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Marco-Ahulló A, Montesinos-Magraner L, González LM, Crespo-Rivero T, Launois-Obregón P, García-Massó X. Encouraging People with Spinal Cord Injury to Take Part in Physical Activity in the COVID-19 Epidemic through the mHealth ParaSportAPP. Healthcare (Basel) 2022; 10:1069. [PMID: 35742120 PMCID: PMC9223296 DOI: 10.3390/healthcare10061069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 06/01/2022] [Accepted: 06/07/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Although mHealth tools have great potential for health interventions, few experimental studies report on their use by people with spinal cord injuries in physical activity. OBJECTIVE The main objective of this study was to analyze the effect of the ParaSportAPP on different physical and psychological variables in people with paraplegia. METHODS Fourteen of these subjects made up the final sample. All the participants performed two pre-tests (control period) and a post-test with 8 months between the evaluations (COVID-19 broke out between pre-test 2 and the post-test). The ParaSportAPP was installed on their smartphones when they performed pre-test 2. The same tests were performed in the same order in all the evaluations: (i) the questionnaires PASIPD, HADS, RS-25; SCIM III and AQoL-8D, (ii) respiratory muscle strength, (iii) spirometry and (iv) cardiopulmonary exercise test. RESULTS The results showed no differences in any of the variables studied between the measurement times. CONCLUSIONS Although none of the variables experienced improvements, the ParaSportAPP mobile application was able to lessen the impact of the pandemic on the variables studied.
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Affiliation(s)
- Adrià Marco-Ahulló
- Departamento de Neuropsicobiología, Metodología y Psicología Social, Universidad Católica de Valencia, 46100 Valencia, Spain;
| | - Lluïsa Montesinos-Magraner
- Spinal Cord Injury Unit, Physical Medicine and Rehabilitation, University Vall d’Hebron Campus, 08035 Barcelona, Spain; (L.M.-M.); (T.C.-R.)
| | - Luís-Millan González
- Department of Physical Education and Sport, FCAFE, Universitat de Valencia, 46010 Valencia, Spain;
| | - Teresa Crespo-Rivero
- Spinal Cord Injury Unit, Physical Medicine and Rehabilitation, University Vall d’Hebron Campus, 08035 Barcelona, Spain; (L.M.-M.); (T.C.-R.)
| | - Patricia Launois-Obregón
- Cardiorrespiratory Rehabilitation Unit, Physical Medicine and Rehabilitation, University Vall d’Hebron Campus, 08035 Barcelona, Spain;
| | - Xavier García-Massó
- Departamento de Expresión Musical, Plástica y Corporal, University of Valencia, 46022 Valencia, Spain
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Raguindin PF, Stoyanov J, Eriks-Hoogland I, Stucki G, Jordan X, Schubert M, Franco OH, Muka T, Glisic M. Cardiometabolic risk profiling during spinal cord injury rehabilitation: A longitudinal analysis from Swiss Spinal Cord Injury cohort (SwiSCI). PM R 2022. [PMID: 35648677 DOI: 10.1002/pmrj.12857] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 05/04/2022] [Accepted: 05/17/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Early screening is important in individuals with spinal cord injury (SCI) as they were deemed high-risk for cardiometabolic diseases. Few studies explored changes in cardiometabolic risk profile in the early phase of the injury. Thus, it remains unclear how early the cardiometabolic status deteriorates after injury. OBJECTIVE We determined the longitudinal changes in the cardiometabolic risk profile and examined the association between injury characteristics and cardiometabolic status in subacute SCI. SETTING Multicenter Swiss Spinal Cord Injury Cohort. PARTICIPANTS Adults with traumatic SCI without history of cardiovascular disease or type 2 diabetes. MAIN OUTCOME MEASURES Blood pressure (BP), lipid profile, fasting glucose, waist circumference (WC), weight, body mass index (BMI) and Framingham risk score (FRS) were compared across time and according to the injury characteristics. RESULTS We analyzed the data of 258 individuals with traumatic SCI (110 tetraplegia and 148 paraplegia, 122 motor complete and 136 incomplete). The median age was 50 years (IQR 32-60), with 76.36% (n=197) of the population being male. The median rehabilitation duration was 5.5 months (IQR 3.2-7.1). At admission to rehabilitation, fully-adjusted