Michael G. Fehlings, Toronto Western Hospital; University of Toronto
Lindsay A. Tetreault, Toronto Western Hospital; University College Cork
Bizhan Aarabi, University of Maryland
Paul Anderson, University of Wisconsin, Madison
Paul M. Arnold, The University of Kansas
Darrel S. Brodke, University of Utah
Kazuhiro Chiba, National Defense Medical College
Joseph R. Dettori, Spectrum Research, Inc
Julio C. Furlan, University of Toronto; Toronto Rehabilitation Institute
James Harrop, Thomas Jefferson UniversityFollow
Gregory Hawryluk, University of Utah
Langston T. Holly, University of California at Los Angeles
Susan Howley, Christopher & Dana Reeve Foundation
Tara Jeji, Ontario Neurotrauma Foundation
Sukhvinder Kalsi-Ryan, Toronto Western Hospital
Mark Kotter, University of Cambridge
Shekar Kurpad, Medical College of Wisconsin
Brian K. Kwon, University of British Columbia
Ralph J. Marino, Thomas Jefferson UniversityFollow
Allan R. Martin, Toronto Western Hospital
Eric Massicotte, Toronto Western Hospital
Geno J. Merli, Thomas Jefferson UniversityFollow
James W. Middleton, University of Sydney
Hiroaki Nakashima, Nagoya University Graduate School of Medicine
Narihito Nagoshi, Toronto Western Hospital
Katherine Palmieri, The University of Kansas
Anoushka Singh, Toronto Western Hospital
Andrea C. Skelly, Spectrum Research, Inc
Eve C. Tsai, University of Ottawa
Alexander R. Vaccaro, Thomas Jefferson UniversityFollow
Jefferson R. Wilson, University of Toronto; St. Michael's Hospital
Albert Yee, Sunnybrook Health Sciences Centre
Anthony S. Burns, Toronto Rehabilitation Institute

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Publication Date



This article has been peer reviewed. It is the author’s final published version in Global Spine Journal

Volume 7, Issue 3 Supplement, September 2017, Pages 231S-238S.

The published version is available at DOI: 10.1177/2192568217701910. Copyright © Fehlings et al.


Introduction: The objective of this study is to develop guidelines that outline the appropriate type and timing of rehabilitation in patients with acute spinal cord injury (SCI). Methods: A systematic review of the literature was conducted to address key questions related to rehabilitation in patients with acute SCI. A multidisciplinary guideline development group used this information, and their clinical expertise, to develop recommendations for the type and timing of rehabilitation. Based on GRADE (Grading of Recommendation, Assessment, Development and Evaluation), a strong recommendation is worded as “we recommend,” whereas a weaker recommendation is indicated by “we suggest. Results: Based on the findings from the systematic review, our recommendations were: (1) We suggest rehabilitation be offered to patients with acute spinal cord injury when they are medically stable and can tolerate required rehabilitation intensity (no included studies; expert opinion); (2) We suggest body weight–supported treadmill training as an option for ambulation training in addition to conventional overground walking, dependent on resource availability, context, and local expertise (low evidence); (3) We suggest that individuals with acute and subacute cervical SCI be offered functional electrical stimulation as an option to improve hand and upper extremity function (low evidence); and (4) Based on the absence of any clear benefit, we suggest not offering additional training in unsupported sitting beyond what is currently incorporated in standard rehabilitation (low evidence). Conclusions: These guidelines should be implemented into clinical practice to improve outcomes and reduce morbidity in patients with SCI by promoting standardization of care, decreasing the heterogeneity of management strategies and encouraging clinicians to make evidence-informed decisions. © 2017, © The Author(s) 2017.

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Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.