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Background and Purpose Collaboration between scientists and clinicians effectively accelerated translation of scientific evidence for activity-based therapies (ABT) into rehabilitation. This article addresses the basic scientific findings of activity-dependent plasticity that led to Locomotor Training (LT), an ABT, and its principles to advance recovery in adult and pediatric populations with spinal cord injury (SCI). Expansion to new therapies based on these common principles is highlighted, e.g., epidural stimulation. The article also describes a recently developed measure, the Neuromuscular Recovery Scale (NRS), and its psychometric properties. Summary of Key Points LT has led to recovery of walking in some individuals with motor-incomplete SCI even years after injury. Recent studies resulted in individuals with motor- complete SCI regaining some voluntary movements and standing in the presence of epidural stimulation. The level of success for LT and epidural stimulation appears dependent on spinal networks maintaining the appropriate central state of excitability for the desired task. As these new advances in restorative therapies required an outcome measure that measured performance without compensation, the NRS was developed. The NRS has strong psychometric properties in adults, and a pediatric version is under development. Application of LT in children is still novel. Preliminary evidence suggests that LT can improve trunk control, and also foster participation in children with chronic SCI. Recommendations for Clinical Practice Activity-based therapies may effectively promote neuromuscular recovery, improve function and participation in adults and children post-SCI. Evaluation of outcomes with valid measures, such as the NRS, is necessary to document the ability to perform functional tasks, and to assess progress as function improves.

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This is the first step in development and validation of a pediatric SCI scale that evaluates neuromuscular capacity, in the context of pediatric function, without compensation.

Development of an all-inclusive clinical instrument assessing balance in the SCI population was accomplished using the Delphi technique. Modifications of the ABLE scale based on the Rasch analysis yielded a 28-item scale with minimal floor or ceiling effects. Larger studies using the revised scale and factor analyses are necessary to establish unidimensionality and reduction of the total item number.