor Training is based on our current knowledge of how the brain and spinal cord control stepping and how the nervous system learns a motor skill. The ultimate goal is to retrain participants to stand and walk again.

Step training utilizes body weight support on a treadmill in which a participant is suspended in a harness over a treadmill while specially trained therapists and technicians move his or her legs to simulate walking at a normal pace. The idea behind step training is to help the nervous system relearn motor patterns associated with walking.     

Overground walking training takes the nervous system’s new capacity to the overground environment. In this setting, specific limitations to independent walking including gait deviations are addressed.     

Walking Systems and Braces   

Orthoses and braces are tools common in rehabilitation, these are innovative devices that support the body while working on standing, walking, ect., that can help improve SCI survivor function and allow for greater overall health.

An orthosis might be used for positioning a hand, arm or leg, or to magnify or enhance function. It can also be as simple as a splint or as a complex as functional electrical stimulation (FES) brace for ambulation in paraplegics.

There are wearable robotic exoskeletons that can provide powered hip and knee motion to enable individuals with SCI to stand upright, walk, and turn. On their first day using the device, most people can stand and take a few steps, although it takes practice and training to use it properly.

Functional Electrical Stimulation


Functional electrical stimulation (FES) applies small electrical pulses to paralyzed muscles to restore or improve their function. FES is commonly used for exercise, but also to assist with breathing, grasping, transferring, standing and walking. It can also lead to improved bladder and bowel function. There’s even evidence that FES may reduce the frequency of pressure sores and urinary tract infections.     

FES bikes allow people with little or no voluntary leg movement to pedal a stationary leg-cycle called an ergometer. Computer generated, low-level electrical pulses are transmitted through surface electrodes to the leg muscles. This causes coordinated contractions and the pedaling motion.   

FES bikes, however, are not cheap — they are in the range of $15,000. The manufacturers have yet to convince Medicare to pay for the devices. Some private insurance companies have reimbursed for them, but many people access FES exercise in community settings like health clubs, rehab clinics, and activity based training centers.

Aquatic Therapies

aquatic-therapiesAquatic therapy uses the aquatic environment in conjunction with land therapies as part of its Activity-Based Restorative therapies.

Gait training on the underwater treadmill can help patients regain balance, movement, and strength when working to re-educate muscles to stand and walk after a brain injury.

Underwater Treadmills are available at facilities that have specialized state-of-the-art therapy pools. As opposed to gait training in a standard pool, the underwater treadmill allows individuals to practice gait patterns that closely mimic land patterns. The speed of the underwater treadmill starts at .2 mph and increases in .2 mph increments allowing patients to progress at their own speed safely.

Peer Support Programs 


  • Activity-based training programs offer peer support where you can connect with others who are living with spinal cord injuries.
  • Whether it’s eating out at a restaurant, going to the movies, or hanging out as a group, being surrounded by people in a similar situation can help individuals living with SCI rebuild their sense of independence, build self-confidence, learn new life skills, and make new friends.

The Is No Cure Just Yet   sci-research

Research is ongoing to treat the various symptoms and problems associated with Spinal Cord Injuries and to develop therapies that promote the regeneration of nerves. The National Institute of Neurological Disorders and Stroke supports research to help people with SCI, as do other institutions, including the NICHD. This includes research on the four principals of spinal cord repair:

    1. Protecting surviving nerve cells from further damage
    2. Replacing damaged nerve cells
    3. Stimulating the regrowth of axons and targeting their connections appropriately
    4. Retraining neural circuits to restore body functions  

Studies Relevant to Activity-Based Training

Neuroplasticity After SCI and Training: An Emerging Paradigm Shift in Rehabilitation and Walking Recovery

Balance and Ambulation Improvements in Individuals with Chronic Incomplete Spinal Cord Injury Using Locomotor Training based Rehabilitation

Functional Electrical Stimulation Helps Replenish Progenitor Cells

China Trials Suggest Walking can Unlock SCI Damage