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NeuroRecovery Network (NRN)

NeuroRecovery Network (NRN)

  • The NeuroRecovery Network (NRN) is a cooperative network between the Christopher & Dana Reeve Foundation, the Centers for Disease Control and Prevention and 6 cutting-edge rehabilitation centers designed to provide and develop therapies to promote functional recovery and improve the health and quality of life for people living with paralysis
  • The NRN translates the latest scientific advances into effective, activity-based rehabilitation treatments
  • Locomotor Training (LT) is the primary activity-based intervention provided by the NRN
  • LT derives from recent advances in scientific understanding about neural plasticity (the ability of the neurons in the nervous system to develop new connections and “learn” new functions) and the role the spinal cord plays in controlling step¬ping and standing. Locomotor training works to “awaken” dormant neural pathways by repetitively stimulating the muscles and nerves in the lower body—allowing patients whose lower bodies may appear partially or completely disconnected from input from the brain to regain motor abilities and achieve rehabilitation goals
  • LT sessions consist of one hour in the body weight support environment, where the patient is suspended in a harness over the treadmill while specially trained therapists move their legs and body to simulate walking, and 30 minutes of training in the Overground environment
  • NRN is an outpatient physical therapy program with LT sessions 5 times per week for 2 hours per day
  • The intensity of the intervention combined with the repetition and task specific activity is what helps drive recovery and changes in functional ability

What data is collected by the NRN?

  • Participants in the NRN become part of a network-wide database that is collecting information about the progress of each patient, such as changes on functional outcome measures
  • By collecting and analyzing this information, the NRN is able to accurately measure program outcomes
  • Recent findings from this program evaluation were published in the September 2012 issue of the Archives of Physical Medicine and Rehabilitation and provide guidance for clinical decision-making

What results can I expect?

  • A range of results and health improvements are reported in the scientific literature after participating in activity-based therapy
  • This therapy may contribute to improved cardiovascular and pulmonary function and blood flow to the arms and legs. In some patients, it may boost the healing potential of the skin, help increase bone density, and improve bladder function
  • Functional results among NRN patients have ranged from improved trunk stability and increased independence with transfers to recovery of standing and walking.

Who can participate in the NRN program?

  • The inclusion criteria are listed below
  • If an individual is unable to meet these criteria we would recommend they follow up with our outpatient facility for therapy

NeuroRecovery Network (NRN) Inclusion Criteria

February 2015

  1. Non-progressive spinal cord lesion at level T10 or above
  2. American Spinal Injury Association Impairment Scale (AIS) grade A or B
  3. Chronic (>5 yrs post injury) American Spinal Injury Association Impairment Scale (AIS) grade C or D
  4. No signs of lower motor neuron lesion
  5. The following diagnostic groups may be included in the NRN: traumatic, transverse myelitis, spinal cord infarct, surgically decompressed primary tumor (excluding radiation or chemo), stable infectious treated infections (excluding HIV)
  6. Following are excluded from participation in the NRN: multiple sclerosis, ALS, lower motor neuron disorders
  7. Not participating in an inpatient rehabilitation program
  8. Funding source and ability to complete a minimum of 65 therapy visits
  9. Stable with no deteriorating medical condition
  10. No pacemaker present
  11. If had tendon lengthening procedure in previous 6 months, surgical wounds must be well healed and they must have approval from their surgeon to participate in the NRN
  12. Not ventilator dependent
  13. Able to voluntarily extend head
  14. No painful musculoskeletal dysfunction, or unhealed fractures, that would contraindicate Locomotor Training
  15. Able to follow/understand verbal commands
  16. Demonstrates capacity for generating a lower extremity reciprocal alternating flexion/extension stepping pattern (volitional or non-volitional with manual facilitation) in the step training environment
  17. Normal or hypertonicity present in the absence of anti-spasticity meds
  18. No oral or intrathecal pump (baclofen, morphine, clonidine, benzos, antispasticity agents, etc.) delivery – or compliance to reduce and eliminate these medications
  19. No use of botulinum toxin within the previous 3 months. This includes injection or washing of the bladder with botox, no injection of botox to the skin, the muscles of the upper or lower extremities or the trunk. If a patient receives botox injection or washing after enrollment in the NRN, the patient will be suspended or discharged from the NRN program
  20. Consideration of seizure medication use
  21. Compliance to eliminate or minimize lower extremity orthotics
  22. No current illegal drug use
  23. Compliance and motivation of person to participate
  24. Ability to adhere to attendance and frequency policy
    • Therapy 5x/week
    • No > 2 missed therapy sessions every month
  25. Compliance with completing all outcome measures at each evaluation
    • Includes things like online quality of life survey and blood draw for evaluation of fasting lipid profile
  26. Agreeable to return for 6 month and 1 year follow up visits after discharge from the program

Request More Information

Request more information about the NRN from TIRR Memorial Hermann by completing a form for TIRR Memorial Hermann on the Christer & Dana Reeve Foundation website.

Learn more about the NRN on the Christopher and Dana Reeve Foundation website.