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

Document Type


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.

Creative Commons License

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