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What is Activity Based Rehabilitation?

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Neurokinex specialises in Activity Based Rehabilitation and our approach is one that attracts a great deal of interest and intrigue.  Firstly people ask ‘what is Activity Based Rehabilitation?’

You could describe it as the best recovery opportunity for people with a spinal cord injury which redefines possibility and defies convention.  But, more accurately, Activity Based Rehabilitation (ABR) is a form of neurological rehabilitation devised to encourage functional recovery following spinal cord injury by utilising multiple strategies to encourage neuroplasticity within the nervous system.  

Also known as Activity Based Therapy and commonly shortened to ABR or ABT, it is gradually gaining in popularity around the world, both because of the positive outcomes it achieves and the high levels of engagement from its participants.  

Diverse and creative

The rehabilitation itself is diverse and creative, individualised to the needs of each participant, but common in its principles.  Exercises and activities are set to a level that is both challenging and intensive for the participant, with high repetitions of each task undertaken.  Wherever possible, the activities take place outside of the participant’s wheelchair, utilising equipment or physical assistance to work in supported weight-bearing positions.  Electrical stimulation is an adjunct commonly used to enhance muscle recruitment, timing and feedback. The newer Wide Pulse Stimulation is favoured due to the indications that, alongside reflex muscle contractions, it also leads to excitatory ascending impulses within the central nervous system, thereby encouraging communication between the brain and injured areas of the body.

In common with more traditional forms of rehabilitation, Activity Based Rehabilitation favours holistic goal setting with participants, breaking down larger and more ambitious goals into smaller, bite-size pieces that can be checked off, helping track the progress being achieved.  It is also evidence-based, underpinned by research and measured by outcomes recognised throughout the speciality of neurorehabilitation.

The optimal environment for Activity Based Rehabilitation is a fusion of a conventional neuro-rehabilitation gym containing plinths and parallel bars interspersed with the facilities of a commercial gym, kitted out with resistance equipment and weights.  In this environment, the trainers, who have backgrounds in both health and sports performance – from Sports Scientists and Exercise Physiologists to Physiotherapists – can develop programmes which challenge fitness, strength and function in unison.  Armed with an in-depth knowledge of neuroplasticity alongside skills in exercise programming and functional task acquisition, they train participants as they would an elite athlete, aided by equipment and techniques designed specifically for neurological rehabilitation.

Engagement is key

To get the best out of the training, participant engagement is key and all activities are completed one-to-one with a trainer who keeps the participant focused on the task, often setting goals or challenges to add an element of competition.  The nature of Activity Based Rehabilitation necessitates a good relationship between trainer and participant as they work symbiotically through a series of exercises, in which the trainer will also play an active role.  This differs greatly from much of the community-based rehabilitation currently provided in the UK, where a hands-off approach is taken.  Unsurprisingly, a strong sense of camaraderie develops between trainer and participant which boosts morale and encourages a ‘can do’ attitude. This, in turn, reduces dependency and increases the likelihood of the participant embracing new opportunities.

Activity Based Rehabilitation is important in the early stages following injury or diagnosis to encourage the maximum functional recovery, but also has an important role to play in the chronic phases of neurological conditions.  The risk of developing secondary complications after spinal cord injury, such as pressure sores, contractures, cardiovascular disease and diabetes, is high.  To combat these, exercise and movement are vital, but regular gym facilities are often inadequately adapted for wheelchair users or unable to provide the necessary physical assistance for individuals to fully participate.  Alongside these factors, it is important to recognise how difficult it is for anyone to train and stay motivated by themselves.  Activity Based Rehabilitation in chronic injury allows participants to set health and fitness goals, get out of their wheelchairs to exercise in positions that are beneficial for their health and build strength and endurance that can have knock on benefits to their function even after many years of injury. 

Far-reaching benefit

Finally, alongside the physical benefits of Activity Based Rehabilitation, there are also psychological and social benefits, which impact on not only the participant, but also their families, friends, work colleagues and employers.  The combination of these positive impacts leads to a strong case for the Health Economics of Activity Based Rehabilitation as individuals who participate are likely to be healthier and more independent through the physical exercise, but also display superior mental health. This leads to greater resilience and more ability to cope with the demands of their altered lifestyle.  As someone who specialises in Activity Based Rehabilitation at Neurokinex, I can honestly say it’s a hugely rewarding area to work in.

Jane Symonds, Clinical Lead, Neurokinex www.neurokinex.org

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Spinal cord patients see improvement in motor functions in new trial

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After being injected with stem cells, patients reported an improvement with their motor skills

Intravenous injection of bone marrow derived stem cells (MSCs) in patients with spinal cord injuries led to significant improvement in motor functions, new research has found.

For more than half of the patients, substantial improvements in key functions — such as ability to walk, or to use their hands — were observed within weeks of stem cell injection, the study from Yale University reports.

No substantial side effects were observed, they added.

The patients had sustained non-penetrating spinal cord injuries, in many cases from falls or minor trauma, several weeks prior to implantation of the stem cells.

Their symptoms involved loss of motor function and co-ordination, sensory loss, as well as bowel and bladder dysfunction.

The stem cells were prepared from the patients’ own bone marrow, via a culture protocol that took several weeks in a specialised cell processing centre.

The cells were injected intravenously in this series, with each patient serving as their own control. Results were not blinded and there were no placebo controls.

Yale scientists Jeffery D. Kocsis, professor of neurology and neuroscience, and Stephen G. Waxman, professor of neurology, neuroscience and pharmacology, were senior authors of the study, which was carried out with investigators at Sapporo Medical University in Japan.

