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Arm Crank and Wheelchair Ergometry Produce Similar Peak Oxygen Uptake but Different Work Economy Values in Individuals with Spinal Cord Injury. BIOMED RESEARCH INTERNATIONAL 2016; 2016:5481843. [PMID: 27144169 PMCID: PMC4842047 DOI: 10.1155/2016/5481843] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 03/20/2016] [Indexed: 01/31/2023]
Abstract
Objective. To study whether values for peak oxygen uptake (VO2peak) and work economy (WE) at a standardized workload are different when tested by arm crank ergometry (ACE) and wheelchair ergometry (WCE). Methods. Twelve paraplegic men with spinal cord injury (SCI) in stable neurological condition participated in this cross-sectional repeated-measures study. We determined VO2peak and peak power output (POpeak) values during ACE and WCE in a work-matched protocol. Work economy was tested at a standardized workload of 30 Watts (W) for both ACE and WCE. Results. There were no significant differences in VO2peak (mL·kg−1·min−1) between ACE (27.3 ± 3.2) and WCE (27.4 ± 3.8) trials, and a Bland-Altman plot shows that findings are within 95% level of agreement. WE or oxygen consumption at 30 W (VO2-30W) was significantly lower during WCE compared to ACE (P < 0.039). Mean (95% CI) POpeak (W) were 130 (111–138) and 100 (83–110) during ACE and WCE, respectively. Conclusion. The findings in the present study support the use of both ACE and WCE for testing peak oxygen uptake. However, WE differed between the two test modalities, meaning that less total energy is used to perform external work of 30 W during wheelchair exercise when using this WCE (VP100 Handisport ergometer). Clinical Trials Protocol Record is NCT00987155/4.2007.2271.
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Chronic effects of simultaneous electromyostimulation and vibration on leg blood flow in spinal cord injury. Spinal Cord 2016; 54:1169-1175. [DOI: 10.1038/sc.2016.60] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 03/22/2016] [Accepted: 03/24/2016] [Indexed: 02/06/2023]
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Allison DJ, Chapman B, Wolfe D, Sequeira K, Hayes K, Ditor DS. Effects of a Functional Electrical Stimulation-Assisted Cycling Program on Immune and Cardiovascular Health in Persons with Spinal Cord Injury. Top Spinal Cord Inj Rehabil 2016; 22:71-78. [PMID: 29398895 DOI: 10.1310/sci2201-71] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Background: Spinal cord injury (SCI) is associated with both a state of chronic inflammation and an increased prevalence of cardiovascular disease (CVD). These disorders are closely linked and have been shown to negatively influence one another. Participation in regular exercise has been shown to be an effective intervention strategy in the treatment of each of these disorders. For individuals with SCI who may lack the lower limb motor capabilities to perform certain traditional exercise modalities, functional electrical stimulation (FES) cycling may provide an effective alternative. Objective: The purpose of this study was to examine the effects of 12 weeks of FES training performed 3 times per week on physiological indices of cardiovascular function as well as molecular indices of inflammation and cardiovascular health. Methods: Ten individuals with chronic SCI were included. Measures of central and peripheral cardiovascular function as well as hematological and immunological markers were assessed before and after the 12-week exercise program. Results: Enhancements in exercise performance as well as a corresponding increase in peripheral cardiovascular function were achieved, as shown by a significant 34% increase in pulse volume (P = .04) and trends toward increases in cross-sectional area (P = .09) and arterial inflow volume (P = .11) of the common femoral artery. Despite this, no change in any hematological or immunological markers was evident. Conclusion: Although the efficacy of FES exercise in enhancing exercise performance (time and distance to fatigue) and peripheral cardiovascular function has been reaffirmed, no alterations in any molecular indices of cardiovascular risk were achieved.
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Affiliation(s)
- David J Allison
- Department of Kinesiology, Brock University, St. Catharines, Ontario, Canada.,Brock-Niagara Centre for Health and Well-being, St Catharines, Ontario, Canada
| | - Bonnie Chapman
- Aging, Rehabilitation & Geriatric Care, Lawson Health Research Institute, London, Ontario, Canada
| | - Dalton Wolfe
- Aging, Rehabilitation & Geriatric Care, Lawson Health Research Institute, London, Ontario, Canada
| | - Keith Sequeira
- Aging, Rehabilitation & Geriatric Care, Lawson Health Research Institute, London, Ontario, Canada
| | - Keith Hayes
- Aging, Rehabilitation & Geriatric Care, Lawson Health Research Institute, London, Ontario, Canada
| | - David S Ditor
- Department of Kinesiology, Brock University, St. Catharines, Ontario, Canada.,Brock-Niagara Centre for Health and Well-being, St Catharines, Ontario, Canada
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Ganzer PD, Manohar A, Shumsky JS, Moxon KA. Therapy induces widespread reorganization of motor cortex after complete spinal transection that supports motor recovery. Exp Neurol 2016; 279:1-12. [PMID: 26826448 DOI: 10.1016/j.expneurol.2016.01.022] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Revised: 12/28/2015] [Accepted: 01/26/2016] [Indexed: 01/07/2023]
Abstract
Reorganization of the somatosensory system and its relationship to functional recovery after spinal cord injury (SCI) has been well studied. However, little is known about the impact of SCI on organization of the motor system. Recent studies suggest that step-training paradigms in combination with spinal stimulation, either electrically or through pharmacology, are more effective than step training alone at inducing recovery and that reorganization of descending corticospinal circuits is necessary. However, simpler, passive exercise combined with pharmacotherapy has also shown functional improvement after SCI and reorganization of, at least, the sensory cortex. In this study we assessed the effect of passive exercise and serotonergic (5-HT) pharmacological therapies on behavioral recovery and organization of the motor cortex. We compared the effects of passive hindlimb bike exercise to bike exercise combined with daily injections of 5-HT agonists in a rat model of complete mid-thoracic transection. 5-HT pharmacotherapy combined with bike exercise allowed the animals to achieve unassisted weight support in the open field. This combination of therapies also produced extensive expansion of the axial trunk motor cortex into the deafferented hindlimb motor cortex and, surprisingly, reorganization within the caudal and even the rostral forelimb motor cortex areas. The extent of the axial trunk expansion was correlated to improvement in behavioral recovery of hindlimbs during open field locomotion, including weight support. From a translational perspective, these data suggest a rationale for developing and optimizing cost-effective, non-invasive, pharmacological and passive exercise regimes to promote plasticity that supports restoration of movement after spinal cord injury.
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Affiliation(s)
- Patrick D Ganzer
- School of Biomedical Engineering, Science and Health Systems, Drexel University, 3141 Chestnut St., Philadelphia, PA 19104, United States
| | - Anitha Manohar
- School of Biomedical Engineering, Science and Health Systems, Drexel University, 3141 Chestnut St., Philadelphia, PA 19104, United States
| | - Jed S Shumsky
- Department of Neurobiology and Anatomy, Drexel University College of Medicine, 2900 Queen Lane, Philadelphia, PA 19129, United States
| | - Karen A Moxon
- School of Biomedical Engineering, Science and Health Systems, Drexel University, 3141 Chestnut St., Philadelphia, PA 19104, United States; Department of Neurobiology and Anatomy, Drexel University College of Medicine, 2900 Queen Lane, Philadelphia, PA 19129, United States.
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Gorgey AS, Lawrence J. Acute Responses of Functional Electrical Stimulation Cycling on the Ventilation-to-CO2 Production Ratio and Substrate Utilization After Spinal Cord Injury. PM R 2015; 8:225-34. [PMID: 26493854 DOI: 10.1016/j.pmrj.2015.10.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Revised: 10/02/2015] [Accepted: 10/07/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND Ventilation-to-carbon dioxide ratio is comparable with peak oxygen uptake in the prognosis of cardiovascular disorders. Currently, there are no established indices to determine the submaximal effects of functional electrical stimulation on cardiovascular performance in persons with spinal cord injury. OBJECTIVE To determine the effects of an acute bout of functional electrical stimulation-lower extremity cycling on ventilation, carbon dioxide production, ventilation-to-carbon dioxide ratio, and substrate utilization in people with motor complete spinal cord injury. DESIGN Observational cross-sectional design. SETTING Clinical laboratory setting. PARTICIPANTS Ten individuals with motor complete spinal cord injury. METHODS Participants were allowed to cycle until fatigue. The effects of functional electrical stimulation on ventilation, carbon dioxide production, ventilation-to-carbon dioxide ratio, and substrate utilization were measured with a portable metabolic cart (COSMED K4b2). Body composition was determined with bioelectrical impedance. RESULTS Resting and warm-up ventilation were 8.15 ± 3.5 L/min and 8.15 ± 2.8 L/min, respectively. Functional electrical stimulation increased ventilation significantly (14.5 ± 6.4 L/min), which remained significantly elevated (13.3 ± 4.3 L/min) during the recovery period. During resting and warm-up phases, the ventilation-to-carbon dioxide ratios were 41 ± 4.8 and 38 ± 5.4, respectively. Functional electrical stimulation decreased the ventilation-to-carbon dioxide ratio significantly to 31.5 ± 4, which remained significantly reduced during the recovery period (34.4 ± 3). Functional electrical stimulation relied primarily on carbohydrate utilization (188 ± 160 g/day to 574 ± 324 g/day; P = .001) with no changes in fat utilization (77.5 ± 28 g/day to 93.5 ± 133.6 g/day; P = .7) from resting to exercise periods. Significant relationships were noted between carbohydrate utilization during functional electrical stimulation and carbon dioxide (r = 0.98; P = .00010) production. The percentage whole body fat-free mass was negatively related to the exercise ventilation-to-carbon ratio (r = -0.66; P = .045). CONCLUSIONS An acute bout of functional electrical stimulation resulted in a significant drop in the ventilation-to-carbon ratio, accompanied with a reliance on carbohydrate utilization and a diminished capacity to utilize fat as a substrate. Fat-free mass may be associated with a decrease in ventilation to carbon dioxide ratio and an increase in carbohydrate utilization in persons with spinal cord injury.