linear regression models showed higher baseline weight (β 0.06, 95% CI 0.005, 0.11), systolic BP (β 0.05, 95% CI 0.008, 0.09), diastolic BP (β 0.05 95% CI 0.004, 0.10), and triglycerides (β 0.27 95% CI 0.13, 0.42) in paraplegia than tetraplegia. Systolic BP, diastolic BP, HDL-C were higher in incomplete than complete injury. In our main analysis, we observed an increase in cholesterol and HDL-C and lipid ratio when comparing the beginning and end of rehabilitation. Individuals with paraplegia had a higher increase in BMI than tetraplegia, while no differences in other cardiometabolic risk factors were detected when comparing motor incomplete and complete injury. Trajectories of each participant showed that the majority of individuals with SCI decreased FRS score at follow-up compared to baseline and no significant changes in prevalence of cardiometabolic syndrome were observed. At discharge, one-third of study participants were classified as moderate to high risk of CVD, 64% were overweight, and 39.45% had cardiometabolic syndrome. CONCLUSION We observed a modest improvement in lipid profile and FRS during the first inpatient rehabilitation hospitalization. Injury characteristics, such as level and completeness, were not associated with changes in cardiometabolic risk factors in the subacute phase of the injury. Despite this, a significant proportion of study participants remained at risk of cardiometabolic disease at discharge, suggesting that early cardiometabolic preventive strategies may be initiated as early as during the first inpatient rehabilitation hospitalization. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Peter Francis Raguindin
- Swiss Paraplegic Research, Guido A. Zäch Str. 4, 6207 Nottwil, Switzerland.,Institute of Social and Preventive Medicine, University of Bern, Mittelstrasse 43, Bern, Switzerland.,Graduate School for Health Sciences, University of Bern, Mittelstrasse 43, Bern, Switzerland
| | - Jivko Stoyanov
- Swiss Paraplegic Research, Guido A. Zäch Str. 4, 6207 Nottwil, Switzerland
| | | | - Gerold Stucki
- Swiss Paraplegic Research, Guido A. Zäch Str. 4, 6207 Nottwil, Switzerland
| | - Xavier Jordan
- Clinique Romande de Réadaptation, Avenue du Grand-Champsec 90, 1950 Sion, Switzerland
| | - Martin Schubert
- University Hospital Balgrist, Spinal Cord Injury Center, Forchstrasse 340, Zurich, Switzerland
| | - Oscar H Franco
- Institute of Social and Preventive Medicine, University of Bern, Mittelstrasse 43, Bern, Switzerland
| | - Taulant Muka
- Institute of Social and Preventive Medicine, University of Bern, Mittelstrasse 43, Bern, Switzerland
| | - Marija Glisic
- Swiss Paraplegic Research, Guido A. Zäch Str. 4, 6207 Nottwil, Switzerland.,Institute of Social and Preventive Medicine, University of Bern, Mittelstrasse 43, Bern, Switzerland
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Reid KF, Storer TW, Pencina KM, Valderrabano R, Latham NK, Wilson L, Ghattas C, Dixon R, Nunes A, Bajdek N, Huang G, Skeels SE, Lin AP, Merugumala SM, Liao HJ, Bouxsein ML, Zafonte RD, Bhasin S. A multimodality intervention to improve musculoskeletal health, function, metabolism, and well-being in spinal cord injury: study protocol for the FIT-SCI randomized controlled trial. BMC Musculoskelet Disord 2022; 23:493. [PMID: 35614404 PMCID: PMC9130453 DOI: 10.1186/s12891-022-05441-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 05/16/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND A spinal cord injury (SCI) is a devastating, life-changing event that has profoundly deleterious effects on an individual's health and well-being. Dysregulation of neuromuscular, cardiometabolic, and endocrine organ systems following an SCI contribute to excess morbidity, mortality and a poor quality of life. As no effective treatments currently exist for SCI, the development of novel strategies to improve the functional and health status of individuals living with SCI are much needed. To address this knowledge gap, the current study will determine whether a Home-Based Multimodality Functional Recovery and Metabolic Health Enhancement Program that consists of functional electrical stimulation of the lower extremity during leg cycling (FES-LC) plus arm ergometry (AE) administered using behavioral motivational strategies, and testosterone therapy, is more efficacious than FES-LC plus AE and placebo in improving aerobic