Andrea L Behrman

University of Louisville, Louisville, Kentucky, United States

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Publications (115)368.44 Total impact

  • David J Clark · Richard R Neptune · Andrea L Behrman · Steven A Kautz ·
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    ABSTRACT: Objective: To test the hypothesis that participants with stroke will exhibit appropriate increases in muscle activation of the paretic leg when taking a non-paretic long step compared to steady state walking, with a consequent increase in biomechanical output and symmetry during the stance phase of the modified gait cycle. Design: Single-session observational study SETTING: Clinical research center in an outpatient hospital setting. Participants: Fifteen adults with chronic post-stroke hemiparesis. Interventions: Participants walked on an instrumented treadmill while kinetic, kinematic and electromyographical data were recorded. Participants performed steady state walking and a separate trial of the long step adaptability task in which they were instructed to intermittently take a longer step with the non-paretic leg. Main outcome measure(s): Forward progression, propulsive force, and neuromuscular activation during walking. Results: Participants performed the adaptability task successfully and demonstrated greater neuromuscular activation in appropriate paretic leg muscles, particularly heightened activity in paretic plantarflexor muscles. Propulsion and forward progression by the paretic leg were also increased. Conclusions: These findings support the assertion that the non-paretic long step task may be effective for use in post-stroke locomotor rehabilitation in order to engage the paretic leg and promote recovery of walking.
    Archives of physical medicine and rehabilitation 11/2015; DOI:10.1016/j.apmr.2015.10.081 · 2.57 Impact Factor
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    ABSTRACT: Background: The Neuromuscular Recovery Scale (NRS) was developed by researchers and clinicians to functionally classify people with spinal cord injury (SCI) by measuring functionally relevant motor tasks without compensation. Previous studies established strong interrater and test-retest reliability and validity of the scale. Objective: To determine responsiveness of the NRS, a version including newly added upper-extremity items, in an outpatient rehabilitation setting. Methods: Assessments using the NRS and 6 other instruments were conducted at enrollment and discharge from a locomotor training program for 72 outpatients with SCI classified as American Spinal Injury Association Impairment Scale grades A to D (International Standards for Neurological Classification of Spinal Cord Injury). Mixed-model t statistics for instruments were calculated and adjusted for confounding factors (eg, sample size, demographic variables) for all patients and subgroups stratified by injury level and/or severity. The resulting adjusted response means (ARMs) and 95% confidence intervals (CIs) were used to determine responsiveness, and significant differences between instruments were identified with pairwise comparisons. Results: The NRS was significantly responsive for SCI outpatients (ARM = 1.05; CI = 0.75-1.35). Changes in motor function were detected across heterogeneous groups. Regardless of injury level or severity, the responsiveness of the NRS was equal to, and often significantly exceeded, the responsiveness of other instruments. Conclusions: The NRS is a responsive measure that detects change in motor function during outpatient neurorehabilitation for SCI. There is potential utility for its application in randomized controlled trials and as a measure of clinical recovery across diverse SCI populations.