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Affiliation(s)
- Ashraf S Gorgey
- Spinal Cord Injury and Disorders Center, Hunter Holmes McGuire VAMC, 1201 Broad Rock Boulevard, Richmond, VA 23249; and Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA(∗).
| | - Justin Lawrence
- Spinal Cord Injury and Disorders Center, Hunter Holmes McGuire VAMC, and College of Health and Human Performance; Virginia Commonwealth University, Richmond, VA(†)
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Astorino TA, Harness ET, White AC. Efficacy of Acute Intermittent Hypoxia on Physical Function and Health Status in Humans with Spinal Cord Injury: A Brief Review. Neural Plast 2015; 2015:409625. [PMID: 26167303 PMCID: PMC4475712 DOI: 10.1155/2015/409625] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Revised: 05/25/2015] [Accepted: 05/27/2015] [Indexed: 12/27/2022] Open
Abstract
Spinal cord injury (SCI) results in a loss of motor and sensory function and is consequent with reductions in locomotion, leading to a relatively sedentary lifestyle which predisposes individuals to premature morbidity and mortality. Many exercise modalities have been employed to improve physical function and health status in SCI, yet they are typically expensive, require many trained clinicians to implement, and are thus relegated to specialized rehabilitation centers. These characteristics of traditional exercise-based rehabilitation in SCI make their application relatively impractical considering the time-intensive nature of these regimens and patients' poor access to exercise. A promising approach to improve physical function in persons with SCI is exposure to acute intermittent hypoxia (IH) in the form of a small amount of sessions of brief, repeated exposures to low oxygen gas mixtures interspersed with normoxic breathing. This review summarizes the clinical application of IH in humans with SCI, describes recommended dosing and potential side effects of IH, and reviews existing data concerning the efficacy of relatively brief exposures of IH to modify health and physical function. Potential mechanisms explaining the effects of IH are also discussed. Collectively, IH appears to be a safe, time-efficient, and robust approach to enhance physical function in chronic, incomplete SCI.
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Affiliation(s)
- Todd A. Astorino
- Department of Kinesiology, CSU San Marcos, San Marcos, CA 92096-0001, USA
| | | | - Ailish C. White
- Department of Kinesiology, CSU San Marcos, San Marcos, CA 92096-0001, USA
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Boosting in Elite Athletes with Spinal Cord Injury: A Critical Review of Physiology and Testing Procedures. Sports Med 2015; 45:1133-42. [DOI: 10.1007/s40279-015-0340-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Evans N, Hartigan C, Kandilakis C, Pharo E, Clesson I. Acute Cardiorespiratory and Metabolic Responses During Exoskeleton-Assisted Walking Overground Among Persons with Chronic Spinal Cord Injury. Top Spinal Cord Inj Rehabil 2015; 21:122-32. [PMID: 26364281 DOI: 10.1310/sci2102-122] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Lower extremity robotic exoskeleton technology is being developed with the promise of affording people with spinal cord injury (SCI) the opportunity to stand and walk. The mobility benefits of exoskeleton-assisted walking can be realized immediately, however the cardiorespiratory and metabolic benefits of this technology have not been thoroughly investigated. OBJECTIVE The purpose of this pilot study was to evaluate the acute cardiorespiratory and metabolic responses associated with exoskeleton-assisted walking overground and to determine the degree to which these responses change at differing walking speeds. METHODS Five subjects (4 male, 1 female) with chronic SCI (AIS A) volunteered for the study. Expired gases were collected during maximal graded exercise testing and two, 6-minute bouts of exoskeleton-assisted walking overground. Outcome measures included peak oxygen consumption (V̇O2peak), average oxygen consumption (V̇O2avg), peak heart rate (HRpeak), walking economy, metabolic equivalent of tasks for SCI (METssci), walk speed, and walk distance. RESULTS Significant differences were observed between walk-1 and walk-2 for walk speed, total walk distance, V̇O2avg, and METssci. Exoskeleton-assisted walking resulted in %V̇O2peak range of 51.5% to 63.2%. The metabolic cost of exoskeleton-assisted walking ranged from 3.5 to 4.3 METssci. CONCLUSIONS Persons with motor-complete SCI may be limited in their capacity to perform physical exercise to the extent needed to improve health and fitness. Based on preliminary data, cardiorespiratory and metabolic demands of exoskeleton-assisted walking are consistent with activities performed at a moderate intensity.
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Affiliation(s)
- Nicholas Evans
- Beyond Therapy, Shepherd Center, Atlanta, Georgia.,Hulse Spinal Cord Injury Laboratory, Shepherd Center, Atlanta, Georgia
| | - Clare Hartigan
- Virginia C. Crawford Research Institute, Shepherd Center, Atlanta, Georgia
| | - Casey Kandilakis
- Virginia C. Crawford Research Institute, Shepherd Center, Atlanta, Georgia
| | | | - Ismari Clesson
- Virginia C. Crawford Research Institute, Shepherd Center, Atlanta, Georgia
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Bochkezanian V, Raymond J, de Oliveira CQ, Davis GM. Can combined aerobic and muscle strength training improve aerobic fitness, muscle strength, function and quality of life in people with spinal cord injury? A systematic review. Spinal Cord 2015; 53:418-31. [DOI: 10.1038/sc.2015.48] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Revised: 01/22/2015] [Accepted: 02/23/2015] [Indexed: 11/09/2022]
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Arnet U, Hinrichs T, Lay V, Bertschy S, Frei H, Brinkhof MWG. Determinants of handbike use in persons with spinal cord injury: results of a community survey in Switzerland. Disabil Rehabil 2015; 38:81-6. [DOI: 10.3109/09638288.2015.1024339] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Oh YM, Eun JP. Cardiovascular dysfunction due to sympathetic hypoactivity after complete cervical spinal cord injury: a case report and literature review. Medicine (Baltimore) 2015; 94:e686. [PMID: 25816041 PMCID: PMC4554008 DOI: 10.1097/md.0000000000000686] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Spinal cord injury (SCI) is one of the most devastating of all traumatic events; it may cause permanent dysfunction in several organ systems and lead to motor and sensory impairment. Cardiovascular dysfunction has been recognized to be the leading cause of morbidity and mortality in the acute and chronic stages following SCI. Although cardiovascular dysfunction causes the deaths of many SCI patients, most clinicians are unfamiliar with the phenomenon. The purpose of reporting our case is to remind clinicians to consider the possibility of cardiovascular dysfunction in patients with complete SCI. The patient signed informed consent for publication of this case report and any accompanying image. The ethical approval of this study was waived by the ethics committee of the Chonbuk National University Hospital, Jeonju, Korea, because this study was a case report and the number of patients was <3. A 63-year-old man was transferred to our emergency room after a fall. He complained of weakness and numbness of the lower extremity. Radiologic evaluation revealed C7/T1 unilateral facet dislocation with spinal cord contusion. On neurologic examination, the patient exhibited a paraplegic state below the T4 dermatome because of complete SCI. His vital signs were stable, but respiration was shallow. We performed intraoperative manual reduction and anterior interbody fusion. On the second postoperative day, the patient experienced sudden cardiac arrest after he was shifted from a supine to a semilateral position. Upon position change, heart rate was decreased <40 beats/min and blood pressure could not be checked. We immediately started cardiac massage and administered atropine 0.5 mg and epinephrine 1 mg, and the patient was successfully resuscitated. Cardiac arrest recurred when we performed endotracheal suction or changed patient's position. Echocardiographic and Holter monitoring findings demonstrated normal heart function and sinus bradycardia, and there was no evidence of pulmonary thromboembolism. We concluded that cardiac arrest was induced by sympathetic hypoactivity following complete SCI. Two months later, this phenomenon had resolved, and 4 months after presentation, he was discharged reliant on a home ventilator. Through this report, we emphasize that a thorough understanding of cardiovascular dysfunction following SCI is important for establishing a diagnosis and optimizing clinical outcomes.
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Affiliation(s)
- Young-Min Oh
- From the Department of Neurosurgery (Y-MO, J-PE), Research Institute of Clinical Medicine, Chonbuk National University, and Biomedical Research Institute, Chonbuk National University Hospital, Jeonju, Korea
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Hagen EM. Acute complications of spinal cord injuries. World J Orthop 2015; 6:17-23. [PMID: 25621207 PMCID: PMC4303786 DOI: 10.5312/wjo.v6.i1.17] [Citation(s) in RCA: 108] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Revised: 12/24/2013] [Accepted: 05/28/2014] [Indexed: 02/06/2023] Open
Abstract
The aim of this paper is to give an overview of acute complications of spinal cord injury (SCI). Along with motor and sensory deficits, instabilities of the cardiovascular, thermoregulatory and broncho-pulmonary system are common after a SCI. Disturbances of the urinary and gastrointestinal systems are typical as well as sexual dysfunction. Frequent complications of cervical and high thoracic SCI are neurogenic shock, bradyarrhythmias, hypotension, ectopic beats, abnormal temperature control and disturbance of sweating, vasodilatation and autonomic dysreflexia. Autonomic dysreflexia is an abrupt, uncontrolled sympathetic response, elicited by stimuli below the level of injury. The symptoms may be mild like skin rash or slight headache, but can cause severe hypertension, cerebral haemorrhage and death. All personnel caring for the patient should be able to recognize the symptoms and be able to intervene promptly. Disturbance of respiratory function are frequent in tetraplegia and a primary cause of both short and long-term morbidity and mortality is pulmonary complications. Due to physical inactivity and altered haemostasis, patients with SCI have a higher risk of venous thromboembolism and pressure ulcers. Spasticity and pain are frequent complications which need to be addressed. The psychological stress associated with SCI may lead to anxiety and depression. Knowledge of possible complications during the acute phase is important because they may be life threatening and/ or may lead to prolonged rehabilitation.
