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Sisto SA, Lorenz DJ, Hutchinson K, Wenzel L, Harkema SJ, Krassioukov A. Cardiovascular status of individuals with incomplete spinal cord injury from 7 NeuroRecovery Network rehabilitation centers. Arch Phys Med Rehabil 2012; 93:1578-87. [PMID: 22920455 DOI: 10.1016/j.apmr.2012.04.033] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2012] [Revised: 02/27/2012] [Accepted: 04/19/2012] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To examine cardiovascular (CV) health in a large cohort of individuals with incomplete spinal cord injury (SCI). The CV health parameters of patients were compared based on American Spinal Injury Association Impairment Scale (AIS), neurologic level, sex, central cord syndrome, age, time since injury, Neuromuscular Recovery Scale, and total AIS motor score. DESIGN Cross-sectional study. SETTING Seven outpatient rehabilitation clinics. PARTICIPANTS Individuals (N=350) with incomplete AIS classification C and D were included in this analysis. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Heart rate, systolic and diastolic blood pressure during resting sitting and supine positions and after an orthostatic challenge. RESULTS CV parameters were highly variable and significantly differed based on patient position. Neurologic level (cervical, high and low thoracic) and age were most commonly associated with CV parameters where patients classified at the cervical level had the lowest resting CV parameters. After the orthostatic challenge, blood pressure was highest for the low thoracic group, and heart rate for the high thoracic group was higher. Time since SCI was negatively related to blood pressure at rest but not after orthostatic challenge. Men exhibited higher systolic blood pressure than women and lower heart rate. The prevalence of orthostatic hypotension (OH) was 21% and was related to the total motor score and resting seated blood pressures. Cervical injuries had the highest prevalence. CONCLUSIONS Resting CV parameters of blood pressure and heart rate are affected by position, age, and neurologic level. OH is more prevalent in cervical injuries, those with lower resting blood pressures and who are lower functioning. Results from this study provide reference for CV parameters for individuals with incomplete SCI. Future research is needed on the impact of exercise on CV parameters.
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Affiliation(s)
- Sue Ann Sisto
- Department of Physical Therapy, Division of Rehabilitation Sciences, Stony Brook University, Stony Brook, NY 11794-6018, USA.
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Harkema SJ, Schmidt-Read M, Behrman AL, Bratta A, Sisto SA, Edgerton VR. Establishing the NeuroRecovery Network: Multisite Rehabilitation Centers That Provide Activity-Based Therapies and Assessments for Neurologic Disorders. Arch Phys Med Rehabil 2012; 93:1498-507. [DOI: 10.1016/j.apmr.2011.01.023] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2010] [Revised: 12/08/2010] [Accepted: 01/06/2011] [Indexed: 11/24/2022]
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Patil AG, Chile RH, Hamde ST. Statistical analysis of RR series variability in spinal cord injured persons. J Med Eng Technol 2012; 36:180-4. [PMID: 22420781 DOI: 10.3109/03091902.2012.663053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Disabled persons with spinal cord injury are prone to cardiovascular dysfunction and an increased risk of cardiovascular disease. Rehabilitation of the disabled person is a critical task as it involves multiple therapies. Physical exercise is an important component of rehabilitation, and depends on cardiovascular health. Reduced RR variability is a marker of poor cardiac health. Time domain RR variability analysis of 38 normal healthy subjects and 20 spinal cord injured subjects has been carried out and compared. In this study, RR intervals were recorded in three different modes or positions: supine, sitting and five-second rhythm respiration. At a time of 150 s RR interval data were acquired in each mode and analysed. Statistical parameters (mean, HR, STD, NN50 and pNN50) were calculated. It was observed that most of the indices were significantly and substantially altered in spinal cord injured persons.
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Affiliation(s)
- A G Patil
- Shri Bhagubhai Mafatlal Polytechnic, Vile Parle (West), Mumbai, India.
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West CR, Mills P, Krassioukov AV. Influence of the neurological level of spinal cord injury on cardiovascular outcomes in humans: a meta-analysis. Spinal Cord 2012; 50:484-92. [DOI: 10.1038/sc.2012.17] [Citation(s) in RCA: 100] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Rimaud D, Calmels P, Pichot V, Bethoux F, Roche F. Effects of compression stockings on sympathetic activity and heart rate variability in individuals with spinal cord injury. J Spinal Cord Med 2012; 35:81-8. [PMID: 22333734 PMCID: PMC3304561 DOI: 10.1179/2045772311y.0000000054] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE To investigate whether wearing graduated compression stockings (GCS) could affect the sympatho-adrenergic and heart rate variability (HRV) responses at rest and after a strenuous wheelchair exercise in individuals with spinal cord injury (SCI). DESIGN Crossover trial. SETTING Department of Physical Medicine and Rehabilitation, Saint Etienne, France. PARTICIPANTS Nine men with SCI (five with low paraplegia: LP, four with high paraplegia: HP). INTERVENTIONS Two maximal wheelchair exercise tests: with and without GCS (21 mmHg). MAIN OUTCOME MEASURES HRV measurements: high frequency (HF), low frequency (LF), and LF/HF ratio. Norepinephrine (NOR) and epinephrine (EPI), at rest and post-exercise. Secondary measures were: blood pressure, heart rate, maximal power output, oxygen uptake, stroke volume, cardiac output, at rest, during and after exercise. RESULTS When wearing GCS: LFnu(wavelet-post) significantly increased and HFnu(wavelet-post) significantly decreased (P < 0.05) in SCI subjects, leading to an enhance ratio of LF(wavelet)/HF(wavelet) and a significantly increased in NOR(rest) (P < 0.05). CONCLUSIONS GCS induces an enhanced sympathetic activity in individuals with paraplegia, regardless of the level of the injury. Enhanced post-exercise sympathetic activity with GCS may help prevent orthostatic hypotension or post-exercise hypotension.
