Phase I (Reactivation)
& Phase II (Development/Stablization)

 

Reactivation (some researchers call this stage reorganization or the relearning of the nervous system) is what causes the most controversy regarding The Dardzinski Method™ practiced at Project Walk®. We believe that a nervous system traumatized by a spinal cord injury can reorganize itself when introduced to proper external stimulation. Without external stimulation, the human nervous system deteriorates. When it is drugged to prevent sensation and muscle contractions, when it is exposed to treatment that refuses to touch the paralyzed body parts, how can you expect anyone to improve? NASA and the Russian space programs have both spent millions of dollars researching how the body deteriorates when exposed to reduced gravity, including loss of bone density and muscle mass(1,6-8). Place a person with a spinal cord injury in a power chair, pump them full of drugs, and leave them alone--what do you expect will happen; nothing! If you ever wonder why someone thinks your nervous system can’t reorganize just look at the environment a person with SCI is placed, add the perception of no hope of recovery, and you understand why.

Below are references to research from some of the leading scientists in the world on the subject of reorganization(2-5). In the last six years, several individuals have learned to walk at Project Walk®, right now, several are taking their first steps. Those that have had a follow up MRI of their spinal cord have shown that it is still damaged! So ask yourself this, how are these individuals controlling the muscles below the level of injury? We have been told time and time again by experts that these individuals are walking because they are incomplete injuries and were less than a year post injury. Well, their observations couldn’t be farther from the truth. Some started the program more than five years post; and some were diagnosed complete injuries in the hospital, but after three years were considered incompletes.

For arguments sake, let’s just agree with those experts who claim that all of the walking Project Walk® clients have incomplete injuries and would have healed anyway without our help. If this is so, we pose these very simple questions: where are these thousands of walking incomplete injuries?


Project Walk’s idea of the future:

Hope of recovery from day one. No one knows the future and nothing is guaranteed, but the unknown is better than never!

  • Clients are drug free
  • Muscle contractions are increased and used to build muscle mass and control
  • Load bearing exercises in developmental movement patterns are performed from day one
  • Begin external stimulation for the nervous system to promote reorganization
  • Remove clients from reduced gravity environment while working out

Since 1999 we have been working with PEOPLE WITH SPINAL CORD INJURIES FROM C3 TO L2. Our clients are happy. They are happy because they are doing something about their situation and seeing the accomplishments. While visiting our center and watching our clients work out, a leading SCI scientist once said that one of the reasons our clients are improving is because of their attitude and hope.


Results of Phase I (Reactivation) & Phase II (Development/Stabilization)

  • Increased central nervous system activity
  • Increased muscle mass
  • No loss of bone mass
  • Increased circulation
  • Increased sensation in some clients
  • Increased hot and cold in some clients
  • Decreased pressure sores
  • Decreased use of medications
  • Decreased health problems associated with a spinal cord injury
  • Increased control of their lives

With The Dardzinski Method™, these two phases go hand in hand. As reorganization of the nervous system begins to occur, there is muscle development which leads to increased stabilization of the joints. Think about this statement for a moment. Increased tightness around the joints, isn’t this the complete opposite of traditional treatment? Of course it is, but have you ever tried standing on a pair of wet noodles! You need strong stable joints and muscle mass before you can ever move your legs.

This is what separates us from traditional rehabilitation. We are all about getting spinal cord injuries out of the wheelchair. Project Walk® should start with the client leaving the hospital. We work with all types of injuries (Asia A completes to incompletes), as long as the client can breathe on their own and has their doctor’s clearance to start an intensive fitness program. We reactivate the nervous system with a goal of developing it into a mature, working system.

Increased muscle size/tightness, nervous system activity, and joint stabilization are the goals of Phases I and II. Stabilized joints allow load bearing. Increasing the nervous system activity is like unleashing an internal electric stimulus or FES bike. What makes this more productive than the passive external machines is very simple--YOU are doing it and it is an active response from YOUR nervous system, not a passive response to an external device.