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64
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Gorgey AS, Dolbow DR, Dolbow JD, Khalil RK, Gater DR. The effects of electrical stimulation on body composition and metabolic profile after spinal cord injury--Part II. J Spinal Cord Med 2015; 38:23-37. [PMID: 25001669 PMCID: PMC4293531 DOI: 10.1179/2045772314y.0000000244] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Diet and exercise are cornerstones in the management of obesity and associated metabolic complications, including insulin resistance, type 2 diabetes, and disturbances in the lipid profile. However, the role of exercise in managing body composition adaptations and metabolic disorders after spinal cord injury (SCI) is not well established. The current review summarizes evidence about the efficacy of using neuromuscular electrical stimulation or functional electrical stimulation in exercising the paralytic lower extremities to improve body composition and metabolic profile after SCI. There are a number of trials that investigated the effects on muscle cross-sectional area, fat-free mass, and glucose/lipid metabolism. The duration of the intervention in these trials varied from 6 weeks to 24 months. Training frequency ranged from 2 to 5 days/week. Most studies documented significant increases in muscle size but no noticeable changes in adipose tissue. While increases in skeletal muscle size after twice weekly training were greater than those trials that used 3 or 5 days/week, other factors such as differences in the training mode, i.e. resistance versus cycling exercise and pattern of muscle activation may be responsible for this observation. Loading to evoke muscle hypertrophy is a key component in neuromuscular training after SCI. The overall effects on lean mass were modest and did not exceed 10% and the effects of training on trunk or pelvic muscles remain unestablished. Most studies reported improvement in glucose metabolism with the enhancement of insulin sensitivity being the major factor following training. The effect on lipid profile is unclear and warrants further investigation.
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Affiliation(s)
- Ashraf S. Gorgey
- Correspondence to: Ashraf S. Gorgey, Department of Veterans Affairs, Hunter Holmes McGuire Medical Center, Spinal Cord Injury & Disorders Service, 1201 Broad Rock Boulevard, Richmond, VA 23249, USA.
| | - David R. Dolbow
- School of Human Performance and Recreation, University of Southern Mississippi, Hattiesburg, MS, USA
| | - James D. Dolbow
- Spinal Cord Injury and Disorders Center, Hunter Holmes McGuire VAMC, Richmond, VA, USA
| | - Refka K. Khalil
- Spinal Cord Injury and Disorders Center, Hunter Holmes McGuire VAMC, Richmond, VA, USA
| | - David R. Gater
- Department of Physical Medicine and Rehabilitation, Penn State University, Penn State College of Medicine, Hershey, PA, USA
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Stevens SL, Morgan DW. Heart rate response during underwater treadmill training in adults with incomplete spinal cord injury. Top Spinal Cord Inj Rehabil 2015; 21:40-8. [PMID: 25762859 PMCID: PMC4349174 DOI: 10.1310/sci2101-40] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Walking on a submerged treadmill can improve mobility in persons displaying lower limb muscle weakness and balance deficits. Little is known, however, regarding the effect of water treadmill exercise on cardiac performance in persons with incomplete spinal cord injury (iSCI). OBJECTIVE To assess heart rate response during underwater treadmill training (UTT) in adults with iSCI. METHODS Seven males and 4 females with iSCI (age = 48 ± 13 years; 5 ± 8 years after injury) completed 8 weeks of UTT (3 sessions per week; 3 walks per session) incorporating individually determined walking speeds, personalized levels of body weight unloading, and gradual, alternating increases in speed and duration. Heart rate was monitored during the last 15 seconds of the final 2 minutes of each walk. RESULTS Over the course of 3 biweekly periods in which walking speed remained constant, heart rate fell by 7% (7 ± 1 b•min(-1); P < .001) in weeks 2 and 3, 14% (17 ± 6 b•min(-1); P < .001) in weeks 4 and 5, and 17% (21 ± 11 b•min(-1); P < .001) in weeks 6 and 7. CONCLUSION In adults with iSCI, progressively greater absolute and relative reductions in submaximal exercise heart rate occurred after 2 months of UTT featuring a systematic increase in training volume.
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Affiliation(s)
- Sandra L. Stevens
- Department of Health and Human Performance, Middle Tennessee State University, Murfreesboro, Tennessee
| | - Don W. Morgan
- Department of Health and Human Performance, Middle Tennessee State University, Murfreesboro, Tennessee
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Gorgey AS, Dolbow DR, Dolbow JD, Khalil RK, Castillo C, Gater DR. Effects of spinal cord injury on body composition and metabolic profile - part I. J Spinal Cord Med 2014; 37:693-702. [PMID: 25001559 PMCID: PMC4231957 DOI: 10.1179/2045772314y.0000000245] [Citation(s) in RCA: 195] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Several body composition and metabolic-associated disorders such as glucose intolerance, insulin resistance, and lipid abnormalities occur prematurely after spinal cord injury (SCI) and at a higher prevalence compared to able-bodied populations. Within a few weeks to months of the injury, there is a significant decrease in total lean mass, particularly lower extremity muscle mass and an accompanying increase in fat mass. The infiltration of fat in intramuscular and visceral sites is associated with abnormal metabolic profiles. The current review will summarize the major changes in body composition and metabolic profiles that can lead to comorbidities such as type 2 diabetes mellitus and cardiovascular diseases after SCI. It is crucial for healthcare specialists to be aware of the magnitude of these changes. Such awareness may lead to earlier recognition and treatment of metabolic abnormalities that may reduce the co-morbidities seen over the lifetime of persons living with SCI.
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Affiliation(s)
- Ashraf S. Gorgey
- Correspondence to: Ashraf S. Gorgey, Department of Veterans Affairs, Hunter Holmes McGuire Medical Center, Spinal Cord Injury & Disorders Service, 1201 Broad Rock Boulevard, Richmond, VA 23249, USA.
| | - David R. Dolbow
- School of Human Performance and Recreation, University of Southern Mississippi, Hattiesburg, MS, USA
| | - James D. Dolbow
- Spinal Cord Injury and Disorders Center, Hunter Holmes McGuire VAMC, Richmond, VA, USA
| | - Refka K. Khalil
- Spinal Cord Injury and Disorders Center, Hunter Holmes McGuire VAMC, Richmond, VA, USA
| | - Camilo Castillo
- MedStar National Rehabilitation Network, Washington, DC, USA
| | - David R. Gater
- Department of Physical Medicine and Rehabilitation, Penn State College of Medicine, Penn State University, Hershey, PA, USA
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Grahn PJ, Mallory GW, Berry BM, Hachmann JT, Lobel DA, Lujan JL. Restoration of motor function following spinal cord injury via optimal control of intraspinal microstimulation: toward a next generation closed-loop neural prosthesis. Front Neurosci 2014; 8:296. [PMID: 25278830 PMCID: PMC4166363 DOI: 10.3389/fnins.2014.00296] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2014] [Accepted: 08/31/2014] [Indexed: 11/13/2022] Open
Abstract
Movement is planned and coordinated by the brain and carried out by contracting muscles acting on specific joints. Motor commands initiated in the brain travel through descending pathways in the spinal cord to effector motor neurons before reaching target muscles. Damage to these pathways by spinal cord injury (SCI) can result in paralysis below the injury level. However, the planning and coordination centers of the brain, as well as peripheral nerves and the muscles that they act upon, remain functional. Neuroprosthetic devices can restore motor function following SCI by direct electrical stimulation of the neuromuscular system. Unfortunately, conventional neuroprosthetic techniques are limited by a myriad of factors that include, but are not limited to, a lack of characterization of non-linear input/output system dynamics, mechanical coupling, limited number of degrees of freedom, high power consumption, large device size, and rapid onset of muscle fatigue. Wireless multi-channel closed-loop neuroprostheses that integrate command signals from the brain with sensor-based feedback from the environment and the system's state offer the possibility of increasing device performance, ultimately improving quality of life for people with SCI. In this manuscript, we review neuroprosthetic technology for improving functional restoration following SCI and describe brain-machine interfaces suitable for control of neuroprosthetic systems with multiple degrees of freedom. Additionally, we discuss novel stimulation paradigms that can improve synergy with higher planning centers and improve fatigue-resistant activation of paralyzed muscles. In the near future, integration of these technologies will provide SCI survivors with versatile closed-loop neuroprosthetic systems for restoring function to paralyzed muscles.
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Affiliation(s)
- Peter J. Grahn
- Mayo Clinic College of Medicine, Mayo ClinicRochester, MN, USA
| | | | | | - Jan T. Hachmann
- Department of Neurologic Surgery, Mayo ClinicRochester, MN, USA
| | | | - J. Luis Lujan
- Department of Neurologic Surgery, Mayo ClinicRochester, MN, USA
- Department of Physiology and Biomedical Engineering, Mayo ClinicRochester, MN, USA
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Miyatani M, Szeto M, Moore C, Oh PI, McGillivray CF, Catharine Craven B. Exploring the associations between arterial stiffness and spinal cord impairment: A cross-sectional study. J Spinal Cord Med 2014; 37:556-64. [PMID: 25229737 PMCID: PMC4166190 DOI: 10.1179/2045772314y.0000000261] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND/OBJECTIVE Elevated aortic arterial stiffness (aortic pulse wave velocity: aPWV) is an independent coronary artery disease predictor among the general population. The purpose of this study was to: (1) report aPWV values in a representative cohort of patients with spinal cord injury (SCI); (2) to compare aPWV values in people with SCI based on neurological level of injury; and (3) to contrast the reported aPWV values with available normal values for the general population. METHODS Adults with chronic SCI (n = 87) were divided into two groups (TETRA group, n = 37 and PARA group, n = 50). aPWV and potential confounders of aPWV were assessed. Analysis of covariance was used for comparisons between groups and adjusted for the confounders. Subjects' aPWV values were contrasted with reference values for general population determined by "The Reference value for arterial stiffness' collaboration" and prevalence of abnormal aPWV defined as greater than or equal to the age-specific 90th percentile was reported. RESULTS Prevalence of abnormal aPWV in the cohort was 25.3%. After adjusting for covariates, the mean aPWV values were significantly different between two groups (TETRA: 8.0 (95% confidence interval (CI): 7.5-8.6) m/second, PARA: 9.0 (95% CI: 8.5-9.4) m/second, P = 0.010). The prevalence of abnormal aPWV was significantly higher in the PARA group (36%) compared to the TETRA group (11%) (P = 0.012). CONCLUSIONS One-quarter of the total cohort had an abnormal aPWV. Subjects with paraplegia had higher aPWV values and a higher frequency of abnormal aPWV than subjects with tetraplegia. Elevated aPWV in people with SCI, particularly those with paraplegia, may impart significant adverse cardiovascular consequences.