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Affiliation(s)
- Diana Rimaud
- Service de Medecine Physique et de Readaptation, CHU Bellevue, Saint Etienne, France.
| | - Paul Calmels
- Service de Medecine Physique et de Readaptation, CHU Bellevue, Saint Etienne, France
| | - Vincent Pichot
- Service de Physiologie Clinique et de l'Exercise, CHU Nord, Saint-Etienne, France
| | | | - Frederic Roche
- Service de Physiologie Clinique et de l'Exercise, CHU Nord, Saint-Etienne, France
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The effects of exercise training on physical capacity, strength, body composition and functional performance among adults with spinal cord injury: a systematic review. Spinal Cord 2011; 49:1103-27. [DOI: 10.1038/sc.2011.62] [Citation(s) in RCA: 205] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Using robot-applied resistance to augment body-weight-supported treadmill training in an individual with incomplete spinal cord injury. Phys Ther 2011; 91:143-51. [PMID: 21127165 DOI: 10.2522/ptj.20100026] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND PURPOSE The efficacy of task-specific gait training for people with spinal cord injury (SCI) is premised on evidence that the provision of gait-related afferent feedback is key for the recovery of stepping movements. Recent findings have shown that sensory feedback from flexor muscle afferents can facilitate flexor muscle activity during the swing phase of walking. This case report was undertaken to determine the feasibility of using robot-applied forces to resist leg movements during body-weight-supported treadmill training (BWSTT) and to measure its effect on gait and other health-related outcomes. CASE DESCRIPTION The patient described in this case report was a 43-year-old man with a T11 incomplete chronic SCI. He underwent 36 sessions of BWSTT using a robotic gait orthosis to provide forces that resist hip and knee flexion. OUTCOMES Tolerance to the training program was monitored using the Borg CR10 scale and heart rate and blood pressure changes during each training session. Outcome measures (ie, 10-Meter Walk Test, Six-Minute Walk Test, modified Emory Functional Ambulation Profile [mEFAP], Activities-specific Balance Confidence Scale, and Canadian Occupational Performance Measure) were completed and kinematic parameters of gait, lower-extremity muscle strength (force-generating capacity), lower-limb girth, and tolerance to orthostatic stress were measured before and after the training program. DISCUSSION The patient could tolerate the training. Overground walking speed, endurance, and performance on all subtasks of the mEFAP improved and were accompanied by increased lower-limb joint flexion and toe clearance during gait. The patient's ambulatory self-confidence and self-perceived performance in walking also improved. These findings suggest that this new approach to BWSTT is a feasible and potentially effective therapy for improving skilled overground walking performance.
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Smith RR, Brown EH, Shum-Siu A, Whelan A, Burke DA, Benton RL, Magnuson DSK. Swim training initiated acutely after spinal cord injury is ineffective and induces extravasation in and around the epicenter. J Neurotrauma 2010; 26:1017-27. [PMID: 19331515 DOI: 10.1089/neu.2008-0829] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Activity-based rehabilitation is a promising strategy for improving functional recovery following spinal cord injury (SCI). While results from both clinical and animal studies have shown that a variety of approaches can be effective, debate still exists regarding the optimal post-injury period to apply rehabilitation. We recently demonstrated that rats with moderately severe thoracic contusive SCI can be re-trained to swim when training is initiated 2 weeks after injury and that swim training had no effect on the recovery of overground locomotion. We concluded that swim training is a task-specific model of post-SCI activity-based rehabilitation. In the present study, we ask if re-training initiated acutely is more or less effective than when initiated at 2 weeks post-injury. Using the Louisville Swim Scale, an 18-point swimming assessment, supplemented by kinematic assessment of hindlimb movement during swimming, we report that acute re-training is less effective than training initiated at 2 weeks. Using the bioluminescent protein luciferase as a blood-borne macromolecular marker, we also show a significant increase in extravasation in and around the site of SCI following only 8 min of swimming at 3 days post-injury. Taken together, these results suggest that acute re-training in a rat model of SCI may compromise rehabilitation efforts via mechanisms that may involve one or more secondary injury cascades, including acute spinal microvascular dysfunction.
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Affiliation(s)
- Rebecca R Smith
- Kentucky Spinal Cord Injury Research Center, Department of Neurological Surgery, Louisville, Kentucky 40202, USA
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Jakeman LB, Hoschouer EL, Basso DM. Injured mice at the gym: review, results and considerations for combining chondroitinase and locomotor exercise to enhance recovery after spinal cord injury. Brain Res Bull 2010; 84:317-26. [PMID: 20558254 DOI: 10.1016/j.brainresbull.2010.06.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2010] [Revised: 06/02/2010] [Accepted: 06/02/2010] [Indexed: 01/08/2023]
Abstract
Exercise provides a number of important benefits after spinal cord injury in clinical studies and animal models. However, the amount of functional improvement in overground locomotion obtained with exercise alone has been limited thus far, for reasons that are still poorly understood. One hypothesis is that the complex network of endogenous extracellular matrix components, including chondroitin sulfate proteoglycans (CSPGs), can inhibit exercise-induced remodeling and limit plasticity of spared circuitry in the adult central nervous system. Recent animal studies have shown that chondroitinase ABC (ChABC) can enhance plasticity in the adult nervous system by cleaving glycosaminoglycan sidechains from CSPGs. In this article we review the current literature on plasticity observed with locomotor training and following degradation of CSPGs with ChABC and then present a rationale for the use of exercise combined with ChABC to promote functional recovery after spinal cord injury. We also present results of a preliminary study that tested the simplest approach for combining these treatments; use of a single intraparenchymal injection of ChABC administered to the lumbar enlargement of mice with voluntary wheel running exercise after a mid-thoracic spinal contusion injury. The results are negative, yet serve to highlight limitations in our understanding of the most effective protocols for combining these approaches. Further work is directed to identify the timing, type, and quantity of exercise and pharmacological interventions that can be used to maximize functional improvements by strengthening appropriate synaptic connections.
