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Activity-based therapy (ABT) is a restorative approach that promotes neurological recovery below the level of injury in individuals with spinal cord injury or disease (SCI/D). This study sought to understand how ABT and its associated technologies were being used in community-based facilities across Canada. One to two participants from ten community-based ABT facilities completed a semi-structured interview that queried types of technologies or techniques used in ABT, and barriers and facilitators to providing ABT for individuals with SCI/D. Interviews were audio-recorded and transcribed verbatim, and analyzed using an interpretive description approach to identify themes and categories. The overarching theme that emerged was that ABT in the community is a client-centered approach characterized by variety in techniques, clinicians, and clientele. The researchers identified three categories within this theme: characteristics of ABT in the community, perceived challenges, and a need for advocacy. Participants advocated for earlier implementation, increased education, and reduced costs of ABT to address the challenges with implementation and accessibility. The use of ABT and its associated technologies varied across participating community-based facilities in Canada, despite a consistent focus on client goals and well-being. Addressing system-level limitations of ABT may improve implementation and accessibility in Canada. Activity-based therapy (ABT) is a group of interventions targeting recovery of sensory and motor function below the level of injury in individuals with spinal cord injury or disease (SCI/D). ABT in the community emphasizes a client-centered approach and is characterized by variety in techniques, clinicians, and clientele. Participants advocated that earlier implementation, reduced costs, and increased education will help overcome barriers to providing ABT, ultimately assisting to facilitate neurorecovery in individuals with SCI/D. Challenges in implementation, accessibility, and knowledge of ABT exist, highlighting a need to explore and address system-level limitations in Canada. [ABSTRACT FROM AUTHOR]

Activity-Based Therapy (ABT) targets recovery of function below the injury level in individuals with spinal cord injury (SCI). This qualitative study is the first to capture the perspectives of individuals with SCI on community ABT programs in Canada. Ten participants (6 males, aged 23.0–65.0 years, 2.5–23.0 years post-SCI) were recruited using purposive sampling, and completed semi-structured interviews. Interview questions explored benefits and challenges, facilitators and barriers to access, and motivations for participating in ABT. Themes were identified using conventional content analysis and collaboratively analyzed using the DEPICT model. An overarching theme of ABT as a key part of participants' evolving and lifelong recovery process emerged. Motivations for initiating ABT included dissatisfaction with early rehabilitation, and a desire to improve function and stay active. Participants perceived that ABT contributed to neurological recovery, physical and mental health benefits, independence, and hope. Factors contributing to recovery and factors limiting accessibility and participation in ABT were identified. Participants discussed advocating for ABT, and how ABT empowered self-management. ABT was perceived to play a significant role in promoting ongoing recovery and well-being in individuals with SCI. Addressing limitations in awareness and availability of ABT may improve participation in ABT programs. Activity-Based Therapy (ABT) targets recovery of function and sensation below the level of injury in individuals with spinal cord injury (SCI). ABT plays a key role in the evolving and lifelong recovery process of individuals with SCI. Participants reported that ABT has a positive impact on physical, functional, and psychosocial domains, leading to improved independence and quality of life. Awareness and availability of ABT remain limited, highlighting a need to further explore and address factors limiting access to this therapy. [ABSTRACT FROM AUTHOR]

Spinal cord injury/disease (SCI/D) impacts sensory, motor and autonomic function. Epidural stimulation (ES) has the potential to improve function across many domains. To synthesize the effects of ES on functional goals for individuals with SCI/D. Seven biomedical databases were searched. Inclusion criteria required (1) ES as the primary intervention, (2) human participants with SCI/D, (3) pre-post measure of an orthotic and/or therapeutic effect, and (4) original data. Data extracted were participant characteristics, ES and exercise parameters, outcome measures, complications, orthotic and/or therapeutic effects. Data were synthesized descriptively according to functional goal. Critical appraisal was completed using the Downs and Black modified checklist. Included studies were case studies or case-series (n = 24), or pre-post interventions (n = 23). One study was a case-control. Research quality was poor to fair. There were mixed results of ES on bladder and sexual function, and standing in participants with SCI/D. Effects of ES included improved bowel function, increased cardiorespiratory and cardiometabolic function, pain reduction, decreased spasms and spasticity, and, when combined with repetitive movement training, improved gait parameters. In the one study focused on the upper extremity, grip strength improved. ES shows promise as an intervention to improve functional goals after SCI/D with a focus on locomotion. [ABSTRACT FROM AUTHOR]