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    Can leg muscle recovery stimulate further recovery?

    I was looking at Project Walk's site, under the page The First Year Post-Injury, item #10: "If you are not stimulating your lower body, you will not regain function or use of it."

    I was intrigued by the description of how recovery sometimes takes place. According to the description, as the leg muscles gain strength, more is demanded of muscles above and below the pelvis. This stimulates the hip muscles, and recovery may occur upwards -- lower back, abs, and rest of upper body.

    What do you think of this theory? Also, have you ever heard of anyone recovery use of quadriceps first before toe wiggling?

    Thanks.

    #2
    I think the Project Walk site, while meaning well and does great for people, is sometimes biased towards their own business. I regained motor function of my right leg three months after my injury and I wasn't in heavy therapy because I was still healing from major surgery and an open incision.

    Comment


      #3
      The information posted on the Project Walk site seems to be representative of their observations and theories. Some of their assertions appeal to "common sense." We see a lot of people that are benefitting from Project Walk, peppered on their website and on this one.

      Yet, overwhelmingly, it seems like if you can't succeed it's because you're not trying hard enough/long enough.

      In our years of experience, we have seen clients with the potential to recover, fail, while others with more severe injuries succeed. The difference between these people is how they each approached the process of recovery. The people who failed set deadlines while the successful thought of recovery as a lifelong journey.
      I'm very much interested in hearing from people who may have benefitted from Project Walk from exercise perspective, but not much in the areas of returns.
      Daniel

      Comment


        #4
        Project Walk has never said that spontaneous recovery of function does not occur after injury. It is a medically proven fact that it does. The big question is when do you decide that you are no longer recovering function? The old medical paradigm was that whatever you recovered in the first 2 years is what you would have for the rest of your life. Dr. John McDonald, Project Walk, and other exercise based programs have shown the world that recovery can occur well after that 2 year mark when exercise is introduced. We believe that the sooner you go after regaining function through exercise, the better chance you will have of recovering significant function.

        Research studies are beginning to show that exercise leads to a spike in the levels of neurotrophins within the spinal cord. Neurotrophins are the builders and caretakers of the nervous system. After an injury they are downregulated (levels are depressed), and through exercise we may be able to upregulate them to a level above what they were pre-injury. Would you rather have this happen as soon as possible after your injury or wait for a year or two?


        A couple of studies:



        Gene Expr. 2005;12(2):107-21.

        Exercise-induced gene expression changes in the rat spinal cord.

        Perreau VM, Adlard PA, Anderson AJ, Cotman CW.

        Institute for Brain Aging and Dementia, 1113 Gillespie N.R.F., University of California Irvine, Irvine, CA 92697, USA. vperreau@uci.edu

        There is growing evidence that exercise benefits recovery of neuromuscular function from spinal cord injury (SCI). However, the effect of exercise on gene expression in the spinal cord is poorly understood. We used oligonucleotide microarrays to compare thoracic and lumbar regions of spinal cord of either exercising (voluntary wheel running for 21 days) or sedentary rats. The expression data were filtered using statistical tests for significance, and K-means clustering was then used to segregate lists of significantly changed genes into sets based upon expression patterns across all experimental groups. Levels of brain-derived neurotrophic factor (BDNF) protein were also measured after voluntary exercise, across different regions of the spinal cord. BDNF mRNA increased with voluntary exercise, as has been previously shown for other forms of exercise, contributed to by increases in both exon I and exon III. The exercise-induced gene expression changes identified by microarray analysis are consistent with increases in pathways promoting neuronal health, signaling, remodeling, cellular transport, and development of oligodendrocytes. Taken together these data suggest cellular pathways through which exercise may promote recovery in the SCI population.

        Exp Neurol. 2005 Jun;193(2):411-9.

        Exercise restores levels of neurotrophins and synaptic plasticity following spinal cord injury.

        Ying Z, Roy RR, Edgerton VR, Gomez-Pinilla F.

        Department of Physiological Science, UCLA, Los Angeles, CA 90095-1527, USA; Division of Neurosurgery, UCLA Brain Injury Research Center, Los Angeles, CA 90095-1527, USA.

