Spinal Cord Injury Rehabilitation

Within the Spaulding-Harvard SCI Model System, our teams use a multidisciplinary approach for the treatment of spinal cord injury in order to address your physical, functional and psychosocial needs. Our model system program also encourages family participation.  Our treatment is evidence-based and includes the most recent programs and techniques established on the principles of neuroplasticity. The spinal cord therapy team works closely with a Physical Medicine and Rehabilitation physician, your primary care physician, and our specialty services on the treatment of the spinal cord injury, including Intrathecal Baclofen trials and Baclofen pump maintenance.

Our therapists use a variety of therapy techniques that include:

• Therapeutic exercise
• Short and Long Leg Gait Training Braces
• Upper extremity splinting
• Gulman overhead lifts and track system to assist in transfers, standing and gait
• Compensatory techniques and methods
• Neurological re-education of movement and activity patterns and tasks
• Upper and lower extremity Ergometry

Use of the following modalities are available to you:

• Lokomat
• Armeo
• Electrical Stimulation Units
• Standing Frames
• Functional Electrical Stimulation (FES) Bike
• Bioness
• Esko formerly E-Legs

Spaulding is one of fourteen centers in the US that is a designated Spinal Cord Injury Model System by NIDRR or the National Institute on Disability and Rehabilitation Research.  Grants are awarded in five year cycles by NIDRR through an extremely selective process. NIDRR awards SCI Model Systems (SCIMS) grants to institutions that are national leaders in medical research and patient care.  All SCIMS work together to improve patient care, maintain a national database, provide long term follow up, participate in independent and collaborative research and provide continuing education to individuals and families, healthcare professionals and the community at large.

Each outpatient site provides the highest level of comprehensive specialty services, from the point of injury through rehabilitation and community reentry. Using a comprehensive team approach, our experienced clinicians are committed to the treatment of individuals with spinal cord injury. We work closely with the Greater Boston Chapter of the National Spinal Cord Injury Association to help prepare you for life after a spinal cord injury.

Our staff participates in continuing education as well as teaching at area colleges, universities and conferences.  Many have achieved advanced certification as clinical specialists in the practice area of spinal cord injury rehabilitation.

Each of the Outpatient centers of the Spaulding-Harvard SCI Model System has on-site clinical leaders who direct the spinal cord injury programs.  We work together with the Inpatient Rehabilitation teams to have a seamless continuum of care.

The Spaulding Network is committed to rehabilitation research to find best practices and opportunities to improve the lives of those with paralysis resulting from spinal cord injury. Our efforts not only focus on researching new rehabilitation strategies but also look at ways to prevent long-term complications related to paralysis.

Under the leadership of Dr. Leslie Morse, Associate Director of Research and Director of Spinal Cord Injury Research, several research studies are currently underway for SCI including:

Research Program
Investigation of the Mechanisms of Transcranial Direct Current Stimulation of Motor Cortex for the Treatment of Chronic Pain in Spinal Cord Injury

Description
As part of the Spaulding-Harvard SCI Model System research program, Dr. Felipe Fregni and his team are investigating the effects of transcranial direct current stimulation (tDCS), a form of non-invasive brain stimulation, on chronic central pain in spinal cord injury. We are also using electroencephalography (EEG) and transcranial magnetic stimulation (TMS) to measure changes in the brain, both before and after tDCS. Our primary aim is to see if using tDCS stimulation can help reduce the chronic central pain associated with spinal cord injury.

Research Program
Investigation of the Mechanisms of Transcranial Direct Stimulation of Motor Cortex Coupled with Visual Illusion for the Treatment of Pain in Spinal Cord Injury

Description
Under the leadership of Dr. Felipe Fregni, Spaulding is investigating the effects of transcranial direct current stimulation (tDCS), a form of non-invasive brain stimulation, combined with watching a visual illusion on chronic central pain associated with spinal cord injury. During tDCS stimulation, the participant watches a "visual illusion." The participant will see a video of walking legs on a treadmill, and their torso reflection in a mirror. They are asked to imagine themselves walking while they are watching the illusion. We are also using electroencephalography (EEG) and transcranial magnetic stimulation (TMS) to measure changes in the brain, both before and after tDCS. Our primary aim is to see if using a visual illusion combined with the tDCS stimulation can help reduce the chronic central pain associated with spinal cord injury.

Research Program
FES-Rowing versus Zoledronic Acid to Improve Bone Health in SCI: A Comparative Clinical Trial

Description
The project, which is funded by the Department of Defense and directed by Dr. Leslie Morse, aims to compare the effect of FES-row training alone versus FES-rowing plus Zoledronic Acid on bone density of the paralyzed lower extremity and to compare the effect of FES-row training alone versus FES-rowing plus Zoledronic Acid on bone micro architecture of the paralyzed lower extremity.

Research Program
Effectiveness and Generalizability of Hybrid-FES Exercise for Physiologic Declines in Spinal Cord Injury

Description
The purpose of this research project is to determine the effectiveness and generalizability of an unique aerobic exercise paradigm (hybrid FES-rowing) as an intervention to promote improved health and function in individuals with chronic SCI and to explore this form of exercise as a prevention for the declines that occur within the first years after acute SCI. Our primary outcomes relate to exercise capacity and cardiovascular risk, however given the range of effects exercise can have, we are examining secondary measures of bone density, pulmonary function, psychological affect, social integration, and clinical status.

Research Program
The Spaulding ExPD Program – FES-row Training for SCI

Description
Spaulding’s ExPD program’s mission is to provide appropriate exercise to improve health in those with physical disability. We focus on FES rowing for those with SCI, which requires a level of performance comparable to the able-bodied and can be integrated into currently existing communities of able-bodied rowers and therefore may be an optimal exercise intervention for the SCI population.

Research Program
Adiposity and Bone Loss in Spinal Cord Injury

Description
Under the leadership of Dr. Leslie Morse, Spaulding-Harvard SCI Model System is investigating the the degree of bone formation, bone resorption, and rate of bone loss longitudinally at the distal femur and proximal tibia in subjects with chronic SCI with varying degrees of neurologic impairment and in able-bodied subjects, and to determine the relationship between regional fat distribution assessed directly from DXA scan data and longitudinal change in BMD at the distal femur and proximal tibia, and assess the relationship between circulating levels of adipose derived hormones (leptin and adiponectin) with bone loss at the distal femur and proximal tibia.

Research Program
Longitudinal Assessment of Fracture Risk in Spinal Cord Injury

Description
SCI causes rabid and severe osteoporosis.  This increases the risk of lower extremity fractures.  Our study aims to determine the rate and location of post-SCI fractures as well as identifying risk factors for post-SCI fractures

Outpatient Spinal Cord Rehabilitation programs are offered at these Spaulding locations.

Spaulding Eileen M. Ward Outpatient Center for Children Sandwich
Spaulding Outpatient Center Framingham
Spaulding Outpatient Center for Children Lexington
Spaulding Outpatient Center Medford
Spaulding Outpatient Center Boston
Spaulding Outpatient Center Wellesley
Spaulding Outpatient Center Sandwich

Adaptive Sports
Aquatic Therapy
Assistive Technology (ATEC)/ Alternative and Augmentative Communication (ACC)
Brace Clinic/Prosthetics Clinic
Injections
Physical Medicine and Rehabilitation (PM&R)
Wheelchair Clinic
Biofeedback
Lokomat
Armeo
Esko
Pressure Mapping System
ExPD