nextstep vs traditional sci rehab: a new path to recovery in new zealand

NextStep's spinal injury rehabilitation and traditional spinal cord injury (SCI) rehabilitation in New Zealand differ in their approaches, focuses, and methodologies. While both aim to improve the quality of life for individuals with SCI, they diverge in philosophy, techniques, and delivery. Below is a breakdown of the key differences about NextStep and the broader context of traditional SCI rehabilitation in New Zealand:

1. Philosophy and Focus

•  NextStep's Rehabilitation: NextStep, as part of a global network of activity-based therapy centers (e.g., NextStep Los Angeles, emphasizes a proactive, exercise-intensive approach aimed at maximizing recovery potential. It focuses on neuroplasticity—the brain and spinal cord’s ability to reorganize and form new neural connections—through repetitive, task-specific activities. The goal is not just adaptation to disability but pushing for functional recovery, independence, and long-term health. It treats individuals as “athletes” on a recovery journey, regardless of the severity of their injury.

•  Traditional SCI Rehabilitation in NZ: Traditional rehabilitation focuses on a comprehensive, interdisciplinary approach to help individuals adapt to life post-injury. The emphasis is often on managing the injury’s effects, preventing complications (e.g., pressure sores, spasticity), and achieving independence through compensatory strategies, assistive devices, and environmental adaptations. Recovery of lost function is a goal where feasible, but the primary aim is often stabilization and adjustment to a new baseline.

2. Therapeutic Approach

•  NextStep: Utilizes activity-based therapy (ABT), which includes high-intensity, repetitive exercises tailored to stimulate the nervous system below the injury level. Techniques often involve:

•  Neuromuscular electrical stimulation (NMES): Using devices like the RTI-300 FES bike to activate muscles and improve circulation, strength, and flexibility.

•  Locomotor training: Simulating walking patterns to retrain the spinal cord and muscles.

•  Task-specific training: Repetitive practice of functional movements to promote motor recovery. This approach is grounded in emerging research on neuroplasticity and aims to reverse muscle atrophy and enhance neural excitability, even years after injury.

•  Traditional SCI Rehab: Relies on a broader, more generalized rehabilitation model that integrates physiotherapy, occupational therapy, and medical management. Common elements include:

•  Passive and active exercises to maintain joint mobility and muscle tone.

•  Training with wheelchairs, transfers, and adaptive equipment.

•  Education on managing bowel, bladder, and skin health. While some facilities may incorporate electrical stimulation or advanced technologies, these are not universally standardized, and the focus is often less on aggressive recovery of lost function and more on practical daily living skills.

3. Setting and Accessibility

•  NextStep: Operates as a community-based facility. It provides an accessible, gym-like environment with specialized equipment and certified trainers. Sessions are typically one-on-one or small group, offering personalized attention. It’s designed to be a long-term resource, welcoming clients at any stage post-injury, not just during acute or subacute phases.

•  Traditional SCI Rehab: Delivered primarily through public health systems, which are hospital-affiliated and serve specific regions. Inpatient stays can last weeks to months, followed by outpatient or community support. Access is often tied to referrals and funding through our health system or ACC, which may limit ongoing, intensive therapy after the initial rehab phase.

4. Equipment and Technology

•  NextStep: Emphasizes cutting-edge, specialized equipment like FES (Functional Electrical Stimulation) bikes, locomotor training devices, and other tools designed to stimulate neurological recovery. The environment is described as progressive and motivational, often with uplifting music and a fitness-oriented vibe.

•  Traditional SCI Rehab: Uses a mix of standard rehabilitation tools (e.g., parallel bars, wheelchairs, basic gym equipment) alongside medical interventions. While some units may have access to advanced tech, it’s not consistently prioritized or available across all traditional settings, and the focus may lean more toward conventional physiotherapy and occupational therapy tools.

5. Timing and Duration

•  NextStep: Encourages early intervention but also supports lifelong engagement. There’s no fixed endpoint—recovery is seen as an ongoing journey tailored to individual goals, whether that’s regaining small functions or maintaining health years post-injury.

•  Traditional SCI Rehab: Typically follows a structured timeline, with intensive inpatient care followed by transitional or outpatient support. Long-term care often shifts to community services or self-management, with less emphasis on continuous, aggressive therapy unless complications arise.

6. Cultural and Community Elements

•  NextStep: Builds a supportive, community-driven atmosphere, often integrating peer support and a sense of camaraderie. It aligns with a global movement of activity-based therapy centers (e.g., NextStep in the U.S.) and draws inspiration from international research and practices.

•  Traditional SCI Rehab: Integrates New Zealand-specific cultural considerations, such as adherence to the Treaty of Waitangi and support for Māori health needs. It collaborates with organizations like the New Zealand Spinal Trust for peer support and resources, but the setting is more clinical and less fitness-oriented.

Summary

NextStep spinal injury rehabilitation stands out for its aggressive, activity-based approach, leveraging neuroplasticity and advanced technology to pursue functional recovery beyond traditional limits. In contrast, traditional SCI rehabilitation in New Zealand, while comprehensive and multidisciplinary, prioritizes adaptation, complication prevention, and independence within the constraints of the injury, often within a more clinical, time-bound framework. NextStep offers a specialized, long-term alternative that complements rather than replaces the foundational care provided by traditional rehab, appealing to those seeking a more dynamic, recovery-focused path.