        We have conducted studies to determine the potential of exercise to benefit the injured spinal cord using neurotrophins. Adult rats were randomly assigned to one of three groups: (1) intact control (Con); (2) sedentary, hemisected at a mid-thoracic level (Sed-Hx), or (3) exercised, hemisected (Ex-Hx). One week after surgery, the Ex-Hx rats were exposed to voluntary running wheels for 3, 7, or 28 days. BDNF mRNA levels on the lesioned side of the spinal cord lumbar region of Sed-Hx rats were approximately 80% of Con values at all time points and BDNF protein levels were approximately 40% of Con at 28 days. Exercise compensated for the reductions in BDNF after hemisection, such that BDNF mRNA levels in the Ex-Hx rats were similar to Con after 3 days and higher than Con after 7 (17%) and 28 (27%) days of exercise. After 28 days of exercise, BDNF protein levels were 33% higher in Ex-Hx than Con rats and were highly correlated (r=0.86) to running distance. The levels of the downstream effectors for the action of BDNF on synaptic plasticity synapsin I and CREB were lower in Sed-Hx than Con rats at all time points. Synapsin I mRNA and protein levels were higher in Ex-Hx rats than Sed-Hx rats and similar to Con rats at 28 days. CREB mRNA values were higher in Ex-Hx than Sed-Hx rats at all time points. Hemisection had no significant effects on the levels of NT-3 mRNA or protein; however, voluntary exercise resulted in an increase in NT-3 mRNA levels after 28 days (145%). These results are consistent with the concept that synaptic pathways under the regulatory role of BDNF induced by exercise can play a role in facilitating recovery of locomotion following spinal cord injury.


        Eric Harness, CSCS
        Founder/President
        Neuro Ex, Inc
        Adaptive Performance and Neuro Recovery

        Comment


          #5
          Dan...I think you are taking that particular quote out of context. That statement I believe is in reference to people giving up their life somewhere else to come here and think and do Project walk 24/7. Our experience has shown that these people may begin to see functional return but by the time it happens they are burnt out and just want to return home. That is one reason we developed the Home Based program and the Train Your Trainer program, so people could get the some of the benefits of our program without having to move here.

          The successful people are the ones who devote several hours a week to exercise but have a life to pursue outside of PW/exercise.


          Eric Harness, CSCS
          Founder/President
          Neuro Ex, Inc
          Adaptive Performance and Neuro Recovery

          Comment


            #6
            Eric,

            Of course I understand that it's important to develop a lifestyle of exercise-based-recovery for the best chances of success. I'm hearing a lot of good things about your program, but certainly with SCI nothing is for certain. Are there people who are not accepted into your program? Are there people that Project Walk would not be appropriate for?
            Daniel

            Comment


              #7
              Dan

              The following link takes you to the "Entry Requirements" page of our website.

              Entry Requirements


              Eric Harness, CSCS
              Founder/President
              Neuro Ex, Inc
              Adaptive Performance and Neuro Recovery

              Comment


                #8
                Eric,

                Project Walk is important because I've noticed how much stronger my right leg is just from exercising it and this is eight years post-injury.

                Todd

                Comment


                  #9
                  Dan has some very impotant questions. Also, do most insurance companies provide payment for your clients or do most pay out of pocket?

                  Comment


                    #10
                    Those questions are answered in that link.
                    Some do, some don't depends on the insurer. Many of our clients are paying out of pocket, however this "pocket" does include trust funds (most set up specifically to pay for PW).


                    Eric Harness, CSCS
                    Founder/President
                    Neuro Ex, Inc
                    Adaptive Performance and Neuro Recovery

                    Comment


                      #11
                      Originally posted by Le Type Français
                      Eric,

                      Project Walk is important because I've noticed how much stronger my right leg is just from exercising it and this is eight years post-injury.

                      Todd
                      Todd,

                      Have you been to PW?

