Since the 1928 work of Santiago Ramón y Cajal, famed neuroscientist, the prevailing assumption has been that the central nervous system (CNS) is hard-wired, nonmalleable, and incapable of repairing itself. Current Model of SCI and Rehabilitation: Compensatory Clinical Model Furthermore, the theoretical analysis supporting a recovery model of locomotor function after SCI based on activity-dependent plasticity and neurobiology may be applicable to other biological systems such as respiration and upper-extremity function. This shift could create a temporary period of discomfort as clinicians move from traditional practice to the challenge of creative translation of science into clinical practice.Ī series of hypothesis-based studies are proposed to examine important issues defined by clinicians in partnership with neuroscientists, exercise and muscle physiologists, engineers, biomechanists, physicians, and consumers. Rather, this integration will require a partnership between clinicians and scientists and a shift in mind-set from compensatory training to activity-based therapies as the foundation for rehabilitation. If new basic science findings are efficiently and effectively integrated into clinical practice, it will no longer be possible for scientists and clinicians to work independently. The purpose of this perspective is to summarize the evidence supporting an emerging paradigm shift 1 for the rehabilitation of walking after incomplete spinal cord injury (SCI) from compensation for deficits to activity-dependent neural adaptation and training. Locomotion, Recovery of function, Spinal cord injuries Advanced by partnerships among neuroscientists, clinicians, and researchers, critical rehabilitation concepts are emerging for activity-based therapy to improve walking recovery, with promising clinical findings. ![]() A physiologically based approach for the rehabilitation of walking has developed, translating evidence for activity-dependent neuroplasticity after spinal cord injury and the neurobiological control of walking. The purpose of this perspective article is to summarize the evidence supporting an impending paradigm shift from compensation for deficits to rehabilitation as an agent for walking recovery. The evidence is especially compelling concerning locomotion. Evidence from basic science, however, demonstrates that the central nervous system after injury is malleable and can learn, and this evidence has challenged our current assumptions. Upon this assumption, clinicians have compensated for irremediable sensorimotor deficits using braces, assistive devices, and wheelchairs to achieve upright and seated mobility. ![]() ![]() According to these findings, it is worthwhile to recommend reducing the hours spent in sedentary behaviour, or at least to take frequent short breaks ("activity snacks") during periods of prolonged sitting to get up and walk around.Physical rehabilitation after spinal cord injury has been based on the premise that the nervous system is hard-wired and irreparable. One way to diminish the harm caused by long hours of sitting is to take short breaks during periods of prolonged sitting in order to walk. Although the higher risk brought on by sedentary behaviour is partially reduced by increasing medium-high intensity physical activity, it is not completely neutralized. In recent years, research conducted has begun to examine the effect inactivity has on health and has shown that excess sedentary behaviour is an independent risk factor for a wide range of medical problems such as obesity, metabolic syndrome, poor cardiovascular health profile, diabetes mellitus, and possibly cancer. The remaining waking hours are spent performing low intensity physical activity (25-45%) and medium-high intensity physical activity (less than 5%): Despite this distribution, medical research has focused on the impact of increasing medium-high intensity physical activity and many health organizations' recommendations are in accordance. Modern man spends most of his waking hours (50-70%) in one form or another of sedentary behavior, defined as activity conducted in a sitting or reclining position involving low energy expenditure.
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