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Affiliation(s)
- Lyn B Jakeman
- Department of Physiology and Cell Biology, The Ohio State University Medical Center, Columbus, 43210, USA.
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Cotie LM, Geurts CLM, Adams MME, MacDonald MJ. Leg skin temperature with body-weight-supported treadmill and tilt-table standing training after spinal cord injury. Spinal Cord 2010; 49:149-53. [DOI: 10.1038/sc.2010.52] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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61
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Millar PJ, Rakobowchuk M, Adams MM, Hicks AL, McCartney N, MacDonald MJ. Effects of short-term training on heart rate dynamics in individuals with spinal cord injury. Auton Neurosci 2009; 150:116-21. [DOI: 10.1016/j.autneu.2009.03.012] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2009] [Accepted: 03/30/2009] [Indexed: 11/28/2022]
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Smith RR, Brown EH, Shum-Siu A, Whelan A, Burke DA, Benton RL, Magnuson DS. Swim Training Initiated Acutely after Spinal Cord Injury Is Ineffective and Induces Extravasation In and Around the Epicenter. J Neurotrauma 2009. [DOI: 10.1089/neu.2008.0829] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Affiliation(s)
- Rebecca R. Smith
- Kentucky Spinal Cord Injury Research Center, Department of Neurological Surgery, Louisville, Kentucky
| | - Edward H. Brown
- Kentucky Spinal Cord Injury Research Center, Department of Neurological Surgery, Louisville, Kentucky
| | - Alice Shum-Siu
- Kentucky Spinal Cord Injury Research Center, Department of Neurological Surgery, Louisville, Kentucky
| | - Ashley Whelan
- Kentucky Spinal Cord Injury Research Center, Department of Neurological Surgery, Louisville, Kentucky
| | - Darlene A. Burke
- Kentucky Spinal Cord Injury Research Center, Department of Neurological Surgery, Louisville, Kentucky
| | - Richard L. Benton
- Kentucky Spinal Cord Injury Research Center, Department of Neurological Surgery, Louisville, Kentucky
- Department of Anatomical Sciences and Neurobiology, University of Louisville School of Medicine, Louisville, Kentucky
| | - David S.K. Magnuson
- Kentucky Spinal Cord Injury Research Center, Department of Neurological Surgery, Louisville, Kentucky
- Department of Anatomical Sciences and Neurobiology, University of Louisville School of Medicine, Louisville, Kentucky
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Krassioukov A, Eng JJ, Warburton DE, Teasell R. A systematic review of the management of orthostatic hypotension after spinal cord injury. Arch Phys Med Rehabil 2009; 90:876-85. [PMID: 19406310 DOI: 10.1016/j.apmr.2009.01.009] [Citation(s) in RCA: 106] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2008] [Revised: 01/07/2009] [Accepted: 01/13/2009] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To review systematically the evidence for the management of orthostatic hypotension (OH) in patients with spinal cord injuries (SCIs). DATA SOURCES A key word literature search was conducted of original and review articles as well as practice guidelines using Medline, CINAHL, EMBASE, and PsycInfo, and manual searches of retrieved articles from 1950 to July 2008, to identify literature evaluating the effectiveness of currently used treatments for OH. STUDY SELECTION Included randomized controlled trials (RCTs), prospective cohort studies, case-control studies, pre-post studies, and case reports that assessed pharmacologic and nonpharmacologic intervention for the management of OH in patients with SCI. DATA EXTRACTION Two independent reviewers evaluated the quality of each study, using the Physiotherapy Evidence Database score for RCTs and the Downs and Black scale for all other studies. Study results were tabulated and levels of evidence assigned. DATA SYNTHESIS A total of 8 pharmacologic and 21 nonpharmacologic studies were identified that met the criteria. Of these 26 studies (some include both pharmacologic and nonpharmacologic interventions), only 1 pharmacologic RCT was identified (low-quality RCT producing level 2 evidence), in which midodrine was found to be effective in the management of OH after SCI. Functional electrical stimulation was one of the only nonpharmacologic interventions with some evidence (level 2) to support its utility. CONCLUSIONS Although a wide array of physical and pharmacologic measures are recommended for the management of OH in the general population, very few have been evaluated for use in SCI. Further research needs to quantify the efficacy of treatment for OH in subjects with SCI, especially of the many other pharmacologic interventions that have been shown to be effective in non-SCI conditions.
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Affiliation(s)
- Andrei Krassioukov
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, BC, Canada.