                      Dan
                      Daniel

                      Comment


                        #12
                        Originally posted by Snowman
                        Project Walk has never said that spontaneous recovery of function does not occur after injury. It is a medically proven fact that it does. The big question is when do you decide that you are no longer recovering function? The old medical paradigm was that whatever you recovered in the first 2 years is what you would have for the rest of your life. Dr. John McDonald, Project Walk, and other exercise based programs have shown the world that recovery can occur well after that 2 year mark when exercise is introduced. We believe that the sooner you go after regaining function through exercise, the better chance you will have of recovering significant function.

                        Research studies are beginning to show that exercise leads to a spike in the levels of neurotrophins within the spinal cord. Neurotrophins are the builders and caretakers of the nervous system. After an injury they are downregulated (levels are depressed), and through exercise we may be able to upregulate them to a level above what they were pre-injury. Would you rather have this happen as soon as possible after your injury or wait for a year or two?


                        A couple of studies:



                        Gene Expr. 2005;12(2):107-21.

                        Exercise-induced gene expression changes in the rat spinal cord.

                        Perreau VM, Adlard PA, Anderson AJ, Cotman CW.

                        Institute for Brain Aging and Dementia, 1113 Gillespie N.R.F., University of California Irvine, Irvine, CA 92697, USA. vperreau@uci.edu

                        There is growing evidence that exercise benefits recovery of neuromuscular function from spinal cord injury (SCI). However, the effect of exercise on gene expression in the spinal cord is poorly understood. We used oligonucleotide microarrays to compare thoracic and lumbar regions of spinal cord of either exercising (voluntary wheel running for 21 days) or sedentary rats. The expression data were filtered using statistical tests for significance, and K-means clustering was then used to segregate lists of significantly changed genes into sets based upon expression patterns across all experimental groups. Levels of brain-derived neurotrophic factor (BDNF) protein were also measured after voluntary exercise, across different regions of the spinal cord. BDNF mRNA increased with voluntary exercise, as has been previously shown for other forms of exercise, contributed to by increases in both exon I and exon III. The exercise-induced gene expression changes identified by microarray analysis are consistent with increases in pathways promoting neuronal health, signaling, remodeling, cellular transport, and development of oligodendrocytes. Taken together these data suggest cellular pathways through which exercise may promote recovery in the SCI population.

                        Exp Neurol. 2005 Jun;193(2):411-9.

                        Exercise restores levels of neurotrophins and synaptic plasticity following spinal cord injury.

                        Ying Z, Roy RR, Edgerton VR, Gomez-Pinilla F.

                        Department of Physiological Science, UCLA, Los Angeles, CA 90095-1527, USA; Division of Neurosurgery, UCLA Brain Injury Research Center, Los Angeles, CA 90095-1527, USA.

                        We have conducted studies to determine the potential of exercise to benefit the injured spinal cord using neurotrophins. Adult rats were randomly assigned to one of three groups: (1) intact control (Con); (2) sedentary, hemisected at a mid-thoracic level (Sed-Hx), or (3) exercised, hemisected (Ex-Hx). One week after surgery, the Ex-Hx rats were exposed to voluntary running wheels for 3, 7, or 28 days. BDNF mRNA levels on the lesioned side of the spinal cord lumbar region of Sed-Hx rats were approximately 80% of Con values at all time points and BDNF protein levels were approximately 40% of Con at 28 days. Exercise compensated for the reductions in BDNF after hemisection, such that BDNF mRNA levels in the Ex-Hx rats were similar to Con after 3 days and higher than Con after 7 (17%) and 28 (27%) days of exercise. After 28 days of exercise, BDNF protein levels were 33% higher in Ex-Hx than Con rats and were highly correlated (r=0.86) to running distance. The levels of the downstream effectors for the action of BDNF on synaptic plasticity synapsin I and CREB were lower in Sed-Hx than Con rats at all time points. Synapsin I mRNA and protein levels were higher in Ex-Hx rats than Sed-Hx rats and similar to Con rats at 28 days. CREB mRNA values were higher in Ex-Hx than Sed-Hx rats at all time points. Hemisection had no significant effects on the levels of NT-3 mRNA or protein; however, voluntary exercise resulted in an increase in NT-3 mRNA levels after 28 days (145%). These results are consistent with the concept that synaptic pathways under the regulatory role of BDNF induced by exercise can play a role in facilitating recovery of locomotion following spinal cord injury.

