Going "Beyond Therapy" to Enhance Strength and Wellness

Nothing ever hurt so good to Vicky Stewart than her first week in Shepherd Center's Beyond Therapy program. For four grueling days, the 54-year-old former barrel-horse racer worked out on cardiovascular machines, contracting muscles in her legs and buttocks with the help of electrical stimulation. While immersed in the warm water of Shepherd's accessible pool, she also stretched and flexed dozens of muscles, like her thighs and abs, that hadn't been exercised in four years.

"I'm getting everything back in shape," said Stewart, an incomplete C-6/7 tetraplegic who was injured during a horse-riding accident in 2001. "My goal is to get as strong as I possibly can."

Toning up seldom-used muscles is a central objective of the new Beyond Therapy program at Shepherd Center. The program, which started in May, is designed to help people with SCI improve their lifelong health, minimize secondary complications and get the most out of any new neural links to their muscles.

"We recognized the need for our patients to receive intense therapy beyond what traditional healthcare provides," explains Debbie Backus, Shepherd Center's SCI research director. "We also wanted to establish a good, activity-based program to promote lifelong wellness."

Beyond Therapy has three main components: a traditional wellness program that offers nutritional counseling and access to Shepherd Center's ProMotion fitness center; a "rigorous boot camp" that's like getting your own hard-nosed personal trainer; and a service that helps people with SCI both evaluate and get evaluated for experimental therapies. The staff consists of a full-time manager, exercise physiologist, physical therapist, and a part-time occupational therapist.

Backus said the program goes beyond the therapy a person receives as an inpatient or even an outpatient, where the focus is on adapting to a new set of capabilities. "Those programs are designed to get patients as independent as possible and trained on how to take care of themselves after discharge," she explains.

In contrast, Beyond Therapy focuses on maximizing muscle return, especially weaker muscles that may have been ignored in the initial phases of recovery.

For Stewart, the difference is like "night and day."

"When I was an inpatient at Shepherd Center, they helped me maximize the muscles I had and taught me a whole new lifestyle," she said. "This program seems almost geared to get you up and walking -- if you have the muscles and the connections left."

Before enrolling in Beyond Therapy, Stewart had been slowly regaining muscle sensation and movement. Since her 2001 discharge, she kept in shape by exercising occasionally on a hand-powered exercise bicycle and a standing glider - a machine for people with leg paralysis that resembles a NordicTrack cross-country ski trainer - in her Barnesville, Georgia home.

Resting on her couch one night last spring, she surprised herself and her personal-care attendant by lifting up her right foot for the first time since her injury. Soon after, Stewart visited Shepherd Center to inquire about an experimental-drug trial to optimize muscle function. She didn't qualify for the trial, but, because of her improved functional level, she did qualify for the fitness component of Beyond Therapy.

Today, Stewart continues to build endurance and strength by working with physical therapist Candy Tefertiller and exercise physiologist Josh Zottnick on an electrical-stimulation bike, a standing frame and a new machine called the Giger, which exercises all four extremities simultaneously.

The only downside is that she has to pay for Beyond Therapy out of her own pocket. That's because most insurers pay only for therapy designed to help a patient reach a specific functional goal, like getting dressed independently or transferring from their wheelchair into the shower. Backus, however, is pushing insurers to cover the program.

"What we're doing in Beyond Therapy should decrease secondary complications in your typical SCI patient," she said.

Even without insurance coverage, Beyond Therapy has a waiting list of would-be participants. Stewart said it's well worth the cost. On a recent visit to her local doctor, the staff took note of better muscle definition in her legs and her improved posture. She hopes the improvement continues. "My goal is to get as strong as I possibly can," says Stewart, who plans to walk again someday, "and I'm definitely getting stronger."