Spinal cord injury in infancy: activity-based therapy impact on health, function, and quality of life in chronic injury

Abstract

Introduction Spinal cord injury (SCI) in infancy magnifies the complexity of a devastating diagnosis. Children injured so young have high incidences of scoliosis, hip dysplasia, and respiratory complications leading to poor health and outcomes. We report the medical history, progression of rehabilitation, usual care and activity-based therapy, and outcomes for a child injured in infancy. Activity-based therapy (ABT) aims to activate the neuromuscular system above and below the lesion through daily, task-specific training to improve the neuromuscular capacity, and outcomes for children with acquired SCI. Case presentation A 3-month-old infant suffered a cervical SCI from a surgical complication with resultant tetraplegia. Until age 3, her medical complications included scoliosis, kyphosis, and pneumonia. Even with extensive physical and occupational therapy, she was fully dependent on caregivers for mobility and unable to roll, come to sit, sit, stand or walk. She initiated ABT at~3 years old, participating for 8 months. The child's overall neuromuscular capacity improved significantly, especially for head and trunk control, contributing to major advances in respiratory health, novel engagement with her environment, and improved physical abilities. Discussion From injury during infancy until 3 years old, this child's health, abilities, and complications were consistent with the predicted path of early-onset SCI. Due to her age at injury, severity and chronicity of injury, she demonstrated unexpected, meaningful changes in her neuromuscular capacity during and post-ABT associated with improved health, function and quality of life for herself and her caregivers.

Impact of Activity-Based Therapy on Respiratory Outcomes in a Medically Complex Child

“…The patient’s improved respiratory trajectory as well as gains in trunk control are similar to that of another child on whom we recently reported [ 10 ], though that patient had not required the use of chronic mechanical ventilation. The patient in this case report had never developed head control, and following intervention, he gained both head and upper thoracic trunk control.…”

“…Children with this constellation of insults are at high risk for needing chronic mechanical ventilation for many years, if not their entire life. We report the case of a two-year-old male with a history of prematurity at 29 weeks gestational age and with an early-onset severe cervical SCI complicated by prolonged mechanical ventilation whose respiratory status improved with intensive activity-based therapy (ABT) [ 8 , 9 , 10 ].…”

Recovery of walking in nonambulatory children with chronic spinal cord injuries: Case series

“…This association between postural control, gross motor function, and mobility as scored on the GMFM is consistent with observations in children with cerebral palsy (Butler et al, 2010) and gains in trunk control likely contributed to gains in GMFCS level. Recent studies show that children with SCIs who received 60 ABLT sessions or more showed improved trunk control based on Segmental Assessment of Trunk Control scores (Argetsinger et al, 2019, 2020; Behrman et al, 2019; Goode‐Roberts et al, 2021). Mechanisms for improved trunk control align with those activating the neuromuscular system below the lesion via sensory input during ABLT (Angeli et al, 2014; Rejc & Angeli, 2019), as well as potential activation of trunk musculature above, across, and below the lesion.…”

“…Broken line arrow indicates onset of sound stimulus. Scale bars = 500 ms. Bi, biceps brachii; MG, medial gastrocnemius; sound, recorded train blast; TA, tibialis anterior.showed improved trunk control based on Segmental Assessment of Trunk Control scores(Argetsinger et al, 2019(Argetsinger et al, , 2020Behrman et al, 2019;Goode-Roberts et al, 2021). Mechanisms for improved trunk control align with those activating the neuromuscular system below the lesion via sensory input during ABLT(Angeli et al, 2014;Rejc & Angeli, 2019), as well as potential activation of trunk musculature above, across, and below the lesion.…”

Spinal Cord Injury at Birth, Expected Medical and Health Complexity in Chronic Injury Guided Anew by Activity-Based Restorative Therapy: Case Report

“…Infancy is a rich period of sensorimotor experiences, typically learning through trial and error, that together with maturation and activity-dependent plasticity drive development ( Campos et al, 2000 ; Pape, 2012 ). Infants who have interruptions to development due to disease, illness, or injury, alter the malleable natural learning process, deviate from this well-known trajectory, and are at risk for maladaptive neuroplasticity ( Campos et al, 2000 ; Pape, 2012 ; Bhutta et al, 2017 ; Argetsinger et al, 2020 ). Spinal cord injury (SCI) presents unique challenges to the health and development of young children when injured under 5 years of age ( Schottler et al, 2012 ), and perhaps even more so when injured at birth.…”