capacity, musculoskeletal health, function, metabolism, and wellbeing in SCI. METHODS This single-site, randomized, placebo-controlled, parallel group trial will enroll 88 community-dwelling men and women, 19 to 70 years of age, with cervical and thoracic level of SCI, ASIA Impairment Scale grade: A, B, C, or D, 6 months or later after an SCI. Participants randomized to the multimodality intervention will undergo 16 weeks of home-based FES-LC and AE training plus testosterone undecanoate. Testosterone undecanoate injections will be administered by study staff in clinic or by a visiting nurse in the participant's home. The control group will receive 16 weeks of home-based FES-LC and AE exercise plus placebo injections. The primary outcome of this trial is peak aerobic capacity, measured during an incremental exercise testing protocol. Secondary outcomes include whole body and regional lean and adipose tissue mass; muscle strength and power; insulin sensitivity, lipids, and inflammatory markers; SCI functional index and wellbeing (mood, anxiety, pain, life satisfaction and depressive symptoms); and safety. DISCUSSION We anticipate that a multimodality intervention that simultaneously addresses multiple physiological impairments in SCI will result in increased aerobic capacity and greater improvements in other musculoskeletal, metabolic, functional and patient-reported outcomes compared to the control intervention. The findings of this study will have important implications for improving the care of people living with an SCI. TRIAL REGISTRATION ClinicalTrials.gov : ( NCT03576001 ). Prospectively registered: July 3, 2018.
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Affiliation(s)
- K F Reid
- Research Program in Men's Health: Aging and Metabolism, Boston Claude D. Pepper Older Americans Independence Center for Function Promoting Therapies, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - T W Storer
- Research Program in Men's Health: Aging and Metabolism, Boston Claude D. Pepper Older Americans Independence Center for Function Promoting Therapies, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - K M Pencina
- Research Program in Men's Health: Aging and Metabolism, Boston Claude D. Pepper Older Americans Independence Center for Function Promoting Therapies, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - R Valderrabano
- Research Program in Men's Health: Aging and Metabolism, Boston Claude D. Pepper Older Americans Independence Center for Function Promoting Therapies, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - N K Latham
- Research Program in Men's Health: Aging and Metabolism, Boston Claude D. Pepper Older Americans Independence Center for Function Promoting Therapies, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - L Wilson
- Research Program in Men's Health: Aging and Metabolism, Boston Claude D. Pepper Older Americans Independence Center for Function Promoting Therapies, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - C Ghattas
- Research Program in Men's Health: Aging and Metabolism, Boston Claude D. Pepper Older Americans Independence Center for Function Promoting Therapies, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - R Dixon
- Research Program in Men's Health: Aging and Metabolism, Boston Claude D. Pepper Older Americans Independence Center for Function Promoting Therapies, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - A Nunes
- Research Program in Men's Health: Aging and Metabolism, Boston Claude D. Pepper Older Americans Independence Center for Function Promoting Therapies, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - N Bajdek
- Research Program in Men's Health: Aging and Metabolism, Boston Claude D. Pepper Older Americans Independence Center for Function Promoting Therapies, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - G Huang
- Research Program in Men's Health: Aging and Metabolism, Boston Claude D. Pepper Older Americans Independence Center for Function Promoting Therapies, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - S E Skeels
- Research Program in Men's Health: Aging and Metabolism, Boston Claude D. Pepper Older Americans Independence Center for Function Promoting Therapies, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - A P Lin
- Center for Clinical Spectroscopy, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - S M Merugumala