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Affiliation(s)
- Masae Miyatani
- Toronto Rehabilitation Institute-UHN, Brain and Spinal Cord Rehabilitation Program, Toronto, ON, Canada,Correspondence to: Masae Miyatani, Lyndhurst Centre, Toronto Rehabilitation Institute-UHN, 520 Sutherland Drive, Toronto, ON M4G 3V9, Canada.
| | - Maggie Szeto
- Toronto Rehabilitation Institute-UHN, Brain and Spinal Cord Rehabilitation Program, Toronto, ON, Canada
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Sisto SA, Evans N. Activity and Fitness in Spinal Cord Injury: Review and Update. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2014. [DOI: 10.1007/s40141-014-0057-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Reproducibility and responsiveness of heart rate indexes to assess wheeling efficiency in patients with spinal cord injuries. Spinal Cord 2014; 52:683-8. [PMID: 25000952 DOI: 10.1038/sc.2014.108] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2014] [Revised: 03/31/2014] [Accepted: 04/08/2014] [Indexed: 11/08/2022]
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Moxon KA, Oliviero A, Aguilar J, Foffani G. Cortical reorganization after spinal cord injury: always for good? Neuroscience 2014; 283:78-94. [PMID: 24997269 DOI: 10.1016/j.neuroscience.2014.06.056] [Citation(s) in RCA: 86] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Revised: 06/09/2014] [Accepted: 06/25/2014] [Indexed: 12/29/2022]
Abstract
Plasticity constitutes the basis of behavioral changes as a result of experience. It refers to neural network shaping and re-shaping at the global level and to synaptic contacts remodeling at the local level, either during learning or memory encoding, or as a result of acute or chronic pathological conditions. 'Plastic' brain reorganization after central nervous system lesions has a pivotal role in the recovery and rehabilitation of sensory and motor dysfunction, but can also be "maladaptive". Moreover, it is clear that brain reorganization is not a "static" phenomenon but rather a very dynamic process. Spinal cord injury immediately initiates a change in brain state and starts cortical reorganization. In the long term, the impact of injury - with or without accompanying therapy - on the brain is a complex balance between supraspinal reorganization and spinal recovery. The degree of cortical reorganization after spinal cord injury is highly variable, and can range from no reorganization (i.e. "silencing") to massive cortical remapping. This variability critically depends on the species, the age of the animal when the injury occurs, the time after the injury has occurred, and the behavioral activity and possible therapy regimes after the injury. We will briefly discuss these dependencies, trying to highlight their translational value. Overall, it is not only necessary to better understand how the brain can reorganize after injury with or without therapy, it is also necessary to clarify when and why brain reorganization can be either "good" or "bad" in terms of its clinical consequences. This information is critical in order to develop and optimize cost-effective therapies to maximize functional recovery while minimizing maladaptive states after spinal cord injury.
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Affiliation(s)
- K A Moxon
- School of Biomedical Engineering, Science and Health Systems, Drexel University, 3141 Chestnut Street, Philadelphia, PA 19104, USA.
| | - A Oliviero
- Hospital Nacional de Parapléjicos, SESCAM, Finca la Peraleda s/n, 45071 Toledo, Spain
| | - J Aguilar
- Hospital Nacional de Parapléjicos, SESCAM, Finca la Peraleda s/n, 45071 Toledo, Spain
| | - G Foffani
- Hospital Nacional de Parapléjicos, SESCAM, Finca la Peraleda s/n, 45071 Toledo, Spain.
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Metabolic demand and muscle activation during different forms of bodyweight supported locomotion in men with incomplete SCI. BIOMED RESEARCH INTERNATIONAL 2014; 2014:632765. [PMID: 24971340 PMCID: PMC4055602 DOI: 10.1155/2014/632765] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Revised: 04/18/2014] [Accepted: 04/23/2014] [Indexed: 12/02/2022]
Abstract
Body weight supported locomotor training uses neuroplasticity principles to improve recovery following a spinal cord injury (SCI). Steady state locomotion using the same body weight support (BWS) percent was compared in 7 males (42.6 ± 4.29 years) with incomplete SCI and matched (gender, age) noninjured controls (42.7 ± 5.4 years) using the Lokomat, Manual Treadmill, and ZeroG. The VO2000, Polar Heart Rate (HR) Monitor, and lower limb electromyography (EMG) electrodes were worn during the 2-minute sessions. Oxygen uptake (VO2) and HR were expressed as percentage of peak values obtained using progressive arm ergometry; VO2 was also expressed relative to resting metabolic equivalents (METS). Filtered EMG signals from tibialis anterior (TA), rectus femoris (RF), biceps femoris (BF), and medial gastrocnemius (MG) were normalized to ZeroG stepping. The Lokomat required 30% of VO2 peak (2METS) compared to ~54% (3METS) for Manual Treadmill and ZeroG sessions. HR was 67% of peak during Lokomat sessions compared to ~83% for Manual Treadmill and ZeroG. Muscle activation was higher in treadmill conditions compared to the ZeroG primarily due to increased BF activity. At the same level of BWS, locomotion using the Manual Treadmill or the ZeroG is more aerobically demanding than the Lokomat. Treadmill modalities encourage greater hip extensor activation compared to overground locomotion.
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Driussi C, Ius A, Bizzarini E, Antonini-Canterin F, d'Andrea A, Bossone E, Vriz O. Structural and functional left ventricular impairment in subjects with chronic spinal cord injury and no overt cardiovascular disease. J Spinal Cord Med 2014; 37:85-92. [PMID: 24456485 PMCID: PMC4066555 DOI: 10.1179/2045772313y.0000000161] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
CONTEXT Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in subjects with long-term spinal cord injury (SCI). More specific recommendations for CVD prevention in this population are needed. METHODS One hundred thirty male subjects (47 subjects with SCI and 83 able-bodied persons (ABPs), mean age 43.89 ± 1.9 and 45.44 ± 12.2 years; P = 0.48) underwent transthoracic echocardiography (TTE). The effects of age, weight, mean arterial pressure (MAP) and level of physical training on cardiac adaptations were evaluated through multiple regression analysis. RESULTS In subjects with SCI, TTE revealed increased wall thickness (P < 0.05), lower E wave, E/A ratio and early diastolic myocardial relaxation velocity on Tissue Doppler Imaging (TDI) (P < 0.05) and higher systolic myocardial contraction velocity on TDI (0.10 ± 0.02 vs. 0.09 ± 0.02 m/seconds, P = 0.002) and peak systolic pressure to end-systolic volume ratio (3.62 ± 1.39 vs. 2.82 ± 0.90, P < 0.001) compared with ABPs. Aortic diameters were larger in subjects with SCI than ABPs. Differences remained statistically significant even after adjustment for age, weight, MAP, and level of physical training. Weight and age were found to be independent variables that substantially affected left ventricular structure and function in subjects with SCI. CONCLUSIONS Subjects with post-traumatic chronic SCI and no overt cardiovascular risk factors, exhibit initial left ventricular remodeling (as assessed by TTE) compared with ABPs. Lifestyle modifications, including regular physical exercise and weight control, should be implemented in all subjects with SCI, even at a very early stage, in order to reduce cardiovascular risk and prevent the development of CVD.
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Affiliation(s)
- Caterina Driussi
- Correspondence to: Caterina Driussi, Department of Emergency and Cardiology, San Antonio Community Hospital, Via Trento-Trieste, 33038 San Daniele del Friuli, Udine, Italy.
| | - Arianna Ius
- Cardiology and Emergency Department, San Antonio Hospital, San Daniele del Friuli, Udine, Italy
| | | | | | | | - Eduardo Bossone
- Department of Cardiac Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Olga Vriz
- Cardiology and Emergency Department, San Antonio Hospital, San Daniele del Friuli, Udine, Italy
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Ribeiro Neto F, Lopes GHR. Análise dos valores de composição corporal em homens com diferentes níveis de lesão medular. FISIOTERAPIA EM MOVIMENTO 2013. [DOI: 10.1590/s0103-51502013000400004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUÇÃO: A proporção entre massa corporal magra e de gordura é um preditor de doenças metabólicas. Assim, quantificar variáveis de composição corporal, iniciando uma análise de valores de referência de acordo com o nível da lesão medular (LM), tornou-se importante para o planejamento e monitoramento de atividades físicas. OBJETIVOS: 1) Determinar valores de referências de somatório de dobras cutâneas (ΣDC) e percentual de gordura em diferentes níveis de LM. 2) Detectar diferenças de composição corporal entre níveis de LM. 3) Correlacionar ΣDC com tempo de lesão e índice de massa corpórea (IMC). MATERIAIS E MÉTODOS: Setenta e quatro pacientes homens com LM, de 18 a 52 anos, foram divididos em tetraplegia (TT - C4 a C8), paraplegia alta (PPa - T1 a T6) e paraplegia baixa (PPb - T7 a L3). A composição corporal foi avaliada pelas dobras cutâneas. RESULTADOS: Não houve diferença significativa entre TT, PPa e PPb para as variáveis tempo de lesão, estatura, massa corporal total, ΣDC, percentual de gordura, massa corporal magra e IMC. Apenas a idade diferenciou entre os grupos TT e PPb (P < 0,05). A variável ΣDC não se correlacionou com o nível de lesão (rho = -0,08; IC95%: -0,537 a 0,420) ou com tempo de lesão (rho = 0,18; IC95%: -0,050 a 0,393). Não houve diferença significativa entre lesão completa e incompleta para todas as variáveis antropométricas. O ΣDC correlacionou-se positivamente com o IMC (rho = 0,68; IC95%: 0,539 a 0,739). CONSIDERAÇÕES FINAIS: TT, PPa e PPb não apresentaram diferenças significativas nos valores de composição corporal. O IMC apresentou boa correlação com ΣDC entre os grupos.