    Neurorehabilitation and neural repair 09/2015; DOI:10.1177/1545968315605181 · 3.98 Impact Factor
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    ABSTRACT: To determine how well the Neuromuscular Recovery Scale (NRS) items fit the Rasch, 1-parameter, partial-credit measurement model. Confirmatory factor analysis (CFA) and principal components analysis (PCA) of residuals were used to determine dimensionality. The Rasch, 1-parameter, partial-credit, rating scale model was used to determine rating scale structure, person/item fit, point-biserial item correlations, item discrimination and measurement precision. Seven NeuroRecovery Network clinical sites. One hundred eighty-eight outpatients with spinal cord injury. Not applicable. Neuromuscular Recovery Scale. While the NRS met one of three CFA criteria, the PCA revealed that the Rasch measurement dimension explained 76.9% of the variance. Ten of 11 items and 91% of the patients fit the Rasch model with 9 of 11 items showing high discrimination. Sixty-nine percent of the ratings met criterion. The items showed a logical item-difficulty order with stand retraining as the easiest item and walking as the most challenging item. The NRS showed no ceiling or floor effects and separated the sample into almost five statistically distinct strata; individuals with American Spinal Injury Association Impairment Scale (AIS)-D classifications showed the most ability and AIS-A classifications showed the least ability. Items not meeting the rating scale criterion appear to be related to the low frequency counts. The NRS met many of the Rasch model criteria for construct validity. Copyright © 2015 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
    Archives of physical medicine and rehabilitation 04/2015; 96(8). DOI:10.1016/j.apmr.2015.04.004 · 2.57 Impact Factor
  • Andrea L Behrman · Craig Velozo · Sarah Suter · Doug Lorenz · D Michele Basso ·
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    ABSTRACT: Determine test-retest reliability of the Neuromuscular Recovery Scale (NRS), a measure to classify lower extremities and trunk recovery of individuals with spinal cord injury (SCI) to typical, pre-injury performance of functional tasks without use of external and behavioral compensation. Multi-center observational study. Five out-patient rehabilitation clinics. Fourteen physical therapists trained and competent in conducting NRS. No intervention was delivered. Therapists rated 69 out-patients with SCI using the NRS. Testing occurred on two days, separated by 24 to 48 hours, on the same patient by the same therapist. Spearman rank correlation coefficients to compare NRS results. The NRS scores motor performance based on normal, pre-injury function on 11 items: 4 treadmill-based items (standing and stepping), 7 overground/mat items (Sitting, Sit-up, Reverse Sit-up, Trunk Extension, Sit-to-Stand, Standing, and Walking). Test-retest reliability was very strong for the NRS items. Ten of the 11 items exhibited Spearman correlation coefficients of 0.92 and greater, and lower bounds of the 95% confidence intervals for these items met or exceeded 0.83. The exception was stand re-training (0.84, [0.68, 0.96]. The test-retest reliability of the measurement model-derived summary score was very strong (0.99 [0.96, 0.99]. The NRS had excellent test-retest reliability when conducted by trained therapists in adults with chronic SCI across all levels of injury severity. All raters had undergone standardized training in use of the NRS. The minimal requirement of training to achieve test-retest reliability has not been established. Copyright © 2015 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
    Archives of physical medicine and rehabilitation 04/2015; 96(8). DOI:10.1016/j.apmr.2015.03.022 · 2.57 Impact Factor
  • D Michele Basso · Craig Velozo · Doug Lorenz · Sarah Suter · Andrea L Behrman ·
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    ABSTRACT: To determine the inter-rater reliability of the Neuromuscular Recovery Scale (NRS) an outcome measure designed for spinal cord injury (SCI). The scale classifies people with complete or incomplete SCI into four phase of injury groups exhibiting reduced variability in measures of balance, gait speed and walking. The NRS, which assesses motor performance based on normal, pre-injury function disallowing use of compensation, includes 4 treadmill-based items, 6 overground/mat items and an overall rating. Outcomes range from 1-4 with up to 3 subclassifications (A, B, C). Higher ratings reflect greater recovery of normal function. Masked comparison, multi-center observational study SETTING: Outpatient rehabilitation PARTICIPANTS: Fourteen raters and a criterion standard expert assigned scores to 10 video NRS assessments of persons with SCI. The raters were volunteers from the NeuroRecovery Network. Not applicable Main outcome measure: Inter-rater reliability measured with Kendall's coefficient of concordance (W) RESULTS: Inter-rater reliability was generally strong (W: 0.91-0.98; CI: 0.65-0.99) while lower reliability occurred for treadmill stand retraining (W: 0.87; CI: 0.06, 1) and seated trunk extension (W: 0.82; CI: 0.28, 0.94). Less experienced raters assigned slightly lower scores than the expert for most items but the difference was less than half a point and did not weaken concordance. NRS had strong inter-rater reliability, a necessary first step in establishing its utility as a clinical and research outcome measure. Copyright © 2015 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
    Archives of Physical Medicine and Rehabilitation 12/2014; 96(8). DOI:10.1016/j.apmr.2014.11.026 · 2.57 Impact Factor
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    ABSTRACT: The Locomotor Experience Applied Post Stroke rehabilitation trial found equivalent walking outcomes for body weight-supported treadmill plus overground walking practice versus home-based exercise that did not emphasize walking. From this large database, we examined several clinically important questions that provide insights into recovery of walking that may affect future trial designs. Using logistic regression analyses, we examined predictors of response based on a variety of walking speed-related outcomes and measures that captured disability, physical impairment, and quality of life. The most robust predictor was being closer at baseline to the primary outcome measure, which was the functional walking speed thresholds of 0.4 m/s (household walking) and 0.8 m/s (community walking). Regardless of baseline walking speed, a younger age and higher Berg Balance Scale score were relative predictors of responding, whether operationally defined by transitioning beyond each speed boundary or by a continuous change or a greater than median increase in walking speed. Of note, the cutoff values of 0.4 and 0.8 m/s had no particular significance compared with other walking speed changes despite their general use as descriptors of functional levels of walking. No evidence was found for any difference in predictors based on treatment group.