                        OK-OK enough email already! I want to thank the dedicated and concerned CC members who have emailed requests for my commentary on Snowman and PW’s latest attempt to “Snow the CC” readers.

                        Snowman,
                        For Project Walk (remember, people, this is just a gym in southern CA) to say, worse, to mislead readers of CC to believe that they are on the same level of expertise as Dr. McDonald and the rest of the scientists at Kennedy Krieger Institute’s International Center for Spinal Cord Injury is a self serving maneuver as well as a blatant lie through false advertising--- plain and simple.

                        True, scientific journals have published results of controlled clinical trials conducted by Dr. McDonald demonstrating proof of his hypothesis. What data from controlled trials has Project walk generated to support this theory? Aligning yourselves with Dr. McDonald based on what is most likely some anecdotal conclusion once again demonstrates Project Walk’s pattern of false advertising for monetary gain.



                        Readers, ask PW for proof of how “PW’s has shown the world that recovery can occur well after that 2 year mark when exercise is introduced”, as Snowman stated above. Since he aligns himself with the type of Proof demonstrated by John McDonald’s work, we must all ask him to provide proof of his contribution to this body of research. We know medical institutions like Shepherded, KKI, Craig, Wash U and RCI can prove their assertions with clinical data. PW, on the other hand, will sight gym members’ anecdotal, subjective personal commentary as evidence of their claims. The two bodies of proof are mutually exclusive. Kudos to PW for supporting the rehab of SCI patients as a means to more movement. Shame on PW for alluding to research never conducted on the premises and claiming alignment with other researchers for personal profit.

                        Further, readers of CC, PW’s program has no similarity to the SCI program administered at KKI. Dr. McDonald’s scientific, advanced restoration therapies and clinical trials are designed to aid in restoring function as well as measure the therapies’ efficacy based on years of scientific research by some of our nations most respected medical MDs & PhDs. That type of program is in no way similar to the exercises recommended by SOME GUY IN A GYM (Snowman)!

                        How does a gym compare itself to a facility with medical staff trained to address pressure sores, UTI, chemical imbalances, proper medications, just to name a few critical issues surrounding the daily care and rehabilitation needs of a person with an SCI.

                        If a gym like PW is going to try and piggyback off of years of work and studies completed by world renowned MDs, PhDs like Dr. McDonald, than the PW gym should publicize data supporting their own claims specifying PW’s scientific exercise recovery studies. They should utilize specific exclusion criteria as well as scientific protocols and end points that Project Walk has sent through an RIB process destined for approval by top national and international review boards consisting of SCI PhDs & MDs before being published in a medical journal. Once completed, they may then claim to align with others conducting similar research.

                        How ironic that PW aligns with Dr. McDonald without following the scientific principles of advanced restoration therapies developed by this world-renowned expert in SCI research. .

                        We, the readers of CC, would also like to see PW’s scientific studies providing proof of their statement “We believe that the sooner you go after regaining function through exercise, the better chance you will have of recovering significant function”. PW has neither the creditability nor proof to state anything other than that they (PW) are a gym that SCI may use in lieu of expert care such as that provided in specialized institutions such as KKI.


                        If an organization, in this case a gym, makes statements aligning themselves with experts, they should be ready to back up their claims with scientific proof. Anything less constitutes false advertising begging the question, “who gains from such cavalier claims”.
                        Ross

                        Comment


                          #13
                          Originally posted by dan_nc
                          Todd,

                          Have you been to PW?

                          Dan
                          No, I'm still under my dad's insurance so I seek out forms that will be covered by federal insurance. Plus I'm fortunate in that a lot of the therapy I can and will continue to do can be done on my own.

