David R Dolbow
Assistant Professor
School of Kinesiotherapy
University of Southern Mississippi

Tell me a little about your background?

I completed BS and Master of Education degrees in Human Movement with specializations in Kinesiotherapy and Exercise Science respectively from Boston University. Then a PhD in Human Performance with specialization in Exercise Science from Middle Tennessee State University and a DPT in Physical Therapy from Belmont University. Initially, I pursued a career in clinical rehabilitation as a Kinesiotherapist and then later as a Physical Therapist. I then transitioned to research as a Physical Therapist Research Specialist. After more than thirty years of working in medical settings I again transitioned to academia where I have been teaching and conducting research at the University of Southern Mississippi for nearly three years.

Tell us about the research that you have been conducting into the accelerated ageing phenomenon following a SCI?

Physical activity is vital to countering the effects of aging and age related diseases and is a key component in the maintenance of a healthy body composition. Individuals with a SCI have been reported to have physical activity levels 60% below that of the able-bodied population. This leads to an increased incidence of conditions associated with physical inactivity, including heart disease, atherosclerosis, metabolic syndrome, diabetes mellitus, obesity, and osteoporosis.

My research focus is on the deconditioning phenomenon that takes place after spinal cord injury, and serves to highlight the benefits of activity based restorative therapies including functional electrical neuromuscular stimulation. Restoration of a healthy body composition for those two years or greater post spinal cord injury is vital for decreased the elevated risk of cardiovascular and metabolic diseases shared within the SCI population.

From your research what do you see are the benefits of activity based restorative therapies for individuals following a SCI?

There was once a belief that the central nervous system was hardwired with no hope of restoration of function after injury. Over the last couple of decades there has been a gradual paradigm shift of philosophy guiding SCI rehabilitation, recognizing the potential for neuroplasticity. Neuroplasticity can be defined as the ability of the nervous system to reorganize itself by forming new neural connections in the brain and spinal cord. Neuroplasticity allows the neurons to compensate for injury and disease and appears to be at least partially driven by physical activity.

The term, activity-based restorative therapies (ABRT) is the therapy format that attempts to optimize neuroplasticity for the restoration of function, while at the same time compensating for lost motor activities through the application of skilled rehabilitation techniques.  Thus, activity based restorative therapies provides the opportunity to maximize functional recovery and at the same time helps to establish an active lifestyle needed for the maintenance of long term wellness.

What do you see as the importance of including functional electrical neuromuscular stimulation with activity based restorative therapies for people with a SCI? 

Functional electrical neuromuscular stimulation (FES) activities are physical training activities that use external electrical stimulation to assist muscles or induce activity in paralyzed muscles. They are an essential component of ABRT. People with a SCI and other paralytic conditions find it difficult to engage paretic limbs in physical activity without the application of FES.

FES therapy has been shown to increase muscle mass, decrease fat mass, and improve bone mineral density below the level of injury. Additional benefits found in humans via externally stimulated muscle contractions include increased cardiovascular fitness and decreased risk of gluteal pressure ulcers after FES therapy three times a week for at least two months.

What conclusion are you able to reach from your research?

The catastrophic effects of SCI can be far reaching, resulting in loss of independence and increased risk of inactivity-based medical conditions. ABRT provides one option to help optimize rehabilitation through the restoration of function and the introduction to physical activities via adapted equipment. Rehabilitation centers that specialize in SCI treatment are at best regionally based, thus can be difficult for all individuals with SCI to access. Typical rehabilitation clinics not specializing in SCI care are able to provide modified ABRT programs but lack the staffing and adaptive equipment provided in the larger SCI rehabilitation centers. Community fitness centers offer some possible options but many still lack full accessibility for those who are wheelchair reliant and most do not provide specialized adaptive equipment or trained staff to meet the special needs of individuals with SCI and other paralytic conditions. It is important for health care providers to continue to advocate for greater access and accommodation of wheelchair-reliant individuals by community fitness centers.

What advice would you give to someone who had a SCI?

I would always advise people with a spinal cord injury to stay as active as they are able to be.  After their initial treatment and hospitalization, I would recommend rehabilitation in a center that focuses on ABRT, to optimize the possibility of neuroplasticity leading to the restoration of potential functional recovery.

Post rehabilitation I would recommend they gain access to a RT300 FES system, at home or at a convenient location to enable sessions three times a week. I would also recommend getting involved in appropriate sporting activities, there are so many to choose from. Physical activity is your friend, and participating with a group of friends is the best way to keep actively engaged. Obviously eating well is also important and will assist in the maintenance of health and wellness.