    The Journal of Rehabilitation Research and Development 04/2014; 51(1):39-50. DOI:10.1682/JRRD.2013.04.0080 · 1.43 Impact Factor
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    Preeti M. Nair · Chetan P. Phadke · Andrea L. Behrman ·
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    ABSTRACT: Objective To examine the dynamic modulation of the soleus H-reflex while walking with a posterior leaf spring ankle foot orthosis (PAFO). Methods Soleus H-reflexes were evoked on randomly chosen lower limb of fourteen healthy individuals (age range of 22-36 years, 7 women) while walking on a treadmill with and without a PAFO. In order to capture excitability across the duration of the gait cycle, H-reflexes were evoked at heel strike (HS), HS + 100ms, HS + 200ms, HS + 300ms, HS + 400ms in the stance phase and at toe-off (TO), TO + 100ms, TO + 200ms, TO + 300ms, TO + 400ms in the swing phase respectively. Results H-reflex excitability was significantly higher in the form of greater slope of the rise in H-reflex amplitude across the swing phase (p = 0.024) and greater mean H-reflex amplitude (p = 0.014) in the swing phase of walking with a PAFO. There was no change in the slope (p = 0.25) or the mean amplitude of H-reflexes (p = 0.22) in the stance phase of walking with a PAFO. Mean background EMG activity between the two walking conditions was not significantly different for both the tibialis anterior (p = 0.69) and soleus muscles (p = 0.59). Conclusion PAFO increased reflex excitability in the swing phase of walking in healthy individuals. Altered sensory input originating from joint, muscle and cutaneous receptors may be the underlying mechanism for greater reflex excitability. The neurophysiological effect of PAFOs on reflex modulation during walking needs to be tested in persons with neurological injury. The relationship between the sensory input and the reflex output during walking may assist in determining if there exists a neurological disadvantage of using a compensatory device such as a PAFO.
    Gait & posture 04/2014; 39(4). DOI:10.1016/j.gaitpost.2014.01.017 · 2.75 Impact Factor
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    ABSTRACT: RATIONALE: Intermittent stimulation of the respiratory system with hypoxia causes persistent increases in respiratory motor output (i.e., long-term facilitation) in animals with spinal cord injury. This paradigm, therefore, has been touted as a potential respiratory rehabilitation strategy. OBJECTIVES: To determine whether acute (daily) exposure to intermittent hypoxia can also evoke long-term facilitation of ventilation after chronic spinal cord injury in humans, and whether repeated daily exposure to intermittent hypoxia enhances the magnitude of this response. METHODS: Eight individuals with incomplete spinal cord injury (>1 yr; cervical [n = 6], thoracic [n = 2]) were exposed to intermittent hypoxia (eight 2-min intervals of 8% oxygen) for 10 days. During all exposures, end-tidal carbon dioxide levels were maintained, on average, 2 mm Hg above resting values. Minute ventilation, tidal volume, and breathing frequency were measured before (baseline), during, and 30 minutes after intermittent hypoxia. Sham protocols consisted of exposure to room air and were administered to a subset of the participants (n = 4). MEASUREMENTS AND MAIN RESULTS: Minute ventilation increased significantly for 30 minutes after acute exposure to intermittent hypoxia (P < 0.001), but not after sham exposure. However, the magnitude of ventilatory long-term facilitation was not enhanced over 10 days of intermittent hypoxia exposures. CONCLUSIONS: Ventilatory long-term facilitation can be evoked by brief periods of hypoxia in humans with chronic spinal cord injury. Thus, intermittent hypoxia may represent a strategy for inducing respiratory neuroplasticity after declines in respiratory function that are related to neurological impairment. Clinical trial registered with (NCT01272011).
