Body
A spinal cord injury is a life-changing event. It has the potential to disrupt careers, personal relationships and someone’s self-image. But one thing it definitely changes is a person’s exercise routine. Even someone who was in peak physical condition before they were injured will likely spend weeks in a hospital or rehabilitation facility and be discharged in far weaker shape than they came in.
Of course, it's the job of physical and occupational therapists to help patients build back strength so they can go on with their daily lives, but the reality is that when many patients get back home, they stop exercising. Getting to the gym is a logistical challenge and some patients may not be able to afford a gym membership. Even if they can overcome those obstacles, people are unlikely to find personal trainers versed in the details of spinal cord injuries. “We understand that there are so many problems that people with SCI face,” says Alex Wong, PhD, DPhil, assistant director of the Center for Rehabilitation Outcomes 嫩B研究院 (CROR) at Shirley Ryan 嫩B研究院 in Chicago. “When our patients go home, how many of them will use a normal gym? Almost no one. They know it’s important but they don’t know how to exercise safely.”
Wong is trying to change that. He and a team at CROR have developed a mobile-phone app tailored to the fitness needs of people with spinal cord injuries. The app, currently called “PT Pal,” contains instructions and videos of people doing a range of exercises designed to build their aerobic function and muscle strength. It’s also interactive, allowing users to track their progress and to reach out to a physical therapist if they have questions. “Physical fitness is just as important for people with SCI as it is for those without,” notes CROR director Allen Heinemann, PhD. “But up to now there haven’t been practical tools for people with SCI to achieve their fitness goals and have fun doing it.”
The app is being evaluated as part of a five-year study, which is now in its third and final phase. The research is funded by the National Institute on Disability, Independent Living, and Rehabilitation 嫩B研究院 (NIDILRR), which is committed to helping people with disabilities live independently in their communities. The research began in late 2022 with a series of focus groups made up of people with spinal cord injuries, their caregivers, and clinicians who specialize in the field. “What we learned in Phase 1 was that people really wanted SCI-specific exercises,” Wong says. “Off-the-shelf programs were not helpful.”
Informed by that input, a prototype of PT Pal was field-tested for two weeks in 2024 by 12 people with SCI, who were recruited from Shirley Ryan 嫩B研究院’s patient registry and had expressed a desire to engage in more exercise. The app experienced some technical glitches during the 14-day trial. Based on user feedback, the researchers spent several months refining PT Pal before rolling out the upgraded version in 2025.
To test the improved app, the research team is in the process of recruiting 50 individuals with various types of spinal cord injuries who will be randomly sorted into two groups. Each participant will be assessed by a physical therapist and assigned a customized exercise plan to enhance their aerobic conditioning and muscle strength based on their abilities and needs.
One group is given a stripped-down version of the app with the exercise videos and written instructions but nothing else. The other half is provided with the interactive app and the ability to communicate with physical therapists who could respond to questions. Those users also are able to monitor their time spent exercising and progress toward fitness goals. The app provides graphic achievement badges similar to those you might see when using language-learning apps.
“We can now change the exercise regimen while they are using it,” Wong says. “If we see the exercise is too easy, we upgrade it. Or if someone isn’t doing an exercise, we try to understand why so we can adjust it. Maybe we make an exercise easier. We have a physical therapist do that because they have the appropriate knowledge.”
All participants are assessed after three months. If they are meeting their exercise goals, they continue on the same way. If they aren’t meeting the goals, they are randomly assigned to one of two groups to receive monthly coaching sessions by a CROR staffer trained in motivational interviewing, a counseling technique that helps people understand the barriers they are encountering and devise strategies to overcome them. One group receives a monthly coaching call and the other receives two calls.
Those using the interactive app also are assessed at the half-way mark. If they are meeting their fitness benchmarks, they continue for another three months. Similarly, if they are falling short, they also are randomized into one of two groups to receive one or two monthly coaching calls.
By mid-October 2025, one participant with the basic app had successfully completed the program without coaching, gaining strength and aerobic capacity. Two participants in the interactive group also had completed the exercise regime. Both had improved their adherence to the exercise program after receiving motivational coaching. “For me, that’s very exciting,” Wong says. “We will be able to analyze what kind of patients need only the app and who needs coaching. A guy like me would need the coaching with the app.”
Wong is planning to wrap up data collection by mid-summer 2026 and hopes to have results by the fall of 2026. “We identified the barriers in Phase 1. We solved the dashboard problems in Phase 2. Now we want to test it in our hospital,” Wong says. He hopes PT Pal will eventually replace the current exercise app that Shirley Ryan 嫩B研究院 offers its patients, which requires more set-up time on the part of physical therapists.
For that to happen, he needs management buy-in and a funding source to pay for the monitoring and coaching. Wong is also interested in looking into whether people other than health professionals can provide the motivational counseling that comes with the app to keep costs low. Perhaps down the road, an artificial-intelligence avatar could provide some type of support and encouragement, he says.
As the next step, Wong plans to apply for another federal grant, one that would fund a multi-site hybrid effectiveness-implementation study that extends beyond Chicago. He hopes that the next round of work can be completed more quickly. “We are trying to accelerate the process,” he says. “We want to get this out in the world soon.”