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Moreschi C, Da Broi U, Rodriguez D, Froldi R, Porzionato A, Macchi V, De Caro R. The Eluana Englaro Case: Cause of death after the withdrawal of artificial nutrition and hydration in a subject in a permanent vegetative state and with quadriplegia. Forensic Sci Int 2013; 231:e24-9. [DOI: 10.1016/j.forsciint.2013.05.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Revised: 03/13/2013] [Accepted: 05/18/2013] [Indexed: 01/09/2023]
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Yarar-Fisher C, Bickel CS, Windham ST, McLain AB, Bamman MM. Skeletal muscle signaling associated with impaired glucose tolerance in spinal cord-injured men and the effects of contractile activity. J Appl Physiol (1985) 2013; 115:756-64. [PMID: 23766505 DOI: 10.1152/japplphysiol.00122.2013] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
The mechanisms underlying poor glucose tolerance in persons with spinal cord injury (SCI), along with its improvement after several weeks of neuromuscular electrical stimulation-induced resistance exercise (NMES-RE) training, remain unclear, but presumably involve the affected skeletal musculature. We, therefore, investigated skeletal muscle signaling pathways associated with glucose transporter 4 (GLUT-4) translocation at rest and shortly after a single bout of NMES-RE in SCI (n = 12) vs. able-bodied (AB, n = 12) men. Subjects completed an oral glucose tolerance test during visit 1 and ≈90 NMES-RE isometric contractions of the quadriceps during visit 2. Muscle biopsies were collected before, and 10 and 60 min after, NMES-RE. We assessed transcript levels of GLUT-4 by quantitative PCR and protein levels of GLUT-4 and phosphorylated- and total AMP-activated protein kinase (AMPK)-α, CaMKII, Akt, and AS160 by immunoblotting. Impaired glucose tolerance in SCI was confirmed by higher (P < 0.05) plasma glucose concentrations than AB at all time points after glucose ingestion, despite equivalent insulin responses to the glucose load. GLUT-4 protein content was lower (P < 0.05) in SCI vs. AB at baseline. Main group effects revealed higher phosphorylation in SCI of AMPK-α, CaMKII, and Akt (P < 0.05), and Akt phosphorylation increased robustly (P < 0.05) following NMES-RE in SCI only. In SCI, low skeletal muscle GLUT-4 protein concentration may, in part, explain poor glucose tolerance, whereas heightened phosphorylation of relevant signaling proteins (AMPK-α, CaMKII) suggests a compensatory effort. Finally, it is encouraging to find (based on Akt) that SCI muscle remains both sensitive and responsive to mechanical loading (NMES-RE) even ≈22 yr after injury.
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Affiliation(s)
- Ceren Yarar-Fisher
- Department of Cell, Developmental, and Integrative Biology, University of Alabama at Birmingham, Birmingham, Alabama
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Yarar-Fisher C, Pascoe DD, Gladden LB, Quindry JC, Hudson J, Sefton J. Acute physiological effects of whole body vibration (WBV) on central hemodynamics, muscle oxygenation and oxygen consumption in individuals with chronic spinal cord injury. Disabil Rehabil 2013; 36:136-45. [DOI: 10.3109/09638288.2013.782358] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Graziano A, Foffani G, Knudsen EB, Shumsky J, Moxon KA. Passive exercise of the hind limbs after complete thoracic transection of the spinal cord promotes cortical reorganization. PLoS One 2013; 8:e54350. [PMID: 23349859 PMCID: PMC3551921 DOI: 10.1371/journal.pone.0054350] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2012] [Accepted: 12/12/2012] [Indexed: 02/07/2023] Open
Abstract
Physical exercise promotes neural plasticity in the brain of healthy subjects and modulates pathophysiological neural plasticity after sensorimotor loss, but the mechanisms of this action are not fully understood. After spinal cord injury, cortical reorganization can be maximized by exercising the non-affected body or the residual functions of the affected body. However, exercise per se also produces systemic changes – such as increased cardiovascular fitness, improved circulation and neuroendocrine changes – that have a great impact on brain function and plasticity. It is therefore possible that passive exercise therapies typically applied below the level of the lesion in patients with spinal cord injury could put the brain in a more plastic state and promote cortical reorganization. To directly test this hypothesis, we applied passive hindlimb bike exercise after complete thoracic transection of the spinal cord in adult rats. Using western blot analysis, we found that the level of proteins associated with plasticity – specifically ADCY1 and BDNF – increased in the somatosensory cortex of transected animals that received passive bike exercise compared to transected animals that received sham exercise. Using electrophysiological techniques, we then verified that neurons in the deafferented hindlimb cortex increased their responsiveness to tactile stimuli delivered to the forelimb in transected animals that received passive bike exercise compared to transected animals that received sham exercise. Passive exercise below the level of the lesion, therefore, promotes cortical reorganization after spinal cord injury, uncovering a brain-body interaction that does not rely on intact sensorimotor pathways connecting the exercised body parts and the brain.
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Affiliation(s)
- Alessandro Graziano
- Department of Physiology and Pharmacology, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA.
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Hagen EM, Rekand T, Grønning M, Færestrand S. Cardiovascular complications of spinal cord injury. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2012; 132:1115-20. [PMID: 22614315 DOI: 10.4045/tidsskr.11.0551] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The aim of this paper is to provide an overview of the autonomic innervation of the cardiovascular system and the cardiovascular sequelae of spinal cord injuries. METHOD A literature search was carried out in the PubMed database, with the search phrases "traumatic spinal cord injury"/"traumatic spinal cord injuries" together with "autonomic dysfunction", "autonomic dysreflexia" and "cardiovascular disease". RESULTS The most important cardiovascular complications in the acute phase are bradyarrhythmia, hypotension, enhanced vasovagal reflexes, supraventricular/ventricular ectopic beats, vasodilation and venous stasis. Important in the chronic phase are orthostatic hypotension and impaired regulation of blood pressure, blood volume and body temperature. Tetraplegia is frequently accompanied by autonomic dysreflexia, impaired transmission of cardial pain, loss of muscle mass in the left ventricle and pseudoinfarction. Patients with injuries above the sixth thoracic vertebra have a predisposition for autonomic dysreflexia. This is a condition characterised by sudden, uncontrolled sympathetic response accompanied by a rise in blood pressure. Autonomic dysreflexia usually leads to headaches and erythema on the upper chest. The condition may cause cerebral haemorrhage and is potentially life threatening. Patients with spinal cord injuries have an increased risk of atherosclerotic disease due to overweight, lipid disorders, metabolic syndrome and diabetes. They are predisposed to thrombotic emboli due to venous stasis and hypercoagulopathy, particularly immediately after the injury. INTERPRETATION Knowledge of cardiovascular sequelae after spinal cord injuries and assessment of these is important for correct diagnostics, planning of preventive measures and optimal treatment.
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Affiliation(s)
- Ellen Merete Hagen
- Nevrologisk avdeling, Haukeland universitetssykehus, ogInstitutt for klinisk medisin, Universitet i Bergen.
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Jung DW, Park DS, Lee BS, Kim M. Development of a motor driven rowing machine with automatic functional electrical stimulation controller for individuals with paraplegia; a preliminary study. Ann Rehabil Med 2012; 36:379-85. [PMID: 22837974 PMCID: PMC3400878 DOI: 10.5535/arm.2012.36.3.379] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2011] [Accepted: 05/09/2012] [Indexed: 11/18/2022] Open
Abstract
Objective To examine the cardiorespiratory responses of patients with spinal cord injury (SCI) paraplegia using a motor driven rowing machine. Method Ten SCI patients with paraplegia [A (n=6), B (n=1), and C (n=3) by the American Spinal Injury Association impairment scale] were selected. Two rowing techniques were used. The first used a fixed seat with rowing achieved using only upper extremity movement (fixed rowing). The second used an automatically moving seat, facilitating active upper extremity movement and passive lower extremity movement via the motorized seat (motor rowing). Each patient performed two randomly assigned rowing exercise stress tests 1-3 days apart. The work rate (WR), time, respiratory exchange ratio (R), oxygen consumption (VO2), heart rate (HR), metabolic equivalents (METs), and rating of perceived exertion (RPE) were recorded. Results WR, time, VO2, and METs were significantly higher after the motor rowing test than after fixed motor rowing test (p<0.05). HR after motor rowing was significantly lower than fixed rowing (p<0.05). Conclusion Cardiorespiratory responses as VO2, HR and METs can be elicited by the motor rowing for people with paraplegic SCI.