    American Journal of Respiratory and Critical Care Medicine 11/2013; 189(1). DOI:10.1164/rccm.201305-0848OC · 13.00 Impact Factor
  • Sharon Barak · Samuel S Wu · Yunfeng Dai · Pamela W Duncan · Andrea L Behrman ·
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    ABSTRACT: The step activity monitor (SAM) quantifies steps taken in the home and community by patient populations. While the SAM has been used to study individuals post-stroke, compliance with SAM has not been addressed. Participants' compliance in wearing the monitor is critical for obtaining accurate assessments. The purpose of this study was to determine the rate of and predictors for inferred compliance with the SAM post-stroke. Cross-sectional. 408 community-dwelling individuals two-months post-stroke with moderate-to-severe gait impairment (gait speed of ≤ 0.8 m/s). Step activity was assessed for two days with the SAM. Inferred compliance was established in three periods: 6:00AM-12:00PM, 12:01PM-6:00PM, and 6:01PM-12:00AM. Compliance was defined as activity recorded in all three periods. The percentage of participant compliance for the first day, second day, both days, and either day was calculated. Demographic and clinical characteristics of compliers and non-compliers were compared. Independent compliance predictors were identified using stepwise logistic regression. Inferred compliance rate in the first day, second day, both days, and either day was 68, 61, 53, and 76%, respectively. Upper and lower extremity impairment, balance control and endurance were significantly different between compliers and non-compliers. On the other hand, older age, greater balance self-efficacy, and better walking endurance were found to be significant predictors of compliance. Participants consisted of individuals with sub-acute stroke. Therefore, our findings may not be generalized to individuals during the acute and chronic phases of stroke recovery. Strategies to improve compliance are needed, when collecting data for more than one day, and in samples with younger individuals, and persons with low levels of balance self-efficacy and walking endurance.
    Physical Therapy 09/2013; 94(1). DOI:10.2522/ptj.20120473 · 2.53 Impact Factor
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    ABSTRACT: In this article we explore how people with incomplete spinal cord injury (iSCI) create meaning out of their changing bodies as they undergo a therapeutic intervention called locomotor training (LT). Therapeutic interventions like LT are used to promote the recovery of walking ability among individuals with iSCI. The chronological nature of this study-interviews at three points throughout the 12-week intervention-enhances understanding of the recovering self after spinal cord injury. Drawing on a constructivist theoretical framework, we organize data according to three narrative frames. Participants interpreted LT as (a) a physical change that was meaningful because of its social significance, (b) a coping strategy for dealing with the uncertainty of long-term recovery, and (c) a moral strategy to reconstitute the self. We offer findings that lay the conceptual groundwork for generating new knowledge about what is important to people with iSCI as they relearn how to walk.
    Qualitative Health Research 06/2013; 23(8). DOI:10.1177/1049732313494119 · 2.19 Impact Factor
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    ABSTRACT: A module is a functional unit of the nervous system that specifies functionally-relevant patterns of muscle activation. In adults, 4-5 modules account for muscle activation during walking. Neurologic injury alters modular control and is associated with walking impairments. The effect of neurologic injury on modular control in children is unknown and may differ from adults due to their immature and developing nervous systems. We examined modular control of locomotor tasks in children with incomplete spinal cord injuries (ISCIs) and control children. Five controls (8.6 ± 2.7 years) and five children with ISCIs (8.6 ± 3.7 years) performed treadmill walking, overground walking, pedaling, supine lower extremity flexion/extension, stair climbing, and crawling. Electromyograms (EMGs) were recorded in bilateral leg muscles. Non-negative matrix factorization was applied and the minimum number of modules required to achieve 90% of the "variance accounted for" (VAF) was calculated. On average, 3.5 modules explained muscle activation in the controls; whereas, 2.4 modules were required in the children with ISCIs. To determine if control is similar across tasks, the module weightings identified from treadmill walking were used to reconstruct the EMGs from each of the other tasks. This resulted in VAF values exceeding 86% for each child and each locomotor task. Our results suggest that 1) modularity is constrained in children with ISCIs; 2) for each child, similar neural control mechanisms are used across locomotor tasks. These findings suggest that interventions that activate the neuromuscular system to enhance walking also may influence the control of other locomotor tasks.