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64
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Harkema SJ, Ferreira CK, van den Brand RJ, Krassioukov AV. Improvements in orthostatic instability with stand locomotor training in individuals with spinal cord injury. J Neurotrauma 2009; 25:1467-75. [PMID: 19118454 DOI: 10.1089/neu.2008.0572] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Prospective assessment of cardiovascular control in individuals with spinal cord injury (SCI) in response to active stand training. Cardiovascular parameters were measured at rest and in response to orthostatic challenge before and after training in individuals with clinically complete SCI. The goal of this study was to evaluate the effect of active stand training on arterial blood pressure and heart rate and changes in response to orthostatic stress in individuals with SCI. Measurements were obtained in individuals with SCI (n=8) prior to and after 40 and 80 sessions of the standing component of a locomotor training intervention (stand LT). During standing, all participants wore a harness and were suspended by an overhead, pneumatic body weight support (BWS) system over a treadmill. Trainers provided manual facilitation as necessary at the trunk and legs. All individuals were able to bear more weight on their legs after the stand LT training. Resting arterial blood pressure significantly increased in individuals with cervical SCI after 80 training sessions. At the end of the training period, resting systolic blood pressure (BP) in individuals with cervical SCI in a seated position, increased by 24% (from 84 +/- 5 to 104 +/- 7 mmHg). Furthermore, orthostatic hypotension present in response to standing prior to training (decrease in systolic BP of 24 +/- 14 mmHg) was not evident (decrease in systolic BP of 0 +/- 11 mmHg) after 80 sessions of stand LT. Hemodynamic parameters of individuals with thoracic SCI were relatively stable prior to training and not significantly different after 80 sessions of stand LT. Improvements in resting arterial blood pressure and responses to orthostatic stress in individuals with clinically complete cervical SCI occurred following intensive stand LT training. These results may be attributed to repetitive neuromuscular activation of the legs from loading and/or conditioning of cardiovascular responses from repetitively assuming an upright posture.
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Affiliation(s)
- Susan J Harkema
- Kentucky Spinal Cord Injury Research Center, Department of Neurological Surgery, University of Louisville, Louisville, Kentucky, USA
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65
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Laird AS, Carrive P, Waite PME. Effect of Treadmill Training on Autonomic Dysreflexia in Spinal Cord—Injured Rats. Neurorehabil Neural Repair 2009; 23:910-20. [DOI: 10.1177/1545968309335976] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background. Weight-supported treadmill training is an emerging rehabilitation method used to improve locomotor ability in patients with spinal cord injury (SCI). However, little research has been undertaken to test the effect of such training on other consequences of SCI, such as neuropathic pain and autonomic dysfunction. Objective. This study investigates the effects of chronic treadmill training on the development of autonomic dysreflexia (AD), a form of cardiovascular dysfunction common in patients with cervical or high thoracic injury. Methods. Treadmill training commenced in adult male rats (n = 11) 3 days following complete T4 transection, whereas a sedentary SCI group (n = 9) and an intact group (n = 6) had no intervention. Treadmill training (up to 0.4 m/s) lasted for 10 min/d 5 days a week, for 6 weeks. Weekly measurements of locomotor ability (BBB scale), baseline mean arterial pressure, and heart rate were made, as were cardiovascular responses to training and colorectal distension (to trigger AD). Results. Treadmill training improved BBB scores from 2 weeks post-transection onward ( P = .010). However, it increased AD, resulting in augmented pressor responses from 2 to 6 weeks post-transection ( P = .029). Comparison of the vascular response to phenylephrine under ganglionic blockade showed an enhanced vasoconstrictor response in the renal vasculature of trained SCI animals. Immunohistochemical comparison of the L1—L6 spinal cord segments showed an increased area of CGRP immunoreactivity in the dorsal horn (lamina III/IV) of treadmill-trained SCI compared with intact and sedentary SCI animals. Conclusions. These results suggest that treadmill training exaggerated AD responses perhaps through a combination of enhanced vascular reactivity and central plasticity.
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Affiliation(s)
- Angela S. Laird
- Department of Anatomy, School of Medical Sciences, University of New South Wales, Sydney, NSW 2052, Australia,
| | - Pascal Carrive
- Department of Anatomy, School of Medical Sciences, University of New South Wales, Sydney, NSW 2052, Australia
| | - Phil M. E. Waite
- Department of Anatomy, School of Medical Sciences, University of New South Wales, Sydney, NSW 2052, Australia
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Magagnin V, Porta A, Fusini L, Licari V, Bo I, Turiel M, Molteni F, Cerutti S, Caiani EG. Evaluation of the autonomic response in healthy subjects during treadmill training with assistance of a robot-driven gait orthosis. Gait Posture 2009; 29:504-8. [PMID: 19138523 DOI: 10.1016/j.gaitpost.2008.11.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2008] [Revised: 11/21/2008] [Accepted: 11/24/2008] [Indexed: 02/02/2023]
Abstract
Body weight supported treadmill training assisted with a robotic driven gait orthosis is an emerging clinical tool helpful to restore gait in individuals with loss of motor skills. However, the autonomic response during this rehabilitation protocol is not known. The aim of the study was to evaluate the autonomic response during a routine protocol of motor rehabilitation through spectral and symbolic analyses of short-term heart rate variability in a group of 20 healthy subjects (11 men, mean age 25+/-3.8 years). The protocol included the following phases: (1) sitting position; (2) standing position; (3) suspension during subject instrumentation; (4 and 5) robotic-assisted treadmill locomotion at 1.5km/h and 2.5km/h respectively with partial body weight support; (6) standing recovery after exercise. Results showed a significant tachycardia associated with the reduction in variance during the suspended phase of the protocol compared to the sitting position. Spectral analysis did not demonstrate any significant autonomic response during the entire protocol, while symbolic analysis detected an increase in sympathetic modulation during body suspension and an increase of vagal modulation during walking. These results could be used to improve understanding of the cardiovascular effects of rehabilitation in subjects undergoing robotic driven gait orthosis treadmill training.
