Activity-Based Therapy (ABT) for the Spinal Cord Injured and Neurologically Impaired

Spinal cord injuries, or SCI, are devastating injuries that can leave a person unable to move and/or feel sensations in parts of their body. There are, however, treatments that help restore function and quality of life for SCI patients, ultimately empowering them to live more independently and comfortably. In this article, we will be taking an in-depth look into what spinal cord injuries are, and programs like Activity-Based Therapy play in these patients’ recovery and wellness.

What is a Spinal Cord Injury (SCI)?

A spinal cord injury (SCI) is damage to the tight bundle of cells and nerves that sends and receives signals from the brain to and from the rest of the body. It can be caused by direct injury to the spinal cord itself or damage to the tissue and bones (vertebrae) that surround the spinal cord.

​​An incomplete injury means the spinal cord is still able to transmit some messages to and from the brain to the rest of the body. A complete injury means there is no nerve communication and no sensation below level of injury.

It is estimated that there are approximately 18,000 new cases of SCI occur in the United States each year, and up to 378,000 Americans who live with SCI at any given time.

Complications from SCI can include:

  • Osteoporosis: Up to 22% reduction in bone mineralization in first 3 months post-injury
  • Soft Tissue Changes: Loss, thinning of subcutaneous tissue over the weight-bearing areas
  • Cardiovascular Disease: 200% higher incidence
  • Gastrointestinal: 20% develop difficulty with bowel evacuation
  • Declining Pulmonary Function: Restrictive and obstructive disease
  • Endocrine Changes: 4 x higher incidence of diabetes in SCI population, decreased growth hormone and testosterone
  • Upper Extremity Pain: 70% of individuals report UE pain (compressive neuropathy, DJD, RTC tears/tendonitis, bursitis etc.)
  • Body Composition Changes: Most individuals with SCI experience weight gain that increases with time and that eventually results in a level of obesity that puts significant limitations on the patients’ functional capabilities
  • Scoliosis: 97% of pediatric SCI patients experience scoliosis and just under half of adults

​​What is Activity Based Therapy (ABT)?

Activity-based therapy (or ABT) is a physical exercise program that is intended to treat people suffering from certain medical conditions or recovering from a traumatic injury. It can help restore physiological function in chronic cases even years after an injury and has been widely recommended for Spinal Cord Injuries (SCI), among other conditions.

Using a high-volume and high-intensity approach, and guided by the principle of neuroplasticity, ABT patients may commit up to two to three hours a day of repetitive, task-specific training, to push their boundaries of recovery, restore muscle function, decrease the risk of secondary conditions to maximize the body’s potential.

The five key components of ABT are weight-bearing activities, functional electrical stimulation, task-specific practice, massed practice, and locomotor training.

Note that ABT differs from other types of rehabilitation for SCI patients, such as:

  • Traditional/Restorative Rehabilitation: goal-oriented rehabilitation that aims to restore prior levels of function or maximize function within limitations; this type of rehabilitation is short, typically taking about three sessions per week for up to six weeks.
  • Maintenance Therapy: Maintenance therapy is intended to stabilize or slow the natural course of deterioration with a progressive condition. Improvement is not expected, and this therapy is usually reserved for the medically complex patients. Maintenance therapy is practiced with decreased frequency and longer durations (e.g. 1x week for 50 weeks/year)

The scientific guidelines for adults with a spinal cord injury have set the minimum recommendations for exercise as follows:

  • Cardiorespiratory – 20 minutes 2 x week
  • Musculoskeletal – 3 sets for each functioning muscle group 2 x week
  • Cardiometabolic Health – 30 minutes 3 x Week

Benefits of ABT include:

  • Reduce bone loss
  • Increase bone density
  • Increase metabolism
  • Improve posture
  • Improve function
  • Reduce spasticity
  • Decrease incidents of pressure ulcers
  • Decrease bladder infections
  • Improve bowel regularity
  • Increase ability to straighten one’s legs
  • Increase lean body mass
  • Decrease fat mass
  • Increase cardiovascular fitness and heart health
  • Reduce risk of pressure ulcers

How to Find an ABT Gym

Ask your local neuro therapist(s) if they have any recommendations for ABT gyms near you. Another great resource to find ABT gyms is on SpinalCord.com, or by searching #activitybasedtherapy on social media.

Inclusion of ABT in Life Care Plans

ABT is not intended to replace skilled physical and occupational therapy but should work in conjunction with periodic skilled care. By including ABT in a Life Care Plan, individuals can meet their exercise recommendations to improve their quality of life while addressing SCI complications.

Because ABT is not available in many parts of the country, a life care planner may be able to help account for periodic travel or with the training of the patient’s caregiver to meet program goals. Learn more about how incorporating ABT into your life care plan can benefit SCI by reading our article on Benefits of Activity-Based Therapy (ABT) or contacting us today.


  • National Institute of Neurological Disorders and Stroke
  • Activity-Based Restorative Therapies after Spinal Cord Injury: Inter-institutional conceptions and perceptions
  • Spinal Cord Injury and Aging
  • Physical Activity Guidelines
  • Activity-based Therapies in Spinal Cord Injury: Clinical Focus and Empirical Evidence in Three Independent Programs. Topics in Spinal Cord Injury Rehabilitation, 18(1), 34–42.
  • Activity-Based Restorative Therapies after Spinal Cord Injury: Inter-institutional conceptions and perceptions. Aging and Disease, 6(4), 254.