    Journal of Neurophysiology 06/2013; 110(6). DOI:10.1152/jn.00676.2012 · 2.89 Impact Factor
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    ABSTRACT: Objectives To identify the clinical measures associated with improved walking speed after locomotor rehabilitation in individuals poststroke and how those who respond with clinically meaningful changes in walking speed differ from those with smaller speed increases.DesignA single group pre-post intervention study. Participants were stratified on the basis of a walking speed change of greater than (responders) or less than (nonresponders) .16m/s. Paired sample t tests were run to assess changes in each group, and correlations were run between the change in each variable and change in walking speed.SettingOutpatient interdisciplinary rehabilitation research center.ParticipantsHemiparetic subjects (N=27) (17 left hemiparesis; 19 men; age: 58.74±12.97y; 22.70±16.38mo poststroke).InterventionA 12-week locomotor intervention incorporating training on a treadmill with body weight support and manual trainers accompanied by training overground walking.Main Outcome MeasuresMeasures of motor control, balance, functional walking ability, and endurance were collected at pre- and postintervention assessments.ResultsEighteen responders and 9 nonresponders differed by age (responders=63.6y, nonresponders=49.0y, P=.001) and the lower extremity Fugl-Meyer Assessment score (responders=24.7, nonresponders=19.9, P=.003). Responders demonstrated an average improvement of .27m/s in walking speed as well as significant gains in all variables except daily step activity and paretic step ratio. Conversely, nonresponders demonstrated statistically significant improvements only in walking speed and endurance. However, the walking speed increase of .10m/s was not clinically meaningful. Change in walking speed was negatively correlated with changes in motor control in the nonresponder group, implying that walking speed gains may have been accomplished via compensatory mechanisms.Conclusions This study is a step toward discerning the underlying factors contributing to improved walking performance.
    Archives of physical medicine and rehabilitation 05/2013; 94(5):856–862. DOI:10.1016/j.apmr.2012.11.032 · 2.57 Impact Factor
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    ABSTRACT: OBJECTIVE: To assess the relationship between Exercise Tolerance Test (ETT) performance at 6-weeks post-stroke and subsequent performance in a treadmill and overground Locomotor Training Program (LTP). DESIGN: Prospective, cohort study. SETTING: Exercise testing laboratory in either a primary care hospital or outpatient clinic. PARTICIPANTS: Community-dwelling individuals (n= 469), 54.9±19.0 days post-stroke, enrolled in the Locomotor Experience Applied Post Stroke (LEAPS) randomized controlled trial. INTERVENTIONS: Not applicable MAIN OUTCOME MEASURES: For participants randomized to LTP, the number of sessions needed to attain the training goal of 20 minutes of treadmill stepping was determined. Regression analyses determined the contribution of ETT performance (cycling duration), age, and Six-Minute Walk Test (6MWT) distance to attainment of the stepping duration goal. RESULTS: Age, 6MWT and ETT performance individually accounted for 10.74%, 10.82% and 10.76%, respectively, of the variance in number of sessions needed to attain 20 minutes of stepping. When age and 6MWT were included in the model, the additional contribution of ETT performance was rendered non-significant (p=0.150). CONCLUSION: To the extent that ETT performance can be viewed as a measure of cardiovascular fitness rather than neurological impairment, cardiovascular fitness at the time of the ETT did not make a significant unique contribution to number of sessions needed to achieve 20 minutes stepping duration . The 6MWT, which involves less intensive exercise than the ETT and therefore likely to be predominantly affected by neurological impairment and muscular condition, appeared to account for as much variance as the ETT.