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Characteristics of autonomic nervous system function in individuals after spinal cord injury. Physiotherapy 2009. [DOI: 10.2478/v10109-010-0002-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
Recent findings in animal models of paraplegia suggest that specific nonbenzodiazepine anxiolytics may temporarily restore locomotor functions after spinal cord injury (SCI). Experiments using in vitro models have revealed, indeed, that selective serotonin receptor (5-HTR) ligands such as 5-HTR(1A) agonists, known as relatively safe anxiolytics, can acutely elicit episodes of rhythmic neuronal activity refered to as fictive locomotion in isolated spinal cord preparations. Along the same line, in vivo studies have recently shown that this subclass of anxiolytics can induce, shortly after systemic administration (eg, orally or subcutaneously), some locomotor-like hindlimb movements during 45-60 minutes in completely spinal cord-transected (Tx) rodents. Using 'knock-out' mice (eg, 5-HTR(7)-/-) and selective antagonists, it has been clearly established that both 5-HTR(1A) and 5-HTR(7) were critically involved in mediating the pro-locomotor effects induced by 8-OH-DPAT (typically referred to as a 5-HTR(1A) agonist) in Tx animals. Taken together, these in vitro and in vivo data strongly support the idea that 5-HTR(1A) agonists may eventually become constitutive elements of a novel first-in-class combinatorial treatment aimed at periodically inducing short episodes of treadmill stepping in SCI patients.
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Affiliation(s)
- Pierre A Guertin
- Neuroscience Unit, Laval University Medical Center (CHUL), 2705 Laurier Blvd, Neuroscience Unit, RC-9800, Quebec City, Quebec, Canada.
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Forrest, Sisto, Asselin, Mores, Bond, LaFountaine, Harkema. Locomotor Training with Incremental Changes in Velocity: Muscle and Metabolic Responses. Top Spinal Cord Inj Rehabil 2008. [DOI: 10.1310/sci1401-16] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Linder SP, Wendelken S, Clayman J, Steiner PR. Noninvasive detection of the hemodynamic stress of exercise using the photoplethysmogram. J Clin Monit Comput 2008; 22:269-78. [PMID: 18584296 DOI: 10.1007/s10877-008-9129-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2007] [Accepted: 05/22/2008] [Indexed: 10/21/2022]
Abstract
Exercise induced hemodynamic stress has been studied extensively using a wide range of physiological sensors. While athletes can modulate their training intensity using EKG-based heart rate monitors, there are currently no noninvasive monitors that can be used to ascertain with a high degree of certainty the hemodynamic stress an individual is experiencing because of fatigue or an underlying pathology. We propose that cardiac stress will result in detectable changes in skin blood flow. In a clinical trial with eleven healthy subjects performing the Bruce Protocol treadmill test low frequency waves were observed in the blood flow to both the forehead and ear, but not the finger, using photople- thysmographs (PPG) measured by a pulse oximeter. As volitional fatigue approached, the low frequency (f = 0.05-0.2 Hz) amplitude modulation observed in the PPG became more pronounced; then, within several seconds of the cessa- tion of the protocol, they disappeared. Using a software-based detector, these distinct waves are reliably detected, with a low incidence of false positives, in all subjects before the onset of volitional fatigue. We hypothesize that the low frequency waves observed in the PPG of individuals exercising to volitional fatigue provide a mechanism for noninvasively detecting hemodynamic stress to the human vascular system.
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Preliminary evidence of safety following administration of L-DOPA and buspirone in an incomplete monoplegic patient. Spinal Cord 2008; 47:91-2. [PMID: 18542088 DOI: 10.1038/sc.2008.70] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
STUDY DESIGN Case report. OBJECTIVES To report a case where a monoplegic patient received L-DOPA and/or buspirone. These compounds, normally used in the treatment of Parkinson's disease and anxiety respectively, were recently shown to induce spinal locomotor network activity and reflex stepping-like movements in animal models of spinal cord injury (SCI). However, the safety of these drugs as potential treatments for Central Pattern Generator (CPG) activation in paralyzed individuals remain unclear. SETTING St-Jean-Chrysostome, Quebec, Canada. METHOD The acute effects induced by these compounds were qualitatively assessed by the patient, a 38-year-old man who underwent surgery 17 years ago to remove an intracavernous angioma located at the mid-thoracic level (T5-T6) of the spinal cord. RESULTS Self-administration every 2 days of L-DOPA (200, 400 and 600 mg, p.o.) and buspirone (5, 10 and 15 mg, p.o.) either separately or combined led to no atypical side effects (that is, occasional sleepiness, nervousness, insomnia or mild headaches). No movement was induced ipsilaterally although some sensations referred to by the patient as an increased blood flow in the lower back and upper leg regions were reported shortly after administration of the combined treatment. CONCLUSION The results show no significant side effects following acute administration of L-DOPA and/or buspirone. This constitutes the first report providing preliminary evidence of safety following administration of these drugs in incompletely paralyzed individuals. The sensations of increased blood flow ipsilaterally with the combined treatment may also suggest that the dose regimen was not optimal or sub-threshold for inducing detectable CPG-mediated leg movements.