- Center for Clinical Spectroscopy, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - H J Liao
- Center for Clinical Spectroscopy, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - M L Bouxsein
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - R D Zafonte
- Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - S Bhasin
- Research Program in Men's Health: Aging and Metabolism, Boston Claude D. Pepper Older Americans Independence Center for Function Promoting Therapies, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Dissemination and implementation strategies for physical activity guidelines among adults with disability, chronic conditions, and pregnancy: a systematic scoping review. BMC Public Health 2022; 22:1034. [PMID: 35606712 PMCID: PMC9126633 DOI: 10.1186/s12889-022-13317-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 04/27/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Physical activity guidelines for adults with disability, chronic conditions, and pregnancy (i.e., specific populations) have been developed to provide guidance for engaging in physical activity. However, specific populations remain considerably less physically active compared to the general population, presenting a knowledge-practice gap. PURPOSE The purpose of this systematic scoping review was to identify and evaluate strategies for disseminating and implementing physical activity guidelines among specific populations and/or stakeholders (e.g., healthcare professionals) in Canada. METHODS Five search approaches (peer-reviewed literature databases, grey literature database, custom Google search engines, targeted web-based searches, and content expert consultation) identified records documenting and/or evaluating strategies that had been used to disseminate or implement guidelines from a predetermined list. Systematic and scoping review protocols were followed. Risk of bias assessments were conducted for all studies that evaluated strategies. RESULTS Eighty-one records reported dissemination strategies (n = 42), implementation strategies (n = 28), or both (n = 11). Twenty-two studies reporting on 29 evaluated strategies were deemed "serious" or "high" risk of bias. Common guideline dissemination and implementation strategies are deliberated and recommendations for future practice are made. CONCLUSIONS Findings may inform future dissemination and implementation efforts for physical activity guidelines in Canada or similar countries.
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Nishiyama K, Kamijo YI, van der Scheer JW, Kinoshita T, Goosey-Tolfrey VL, Hoekstra SP, Nishimura Y, Kawasaki T, Ogawa T, Tajima F. Lipid metabolism after mild cold stress in persons with a cervical spinal cord injury. Spinal Cord 2022; 60:978-983. [PMID: 35508537 DOI: 10.1038/s41393-022-00788-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 02/25/2022] [Accepted: 02/28/2022] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Experimental study. OBJECTIVES To compare lipid metabolism in individuals with a cervical spinal cord injury (SCIC) and able-bodied (AB) persons in response to mild cold stress. SETTINGS Laboratory of Wakayama Medical University, Japan. METHODS Nine males with SCIC and 11 AB wore a water-perfusion suit in a supine position. Following 30-min rest thermoneutrality, the whole body was cooled by perfusing 25 °C water through the suit for 15-20 min (CS). Blood samples were collected before, immediately, and 60 (post-CS60) and 120 min after CS (post-CS120). Concentrations of serum free fatty acid ([FFA]s), total ketone bodies ([tKB]s), insulin ([Ins]s) and plasma adrenaline ([Ad]p), noradrenaline ([NA]p) and glucose ([Glc]p) were assessed. RESULTS [Ad]p in SCIC were lower than AB throughout the study (p = 0.0002) and remained largely unchanged in both groups. [NA]p increased after cold stress in AB only (p < 0.0001; GxT p = 0.006). [FFA]s increased by 62% immediately after cold stress in SCIC (p = 0.0028), without a difference between groups (p = 0.65). [tKB]s increased by 69% at post-CS60 and 132% at post-CS120 from the start in SCIC with no differences between groups (p = 0.54). [Glc]p and [Ins]s were reduced in SCIc only (GxT p = 0.003 and p = 0.001, respectively). CONCLUSION These data indicate that mild cold stress acutely elevates lipid and ketone body metabolism in persons with SCIc, despite the presence of sympathetic dysfunction.