                          Comment


                            #14
                            Originally posted by Ross1
                            OK-OK enough email already! I want to thank the dedicated and concerned CC members who have emailed requests for my commentary on Snowman and PW’s latest attempt to “Snow the CC” readers.

                            Snowman,
                            For Project Walk (remember, people, this is just a gym in southern CA) to say, worse, to mislead readers of CC to believe that they are on the same level of expertise as Dr. McDonald and the rest of the scientists at Kennedy Krieger Institute’s International Center for Spinal Cord Injury is a self serving maneuver as well as a blatant lie through false advertising--- plain and simple.

                            True, scientific journals have published results of controlled clinical trials conducted by Dr. McDonald demonstrating proof of his hypothesis. What data from controlled trials has Project walk generated to support this theory? Aligning yourselves with Dr. McDonald based on what is most likely some anecdotal conclusion once again demonstrates Project Walk’s pattern of false advertising for monetary gain.



                            Readers, ask PW for proof of how “PW’s has shown the world that recovery can occur well after that 2 year mark when exercise is introduced”, as Snowman stated above. Since he aligns himself with the type of Proof demonstrated by John McDonald’s work, we must all ask him to provide proof of his contribution to this body of research. We know medical institutions like Shepherded, KKI, Craig, Wash U and RCI can prove their assertions with clinical data. PW, on the other hand, will sight gym members’ anecdotal, subjective personal commentary as evidence of their claims. The two bodies of proof are mutually exclusive. Kudos to PW for supporting the rehab of SCI patients as a means to more movement. Shame on PW for alluding to research never conducted on the premises and claiming alignment with other researchers for personal profit.

                            Further, readers of CC, PW’s program has no similarity to the SCI program administered at KKI. Dr. McDonald’s scientific, advanced restoration therapies and clinical trials are designed to aid in restoring function as well as measure the therapies’ efficacy based on years of scientific research by some of our nations most respected medical MDs & PhDs. That type of program is in no way similar to the exercises recommended by SOME GUY IN A GYM (Snowman)!

                            How does a gym compare itself to a facility with medical staff trained to address pressure sores, UTI, chemical imbalances, proper medications, just to name a few critical issues surrounding the daily care and rehabilitation needs of a person with an SCI.

                            If a gym like PW is going to try and piggyback off of years of work and studies completed by world renowned MDs, PhDs like Dr. McDonald, than the PW gym should publicize data supporting their own claims specifying PW’s scientific exercise recovery studies. They should utilize specific exclusion criteria as well as scientific protocols and end points that Project Walk has sent through an RIB process destined for approval by top national and international review boards consisting of SCI PhDs & MDs before being published in a medical journal. Once completed, they may then claim to align with others conducting similar research.

                            How ironic that PW aligns with Dr. McDonald without following the scientific principles of advanced restoration therapies developed by this world-renowned expert in SCI research. .

                            We, the readers of CC, would also like to see PW’s scientific studies providing proof of their statement “We believe that the sooner you go after regaining function through exercise, the better chance you will have of recovering significant function”. PW has neither the creditability nor proof to state anything other than that they (PW) are a gym that SCI may use in lieu of expert care such as that provided in specialized institutions such as KKI.


                            If an organization, in this case a gym, makes statements aligning themselves with experts, they should be ready to back up their claims with scientific proof. Anything less constitutes false advertising begging the question, “who gains from such cavalier claims”.
                            Ross
                            Ross,
                            I think you have a legitimate point! CC should take a good look at this.
                            gerry

                            Comment


                              #15
                              Originally posted by Ross1
                              OK-OK enough email already! I want to thank the dedicated and concerned CC members who have emailed requests for my commentary on Snowman and PW’s latest attempt to “Snow the CC” readers.

                              Snowman,
                              For Project Walk (remember, people, this is just a gym in southern CA) to say, worse, to mislead readers of CC to believe that they are on the same level of expertise as Dr. McDonald and the rest of the scientists at Kennedy Krieger Institute’s International Center for Spinal Cord Injury is a self serving maneuver as well as a blatant lie through false advertising--- plain and simple.