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Cardiorespiratory capacity after weight-supported treadmill training in patients with traumatic brain injury. Phys Ther 2008; 88:77-87. [PMID: 17940106 DOI: 10.2522/ptj.20070022] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND PURPOSE The primary goal of body-weight-supported treadmill training (BWSTT) has been to improve the temporal and spatial characteristics of unsupported overground walking; however, little attention has been given to cardiorespiratory adaptations. The purpose of this case report is to describe the effects of BWSTT on cardiorespiratory fitness in 2 patients recovering from severe traumatic brain injury (TBI). CASE DESCRIPTION Both patients were involved in motor vehicle accidents and were studied after admission to a postacute residential treatment program. Patient 1 was a 25-year-old man (initial Glasgow Coma Scale [GCS] score=3) who began observation and treatment 3 months after the injury. Patient 2 was an 18-year-old woman (initial GCS=6) who began observation and treatment 1 year after the injury. OUTCOMES Each patient received 2 to 3 sessions of BWSTT per week. Aerobic capacity was measured while they ambulated on a treadmill without body-weight support before and after BWSTT. Both patients' submaximal and peak responses improved. For patient 1 and patient 2, total treadmill work performed increased 134% and 53%, respectively. Peak oxygen uptake increased 24% for patient 1 and 16% for patient 2. Estimated cardiac stroke volume (oxygen pulse) increased 32% and 26% for patient 1 and patient 2, respectively. DISCUSSION The observations made on these 2 patients suggest that BWSTT has the potential to favorably change cardiorespiratory capacity after TBI.
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73
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Warburton DER, Eng JJ, Krassioukov A, Sproule S. Cardiovascular Health and Exercise Rehabilitation in Spinal Cord Injury. Top Spinal Cord Inj Rehabil 2007; 13:98-122. [PMID: 22719205 DOI: 10.1310/sci1301-98] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
There appears to be an increased prevalence and earlier onset of cardiovascular disease (CVD) in persons with SCI. Physical inactivity is thought to be a key factor in the increased risk for CVD. Physical inactivity is highly prevalent in persons with SCI and it appears that activities of daily living are not sufficient to maintain cardiovascular fitness and health. This systematic review examines the current literature regarding the risk for CVD and the effectiveness of varied exercise rehabilitation programs in attenuating the risk for CVD in SCI.
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Affiliation(s)
- Darren E R Warburton
- Cardiovascular Physiology and Rehabilitation Laboratory, Experimental Medicine, Faculty of Medicine, University of British Columbia
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74
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Myers J, Lee M, Kiratli J. Cardiovascular disease in spinal cord injury: an overview of prevalence, risk, evaluation, and management. Am J Phys Med Rehabil 2007; 86:142-52. [PMID: 17251696 DOI: 10.1097/phm.0b013e31802f0247] [Citation(s) in RCA: 398] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Cardiovascular disease is a growing concern for the spinal cord-injured (SCI) population. For long-term SCI, morbidity and mortality from cardiovascular causes now exceeds that caused by renal and pulmonary conditions, the primary causes of mortality in previous decades. Although risk estimates commonly used for ambulatory individuals have not been established from follow-up studies in SCI, nearly all risk factors tend to be more prevalent in SCI subjects compared with ambulatory subjects. These risks include a greater prevalence of obesity, lipid disorders, metabolic syndrome, and diabetes. Daily energy expenditure is significantly lower in SCI individuals, not only because of a lack of motor function, but also because of a lack of accessibility and fewer opportunities to engage in physical activity. Autonomic dysfunction caused by SCI is also associated with several conditions that contribute to heightened cardiovascular risk, including abnormalities in blood pressure, heart rate variability, arrhythmias, and a blunted cardiovascular response to exercise that can limit the capacity to perform physical activity. Thus, screening, recognition, and treatment of cardiovascular disease should be an essential component of managing individuals with SCI, and judicious treatment of risk factors can play an important role in minimizing the incidence of cardiovascular disease in these individuals. This article reviews the cardiovascular consequences of chronic SCI, including the prevalence of cardiovascular disease and risk factors unique to these individuals, and provides a synopsis of management of cardiovascular disease in this population.
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Affiliation(s)
- Jonathan Myers
- Cardiology Division and Spinal Cord Injury Center, Veterans Administration Palo Alto Health Care System and Stanford University, Palo Alto, California 94304, USA
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75
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Wecht JM, Weir JP, Bauman WA. Blunted heart rate response to vagal withdrawal in persons with tetraplegia. Clin Auton Res 2006; 16:378-83. [PMID: 17066256 DOI: 10.1007/s10286-006-0367-y] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2006] [Accepted: 07/13/2006] [Indexed: 11/29/2022]
Abstract
Cardiovascular autonomic mechanisms control heart rate (HR) and determination of heart rate variability (HRV) permits the quantitative assessment of relative shifts in autonomic cardiac control during head-up tilt (HUT). The study herein used HRV techniques to determine the vagal and sympathetic contribution to the change in HR during HUT in persons with tetraplegia (T; n = 7) paraplegia (P; n = 7) and a non-spinal cord injured (non-SCI; n = 8) control group. Heart rate (HR) was continuously monitored and cardiovascular autonomic responses were assessed for 5-minutes at supine and at 45 degrees HUT. Change associated with tilt from supine to 45 degrees HUT was calculated for HR (deltaHR), high & low frequency HRV (HF & LF) and the LF/HF ratio. HR and LF power were lower in the T compared to the P and non-SCI groups at 45 degrees HUT, whereas there were no group differences for HF at 45 degrees HUT. The LF/HF ratio was lower in the T compared to the non-SCI group at 45 degrees HUT. The relationship between delta HR and delta HF response differed between groups (significant group x delta HF interaction) such that the slope of this relationship was reduced in the T (-1.026: 95% CI: -2.623 to 0.571) compared with the non-SCI (-6.985: 95% CI: -11.25 to 2.72) and P (-5.218: 95% CI: -8.197 to -2.239) groups. There was no significant interaction effect for the relationships between deltaHR and deltaLF or deltaLF/HF. In summary, although the magnitude of vagal withdrawal was comparable among the groups, the increase in HR was attenuated in the group with tetraplegia, which may reflect reduced sympathetic cardiac modulation or altered SA node responsiveness to vagal withdrawal.
