depressed at the time of discharge; the rate of depression then dropped, before climbing over the next 6 months. Rates peaked at 60 percent by year’s end and then declined to 16 percent by the end of the second year. The treatment of depression in any group of individuals with a chronic physical illness, particularly those with spinal cord injuries, is expected to reduce unnecessary suffering and disability and to motivate adherence to complex programs of self-care, rehabilitation, and treatment.

Effective treatments are available for depression (APA, 1994). In 1998, the Consortium for Spinal Cord Medicine published a clinical practice guideline detailing specific steps for assessment, diagnosis, and treatment of depression (PVA, 1998).

RETRAINING AND RELEARNING MOTOR TASKS

The plasticity of the nervous system, or the nervous system’s ability to adapt and reorganize itself, sometimes allows the body to partially recover some of the motor function lost as a result of a spinal cord injury. As described throughout this report, a great deal of the research and clinical effort has been focused on restoring lost motor function through pharmacological or surgical methods. However, physical training and rehabilitation techniques and neuroprostheses also provide individuals with additional tools that they can use to recover from a spinal cord injury.

Body Weight Support Training

It is important that patients do not overcompensate with motor function that has been spared, thus limiting the capacity of the nervous system to adapt (Barbeau, 2003). Therefore, body weight support techniques have been developed that assist in locomotion, while minimizing compensation. One therapy that is used to improve walking in individuals in both the acute and the chronic stages of their injuries is body weight-supported treadmill training. During this therapy, individuals are placed in a harness to unload between 0 and 50 percent of their weight and are then put on a treadmill to simulate walking (Wernig et al., 1995, 1998; Protas et al., 2001; Dobkin et al., 2003a). Therapists then systematically reduce the amount of weight support, while training patients to walk on the treadmill at faster speeds.

Although this technique is promising, it is still unclear how effective body weight support treadmill training is at improving function in individuals with incomplete chronic spinal cord injuries. It is believed that body weight-supported training enhances the relearning of motor skills in the presence of spared pathways and facilitates the remaining pathways to



The National Academies | 500 Fifth St. N.W. | Washington, D.C. 20001
Copyright © National Academy of Sciences. All rights reserved.
Terms of Use and Privacy Statement