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Affiliation(s)
- Kazunari Nishiyama
- Department of Rehabilitation Medicine, Wakayama Medical University, Kimiidera, Wakayama, Japan.,Department of Rehabilitation Medicine, Iwate Medical University, Morioka, Japan
| | - Yoshi-Ichiro Kamijo
- Department of Rehabilitation Medicine, Wakayama Medical University, Kimiidera, Wakayama, Japan.
| | - Jan W van der Scheer
- The Healthcare Improvement Studies Institute (THIS Institute), Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge, Cambridge, UK.,The Peter Harrison Centre for Disability Sport, School of Sport, Exercise and Health Sciences Loughborough University, Loughborough, UK
| | - Tokio Kinoshita
- Department of Rehabilitation Medicine, Wakayama Medical University, Kimiidera, Wakayama, Japan
| | - Victoria L Goosey-Tolfrey
- The Peter Harrison Centre for Disability Sport, School of Sport, Exercise and Health Sciences Loughborough University, Loughborough, UK
| | - Sven P Hoekstra
- The Peter Harrison Centre for Disability Sport, School of Sport, Exercise and Health Sciences Loughborough University, Loughborough, UK
| | - Yukihide Nishimura
- Department of Rehabilitation Medicine, Wakayama Medical University, Kimiidera, Wakayama, Japan.,Department of Rehabilitation Medicine, Iwate Medical University, Morioka, Japan
| | - Takashi Kawasaki
- Department of Rehabilitation Medicine, Wakayama Medical University, Kimiidera, Wakayama, Japan
| | - Takahiro Ogawa
- Department of Rehabilitation Medicine, Wakayama Medical University, Kimiidera, Wakayama, Japan
| | - Fumihiro Tajima
- Department of Rehabilitation Medicine, Wakayama Medical University, Kimiidera, Wakayama, Japan
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Dolbow DR, Davis GM, Welsch M, Gorgey AS. Benefits and interval training in individuals with spinal cord injury: A thematic review. J Spinal Cord Med 2022; 45:327-338. [PMID: 34855568 PMCID: PMC9135438 DOI: 10.1080/10790268.2021.2002020] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND Arm crank ergometry (ACE), functional electrical stimulation leg cycling exercise (FES-LCE), and the combination of the two (FES hybrid exercise) have all been used as activities to help improve the fitness-related health of individuals with spinal cord injury (SCI). More recently, high-intensity interval training (HIIT) has become popular in the non-disabled community due to its ability to produce greater aerobic fitness benefits or equivalent benefits with reduced time commitment. OBJECTIVE This thematic review of the literature sought to determine the potential benefits and practicality of using ACE, FES-LCE, and FES hybrid exercise in an interval training format for individuals with SCI. METHODS Systematic literature searches were conducted in May 2020 and March 2021 focusing on interval training in individuals with SCI. Pre-defined nested search terms were used to narrow the available literature from 4273 citations to 1362 articles. The titles and abstracts were then reviewed to determine the appropriateness of the articles ending with fifteen articles. RESULTS The literature was limited to fifteen articles with low participant numbers (n = 1-20). However, in each article, HIIT protocols either demonstrated a greater improvement in cardiovascular, metabolic, or practicality scores compared to moderate intensity continuous training (MICT) protocols, or improvement during relatively brief time commitments. CONCLUSION The available literature lacked sufficient numbers of randomized control trials. However, the available evidence is encouraging concerning the potential benefits and practicality of using HIIT (ACE, FES-LCE, or FES hybrid exercise) to improve aerobic and anaerobic capacity and decrease cardiometabolic risk after SCI.
