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Dardzinski Method

”The Dardzinski Method” er et rehabiliterings program basert på intens trening, designet for å stimulere et skadet nervesystem. Målet er å etablere kontakt med muskulatur under skadestedet. Metoden er dannet av erfaringer etter 10 års arbeid med ryggmargsskade på senteret ”Project Walk” i California. Programmet er oppdelt i 5 faser. Hver fase representerer hvilket nivå kroppen under skadestedet er.

Fase 1og 2 er reaktivering, utvikling og stabilitet.
Fase 3 er eksentrisk og konsentrisk kontraksjon/muskelsammentrekning.
Fase 4 er funksjon og koordinasjon trening.
Fase 5 er gangtrening.

Phase I – Reactivation & Phase II - Development/Stabilization
Project Walk® starts once a spinal cord injured person leaves the hospital. We work with all types of injuries (ASIA A to ASIA D), as long as the person can breathe on his/her own, does not have severe osteoporosis, and has obtained a doctor’s clearance to start an intensive exercise program.

Reactivation or reorganization of the nervous system is what seems to cause the most controversy regarding The Dardzinski Method™. We started this program with the belief that a nervous system traumatized by a spinal cord injury could reorganize itself when introduced to proper external stimulation. Recent research has confirmed that the central nervous system can reorganize itself after spinal cord injury (2-5). However, without proper external stimulation the human nervous system will deteriorate after injury. When the nervous system is medicated with drugs that interfere with correct sensation and prevent errant muscle contractions, when it is exposed to treatment that refuses to stimulate the paralyzed body parts, how can it be expected 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 (reduced gravity), pump them full of drugs, and leave them alone--what do you expect will happen; nothing.  At Project Walk, we are attempting to reactivate the nervous system with a goal of developing it into a more functional system. We will never guarantee that a client will walk because the truth is, we don’t know. What we do know, is that we have developed a method that can aid the injured nervous system in regaining lost function.

Many of our clients are now controlling their muscles below the level of injury. However, time and time again, we hear they are doing so because they are incomplete injuries. This is untrue. Some started the program many years post injury when “spontaneous” recovery should have plateaued; others were diagnosed complete injuries in the hospital, but have regained enough function to now be considered incomplete.
The Old Approach to SCI
No hope for recovery
Interfere with sensation and muscle contractions with drugs
Limited to no stimulation of the paralyzed areas
Place the person in a continual reduced gravity environment (the wheelchair)


Results
Loss of bone density and muscle mass, further reducing the chances of recovery in the future
Decreased circulation
Increased risk of infections and pressure sores
No improvement of function
The Dardzinski Method (Exercise-Based Recovery)
Hope of recovery. No one knows the future and nothing is guaranteed, but the unknown is better than never 
Begin external stimulation for the nervous system to promote reorganization
Remove clients from reduced gravity environment while working out
Muscle contractions are increased and used to build muscle mass and control
Load bearing exercises are performed from day one
Worse case result is the client is healthy and more independent
Best case result is the client begins to regain function and continues to improve

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

Simply stated, in Phase I and II, our goal is to act as your nervous system by manipulating the affected areas of the body thereby stimulating sensory input and exciting a motor response. We believe this is when clients begin to awaken dormant nervous pathways and develop new ones.

References
Fitts RH, Riley DR, Widrick JJ. Physiology of a microgravity environment. Invited review: Microgravity and skeletal muscle. J Appl Physiol. 2000 Aug;89(2):823-39
Koopmans GC, Minaard R, Deumens R, et al. Cytogenesis and improved functional recovery after enriched environment in the spinal cord injured rat. Program No. 498.9. 2003 Abstract Viewer/Itinerary Planner. Washington DC: Society for Neuroscience, 2003. Online.
McDonald JW, Becker D, Sadowsky CL, et al. Late recovery following spinal cord injury. J Neurosurg Spine. 2002 Sep;97(2)
Raineteau O, Fouad K, Bareyre FM, et al. Reorganization of descending motor tracts in the rat spinal cord. Eur J Neurosci. 2002 Nov;16(9):1761-72
Raineteau O, Schwab ME. Plasticity of motor systems after incomplete spinal cord injury. Nat Rev Neurosci. 2001 Apr;2(4):263-73
Shapiro JR, Beck TJ, LeBlanc A, et al. Patterns of femoral neck bone loss in spinal cord injury and in spaceflight. Bioastronautics Investigators’ Workshop. 2003 Jan
Smith SM, Nillen JL, Leblanc A, et al. Collagen cross-link excretion during space flight and bed rest. J Clin Endocr Metabol. 1998; 83(10):3584-91
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: attempts at countermeasure. Bone Miner. 1987 Aug;2(5):383-94

Phase III Strength - Eccentric/Concentric Muscle Contractions
Moving into Phase III doesn’t mean your body has stopped relearning. It hasn’t. Your body will continue in Phases I and II throughout the entire recovery process. You don’t just graduate from one phase to another, it is a gradual change that happens over time. There are clients taking steps and walking who still have paralyzed areas of their bodies in Phases I and II. 