Phases I and II are the most difficult stages of our program, and can be the longest in the road to recovery. We compare this part of recovery to back country skiing--you spend all day getting up a mountain for a 30 second trip downhill. Some of our clients have spent over two years in these phases, where others have spent a few months. What we have learned over the last six years is that the level of injury doesn’t really affect how long it takes someone to move through Phases I and II. It is different for each individual because each individual brings us a different nervous system. Some have uncontrolled muscle contractions (spasms); others have pain; and others have nothing at all. Spasms and pain are just symptoms of a spinal cord trying to heal, and without the proper stimulus, these symptoms get worse. With The Dardzinski Method™, these symptoms slowly go away as the nervous system matures. This is also the stage of the journey when most of our clients choose to decrease or completely eliminate antispasmodic medications.

Simply stated, In Phase I (Reactivation), our goal is to act as your nervous system; to create, change, and excite it. In Phase II (Development/Stabilization), we are building the nervous pathways that you will use in later phases of our program.

No one learns to walk during these phases, it's not about walking, it’s about improving your quality of life. It’s about achieving little things that are huge, like being able to feed yourself, rolling over in bed, driving, and becoming independent of care. Traditional methods give you a lifetime of depending on care. We are about giving you a lifetime without it.


TRAINING GUIDELINES

Appointments

Over the last four years we have been trying to figure out what is the best amount of time to spend in the center to get maximum gains. Clients start with either two or three hour appointments, depending on the level of injury. For example, clients with a C injury need to work both upper and lower extremities, and in general, require longer appointments. Each client will come in three days a week to start. Our research shows that those that come in five days a week do not give themselves the proper amount of recovery time between sessions. Five-day-a-week clients come in with tired nervous systems that do not respond to our stimulus; while those that come in three days a week come back stronger each session. These clients are able to make more out of the time they spend in the center.

At this stage of the program, recovery time is the MOST important aspect of the training day. The Dardzinski Method™ is an elite performance training program for SCI and works best with an active nervous system. Allowing the nervous system to recover between workouts allows us to strengthen the new connections. Without an active nervous system, the only thing we can do is passive range of motion which does not benefit the client. We like to maximize time and effort in order to achieve the client’s goals in the shortest amount of time.

Now that we’ve given you our training guidelines, it is important to note that we realize every client is an individual with individual needs and goals. To keep up with each client’s evolution through recovery, we re-evaluate workout prescriptions on a monthly basis and may change the training guidelines based on their recovery process.


Workout Prescriptions for Phases I and II

 Daily exercise prescriptions include some or all of the following techniques:

  • Developmental movement patterns
  • Active Nervous System Recruitment™ or ANSR™
  • Active load bearing
  • Active spin bike pedaling
  • Passive gait training

What to Expect and Symptoms

Change—it’s that simple! Physical changes occur almost immediately from improvement in overall health to your nervous system reacting to the stimulus that it receives. One of the first things you may notice is a change at night. You may begin to get uncontrolled muscle contractions (spasms) in the evening or while you sleep; or you may notice more burning or even pain in the evenings. Why in the evenings? During the day while you workout, your nervous system is reacting to the stimulus that is provided. At night it starts to recover and heal. Night time will get very interesting as you progress through Phases I and II.

Research/Measurements

We have an ongoing research program at Project Walk® to quantify and validate client progress. Many of the changes clients experience are subjective and difficult to access, such as increases in endurance and feeling stronger overall. However, we record objective parameters such as muscle circumference, amount of weight lifted and duration of activities to clearly quantify improvement. We have also developed a scale that every client is rated on when they enter the program and every three months there after. Our staff collaborates with every client on at least a monthly basis to establish short and long-term goals. Daily activities and new “ breakthroughs” are documented. A video is taken of each client upon entry in the program to establish a baseline, and subsequent videos are completed when significant changes occur.

ADDITIONAL MODALITIES

We have found that the addition of the following modalities help in the road to recovery.

Acupuncture can be started anytime during Phases I and II. The goal of acupuncture is to help the nervous system connect and repair itself, and since acupuncture is passive, it is a good adjunct to the early recovery phases. Michael Akong MPH, LAc, is located inside our center and specializes in spinal cord injury acupuncture. www.neuroacupuncture.org

Hyperbaric Chamber treatments are an excellent adjunct, particularly during the early phases of recovery. Injuries, infections and diseases can result in decreased levels of oxygen in the body’s tissues. Hyperbaric treatments promote wound healing and fight infection because 100% oxygen is provided to all areas of the body. There is a hyperbaric chamber facility local to our center. For more information please go to www.HBOinfo.com

Standing Frames are very important in this early stage of recovery. You will begin to lose bone density and muscle mass so it is very important to your future that you maintain your bone density. Although blood pressure is sometimes a problem, it is still imperative that you get up in the standing frame. Each week you will be able to last longer. Insurance may not cover a standing frame, so you may have to be creative and have someone build it for you. But don’t wait--without load bearing forces on your legs, you will lose the bones.