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Affiliation(s)
- David R. Dolbow
- Department of Physical Therapy and College of Osteopathic Medicine, William Carey University, Hattiesburg, Mississippi, USA,Correspondence to: David R. Dolbow, Department of Physical Therapy and College of Osteopathic Medicine, William Carey University, 710 William Carey Parkway, Hattiesburg, Mississippi39401, USA.
| | - Glen M. Davis
- Clinical Exercise and Rehabilitation Unit, Discipline of Exercise and Sports Science, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia
| | - Michael Welsch
- School of Population Health, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Ashraf S. Gorgey
- Spinal Cord Injury & Disorders Center, Hunter Holmes McGuire VAMC and Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, Virginia, USA
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Juul-Kristensen B, Bech C, Liaghat B, Cools AM, Olsen HB, Søgaard K, Larsen CM. Assessment of shoulder rotation strength, muscle co-activation and shoulder pain in tetraplegic wheelchair athletes - A methodological study. J Spinal Cord Med 2022; 45:410-419. [PMID: 32808885 PMCID: PMC9135435 DOI: 10.1080/10790268.2020.1803659] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Objective: To develop a feasible protocol for testing maximum shoulder rotation strength in tetraplegic wheelchair athletes, and investigate concurrent validity of maximum isometric handheld dynamometer (HHD) towards maximum isokinetic dynamometer (ID) strength measurements; secondly, to study shoulder muscle activation during maximum shoulder rotation measurements, and the association between shoulder strength and shoulder pain.Design: Descriptive methodological.Setting: Danish Wheelchair Rugby (WCR) association for WCR tetraplegic athletes from local WCR-clubs.Participants: Twelve adult tetraplegics.Interventions: N/A.Outcome measures: Wheelchair User's Shoulder Pain Index (WUSPI) and Visual Analog Scale (VAS) measured shoulder pain, isometric HHD and ID (60°/s) measured maximum internal (IR) and external (ER) shoulder rotation strength. Surface Electromyography normalized to maximum EMG measured muscle activity (mm Infraspinatus and Latissimus Dorsi) during maximum shoulder rotation strength.Results: Concurrent validity of isometric HHD towards ID showed Concordance Correlation Coefficients of left and right arms 0.90 and 0.86 (IR), and 0.89 and 0.91 (ER), with no difference in muscle activity between isometric HHD and ID, but larger co-activation during ER. There was no association between shoulder strength and pain, except for significantly weak negative associations between ID and pain during ER for left and right arms (P = 0.03; P = 0.04).Conclusion: Standardized feasible protocol for tetraplegic wheelchair athletes for measuring maximum shoulder rotation strength was established. Isometric HHD is comparable with ID on normalized peak torques and muscle activity, but with larger co-activation. Strength was not clearly associated with shoulder pain.
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Affiliation(s)
- Birgit Juul-Kristensen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Claus Bech
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Behnam Liaghat
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Ann M. Cools
- Department of Rehabilitation Sciences and Physiotherapy, Gent University, Gent, Belgium
- Department of Occupational and Physical Therapy & Institute of Sports Medicine, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Henrik B. Olsen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Karen Søgaard
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Occupational and Environmental Medicine, University Hospital, Odense, Denmark
| | - Camilla M. Larsen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Health Sciences Research Centre, University College, Odense, Denmark
- Department of Physiotherapy, University College, Odense, Denmark
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108
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Wheelchair-modified ergometer rowing exercise in individuals with spinal cord injury: a feasibility, acceptability, and preliminary efficacy study. Spinal Cord Ser Cases 2022; 8:48. [PMID: 35487894 PMCID: PMC9054742 DOI: 10.1038/s41394-022-00518-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 04/19/2022] [Accepted: 04/19/2022] [Indexed: 11/08/2022] Open
Abstract
STUDY DESIGN Exploratory clinical investigation. OBJECTIVES To assess the feasibility, acceptability, and preliminary efficacy of upper-body rowing exercise adapted to wheelchair users with spinal cord injury (SCI). SETTING University exercise laboratory. METHODS Eight individuals with SCI exercised on a rowing ergometer modified for wheelchair users (REMW), three times weekly, for up to 30 min per session. Participants completed feasibility and acceptability questionnaire (1-5 Likert scale), and the Wheelchair Users Shoulder Pain Index (WUSPI) before and after six weeks of exercise. Average power output (POAVG), distance rowed, percent peak heart rate (%HRpeak), and rating of perceived exertion (RPE) (6-20 scale) were monitored throughout the 18 exercise sessions and analyzed to evaluate preliminary efficacy of the exercise modality. RESULTS All eight participants completed the study (97% adherence). Participants rated the exercise high on the feasibility and acceptability scale; median (interquartile range) = 5.0 (4.0-5.0), where higher numbers indicated greater feasibility. Shoulder pain was reduced by 21% yet not significantly different from baseline (p = 0.899). Physiological measures (%HRpeak = 80-83%; RPE = 15.0-16.0) indicated a high cardiovascular training load. From week 1 to week 6, POAVG and distance rowed increased by 37 and 36%, respectively (both p ≤ 0.001). CONCLUSIONS Data from six weeks of exercise on the REMW suggests that upper-body rowing is a feasible and acceptable exercise modality for wheelchair users with SCI. Session data on %HRpeak, RPE, and shoulder pain indicate that REMW evoked moderate to vigorous intensity exercise without exacerbation of shoulder pain. Future research is required to quantify potential training-induced changes in cardiorespiratory fitness.