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Affiliation(s)
- Jill M Wecht
- Veterans Affairs Medical Center, SCI, Bronx, NY, USA.
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76
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Erschbamer MK, Pham TM, Zwart MC, Baumans V, Olson L. Neither environmental enrichment nor voluntary wheel running enhances recovery from incomplete spinal cord injury in rats. Exp Neurol 2006; 201:154-64. [PMID: 16762344 DOI: 10.1016/j.expneurol.2006.04.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2006] [Accepted: 04/01/2006] [Indexed: 11/26/2022]
Abstract
Environmental enrichment and exercise may be neuroprotective or promote recovery after different forms of CNS injury. Here, we tested the possible effects of moderate environmental enrichment and voluntary exercise on the outcome of incomplete spinal cord injury in rats. We provided rats in standard cages with basic environmental enrichment (carton house, nesting material, tube, gnawing sticks). We also analyzed the effect of increased activity by housing spinal-cord-injured rats in cages with or without access to running wheels. In a third experiment, we looked at the possible effect of pre-injury training. In all experiments, a battery of behavior tests were used. Enriched environment provided before, after or both before and after injury did not alter the outcome on any of these tests. Similarly, despite excessive running after injury, no differences in terms of recovery and behavior were found in the running experiment. Similarly, running prior to injury did not significantly decrease the degree of functional deficit caused by the injury. Since there were no effects of further enrichment, above the possible effects of being socially housed, and since exercise did not improve the outcome, we conclude that these forms of increased activity do not render the animals significantly less sensitive to spinal cord injury and do not cause robust improvement when initiated after injury. While these results pose a limit to how helpful environmental and physical training programs may be in rodent impact injury models, they do not contradict the fact that voluntary and guided training can be effective tools in human spinal cord rehabilitation.
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Affiliation(s)
- M K Erschbamer
- Department of Neuroscience, Karolinska Institutet, Retziusväg 8, 17177 Stockholm, Sweden.
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77
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Giangregorio LM, Hicks AL, Webber CE, Phillips SM, Craven BC, Bugaresti JM, McCartney N. Body weight supported treadmill training in acute spinal cord injury: impact on muscle and bone. Spinal Cord 2006; 43:649-57. [PMID: 15968302 DOI: 10.1038/sj.sc.3101774] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
DESIGN Longitudinal prospective case series. OBJECTIVE To evaluate the impact of early introduction post-spinal cord injury (SCI) of twice-weekly body-weight supported treadmill training (BWSTT) on muscle and bone. SETTING Centre for Health Promotion and Rehabilitation, McMaster University, Canada. METHODS Five individuals who had sustained traumatic SCI within 2-6 months participated in the study. Bone mineral densities (BMD) of proximal femur, distal femur, proximal tibia and lumbar spine were measured before and after training, as well as muscle cross-sectional area (CSA), BMD and bone geometry at mid-femur and proximal tibia. Serum osteocalcin and urinary deoxypyridinoline were measured at baseline, and after 24 and 48 sessions of training. RESULTS All participants experienced increased muscle CSAs, ranging from 3.8 to 56.9%. Reductions in BMD were evident in all participants at almost all lower limb sites after training, ranging in magnitude from -1.2 to -26.7%. Lumbar spine BMD changes ranged from 0.2 to -7.4%. No consistent changes were observed in bone geometry. BWSTT did not alter the expected pattern of change in bone biochemical markers over time. The individual with the greatest improvement in ambulatory ability demonstrated the smallest reduction in lower limb BMD. Conversely, the individual who completed the fewest BWSTT sessions demonstrated the greatest reductions in BMD. CONCLUSIONS Twice-weekly BWSTT appeared to partially reverse muscle atrophy after SCI, but did not prevent bone loss. Larger, controlled trials should evaluate whether relative preservation of bone loss occurs with regular BWSTT following acute SCI. SPONSORSHIP Ontario Neurotrauma Foundation.
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Affiliation(s)
- L M Giangregorio
- Spinal Cord Rehabilitation Program, Toronto Rehabilitation Institute, Ontario, Canada
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Ditor DS, Kamath MV, Macdonald MJ, Bugaresti J, McCartney N, Hicks AL. Reproducibility of heart rate variability and blood pressure variability in individuals with spinal cord injury. Clin Auton Res 2005; 15:387-93. [PMID: 16362541 DOI: 10.1007/s10286-005-0293-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2004] [Accepted: 05/03/2005] [Indexed: 10/25/2022]
Abstract
Individuals with spinal cord injury (SCI) are prone to orthostatic intolerance and an increased risk of cardiovascular disease. The use of heart rate variability (HRV) and blood pressure variability (BPV) as indices of cardiovascular regulation would be valuable in this population; however, their reproducibility has yet to be tested in those with SCI. The purpose of this study was to examine the day-to-day reproducibility of resting HRV and BPV in individuals with SCI. Ten individuals (age 35.9 +/- 13.2 yrs) with chronic (5.4 +/- 7.7 years post injury) SCI (C4-T12; ASIA A-C) participated. On two occasions within a two-week period, 10-minute supine electrocardiogram and Finapres blood pressure recordings were obtained during spontaneous breathing. Computer software calculated frequency domain measures of HRV and BPV (Low frequency (LF) power, High frequency (HF) power, and LF:HF ratio). Intraclass correlations coefficients (R) were used as an index of day-to-day reproducibility, and analyses were conducted on all participants and only those with tetraplegia. For HRV, measures of heart rate, LF, and LF:HF were found to be highly reproducible (R = 0.82-0.88); however, the reproducibility of HF was found to be poor (all participants: R = 0.53, tetraplegia: R = 0.66). Measures of blood pressure as well as systolic BPV also showed high reproducibility (R = 0.72-0.93). Measures of diastolic BPV were less reproducible but still acceptable (R = 0.71-0.89) with the exception of LF:HF(DBP) (R = 0.51). In conclusion, despite the autonomic dysfunction associated with SCI, measures of HRV and BPV may still be used as reproducible indices of autonomic cardiovascular regulation in this population.