    Archives of physical medicine and rehabilitation 03/2013; 94(7). DOI:10.1016/j.apmr.2013.01.031 · 2.57 Impact Factor
  • Andrea L Behrman · Mark G Bowden · Dorian K Rose ·
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    ABSTRACT: The clinical trial is essential to testing efficacy and effectiveness of therapeutic interventions. Neurorehabilitation presents unique challenges in the execution of clinical trials due to the complexity of both human interface with complex interventions and clinical/research staff interaction. Attention to key elements, recruitment, retention, treatment fidelity, and control intervention selection, contributes to successful conduct of a trial. Alternatives to the randomized controlled trial and outcome measure selection are important considerations contributing to the merit of the trial. While clinical trial outcomes contribute to the scientific evidence, their true value and impact comes in the next step, translation to clinical practice and the improvement of patient outcomes and qualify of life. Translation of evidence into practice may best be achieved via partnerships of scientists, clinicians, and administrators resulting in a dynamic interface between science and practice, the laboratory, and the clinic.
    Handbook of Clinical Neurology 01/2013; 110:61-6. DOI:10.1016/B978-0-444-52901-5.00005-8
  • Susan Harkema · Andrea Behrman · Hugues Barbeau ·
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    ABSTRACT: Physical rehabilitation for individuals coping with neurologicaql deficits is evolving in response to a paradigm shift in thinking about the injured nervous system and using evidence as a basis for clinical decisions. Functional recovery from paralysis was generally believed to be nearly impossible, based on traditional expert opinion, and the priority was to develop compensation strategies to achieve functional goals in the home and community. Research, which began in animal models of neurological insult and is currently being translated to the clinic, has challenged these assumptions. The nervous system, whether intact or injured, has enormous potential for adaptation and modification, which can be harnessed to facilitate recovery. In this chapter we will briefly outline the history of physical rehabilitation as it concerns the development of strategies aimed at compensation, rather than functional recovery. Then we will discuss how new activity-based therapies are being developed, based on evidence from basic science and clinical evidence. One of these activity-based therapies is locomotor training, a program which relies on the intrinsic, automatic, control of locomotion by "lower" neural centers. A brief description of the program, including the four foundational principles, will be followed by an introduction to the use of robotics in these programs. Finally, we will discuss a second activity-based therapy, functional electrical stimulation (FES), and the future of physical rehabilitation for spinal cord injury and other neurological disorders.
    Handbook of Clinical Neurology 12/2012; 109:259-74. DOI:10.1016/B978-0-444-52137-8.00016-4
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    Andrea L Behrman · Shelley A Trimble ·

    Developmental Medicine & Child Neurology 10/2012; 54(12). DOI:10.1111/j.1469-8749.2012.04440.x · 3.51 Impact Factor
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    ABSTRACT: To develop a scale (Neuromuscular Recovery Scale [NRS]) for classification of functional motor recovery after spinal cord injury (SCI) based on preinjury movement patterns that would reduce variability of the populations' level of function within each class, because assessment of functional improvement after SCI is problematic as a result of high variability of the populations' level of function and the insensitivity to change within the available outcome measures. Prospective observational cohort with longitudinal follow-up. Seven outpatient rehabilitation centers from the Christopher and Dana Reeve Foundation NeuroRecovery Network (NRN). Individuals (N=95) with American Spinal Injury Association Impairment Scale (AIS) grade C or AIS grade D having received at least 20 locomotor training treatment sessions in the NRN. Intensive locomotor training including stepping on a treadmill with partial body weight support and manual facilitation and translation of skills into home and community activities. Berg Balance Scale, six-minute walk test, and ten-meter walk test. Individuals classified within each of the 4 phases of the NRS were functionally discrete, as shown by significant differences in the mean values of balance, gait speed, and walking endurance, and the variability of these measurements was significantly reduced by NRS classification. The magnitude of improvements in these outcomes was also significantly different among phase groups. Assessment with the NRS provides a classification for functional motor recovery without compensation, which reduces variability in performance and improvements for individuals with injuries classified as AIS grades C and D.