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Affiliation(s)
- Da-Woon Jung
- Department of Motor and Cognitive Function Rehabilitation, National Rehabilitation Research Institute, Seoul 142-884, Korea
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Myers J, Kiratli BJ, Jaramillo J. The Cardiometabolic Benefits of Routine Physical Activity in Persons Living with Spinal Cord Injury. CURRENT CARDIOVASCULAR RISK REPORTS 2012. [DOI: 10.1007/s12170-012-0238-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Autonomic dysreflexia: current evidence related to unstable arterial blood pressure control among athletes with spinal cord injury. Clin J Sport Med 2012; 22:39-45. [PMID: 22222591 DOI: 10.1097/jsm.0b013e3182420699] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To present the complex issues of the impact of spinal cord injury (SCI) in sport, with a specific focus on autonomic dysreflexia (AD) and the potential debilitating effects of unstable blood pressure control among athletes. DATA SOURCES AND METHODS A literature review based on a key word electronic literature search of articles, practice guidelines, and review articles pertaining to AD was conducted using MEDLINE, SportDiscus, and EMBASE. RESULTS Spinal cord injury results not only in devastating paralysis; it also commonly is associated with a range of autonomic dysregulation that can interfere with cardiovascular, bladder, bowel, temperature, and sexual function. Individuals with a cervical or high-thoracic SCI face lifelong abnormalities in systemic arterial pressure control. In general, their resting arterial pressure is lower than that in able-bodied individuals and is commonly associated with persistent orthostatic intolerance. In addition, they experience transient episodes of life-threatening hypertension, known as "AD," which often is associated with disturbances in heart rate and rhythm. Autonomic dysreflexia occurs in up to 90% of individuals with a cervical or high-thoracic SCI and requires prompt intervention. It also is known that, during athletic activities, self-induced AD is used by some individuals to improve their performance, a technique known as "boosting." For health safety reasons, boosting is officially banned by the International Paralympic Committee. CONCLUSIONS Devastating paralysis, a variety of autonomic dysfunctions, and abnormal cardiovascular control after SCI present significant challenges in terms of individuals remaining active in competitive sports. Medical practitioners who are involved in the care of wheelchair athletes should be aware of the unique cardiovascular dysfunction that results from SCI and may occur at any time, even with seemingly innocuous triggers. Prompt recognition and appropriate management of these conditions, including episodes of AD, could be life saving.
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Brurok B, Tørhaug T, Leivseth G, Karlsen T, Helgerud J, Hoff J. Effect of leg vascular occlusion on arm cycling peak oxygen uptake in spinal cord-injured individuals. Spinal Cord 2011; 50:298-302. [PMID: 22124351 DOI: 10.1038/sc.2011.129] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Cross-sectional single-subject design. OBJECTIVES To determine whether leg vascular occlusion (LEVO) augment arm cycling (ACE) peak oxygen uptake in spinal cord-injured individuals. SETTING University Hospital, Norway. METHODS Fifteen individuals with C(4) to T(12) spinal cord injury (SCI) were recruited and divided into two groups: injury above (SCI-high, n=8) or below (SCI-low, n=7) the T(6) level. Peak oxygen uptake (VO(2peak)) was measured during (1) ACE combined with LEVO, (2) ACE alone and (3) ACE combined with functional electrical stimulation cycling (FES hybrid cycling). RESULTS In the SCI-high group, VO(2peak) and peak Watt during ACE with LEVO were higher than ACE alone: 20.0 (±5.0) versus 17.6 (±5.0) ml kg(-1) min(-1) (P=0.006), and 72.5(±32) versus 80.0 (±34) Watt (P=0.016), respectively. However, FES hybrid cycling VO(2peak) was significantly higher than ACE with LEVO: 24.4 (±4.1) versus 20.0 (±5.0) ml kg(-1) min(-1) (P=0.006). In the SCI-low group, there was no difference in VO(2peak) and related parameters between the three modalities. CONCLUSIONS For spinal cord-injured individuals with injury level above T(6) (high) in the present study, LEVO combined with ACE augment VO(2peak). However, this acute increase in VO(2peak) was lower than when FES cycling was combined with ACE. These findings may have future implications for exercise prescription for spinal cord-injured individuals.
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Affiliation(s)
- B Brurok
- Department of Physical Medicine and Rehabilitation, St Olav's University Hospital, Trondheim, Norway.
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Hagen EM, Faerestrand S, Hoff JM, Rekand T, Gronning M. Cardiovascular and urological dysfunction in spinal cord injury. Acta Neurol Scand 2011:71-8. [PMID: 21711260 DOI: 10.1111/j.1600-0404.2011.01547.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE A spinal cord injury (SCI) above the sixth thoracic vertebra interrupts the supraspinal control of the sympathetic nervous system causing an imbalance between the sympathetic and the parasympathetic nervous system. This article focuses on the symptoms, treatment and examination of autonomic disturbances of the cardiovascular and the urinary system after a SCI. METHODS A non-systematic literature search in the PubMed database. RESULTS Frequent complications in the acute phase of cervical and high thoracic SCI are bradyarrhythmias, hypotension, hypothermia/hyperthermia, increased neurogenic shock, vagovagal reflex, supraventricular/ventricular ectopic beats, vasodilatation and congestion. Serious complications in the chronic phase of SCI are orthostatic hypotension, impaired cardiovascular reflexes, autonomic dysreflexia (AD), reduced sensation of cardiac pain, loss of reflex cardiac acceleration, quadriplegic cardiac atrophy due to loss of left ventricular mass and pseudo-myocardial infarction. AD is associated with a sudden, uncontrolled sympathetic response, triggered by stimuli below the injury. It may cause mild symptoms like skin rash or slight headache, but also severe hypertension, cerebral haemorrhage and death. Early recognition and prompt treatment are important. Urinary autonomic dysfunctions include hyperreflexia or areflexia of detrusor and/or sphincter of the bladder. CONCLUSIONS Patients with SCI have a high risk of cardiovascular complications, AD and urinary autonomic dysfunction both in the acute phase and later, affecting their prognosis and quality of life. Knowledge of cardiovascular and urological complications after SCI is important for proper diagnosis and treatment.
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Affiliation(s)
- E M Hagen
- Department of Neurology, Haukeland University Hospital, Bergen, Norway Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.
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Neto FR, Lopes GH. Body composition modifications in people with chronic spinal cord injury after supervised physical activity. J Spinal Cord Med 2011; 34:586-93. [PMID: 22330114 PMCID: PMC3237285 DOI: 10.1179/2045772311y.0000000038] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Quantification of body composition variables is important for planning of better activities in relation to individuals with spinal cord injury (SCI). OBJECTIVES (1) To evaluate changes in body composition in patients with SCI after a supervised physical activity process; (2) To correlate total body fat with time since injury. DESIGN Pre-post intervention. SETTING Sarah Rehabilitation Hospital Network, Brazil. PARTICIPANTS Fifty-three men with SCI aged 18-52 years with duration of injury >3 years. INTERVENTIONS The subjects were divided into three groups: tetraplegia (TT) (C5-C8), high paraplegia (HP) (T1-T6), and low paraplegia (LP) (T7-L2). Body composition was estimated in the first and last weeks of hospitalization. OUTCOME MEASURES Body weight (kg), skinfolds sum (mm), absolute (kg), and relative (%) fat and lean body mass. RESULTS Body weight increased in TT and decreased in HP (0.8 kg, 95%CI 0.1-1.5; and -1.0 kg, 95%CI -2.0 to 0.0, respectively; P < 0.05). Skinfolds sum decreased only in HP (-13.1 mm, 95%CI -20.7 to -5.5; P < 0.05). Absolute and relative body fat decreased significantly in the paraplegia groups. Lean body mass (LBM) percentage increased significantly in the paraplegia groups. Absolute LBM increased in TT and LP (0.8 kg, 95%CI 0.3-1.3; and 1.3 kg, 95%CI 0.8 to 1.8, respectively; P < 0.05). There was no correlation between time since injury and skinfolds sum for the three groups (P < 0.05). CONCLUSION TT, HP, and LP demonstrated favorable changes in body composition after 29 days of supervised physical activity. However, these changes were different in direction and magnitude.
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86
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Benter IF, Abul HT, Al-Khaledi G, Renno WM, Canatan H, Akhtar S. Inhibition of Ras-GTPase farnesylation and the ubiquitin-proteasome system or treatment with angiotensin-(1-7) attenuates spinal cord injury-induced cardiac dysfunction. J Neurotrauma 2011; 28:1271-9. [PMID: 21510818 DOI: 10.1089/neu.2010.1682] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Cardiovascular diseases are one of the principal causes of death and disability in people with spinal cord injury (SCI). The present study was designed to investigate if acute treatment with FPTIII (an inhibitor of Ras-GTPase farnesylation) or MG132 (an inhibitor of ubiquitin-proteasome pathway [UPS]) or administration of angiotensin-(1-7), also known as Ang-(1-7), (a known inhibitor of cardiac NF-kB) would be cardioprotective. The weight drop technique produced a consistent contusive injury of the spinal cord at the T13 segment. Hearts were isolated from rats either 6 months (SCI-6) or 12 months (SCI-12) after SCI. Hearts were perfused for 30 min and then subjected to 30 min ischemia followed by 30 min reperfusion (I/R). Recovery of cardiac function after I/R was measured as left ventricular developed pressure (P(max)) and coronary flow (CF). Drugs were given during perfusion before hearts were exposed to ischemia and reperfusion. Percent recovery (%R) in P(max) and CF in hearts from control animals were 48±6 and 50±5, respectively, whereas none of the hearts from animals with SCI recovered after 30 min of ischemia. Treatment with FPTIII, MG 132, or Ang-(1-7) before ischemia for 30 min led to significant recovery of heart function following ischemia in SCI-6 but not in SCI-12 animals. Thus we have shown that acute treatments with FPTIII, MG132, or Ang-(1-7) improve cardiac recovery following ischemic insult in animals with SCI and may represent novel therapeutic agents for preventing ischemia-induced cardiac dysfunction in patients with SCI.
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Affiliation(s)
- Ibrahim F Benter
- Department of Pharmacology & Toxicology, Kuwait University, Safat, Kuwait.