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Affiliation(s)
- David S Ditor
- Dept. of Kinesiology, McMaster University, Hamilton (OT), Canada.
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79
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Ditor DS, Macdonald MJ, Kamath MV, Bugaresti J, Adams M, McCartney N, Hicks AL. The effects of body-weight supported treadmill training on cardiovascular regulation in individuals with motor-complete SCI. Spinal Cord 2005; 43:664-73. [PMID: 15968298 DOI: 10.1038/sj.sc.3101785] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Four-month longitudinal within-subject exercise training study. OBJECTIVE Although body-weight supported treadmill training (BWSTT) has not shown promise as a means of improving ambulation in individuals with motor-complete spinal cord injury (SCI), it may still improve cardiovascular health and function in this population. The purpose of this study was to (i) investigate the effects of BWSTT on peripheral muscular and elastic artery dimension and function and measures of heart rate variability (HRV) and blood pressure variability (BPV) in individuals with motor-complete SCI, and (ii) to make a preliminary examination of what factors may predict favourable cardiovascular outcomes following BWSTT in this population. SETTING Centre for Health Promotion and Rehabilitation, McMaster University, Hamilton, Ontario, Canada. METHODS Six individuals (four male, two female; age 37.7+/-15.4 years) with chronic SCI (C4-T12; ASIA A-B; 7.6+/-9.4 years post-injury) were included in the present investigation. Doppler ultrasound was used to determine femoral (exercising; muscular), carotid (elastic) and brachial (non-exercising control; muscular) artery dimension and function before and after 4 months of BWSTT. Continuous heart rate and blood pressure were also recorded before and after 4-months of BWSTT to determine frequency domain measures of HRV and BPV; clinically valuable indices of neurocardiac and neurovascular control, respectively. RESULTS Two-way ANOVA (vessel x time) revealed no exercise-induced change in femoral or carotid artery cross-sectional area, blood flow or resistance and no change in carotid artery compliance following the 4 months of BWSTT compared to the non-exercising control brachial artery. However, there was a significant exercise-induced increase in femoral artery compliance. There were no exercise-induced changes in HRV or BPV when all participants were considered together. However, the results suggest that the subgroup of individuals who had a substantial heart rate response to BWSTT (n=3), experienced exercise-training induced changes in HRV reflective of a relative shift toward cardiac vagal predominance and reductions in BPV. CONCLUSIONS BWSTT may cause an increase in femoral artery compliance in individuals with motor-complete SCI and therefore, should be encouraged as a means of improving cardiovascular health in this population. BWSTT may also cause modest improvements in measures of HRV and BPV in a select subgroup of individuals who respond to ambulation with moderate to large increases in HR. In the present study, factors associated with a substantial HR response to BWSTT were a propensity to orthostatic intolerance and muscular spasticity.
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Affiliation(s)
- D S Ditor
- Department of Kinesiology, McMaster University, Hamilton, Ontario, Canada
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80
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Hicks AL, Adams MM, Martin Ginis K, Giangregorio L, Latimer A, Phillips SM, McCartney N. Long-term body-weight-supported treadmill training and subsequent follow-up in persons with chronic SCI: effects on functional walking ability and measures of subjective well-being. Spinal Cord 2005; 43:291-8. [PMID: 15685260 DOI: 10.1038/sj.sc.3101710] [Citation(s) in RCA: 152] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Longitudinal, prospective within-subject design. OBJECTIVES (1) To determine the effects of long-term body-weight-supported treadmill training (BWSTT) on functional walking ability and perceived quality of life in persons with chronic incomplete spinal cord injury (SCI), and (2) to investigate whether training adaptations are maintained following cessation of the BWSTT programme. SETTING Hamilton, Ontario, Canada. METHODS A group of 14 individuals with chronic (mean 7.4 years postinjury) incomplete SCI (ASIA B & C) participated in thrice-weekly sessions of BWSTT for a period of approximately 12 months (144 sessions). Functional walking ability and indices of subjective well-being were evaluated during the training programme and over an 8-month follow-up. RESULTS In total, 13 subjects successfully completed the 144 training sessions in the required study period (max. 15 months). Adherence to the thrice-weekly training frequency was 78.8%. All subjects improved in treadmill walking ability (54% reduction in required external body-weight support (BWS), 180% increase in treadmill walking speed, 335% increase in distance walked/session), and six subjects improved their capacity to walk over ground. There were accompanying increases in satisfaction with life and satisfaction with physical function, both of which were significantly correlated with improvements in treadmill walking ability. All but one subject returned for follow-up assessment 8 months post-training; while there was a slight decline in treadmill walking performance, over ground walking scores remained relatively stable. The only change in subjective well-being in the follow-up was a slight decrease in satisfaction with physical function. CONCLUSION Thrice-weekly BWSTT for 12 months was an effective stimulus to improve treadmill walking ability and indices of subjective well-being in persons with chronic incomplete SCI, and most of these improvements were maintained for up to 8 months following the cessation of training.
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Affiliation(s)
- A L Hicks
- Department of Kinesiology, McMaster University, Hamilton, Ontario, Canada
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