Phase III is where recovery really starts to move away from traditional occupational practices. It is our belief that your nervous system is trying to connect the way it did before your accident, but without the proper external stimulation to re-teach it, the result is spasm and tone. Our knowledgeable, skilled Specialists can help retrain spasm and tone into controlled movement. Because you will enter Phase III with stable joints, a Specialist will be able to create a desired movement by manipulating your body and applying resistance thus creating stronger contractions. You will graduate Phase III when you can create controlled movement without any assistance from a Specialist.

As we work to diminish spasm and tone, we do not do this with medications or Botox. Using medication will treat the symptoms, but does not help with the long-term goal of movement and coordination. When you contract a muscle thousands of times with the right stimulation, the nerves and muscles will gain continued strength but more importantly, coordination. This is why our clients start with simple exercises to stabilize their joints in the earlier phases of recovery training. In time, the muscles are performing isometric contractions. With the right skills, a Specialist can take these small isometric contractions and teach the client how to control them through the full range of motion. This technique is called Active Nervous System Recruitment (ANSR)™. Our certified Specialists are the only practitioners who understand and utilize ANSR.

Results of Phase III Strength:  Eccentric/Concentric Muscle Contractions

A side affect of Phase III is an increase in occupational abilities. Each client comes to us with a goal of walking, but amazing things happen along the way in the form of occupational milestones. In phase III, most clients are able to drive, can transfer using their legs for support, can stand without a standing frame, and many have gained back their independence.

Phase IV - Function & Coordination
Phase IV is the transition phase because the client is now between worlds; they have the ability to move and control their legs and arms, but do not have the strength or coordination to walk without aids. The evolution from Phase III to Phase IV can be long and arduous and quite frustrating. And, not every person will make the transition.

Movement creates more movement. Once spasms and tone are broken down, controlled movement can occur. The more one moves, the easier it becomes; and because it is easier, activity levels increase. Because activity levels increase, the client continues to improve. It’s like going downhill; as you gain momentum, the faster you go.
Phase IV, like the entire recovery process, doesn’t happen in distinct stages. Each stage overlaps with the next. Clients usually begin to have coordinated movement in one area and plane of motion while they are unable to control other movements. For example, a client may have one leg that is more functional than the other. Even though they are mobile, they are still relearning to use their nervous system.

What sets us a part is that The Dardzinski Method™ addresses nervous system discrepancies by working the nervous system as a whole. As the nervous system continues to reorganize, function slowly returns to more and more of the body. Because of this, we pay close attention to posture and biomechanics. Everyday, we train the body to work in a functional manner with a goal of preventing a dysfunctional gait. Gait patterns are much easier to fix before walking and before compensations become severe.

If you can move your legs, you should be able to walk if you have the right stimulation and the knowledge of a trained professional. Our combined background and experience in performance training gives us a totally different mindset when it comes to this process. We work and train our clients like athletes and teach them the skills they need to walk well.

Gait Training Center for Excellence
- Phase V -
Objective
The objective of Phase V is to provide advanced functional gait training for our clients who are moving their legs or are able to walk with or without adaptive aids. 

The foundation of our Functional Gait Performance Program™ is education and workout design. Our goal is to teach each client the tools necessary to improve on their own, allowing out-of-town clients to return home and continue their progress.

Our “finishing school” was created out of demand. Some clients in the walking phase come to us with almost perfect gaits, while others compensate so much that walking long distance isn’t an option. We have determined that the difference is not due to the level of injury, but how these people were trained over the years and what was expected of them. Their gait is not predetermined but developed through the stimulation received.  Over time, just as with any person, compensation leads to loss of function. It is not only a problem with SCI, but a normal response to an inefficient gait pattern. Correcting this compensation isn’t easy, but with the right stimulation, workout program and client determination, improvement can happen. At Project Walk, we believe that progress only stops when the client is satisfied with his or her results. 
 
Theory of Drills and Skills
We don’t teach you to walk; we teach you the skills necessary to walk well.
It is our philosophy that a functional gait is determined by the coordination between your mechanical center of gravity (pelvis) and your balance (ankles and inner ear). You don’t learn how to coordinate these factors walking in parallel bars or on a mechanical gait trainer. To improve coordination and balance you must be able to trust your legs to support and balance you. This is the cornerstone of our Functional Gait Performance Program.
If you want to walk with a functionally sound gait, you must first learn to master the basic skills of controlling the muscles that support and move your hips in a full range of motion.  You must have control of your hip, knee and ankle joints, and you must be able to coordinate these movements with your upper body. Skills you must have are:  the ability to do full knee and hip flexion; maintain control throughout the full range of motion of the femur; move side to side, forward and backwards; and you must be able to go to the floor and get back up in all different body positions. 
Posture and functional range of motion is what sets our training program apart from the rest. Our program has nothing to do with traditional methods or ideas of how someone with SCI recovers. We have a history of training elite athletes and that’s the approach we still use. This is why our clients recover faster, walk better, and are stronger than their peers. Decades ago, teaching coordination within the sports world was something that just wasn’t done. Either you were born with it, or you weren’t. Things have changed since then. Each year performance trainers take average athletes and turn them into scholarship athletes by teaching them all the aspects of performance, including coordination. It is accomplished by stimulating the nervous system with specific drills designed to elicit certain responses. Once that skill has been mastered, programs become more demanding requiring more from the nervous system. At Project Walk, our performance training is designed to elicit a functional gait.