Activity-Based Training Helps Clients Go Beyond Therapy

With fitness equipment lining the walls and loud music pumping overhead, the gym that houses Shepherd Center’s Beyond Therapy^® program is a good place to get a workout. But for clients of the program, it’s the workout of a lifetime.

“They push you harder than any therapy you’ll ever do,” says Beyond Therapy client Reid Roller, 23, of Scottsburg, Va. “When you feel like you don’t have anything left in the tank, they know how to get even more out of you.”

Launched in 2005, Beyond Therapy is Shepherd Center’s rigorous, activity-based neurological rehabilitation program. It integrates physical therapy and exercise physiology to facilitate neurological and functional recovery in people who have sustained a neurological injury, such as a spinal cord injury (SCI), acquired brain injury (ABI) or stroke.

Reid sustained an SCI at age 20 in a high-speed automobile crash. In the accident, Reid’s spinal cord was pinched around his C-7 vertebra, resulting in paralysis from the chest down. After an initial stay at Duke University Hospital, Reid was transferred to Shepherd Center, where he spent more than a week in intensive care before moving to the inpatient rehabilitation program. Because of Shepherd Center’s broad continuum of care, Reid was able to continue his care in Beyond Therapy after completing inpatient and day program rehabilitation. While he had just started learning to walk with a walker when he joined the program, he struggled with maintaining balance. Reid’s therapists focused on this issue.

“They really worked on getting me to regain my sense of balance,” Reid says. “I did a lot of leg and core strengthening. I gained so much strength in those few weeks at Beyond Therapy that I knew I had to come back.”

Rather than helping patients merely compensate for their injuries, Beyond Therapy works to promote both neurological and functional recovery. The program is based on research suggesting that activity-based therapy can help the central nervous system strengthen and reorganize, a concept known as neuroplasticity. Physical therapy and exercise physiology work together to encourage neuroplasticity.

“We work clients at a level that is 50 to 75 percent more intensive than traditional physical therapy programs,” says Rebecca Washburn, M.S., wellness manager at Shepherd Center. “If you’re training at that level, then you’re likely to be more successful.”

The program also uses a balanced total-body approach rather than focusing just on the areas affected by injury.

“Say the goal is arms,” Washburn says. “We might put somebody in a standing position or a quadruped position to work their core lower extremities, as well as focus on their upper extremities. For someone to be most successful, they have to strengthen all aspects of their body.”

Typically, clients participate in Beyond Therapy from 12 to 24 weeks. After they return home and work on the exercises the program assigns, they often come back for a shorter six- to eight-week stay to continue to improve. While Beyond Therapy is a self-pay program and costs $100 per hour, the program staff can give clients tips on how to raise the funds for treatment. Some workers' compensation carriers cover the cost of Beyond Therapy.

Reid returned to Beyond Therapy after more than a year at home to build his endurance and balance and to get closer to his goal of walking again. At first, he could only use the walker for 30 minutes without tiring. Now, he can go for one to two hours. He’s also much better at walking with forearm crutches. More than just improving his physical strength, Reid says Beyond Therapy also has boosted his mental strength.

“My confidence is 10 times better than it was since coming here the second time,” he notes. “I wasn’t really confident with the crutches, but they watched me use them and saw I could do it. They said, ‘It’s all in your head. You have the balance. You’re just afraid of falling, and that keeps you from doing what you need to do to take better steps, I’ve gained strength and learned how to use my legs as they’re supposed to be used.”

While most therapy programs mainly use exercise physiologists, Beyond Therapy assigns each client to a primary physical therapist, as well as a primary exercise physiologist. The team spends two days evaluating the client’s strength and abilities and working with them to set goals. They then spend the rest of their time driving their clients to meet their potential.

“While we look at their level of function when they come in, we don’t want to be limited by that,” Washburn says. “Our therapists are so creative.”

Shepherd Center also has made a commitment to provide the best equipment to help clients achieve their goals. This includes tools such as the Lokomat^®, a robotic, body-weight supported gait-training device, Bioness electrical stimulation devices and WAVE vibration plates – to name a few.

At the conclusion of Beyond Therapy, therapists spend a good amount of time planning an at-home exercise regimen for clients to help them improve once they’ve returned home.

“They work to help you get stronger,” Reid says. “They make you work harder than you think you’re able to, and once you see how far you can go, it really builds up your confidence. They really care about getting you where you want to be.”

For more information, visit www.beyond-therapy.org.

Written By David Terraso
Photos by Louie Favorite