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87
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Robotic treadmill training improves cardiovascular function in spinal cord injury patients. Int J Cardiol 2011; 149:323-9. [DOI: 10.1016/j.ijcard.2010.02.010] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2009] [Revised: 01/05/2010] [Accepted: 02/06/2010] [Indexed: 11/18/2022]
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88
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Effect of Aerobic High-Intensity Hybrid Training on Stroke Volume and Peak Oxygen Consumption in Men with Spinal Cord Injury. Am J Phys Med Rehabil 2011; 90:407-14. [DOI: 10.1097/phm.0b013e31820f960f] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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89
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Hsu MJ, Wei SH, Chang YJ. Effect of neuromuscular electrical muscle stimulation on energy expenditure in healthy adults. SENSORS 2011; 11:1932-42. [PMID: 22319390 PMCID: PMC3274051 DOI: 10.3390/s110201932] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2011] [Revised: 01/25/2011] [Accepted: 01/30/2011] [Indexed: 11/22/2022]
Abstract
Weight loss/weight control is a major concern in prevention of cardiovascular disease and the realm of health promotion. The primary aim of this study was to investigate the effect of neuromuscular electrical stimulation (NMES) at different intensities on energy expenditure (oxygen and calories) in healthy adults. The secondary aim was to develop a generalized linear regression (GEE) model to predict the increase of energy expenditure facilitated by NMES and identify factors (NMES stimulation intensity level, age, body mass index, weight, body fat percentage, waist/hip ratio, and gender) associated with this NMES-induced increase of energy expenditure. Forty sedentary healthy adults (18 males and 22 females) participated. NMES was given at the following stimulation intensities for 10 minutes each: sensory level (E1), motor threshold (E2), and maximal intensity comfortably tolerated (E3). Cardiopulmonary gas exchange was evaluated during rest, NMES, and recovery stage. The results revealed that NMES at E2 and E3 significantly increased energy expenditure and the energy expenditure at recovery stage was still significantly higher than baseline. The GEE model demonstrated that a linear dose-response relationship existed between the stimulation intensity and the increase of energy expenditure. No subject’s demographic or anthropometric characteristics tested were significantly associated with the increase of energy expenditure. This study suggested NMES may be used to serve as an additional intervention for weight loss programs. Future studies to develop electrical stimulators or stimulation electrodes to maximize the comfort of NMES are recommended.
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Affiliation(s)
- Miao-Ju Hsu
- Department of Physical Therapy, College of Health Science, Kaohsiung Medical University, Kaohsiung, Taiwan; E-Mail:
- Department of Rehabilitation, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Shun-Hwa Wei
- Department of Physical Therapy and Assistive Technology, National Yang Ming University, Taipei, Taiwan; E-Mail:
| | - Ya-Ju Chang
- Department of Physical Therapy, Graduate Institute of Rehabilitation Science, Chang Gung University, Tao-Yuan, Taiwan
- Author to whom correspondence should be addressed; E-Mail: ; Tel.: +886-3-2118800-5515; Fax: +886-3-2118421
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90
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The Comprehensive ICF core sets for spinal cord injury from the perspective of physical therapists: a worldwide validation study using the Delphi technique. Spinal Cord 2010; 49:502-14. [DOI: 10.1038/sc.2010.155] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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91
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Castro RRT, Pedrosa S, Chabalgoity F, Sousa EB, Nobrega ACL. The influence of a fast ramp rate on peak cardiopulmonary parameters during arm crank ergometry. Clin Physiol Funct Imaging 2010; 30:420-5. [PMID: 20718807 DOI: 10.1111/j.1475-097x.2010.00958.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The influence of a very fast ramp rate on cardiopulmonary variables at ventilatory threshold and peak exercise during a maximal arm crank exercise test has not been extensively studied. Considering that short arm crank tests could be sufficient to achieve maximal oxygen consumption (VO₂), it would be of practical interest to explore this possibility. Thus, this study aimed to analyse the influence of a fast ramp rate (20 W min⁻¹) on the cardiopulmonary responses of healthy individuals during a maximal arm crank ergometry test. Seventeen healthy individuals performed maximal cardiopulmonary exercise tests (Ultima CardiO2; Medical Graphics Corporation, St Louis, USA) in arm ergometer (Angio, LODE, Groningen, The Netherlands) following two protocols in random order: fast protocol (increment: 2 w/6 s) and slow protocol (increment: 1 w/6 s). The fast protocol was repeated 60-90 days after the 1st test to evaluate protocol reproducibility. Both protocols elicited the same peak VO₂ (fast: 23.51 ± 6.00 versus slow: 23.28 ± 7.77 ml kg⁻¹ min⁻¹; P = 0.12) but peak power load in the fast ramp protocol was higher than the one in the slow ramp protocol (119 ± 43 versus. 102 ± 39 W, P < 0.001). There was no other difference in ventilatory threshold and peak exercise variables when 1st and 2nd fast protocols were compared. Fast protocol seems to be useful when healthy young individuals perform arm cardiopulmonary exercise test. The usefulness of this protocol in other populations remains to be evaluated.
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Affiliation(s)
- Renata R T Castro
- Exercise Physiology Laboratory, National Institute of Traumatology and Orthopedics, Rio de Janeiro, Brazil.
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92
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Matos-Souza JR, Pithon KR, Oliveira RTD, Téo FH, Blotta MHSL, Cliquet A, Nadruz W. Altered left ventricular diastolic function in subjects with spinal cord injury. Spinal Cord 2010; 49:65-9. [PMID: 20661253 DOI: 10.1038/sc.2010.88] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN This is cross-sectional study. OBJECTIVES The aim of this study is to investigate the cardiac structure and function of subjects with spinal cord injury (SCI) and the impact of metabolic, hemodynamic and inflammatory factors on these parameters. SETTING São Paulo, Brazil. METHODS Sixty-five nondiabetic, nonhypertensive, sedentary, nonsmoker men (34 with SCI and 31 healthy subjects) were evaluated by medical history, anthropometry, laboratory tests, analysis of hemodynamic and inflammatory parameters and echocardiography. RESULTS Subjects with SCI had lower systolic blood pressure and higher levels of C-reactive protein and tumor necrosis factor receptors than the healthy ones. Echocardiography data showed that the SCI group presented similar left ventricular (LV) structural and systolic parameters, but lower initial diastolic velocity (Em) (9.2 ± 0.5 vs 12.3 ± 0.5 cm s(-1); P<0.001) and higher peak early inflow velocity (E)/Em ratio (7.7 ± 0.5 vs 6.1 ± 0.3; P = 0.009) compared with the able-bodied group, even after adjustment for systolic blood pressure and C-reactive protein levels. Furthermore, injured subjects with E/Em >8 had lower peak spectral longitudinal contraction (Sm) (9.0 ± 0.7 vs 11.6 ± 0.4 cm s(-1); P<0.001) and cardiac output (4.2 ± 0.2 vs 5.0 ± 0.2 l min(-1); P = 0.029), as well as higher relative wall thickness (0.38 ± 0.01 vs 0.35 ± 0.01; P = 0.005), than individuals with SCI with E/Em<8, but similar age, body mass index, blood pressure, injury level, metabolic parameters and inflammatory marker levels. CONCLUSION Subjects with SCI presented impaired LV diastolic function in comparison with able-bodied ones. Moreover, worse LV diastolic function was associated with a pattern of LV concentric remodeling and subclinical decreases in systolic function among injured subjects. Overall, these findings might contribute to explain the increased cardiovascular risk reported for individuals with SCI.
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Affiliation(s)
- J R Matos-Souza
- Department of Internal Medicine, School of Medicine, University of Campinas, São Paulo, Brazil
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93
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Kahn NN, Feldman SP, Bauman WA. Lower-extremity functional electrical stimulation decreases platelet aggregation and blood coagulation in persons with chronic spinal cord injury: a pilot study. J Spinal Cord Med 2010; 33:150-8. [PMID: 20486534 PMCID: PMC2869270 DOI: 10.1080/10790268.2010.11689690] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Individuals with spinal cord injury (SCI) develop premature cardiovascular disease. Regular exercise reduces the incidence and symptoms of cardiovascular disease in able-bodied individuals; these salutary effects of exercise have not been documented in persons with SCI. OBJECTIVE To evaluate the effects of functional electrical stimulation leg cycle ergometry (FES-LCE) exercise training on platelet aggregation and blood coagulation in persons with SCI. PARTICIPANTS Subjects (n=14) with stable chronic (>1 year) paraplegia (T1-T10) or tetraplegia (C4-C8). METHODS Blood samples were collected before and after the first and eighth sessions (2 sessions per week for 4 weeks) of FES exercise. RESULTS Platelet aggregation was inhibited by 20% after the first session and by 40% (P < 0.001) after the eighth session. Thrombin activity was unchanged after the first session (10.7 +/- 0.85 s to 10.43 +/- 0.56 s) and decreased after the eighth session (12.5 +/- 1.98 s to 11.1 +/- 1.7 s; P < 0.0003). Antithrombin III activity increased after the first (103.8% +/- 8.9% to 110% +/- 6.9%; P < 0.0008) and eighth sessions (107.8% +/- 12.1% to 120.4% +/- 13.1%; P < 0.0001). Cyclic adenosine monophosphate increased after the first (9.9% + 2.5% to 15.8% +/- 3%; P < 0.001) and eighth sessions (17.8% +/- 4.2% to 36.5% +/- 7.6%; P < 0.0001). After the eighth session, factors V and X increased significantly (88% +/- 27% to 103% +/- 23%, P < 0.0001; 100% +/- 40% to 105% +/- 7%, P < 0.01, respectively); factors VII and VIII and fibrinogen did not change significantly. A significant reduction in platelet activation/aggregation was demonstrated in response to FES-LCE. The decrease in thrombin level was caused by the simultaneous increase in antithrombin activity. CONCLUSION These findings provide new insight into the potential protective effects of FES-LCE against the risk of cardiovascular disease.