    Archives of physical medicine and rehabilitation 09/2012; 93(9):1518-29. DOI:10.1016/j.apmr.2011.04.027 · 2.57 Impact Factor
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    ABSTRACT: Scientists, clinicians, administrators, individuals with spinal cord injury (SCI), and caregivers seek a common goal: to improve the outlook and general expectations of the adults and children living with neurologic injury. Important strides have already been accomplished; in fact, some have labeled the changes in neurologic rehabilitation a "paradigm shift." Not only do we recognize the potential of the damaged nervous system, but we also see that "recovery" can and should be valued and defined broadly. Quality-of-life measures and the individual's sense of accomplishment and well-being are now considered important factors. The ongoing challenge from research to clinical translation is the fine line between scientific uncertainty (ie, the tenet that nothing is ever proven) and the necessary burden of proof required by the clinical community. We review the current state of a specific SCI rehabilitation intervention (locomotor training), which has been shown to be efficacious although thoroughly debated, and summarize the findings from a multicenter collaboration, the Christopher and Dana Reeve Foundation's NeuroRecovery Network.
    Archives of physical medicine and rehabilitation 09/2012; 93(9):1588-97. DOI:10.1016/j.apmr.2012.04.032 · 2.57 Impact Factor
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    ABSTRACT: We present a retrospective case series of 2 individuals with motor-incomplete spinal cord injury (SCI) to examine differences in lifetime cost estimates before and after participation in an intensive locomotor training (LT) program. Sections of a life care plan (LCP) were used to determine the financial implications associated with equipment, home renovations, and transportation for patients who receive LT. An LCP is a viable method of quantifying outcomes following any therapeutic intervention. The LCP cases analyzed were a 61-year-old woman and a 4½-year-old boy with motor-incomplete SCI and impairments classified by the American Spinal Injury Association Impairment Scale (AIS) as AIS D and AIS C, respectively. Each patient received an intensive outpatient LT program 3 to 5 days per week. The 61-year-old woman received 198 sessions over 57 weeks and the 4½-year-old boy received 76 sessions over 16 weeks. The equipment, home renovation, and transportation costs of an LCP were calculated before and after LT. Prior to the implementation of LT, the 61-year-old woman had estimated lifetime costs between $150,247.00 and $199,654.00. Following LT, the estimated costs decreased to between $2010.00 and $2446.00 (a decrease of $148,237.00 and $197,208.00). Similarly, the 4-year-old boy had estimated lifetime costs for equipment, home renovation, and transportation between $535,050.00 and $771,665.00 prior to LT. However, the estimated costs decreased to between $97,260.00 and $200,047.00 (a decrease of $437,790.00 and $571,618.00) following LT. The lifetime financial costs associated with equipment, home renovations, and transportation following a motor-incomplete SCI were decreased following an intensive LT program for the 2 cases presented in this article. The LCP, including costs of rehabilitation and long-term medical and personal care costs, may be an effective tool to discern cost benefit of rehabilitation interventions.
    Journal of neurologic physical therapy: JNPT 07/2012; 36(3):144-53. DOI:10.1097/NPT.0b013e318262e5ab · 1.77 Impact Factor
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    ABSTRACT: Harkema SJ, Schmidt-Read M, Lorenz D, Edgerton VR, Behrman AL. Balance and ambulation improvements in individuals with chronic incomplete SCI using locomotor training–based rehabilitation.
    Archives of physical medicine and rehabilitation 05/2012; 93(5):919-21. DOI:10.1016/j.apmr.2012.02.022 · 2.57 Impact Factor

Publication Stats

3k Citations
368.44 Total Impact Points


  • 2012-2015
    • University of Louisville
      • • Kentucky Spinal Cord Injury Research Center
      • • Department of Neurological Surgery
      Louisville, Kentucky, United States
  • 1995-2013
    • University of Florida
      • • Department of Physical Therapy
      • • Department of Neuroscience
      Gainesville, Florida, United States
  • 2011
    • Duke University
      • Center for Health Policy & Inequalities Research
      Durham, North Carolina, United States
  • 2010
    • University of Victoria
      • Laboratory for Rehabilitation Neuroscience
      Victoria, British Columbia, Canada
  • 2009
    • McKnight Brain Institute
      Gainesville, Florida, United States
  • 2003
    • University of California, Los Angeles
      • Department of Neurology
      Los Ángeles, California, United States