                              True, scientific journals have published results of controlled clinical trials conducted by Dr. McDonald demonstrating proof of his hypothesis. What data from controlled trials has Project walk generated to support this theory? Aligning yourselves with Dr. McDonald based on what is most likely some anecdotal conclusion once again demonstrates Project Walk’s pattern of false advertising for monetary gain.



                              Readers, ask PW for proof of how “PW’s has shown the world that recovery can occur well after that 2 year mark when exercise is introduced”, as Snowman stated above. Since he aligns himself with the type of Proof demonstrated by John McDonald’s work, we must all ask him to provide proof of his contribution to this body of research. We know medical institutions like Shepherded, KKI, Craig, Wash U and RCI can prove their assertions with clinical data. PW, on the other hand, will sight gym members’ anecdotal, subjective personal commentary as evidence of their claims. The two bodies of proof are mutually exclusive. Kudos to PW for supporting the rehab of SCI patients as a means to more movement. Shame on PW for alluding to research never conducted on the premises and claiming alignment with other researchers for personal profit.

                              Further, readers of CC, PW’s program has no similarity to the SCI program administered at KKI. Dr. McDonald’s scientific, advanced restoration therapies and clinical trials are designed to aid in restoring function as well as measure the therapies’ efficacy based on years of scientific research by some of our nations most respected medical MDs & PhDs. That type of program is in no way similar to the exercises recommended by SOME GUY IN A GYM (Snowman)!

                              How does a gym compare itself to a facility with medical staff trained to address pressure sores, UTI, chemical imbalances, proper medications, just to name a few critical issues surrounding the daily care and rehabilitation needs of a person with an SCI.

                              If a gym like PW is going to try and piggyback off of years of work and studies completed by world renowned MDs, PhDs like Dr. McDonald, than the PW gym should publicize data supporting their own claims specifying PW’s scientific exercise recovery studies. They should utilize specific exclusion criteria as well as scientific protocols and end points that Project Walk has sent through an RIB process destined for approval by top national and international review boards consisting of SCI PhDs & MDs before being published in a medical journal. Once completed, they may then claim to align with others conducting similar research.

                              How ironic that PW aligns with Dr. McDonald without following the scientific principles of advanced restoration therapies developed by this world-renowned expert in SCI research. .

                              We, the readers of CC, would also like to see PW’s scientific studies providing proof of their statement “We believe that the sooner you go after regaining function through exercise, the better chance you will have of recovering significant function”. PW has neither the creditability nor proof to state anything other than that they (PW) are a gym that SCI may use in lieu of expert care such as that provided in specialized institutions such as KKI.


                              If an organization, in this case a gym, makes statements aligning themselves with experts, they should be ready to back up their claims with scientific proof. Anything less constitutes false advertising begging the question, “who gains from such cavalier claims”.
                              Ross
                              Ross,

                              You need to relax. PW offers a service and if you don't like it, don't buy it.

                              This same post can be said about a number of SCI recovery centers. Some incorporate FES machines, some don't. If you want FES, don't go to PW, or just supplement FES elsewhere.

                              PW is a gym that specializes in SCI recovery. It's not a research center, hospital, or medical institute. To me, after dealing with the medical community for whatever length of time after SCI, this is a good thing and quite refreshing. PW is a recovery/training center, not PT/OT that you get in the hospital. They treat you as an 'injured athlete' being rehabed back, not as a sick person. I like this, this is how I'd rather be treated.

                              FES has proven to beneficial, OK. PW currently chooses not to incorporate it in their program, for whatever reason, this is OK too.

                              Snowman, thanks for all that you do, you offer your knowledge freely. Your time is valuable and precious, we don't take it for granted.

                              I haven't read much from other 'experts', from other centers, in regards to practical exercise advice. I hope they will take your lead and try to be as helpful as you have been.

                              This cannibalistic attitude that Ross has employed needs to stop. We all need each other to get through this.
                              Last edited by rickhemi; 9 Feb 2006, 1:30 PM.
                              Rick

                              GO FORWARD! 2 FIGHT! PARALYSIS!

                              Comment

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