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Affiliation(s)
- Nighat N Kahn
- Center of Excellence, James J. Peters VA Medical Center, 130 W. Kingsbridge Road, Bronx, NY 10468, USA.
| | | | - William A Bauman
- James J. Peters VA Medical Center, Bronx, New York
,Mount Sinai School of Medicine, New York, New York
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94
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Wilson LC, Cotter JD, Fan JL, Lucas RAI, Thomas KN, Ainslie PN. Cerebrovascular reactivity and dynamic autoregulation in tetraplegia. Am J Physiol Regul Integr Comp Physiol 2010; 298:R1035-42. [PMID: 20089710 DOI: 10.1152/ajpregu.00815.2009] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Humans with spinal cord injury have impaired cardiovascular function proportional to the level and completeness of the lesion. The effect on cerebrovascular function is unclear, especially for high-level lesions. The purpose of this study was to evaluate the integrity of dynamic cerebral autoregulation (CA) and the cerebrovascular reactivity in chronic tetraplegia (Tetra). After baseline, steady-state hypercapnia (5% CO(2)) and hypocapnia (controlled hyperventilation) were used to assess cerebrovascular reactivity in 6 men with Tetra (C5-C7 lesion) and 14 men without [able-bodied (AB)]. Middle cerebral artery blood flow velocity (MCAv), cerebral oxygenation, arterial blood pressure (BP), heart rate (HR), cardiac output (Q; model flow), partial pressure of end-tidal CO(2) (Pet(CO(2))), and plasma catecholamines were measured. Dynamic CA was assessed by transfer function analysis of spontaneous fluctuations in BP and MCAv. MCAv pulsatility index (MCAv PI) was calculated as (MCAv(systolic) - MCAv(diastolic))/MCAv(mean) and standardized by dividing by mean arterial pressure (MAP). Resting BP, total peripheral resistance, and catecholamines were lower in Tetra (P < 0.05), and standardized MCAv PI was approximately 36% higher in Tetra (P = 0.003). Resting MCAv, cerebral oxygenation, HR, and Pet(CO(2)) were similar between groups (P > 0.05). Although phase and transfer function gain relationships in dynamic CA were maintained with Tetra (P > 0.05), coherence in the very low-frequency range (0.02-0.07 Hz) was approximately 21% lower in Tetra (P = 0.006). Full (hypo- and hypercapnic) cerebrovascular reactivity to CO(2) was unchanged with Tetra (P > 0.05). During hypercapnia, standardized MCAv PI reactivity was enhanced by approximately 78% in Tetra (P = 0.016). Despite impaired cardiovascular function, chronic Tetra involves subtle changes in dynamic CA and cerebrovascular reactivity to CO(2). Changes are evident in coherence at baseline and MCAv PI during baseline and hypercapnic states in chronic Tetra, which may be indicative of cerebrovascular adaptation.
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Affiliation(s)
- Luke C Wilson
- Department of Physiology, University of British Columbia Okanagan, Kelowna, BC V1X, Canada
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95
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Groah S, Kehn M. The State of Aging and Public Health for People with Spinal Cord Injury: Lost in Transition? Top Spinal Cord Inj Rehabil 2010. [DOI: 10.1310/sci1503-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Abstract
INTRODUCTION The specific effects of resistance and endurance training on upper extremity work capacity, muscular strength, and anaerobic power in chronic survivors of paraplegia have not been previously determined. PURPOSE This study compared the effects of 12 wk of endurance training (ET) with 12 wk of resistance training (RT) on VO(2peak), upper extremity strength, and power output in persons with chronic paraplegia. METHODS Eighteen subjects with neurologically complete paraplegia, T6-T10, participated in three weekly exercise sessions during a 12-wk training period. Subjects were matched into pairs (body mass and gender) and were randomly assigned to ET or RT. The ET group performed 30 min of arm cranking at 70%-85% of HR(peak). The RT group performed three sets of 10 repetitions at six exercise stations with an intensity of ranging from 60% to 70% of 1 repetition maximum (1RM). Values of upper extremity strength (1RM) were established using the Mayhew regression equation. VO(2peak) was determined during arm ergometry testing using open circuit spirometry. Arm Wingate anaerobic testing (WAnT) was used to determine subjects' peak and mean anaerobic power output. RESULTS VO(2peak) values were significantly greater after RT (15.1%) and ET (11.8%). Muscular strength significantly increased for all exercise maneuvers in the RT group (P values < 0.01) with no changes detected in the ET group. Mean WAnT power increased in the RT and ET groups by 8% and 5%, respectively. The RT group displayed significantly greater gains in peak WAnT power (P < 0.001) than ET, 15.6% and 2.6%, respectively. CONCLUSION Persons with paraplegia can significantly improve their upper extremity work capacity, muscular strength, and power by participating in RT.
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Affiliation(s)
- Patrick L Jacobs
- Department of Exercise Science and Health Promotion, Florida Atlantic University, Davie, FL 33314, USA.
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97
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Yoshida M, Murayama Y, Chishaki A, Sunagawa K. Noninvasive transcutaneous bionic baroreflex system prevents severe orthostatic hypotension in patients with spinal cord injury. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2009; 2008:1985-7. [PMID: 19163081 DOI: 10.1109/iembs.2008.4649578] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Central baroreflex failure in patients with spinal cord injury results in serious orthostatic hypotension. We examined if transcutaneous electrical stimulation regulates arterial pressure in those patients. We identified skin regions capable of increasing arterial pressure and determined respective transfer function. Using the transfer function, we designed the feedback regulator (i.e., bionic baroreflex system) to control arterial pressure. Orthostatic stress decreased arterial pressure profoundly. Activation of bionic regulator restored and maintained arterial pressure at pre-specified levels. We conclude that the transcutaneous bionic system is noninvasive and capable of stabilizing arterial pressure in patients with spinal cord injury.
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98
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Myers J. Cardiovascular Disease After SCI: Prevalence, Instigators, and Risk Clusters. Top Spinal Cord Inj Rehabil 2009. [DOI: 10.1310/sci1403-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Sabatier MJ, Schwark EH, Lewis R, Sloan G, Cannon J, McCully K. Femoral artery remodeling after aerobic exercise training without weight loss in women. DYNAMIC MEDICINE : DM 2008; 7:13. [PMID: 18775082 PMCID: PMC2551586 DOI: 10.1186/1476-5918-7-13] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/03/2008] [Accepted: 09/08/2008] [Indexed: 01/22/2023]
Abstract
Background It is currently unclear whether reductions in adiposity mediate the improvements in vascular health that occur with aerobic exercise. The purpose of this longitudinal study of 13 healthy women (33 ± 4 years old) was to determine whether 14 weeks of aerobic exercise would alter functional measures of vascular health, namely resting aortic pulse wave velocity (aPWV, an index of arterial stiffness), femoral artery diameter (DFA), and femoral artery blood flow (BFFA) independent of changes in adiposity. Methods Aerobic fitness was assessed as VO2peak normalized to fat-free mass, and adiposity (percent body fat) was determined by dual energy x-ray absorptiometry. Serum concentrations of proteins associated with risk for cardiovascular disease, including C-reactive protein (CRP), soluble intercellular adhesion molecule-1 (sICAM-1), and leptin, were also measured. Subjects cycled for 50 minutes, 3 times per week. Results Aerobic fitness normalized to fat-free mass increased 6% (P = 0.03) whereas adiposity did not change. Resting DFA increased 12% (P < 0.001) and resting shear rate decreased 28% (P = 0.007). Aortic PWV, and serum sICAM-1, CRP and leptin did not change with training. Conclusion Significant reductions in adiposity were not necessary for aerobic exercise training to bring about improvements in aerobic fitness and arterial remodeling. Peripheral arterial remodeling occurred without changes in central arterial stiffness or markers of inflammation.
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Affiliation(s)
- Manning J Sabatier
- Department of Kinesiology, The University of Georgia, Athens, GA 30602, USA.
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100
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Morse LR, Stolzmann K, Nguyen HP, Jain NB, Zayac C, Gagnon DR, Tun CG, Garshick E. Association between mobility mode and C-reactive protein levels in men with chronic spinal cord injury. Arch Phys Med Rehabil 2008; 89:726-31. [PMID: 18374004 DOI: 10.1016/j.apmr.2007.09.046] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2007] [Revised: 09/17/2007] [Accepted: 09/18/2007] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To assess clinical determinants of systemic inflammation in persons with chronic spinal cord injury (SCI). DESIGN Cross-sectional survey. SETTING Veterans Affairs medical center. PARTICIPANTS As part of an epidemiologic study assessing SCI-related health conditions, 63 men with chronic SCI provided a blood sample and information regarding locomotive mode and personal habits. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE Plasma high-sensitivity C-reactive protein (CRP). RESULTS The mean +/- standard deviation age was 56+/-14y, and participants were assessed 21+/-13y after injury. Adjusting for heart disease, hypertension, and body mass index (BMI), the mean CRP in 12 motorized wheelchair users (5.11mg/L) was not significantly greater than 23 participants who used a manual wheelchair (2.19mg/L) (P=.085) but was significantly greater than the 17 who walked with an assistive device (1.41mg/L) (P=.005) and the 12 who walked independently (1.63mg/L) (P=.027). CRP was significantly greater in participants with obesity but was not related to age, smoking, or SCI level and severity. CRP was elevated in participants reporting a urinary tract infection (UTI) or pressure ulcer within a year, but adjustment for this did not account for the elevated CRP in motorized wheelchair users. CONCLUSIONS These results suggest that CRP in chronic SCI is independently related to locomotive mode, BMI, and a history of pressure ulcers and UTI. It is suggested that future studies in SCI investigate whether modifying these factors influence systemic inflammation and cardiovascular health.
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Affiliation(s)
- Leslie R Morse
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA 02114, USA.
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