Activity-Based Interventions for the Upper Extremity in Spinal Cord Injury

Although approximately half of all people with spinal cord injury (SCI) have upper extremity (UE) dysfunction, there is a great deal of technology and focus on improving leg strength and retraining gait after SCI and not on UE strength and function. The principles of activity-based interventions, which involve intense activity to access and improve spinal cord circuitry and to produce long-lasting neural and functional changes, are being routinely translated to rehabilitation of the lower extremities in individuals with SCI. Activity-based approaches may be useful for facilitating long-term neural and functional changes in the UE as well. Yet, the understanding of how to facilitate UE movement in tetraplegia and how to develop and apply new approaches or technology to improve UE function is significantly lacking. This article evaluates the literature pertaining to the use of activity-based interventions to improve UE function after SCI and discusses the relevance of evidence for activity-based interventions in the stroke population as well as that from the literature examining the effects of activity-based interventions for retraining the lower extremity after SCI to determine whether activity-based interventions may be useful for retraining arm and hand function after SCI.