 Nutrition for a spinal cord injured client is very important in all phase of recovery. It is extremely important to know what and how much to eat so there is no excessive weight gain.

FES Bikes and other forms of electrical stimulation are important during the early stages of recovery. The external electrical stimulation will maintain muscle mass and help with circulation, which as you are now learning, are very important.

 PSYCHOLOGICAL OUTLOOK

 A good, strong mental outlook is one of the most important facets of Phases I and II. Understandably, most clients enter our program with some aspect of depression. However, being surrounded by over 50 of their peers on a weekly basis, an individual has access to some of the greatest counselors money can buy! Most clients will tell you that the first couple of months they are here is the happiest they’ve been since their accident. And, as they improve physically, so do their spirits. There is no better support group! Clients that have graduated from the program have great support from peers, family and friends. Those that have trouble are usually by themselves with just a caregiver, miles away from family and friends. Please take this advice into consideration: you need daily distractions away from the recovery process to mentally survive and achieve your goals. For example, our college age clients take classes, our high school clients finish high school, and many clients work. If you don’t have a local support group, you need to have something outside of Project Walk®.

POOL TRAINING

At this stage of your recovery, pool therapy is not the most productive modality for the lower extremities. Since Phase I is Reactivation and Phase II is Development/Stabilization, a reduced gravity environment is not very efficient. In general, swimming promotes flexibility and hyper-mobile joints. This is just the opposite of what we are trying to do—joint stability. One the most important features of our method is closing the connection with the nervous system. To do this, you need direct stimulation from either a highly skilled Specialist, or a closed chain platform.

Exception: Those with C injuries can begin pool therapy on their off days from Project Walk®. However, the focus should only be on the upper extremities, working on coordination and overall strength.

Those with T injuries should wait until entering Phase IV (Function/Coordination) before beginning pool training.

GRADUATION FROM PHASES I AND II

During the recovery process your nervous system is always re-learning; the phases only represent a change of function. Change of function is very important in a physical training program for paralyzed clients because the stimulation can only change when a clients’ physical function changes. Moving out of Phase II the client’s nervous system has improved to a point where they begin to get some basic control of their muscles which should be very strong and tight. At night the legs should be doing all kind of movements: the flexors flexing and the extensors extending. With tight legs our clients can now feel a stretch reflex, even some of our ASIA A completes.

Clients now have stable joints for load bearing because the shoulder, hip, knee and ankle joints are all being held in place. At this time we move into Phase III of our program, Strength: Eccentric/Concentric Muscle Contractions.


References

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http://jap.physiology.org/cgi/content/full/89/2/823

  • Koopmans GC, Minaard R, Deumens R, et al. Cytogenesis and improved functional recovery after enriched envi ronment in the spinal cord injured rat. Program No. 498.9. 2003 A bstract Viewer/Itinerary Planner. Washington DC: Society for Neuroscience, 2003. Online.

http://sfn.scholarone.com/itin2003/index.html

  • McDonald JW, Becker D, Sadowsky CL, et al. Late recovery following spinal cord injury. J Neurosurg Spine. 2002 Sep;97(2)

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http://www.nature.com/doifinder/10.1038/35067570

  • Shapiro JR, Beck TJ, LeBlanc A, et al. Patterns of f emoral neck bone loss in spinal cord injury and in spaceflight. Bioast ronautics Investigators’ Workshop. 2003 Jan

http://www.dsls.usra.edu/meetings/bio2003/pdf/BoneMuscle/2036Shapiro.pdf

  • Smith SM, Nillen JL, Le blanc A, et al. Collagen cross-link excretion during space flight and bed rest. J Clin Endocr Meta bol. 1998; 83(10):3584-91

http://jcem.endojournals.org/cgi/content/full/83/10/3584

  • Vico L, Chappard D, Alexardre C, et al. Effects of a 120 day period of bed-rest on bone mass and bone cell activities in man: att empts at countermeasure. Bone Miner. 1987 Aug;2(5):383-94

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