Key investigators of the Sapporo team, Osamu Honmou and Masanori Sasaki, both hold adjunct professor positions in neurology at Yale.

Professor Kocsis and Professor Waxman stress that additional studies will be needed to confirm the results of this preliminary, unblinded trial.

They also stress that this could take years, but despite the challenges, remain optimistic.

“Similar results with stem cells in patients with stroke increases our confidence that this approach may be clinically useful,” notes Professor Kocsis.

“This clinical study is the culmination of extensive preclinical laboratory work using MSCs between Yale and Sapporo colleagues over many years.”

“The idea that we may be able to restore function after injury to the brain and spinal cord using the patient’s own stem cells has intrigued us for years,” adds Professor Waxman.

“Now we have a hint, in humans, that it may be possible.”

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Inpatient rehab

Family hail ‘amazing’ care at neurorehab centre

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Fraser Millar and his family

A family whose beloved husband and father had a stroke are fundraising for the neurological centre where he currently resident, after being impressed by the “amazing” standards of care.

Fraser Millar needed life-saving brain surgery in November last year and is now in Woodlands Neurological Care Centre in York, receiving intensive rehabilitation to aid his recovery.

Woodlands, a level two neurorehabilitation centre which is part of Active Care Group, specialises in maximising recovery and independence and sets patients rehabilitation goals that promote re-enablement and enhance quality of life.

Now, Fraser’s family – wife Debs and children Alex and Ryan – are fundraising on behalf of Woodlands, to purchase therapy equipment which will benefit people who are undergoing rehabilitation at the centre.

To remember the long walks Fraser and Debs used to enjoy so much, Debs and daughter Alex are walking the equivalent 230 mile distance from York to Perth in Scotland, where Fraser is from.

Having set a target of £500, the total now stands at over ten times that amount, with over £5,680 being raised at the time of writing.

Family, friends and work colleague donations have come from as far afield as Canada and Australia, from people inspired by the Millar family’s story, which has been widely shared on social media and is touchingly accompanied by the hashtag #comeondad.

“We feel the team at Woodlands have become extended members of our family, they’ve been amazing,” says Alex.

“One of dad’s hobbies is cooking, he’s an amazing chef and loves to watch cookery programmes on TV in the kitchen at home. Woodlands staff noted this on his arrival day and within 20 minutes dad was watching The Hairy Bikers in his room and he continues to watch various culinary programmes!

“Staff there make a huge effort to make dad comfortable, take great care of his needs and interact with us brilliantly, we’re so thankful and extremely happy he’s having the best care.

“We’re raising money to say a huge thank you and while we’re doing it for dad, it’s great that it will benefit other patients too.”

Debs and Alex initially set a target of completing their walk by March 7, which is Debs’ birthday, but typical of their determination, they had already finished by February 24. Their fundraising target has also been vastly exceeded, with donations continuing to come in by the day.

“We initially thought our family and close friends would help with our fundraising cause, but the charity page was quickly circulated and within hours are target was met and the figure kept rising, we couldn’t believe it! We are incredibly thankful for every donation,” says Alex.

“We feel so touched and overwhelmed to have had such amazing support for dad. We walked the long miles but the generous donations kept us going and without them we wouldn’t be in the position to present Woodlands with the equipment they deserve.”

To add support to the Millar family’s fundraising on behalf of Woodlands Neurological Care Centre, visit https://www.gofundme.com/f/woodlands-neurological-rehabilitation-centre

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Could sesame seeds help protect against Parkinson’s?

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There is currently no cure of Parkinson's, but research like this could help change that

A chemical commonly found in discarded waste from the sesame seed oil manufacturing process could have protective effects against Parkinson’s disease, new groundbreaking research has found.

Sesaminol, abundant in the empty shells of sesame seeds which are discarded after the fatty oils are extracted, could have a role to play in protecting against neuron damage in the brain, researchers from Osaka City University have revealed.

“Currently there is no preventive medicine for Parkinson’s disease, we only have coping treatments,” says OCU Associate Professor Akiko Kojima-Yuasa.

Professor Kojima-Yuasa led her research group through a series of experiments to understand the effects of sesaminol on in vitro and in vivo Parkinson’s disease models.

Parkinson’s disease is caused when certain neurons in the brain involved with movement break down or die due in part to a situation called oxidative stress – neurons in the brain come under extreme pressure from an imbalance between antioxidants and reactive oxygen species (ROS).

The team found in cell-based in vitro experiments that sesaminol protected against neuronal damage by promoting the translocation of Nrf2, a protein involved in the response to oxidative stress, and by reducing the production of intracellular ROS.

In vivo experiments brought Professor Kojima-Yuasa’s team what the University have hailed as equally promising results.

The impairment of movement due to Parkinson’s disease is the result of damaged neurons producing less dopamine than is naturally needed.

The team showed that mice with Parkinson’s disease models show this lack of dopamine production. However, after feeding the mice a diet containing sesaminol for 36 days, the research team saw an increase in dopamine levels.

Alongside this, a rotarod performance test revealed a significant increase in motor performance and intestinal motor function.

With the first-ever medicine for Parkinson’s disease potentially being the naturally occurring food ingredient sesaminol, and this ingredient being found in the naturally occurring waste of the sesame seed industry, Professor Kojima-Yuasa and her team are ready to take their work to the clinical trial phase and connect the consumption/production chain in a way that, as she puts it, “prevents diseases with natural foods to greatly promote societal health.”

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