There are significant improvements in participants' function, including trunk control, endurance, speed of walking and balance, which translate into better ability to perform activities of daily living and reduce dependence on caregivers. There are demonstrable improvements in cardiovascular, pulmonary, and bladder function and increased bone density. In general, NRN participants are showing improved overall physical well-being and quality of life.

2008 NRN highlights:

• Over 220 pataients have been enrolled across the seven NRN clinical centers.
• During January's national training week, all NRN personnel were in Louisville to sharpen their Locomotor Training skills and insure the standardization of all programmatic elements across all NeuroRecovery Network sites.
• NextStep Fitness in Lawndale, CA officially opened its doors for business on June 5, 2008; it joins the Community Fitness and Wellness Center at Frazier Rehab Institute as the second NRN community-based facility.
• This year's Regional Training is underway with future sessions slated at Frazier Rehab, Magee and TIRR.

How Locomotor Training works
Significant advances have been made in our understanding of how the brain and spinal cord are wired and their capacity to rewire after injury and disease as a result of activity-based therapies.  As a result of this new knowledge, new rehabilitation strategies have emerged, among them Locomotor Training (LT) which is used for people with brain and spinal cord injury (SCI), stroke and other neurological disorders.  Many people with SCI, regardless of time elapsed since their injury, have improved their walking after receiving Locomotor Training in research programs and clinics in Germany, Canada, Switzerland, and the United States.  Although it is not widely available in clinics in the United States, it is standard therapy for people with an incomplete SCI in Germany, Norway and Switzerland.

Presently, the Reeve Foundation’s NeuroRecovery Network (NRN) is deploying LT to spinal cord injured patients with incomplete cervical or thoracic injuries who have some movement or muscle tone in their legs.

Although no two patients respond to the therapy in exactly the same way, all NRN patients experience change as a result of LT.  These changes can include improved recovery of independent walking and/or improvements in overall health and well-being.  For some, health improvements can include better cardiovascular and pulmonary function, increased bone density, decreased spasticity, a decrease in the likelihood of skin lesions and improved glucose intolerance. 

The way in which the NRN delivers Locomotor Training is based on current knowledge of how the brain and spinal cord control stepping and how the nervous system learns a motor skill.  LT is delivered in a systematic and standardized way across all NRN centers using three primary component parts:

1. Step Training using Body Weight Support on a Treadmill (BWST) and manual assistance
2. Over-Ground Walking Training
3. Community Ambulation Training

During the first phase, sensory information from the legs and trunk during walking is repetitively sent to the spinal cord using BWST.  The sensory input comes from the actual stepping, from the manual contact of the therapist on the patient and from the contact of the sole of the foot on the ground.  The therapist insures that the patient is optimizing standing and walking although as the patient improves, the assistance of the therapist is reduced. 

The same training principles used in Step Training, and the skills acquired by the patient, are then transferred to the Over-Ground Walking, and Community Ambulation phases.  Locomotor Training consists of a continuum of training principles that are applied across the three training environments.

Apply to Become a Patient
To apply to become a patient of the NeuroRecovery Network, please click on the link below of the center(s) where you'd like to receive therapy.  (Note: Please fill out a form for each center you're interested in applying to).

• Frazier Rehab Institute, Louisville, Kentucky

• Magee Rehabilitation Hospital, Philadelphia, Pennsylvania

• The Institute for Rehabilitation and Research, Houston, Texas

• Shepherd Center, Atlanta, Georgia

• Boston Medical Center, Boston, Massachussetts

• Kessler Institute For Rehabilitation, West Orange, New Jersey

• Ohio State University Medical Center, Columbus, Ohio

• Download a brochure about the NRN which includes this years' Regional Training Course Calendar

Community Based NeuroRecovery Network Facilities
In the effort to provide a continuum of care in the area of health promotion, the Community Based NeuroRecovery Network facilities will provide individuals with paralysis the opportunity to be ‘fit for life’. These Community Based NRN facilities host an activity-based exercise program designed specifically for individuals with physical disabilities within the community. These fully accessible facilities are designed to assist clients in the improvement of cardiovascular/aerobic fitness, muscular strengthening and flexibility.

The Reeve Foundation believes that these community-based facilities will enable a more rapid expansion of the NRN program nationwide, which means that more individuals who are spinal cord injured will have access to its cutting-edge activity-based treatments.

Community Based NeuroRecovery Network Facilities FAQ:
What is the difference between a traditional NRN Network Center and a community-based facility?
At the present time, NRN centers can only accept individuals with an incomplete cervical or thoracic spinal cord injury who have some movement or muscle tone in their legs. An NRN community-based facility can accept individuals with gait impairments related to any cause. In a community-based facility, the  NRN Locomotor Training component is part of a larger exercise facility.

What are the criteria for joining a community-based NRN Locomotor Training program?
A client must have a  completed medical release form ,  signed by  his or her  physician, stating that  he or she is medically and physically stable to participate in the NRN LT program.

What is the cost of joining a facility?
Each community-based facility is independently operated; therefore, cost of membership will vary by facility. Unlike traditional NRN Network Centers, the client is responsible for all costs associated with membership.

Our Community Fitness and Wellness Facilities:
Frazier Rehab Institue - Louisville, Kentucky (Download the PDF).
NextStep Fitness - Lawndale, CA
As more community-based NRN facilities come on board we will list them here.

Success Stories:
5-Year-Old Chase is Walking Again

How freshman cornerback for Penn State recovered from his spinal cord injury

The NRN gets this mom back on her feet

Patients’ Frequently Asked Questions
Who qualifies to participate in the NeuroRecovery Network?
At the present time, the program is open to individuals with an incomplete cervical or
thoracic spinal cord injury who have some movement or muscle tone in their legs.

What steps does one have to take to receive treatment by the NRN?
Patients must have a referral from a physician to receive this therapy. All potential
patients must be seen by the NRN physician and physical therapists at the NRN facility, to be screened for any complicating medical issues that would make this therapy inappropriate. Following this valuation, if deemed appropriate for this therapy, a plan of treatment will be established.

How long will the course of therapy take?
The average person receives the therapy for three to four months, and will undergo around 60 sessions. Each patient is re-evaluated every 20 sessions. At that time, the NRN physicians and therapists will take any adjustments to the number of days per week and talk about the goals for the next 20 visits.

How much time will each Locomotor Training session take?
Each session generally lasts one and a half hours. When a patient enters the program, they start five days per week. As they progress through the phases of recovery, the number of days per week declines to four days/week and then three days/week.

What is the cost of receiving therapy through the NRN? Who will pay for it?
NRN sites are committed to working with every patient to secure reimbursement for participating in this program. It is expected that costs will be covered by your insurance company. Membership fees for Community Based NRN facilities are expected to be covered by the patient.

What should I bring to each session? Do I have to buy special equipment?
All patients need bring to a training session is loose-fitting clothes appropriate for physical activity. The equipment needed will be provided by the NRN.

What results can I expect? What long-term improvements to my health will this therapy provide?
A range of results and health improvements are reported in the scientific literature; others are beginning to emerge as we apply this therapy to human patients. What we know is that results will vary from patient to patient. No two NRN patients will respond in exactly the same way, nor is each patient likely to experience the entire range of possible changes and improvements.

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 to recovery of standing and stepping ability.