Through working with clients who suffer from paralysis, neurological disorders, and spinal cord injuries we have a keen understanding that these individuals suffer from dysfunctional nervous systems. Sometimes, this could be present in the form of impaired signals that manifests from pain, burning, pins and needles, and spasms/tone.

We believe these impaired signals assist in the ability to reactivate and reorganize the central nervous system (CNS). Our Perfect Step Specialists work hard to understand the current state of our client’s nervous system and how to create the correct stimuli so it may be able to properly respond.

We use the S.T.E.P (Special Techniques and Exercises for Paralysis) method to do this. Our Specialists have mastered these techniques over hundreds of hours of training and practice.

Three Main Techniques/Components of The S.T.E.P. Method

  1. Patterned Neural Activity Recruitment

  2. Exercise-based therapy.

  3. Load bearing.

Every day we are evaluating and adding new methods and technological advances in order to keep The Perfect Step on the cutting edge of exercise-based therapy for SCI and paralysis recovery. However, these three main components of The S.T.E.P. Method will never change.

1. Patterned Neural Activity Recruitment

Simply put, Patterned Neural Activity Recruitment or “PNAR” is Our Specialists attempting to emulate and serve as the nervous system for our clients in order to stimulate and reorganize it. Patterned Neural Activity Recruitment is our approach towards activity-based therapy or also known as stimulating the nervous system below the level of the injury.

The focus of PNAR is to have clients actively attempting to assist or resist our movements of their body. By using this technique we are controlling the muscles and bones, thereby putting stress on the ligaments and cartilage. This can send signals toward the spinal cord and the brain. The goal of PNAR is to excite the nervous system and create involuntary and/or voluntary muscle contractions. Through hundreds or thousands of repetitions of these movement patterns, we are attempting to re-create patterned neural activity.

Through pattern recognition the Specialist may be able to coax the motor pathways into reorganizing through neuroplasticity and innovating new targets. It is this plasticity/spinal learning that can be brought about through increasing activity.

The neurological repair process within the spinal cord can continue even if functional recovery has plateaued.

2. Exercise-Based Therapy

Often times medical professionals are keen on prescribing medications in order to treat their clientele for their ailments, injuries, and the pain that they experience. At the Perfect Step we believe that independence can also be found through an intense physical approach and through exercise.

The Perfect Step takes a physical approach towards recovery. We get our clients “out of the chair” and allow them to reach their goals and complete fundamental and everyday tasks through physical therapy. Many of our clients are confined to a wheelchair. Because of the negative effects that the wheelchair puts on the body, exercise can help correct this by putting the body into extension anatomically correct position that can both reduce pain, reduce tone and spasms, and increase range of motion.

Participation in high-intensity exercise and movement puts the body back into an anatomically correct position, circulates blood, increases muscle mass, increases bone density, circulates the bowel and bladder, increases function and coordination, and increases sensation.

The Perfect Step believes because of all of the positive benefits that exercise can bring to our clients, that truthfully it is the only direction to move in terms of recovery.

3. Loadbearing

Our clients, who are confined to a wheelchair, or those who have limited time spent in a vertical position, are more susceptible to osteopenia and osteoporosis (weak and brittle bones). After diagnosis, disease, and injury, the brain senses less stress to areas of the body that previously received high impact and jarring into the joints and sockets of the body. The brain thus begins to output less calcium to those parts of the body leaving their bone health in decline.

The Perfect Step takes the approach of incorporating loadbearing into our clients recovery regiments for a few different reasons:

  1. To maintain and increase bone health and to reduce chances of osteopenia and osteoporosis.

  2. For joint stability purposes. To allow for the stability muscles to fire and properly hold the joints into anatomically correct placement.

  3. The body responds to the stimulation of weight-bearing and sensing gravity being put onto the body. Clients are able to see different changes in their body through loadbearing; and possibly sensory feedback or motor function feedback.

  4. The more that the client stands, the more their body will be accustomed to being in a vertical position and the more apt they will be able to circulate blood back up to the brain.

Additional Components to our Methodology

While there are three main components to the S.T.E.P. Method, there are also additional components that aid in perfecting and refining our methodology.

Functional Movement Patterns

Functional Movement Patterns are based upon the movements performed during the early stages of human development. They include such things as pushing the torso off the floor, moving into a hands and knees posture, kneeling, standing, etc.

These movements help develop the nervous pathways that we begin to tap into during PNAR. They are used throughout the entire program and are the basis for a functional gait. They also continue the process of joint stabilization by using weight-bearing to load the joint and increase the stressors to the muscles, ligaments, and cartilage.

By mimicking the developmental process we hope to reorganize the nervous system to reconnect to areas below the level of injury.

Closed Chain Exercises

The primary function of the musculoskeletal system is to resist the effects of gravity on our bodies. Many people with SCI and paralysis are unable to resist gravity, therefore we must assist them with regaining this ability. One of the best ways of doing this is through closed chain exercises.

A way to articulate what a closed chain exercise does for the nervous system is how we understand and view spasms. Spasms indicate a signal from the brain getting sent down to the lower extremities but traveling off into space and not knowing where to end or where to go. By closing the chain and applying pressure to the bottom of the foot with the hands, we might be able to close the circuit of this spasm to create controlled movement. In essence, the client would be sending the signal down to the lower extremities and we would act as an end receptor to send the signal back up to the brain to create a complete current.

A closed chain exercise provides neural stimulation and biofeedback from the extremities to the brain and back again by putting the muscles in a weight-bearing position. This allows for training of postural stabilizers, co-contractors (antagonist muscles) and the neuromuscular system simultaneously. The stimulation may assist in reorganization of the nervous system.

Proper Sequencing

There should always be a why behind every exercise that is performed. With no intent behind a particular exercise, that exercise borderlines meaningless. Our Specialists follow the direction that the body is leading them and they compile a workout that ultimately focuses on:

  1. Different components of the body.

  2. To put the body into an anatomically correct position

  3. To put the body in a cooperative and functional position to ultimately culminate in some form of load bearing.

The order of exercise may be planned in advance, or may be spontaneous, but it is always designed to get the most reaction from the client. By implementing creative and variable routines the nervous system is more likely to adapt and improve.

Limited movement patterns will only teach limited movement. Dynamic movement patterns will help the client develop normal movement in all planes.

Creativity and A Non-Cookie-Cutter Approach

There are certain protocols and certain workout regimens that are prescribed for the able-bodied population for injuries like ACL tears, UCL tears, etc.… There are certain protocols that physical therapists follow over a 12 week program that are proven to work to heal these injuries. However, in our field this does not always apply. In the field of neurological injuries, illnesses, and impairments, the body presents itself differently each and every day. Thus, our Specialists cannot take a cookie-cutter approach towards treating a client and providing services.

This is why each and every day we learn new things at TPS, because our specialists are continuing to explore new things, do different exercises and think outside the box to treat our clients.

We believe that all the methods we use, the creativity, and the learning environment that we have created is able to assist people with paralysis in ways previously unheard of. Most of our clients have conditions where most medical professionals tell them “there is no real hope for you”. We have challenged these traditional beliefs and have developed innovative treatments that have shown amazing results. We help our clients make progress and live their healthiest life.