Integrative metalearning approach could facilitate improved rehabilitation outcomes for people with severe spinal cord injury.

Abstract

In this research, the residual walking potential for people with severe spinal injury was studied. The primary questions addressed by the research were as follows: (a) What aspects of personal and interpersonal functioning would be greatly affected by severe spinal cord injury (SCI)? (b) What factors may be strongly associated with negative change in the exercise behaviour of SCI people? (c) Is pre-injury normal walking knowledge still available after SCI? (d) If it is, how can it be accessed? The goal of the research was to clarify whether the rehabilitation approach involving normal gait exercise would lead to better outcomes and bring more benefit to SCI people in terms of their physical, emotional, social and vocational well-being. Three independent studies were conducted. In Study 1, a survey questionnaire was used to identify and investigate the beliefs that 219 wheelchair-dependent SCI people had about their post-traumatic physical, psychological and socialvocational life, and to identify the factors that they perceived as being critical influences on their exercise behavior. In Study 2, gait analysis was performed. This compared two walking patterns performed by 20 healthy participants: walking with no aids, or normal gait (NG); and walking with braces, or brace gait (BG). Furthermore, this study investigated the nature of the experience that the participants reported while walking with braces. In Study 3, a comparison was conducted between two walking patterns of a single male participant who experienced an incomplete cervical SCI and was unable to regain his pre-morbid (normal) gait over the five-year post-traumatic period. The participant?s gait pattern was measured and analysed prior to and after introducing guided NG exercise intervention. Study 1 data supported the hypothesis that SCI people do wish to walk again and practice walking exercises, but the nature of this desire changes over time and is influenced by the severity of other impairments (especially bowel and bladder control), the passive nature of the rehabilitation provided and changes in their marital and employment status. In Study 2, the difference between NG and BG was found to be significant. This supported the view that they are two distinctive walking skills. The participant?s perception of low safety and high exertion was closely related to their experience of great discomfort reported during brace walking. The data highlighted several cognitive, emotional and physical factors that could be strongly involved in functional improvements of the current brace aids. Study 3 supported the view that NG walking knowledge was available and accessible after a severe spinal cord injury. Although direct voluntary access to this implicit knowledge remained unavailable, indirect access was gained by means of a client-focused memory reprocessing integrative metalearning approach. This approach involved a collaborative therapist?client relationship, six consecutive rehabilitation stages and consistent support in exercising normal locomotion. The findings of this research enhanced the understanding of changes that SCI people might experience in their personal, emotional, physical and social-vocational functioning. The importance of a holistic rehabilitation approach that strongly integrates normal gait exercises with comprehensive psychosocial rehabilitation was emphasised. The need for early holistic intervention, involving NG exercises and functional electrostimulation, as well as social and vocational rehabilitation, was also emphasised. Overall, the research called for a holistic approach and further integrative study, aiming for better understanding of the critical factors associated with improved rehabilitation, in order to maximise the residual potentials of SCI people.