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Shepherd Center Takes Integrative Approach to Upper Limb Recovery

Research shapes clinical practice and vice versa, reinforcing Shepherd Center’s commitment to caring for the whole person.

Upper limb rehabilitation has often played second fiddle to efforts aimed at re-establishing and strengthening lower-limb function. It’s seemingly not been as glorified in the field where images of someone’s first steps seem unrivaled.

Yet, as many people living with tetraplegia will attest, regaining use of their hands and arms may offer even greater independence. This is not to say walking again isn’t an important goal. But many patients say doing so will not help them get dressed, use the bathroom or feed themselves – daily activities that leave them completely dependent on someone else. 

Shepherd Center has always been dedicated to helping patients regain use of their arms and hands. Now, with the help of Deborah Backus, Ph.D., director of MS research, Shepherd is expanding its efforts and taking an integrative approach to upper limb research and recovery – and, in turn, giving clinicians and patients the tools they need to see improvements sooner.

By marrying its research program and clinical data collection, researchers are able to ask more pointed questions, and clinicians can better tailor treatments to individual patients. Backus and her team are also determining the most important outcome measures and identifying best practices for using various technologies and activity-based interventions.

“We are taking what we learn through research and feeding it directly into the clinic,” Backus explained. “The upper limb lab actually came out of these efforts and is allowing us to deliver a level of care we haven’t been able to provide before.”

It’s become a symbiotic relationship in which research and clinical practice inform each other. The data is also helping researchers understand how the upper limbs recover following spinal cord injury (SCI).

“We are finding that it’s not all about strength, but also spasticity, sensation and dis-coordination,” Backus added. “Patients often have trouble turning their muscles on and off at the right time.”

One promising approach for these patients, in particular, is a device called AMES. It combines sensory input using vibrators during repeated movement to strengthen what normally happens in the muscles. Research using the device, done in collaboration with creator, Paul Cordo, Ph.D., at Oregon Health and Science University, finds some people have less pain and spasticity and improved coordination, which leads to functional improvements in the use of their limbs. In the research setting, people with tetraplegia participated in 12 to 24 sessions with the device, but dramatic changes in function have been reported in as few as four sessions.  

“What we found in our research was great, but even better is that we can use it in the clinic in an everyday setting,” said Casey Kandilakis, PT, a Shepherd Center therapist who splits her time between research and working one-on-one with patients.

She explained there have been real advantages to involving and engaging clinicians in the process, too.

“We are helping them integrate the findings from the literature and our own research studies into more effective, individualized treatment sessions, using the ‘cool tools’ we have,” Kandilakis added.

Another critical goal, Backus noted, is to amass enough data to influence health care reimbursement decisions so people with tetraplegia can access this kind of rehabilitation.  

“Shepherd has really advanced its upper limb rehabilitation program,” Backus said. “We are fortunate to have a unique combination of clinical and research focus.”

For more information on Shepherd Center research, visit

Written by Amanda Crowe, MA, MPH
Photos by Louie Favorite

About Shepherd Center

Shepherd Center provides world-class clinical care, research, and family support for people experiencing the most complex conditions, including spinal cord and brain injuries, multi-trauma, traumatic amputations, stroke, multiple sclerosis, and pain. An elite center recognized as both Spinal Cord Injury and Traumatic Brain Injury Model Systems, Shepherd Center is ranked by U.S. News as one of the nation’s top hospitals for rehabilitation. Shepherd Center treats thousands of patients annually with unmatched expertise and unwavering compassion to help them begin again.