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Froehlich-Grobe K, Lee J, Ochoa C, Lopez A, Sarker E, Driver S, Shegog R, Lin SJ. Effectiveness and feasibility of the workout on wheels internet intervention (WOWii) for individuals with spinal cord injury: a randomized controlled trial. Spinal Cord 2022; 60:862-874. [PMID: 35474116 PMCID: PMC9041282 DOI: 10.1038/s41393-022-00787-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 02/26/2022] [Accepted: 02/28/2022] [Indexed: 11/09/2022]
Abstract
Study design Randomized-controlled trial (RCT) with immediate intervention (IMM) and wait-list control (WLC) groups; WLC participants received the intervention during delivery to subsequent cohorts. Objectives Investigate the effectiveness and feasibility of a virtually-delivered exercise intervention. Setting Home and community. Methods A total of 168 middle-aged (49.6 [12.3] years old) men (57%) and women (43%) who lived an average 15.5 (12.3) years with spinal cord injury (SCI) participated. The 16-week program provides users (a) website access with exercise information, resources, and 16 skill-building modules; (b) virtual 60-minute, group-based weekly meetings; and (c) a starter package of exercise equipment. Primary outcomes included subjective physical activity (IPAQ) and objective exercise (Polar A300 wrist-based activity monitor and H7 heart rate strap). Secondary outcomes included fitness indices during a maximal arm crank test, plus self-reported exercise barriers, exercise self-efficacy, and goal-directed thinking. Results RCT results indicate significant between group differences in participants’ self-reported weekly time spent in vigorous-intensity PA and goal directed thinking but not for fitness changes. Data combined for IMM and WLC participants from Polar monitoring show participants performed 150 min per week of aerobic exercise plus reported significantly greater time spent in moderate-PA, vigorous-PA, self-efficacy for exercise and nutrition, goal directed thinking, and exercise barriers. Oxygen uptake (V̇O2 peak) and power output (watts max) were the only physiologic measures to demonstrate significant change, with a moderate effect size. Conclusion This virtually-delivered program offers a promising approach to increase exercise among those with SCI and may help participants perceive fewer motivational barriers and greater self-efficacy.
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Affiliation(s)
- Katherine Froehlich-Grobe
- Craig Hospital, Englewood, CO, 80113, USA. .,Baylor Scott & White Institute for Rehabilitation, Dallas, TX, 75246, USA. .,Health Promotion and Behavioral Sciences Department, UTHealth School of Public Health, Houston, TX, 77030, USA.
| | - Jaehoon Lee
- Department of Educational Psychology, Leadership, and Counseling, College of Education, Texas Tech University, Lubbock, TX, 79409, USA
| | - Christa Ochoa
- Baylor Scott & White Institute for Rehabilitation, Dallas, TX, 75246, USA.,Baylor Scott & White Research Institute, Dallas, TX, 75246, USA
| | - Amber Lopez
- Baylor Scott & White Institute for Rehabilitation, Dallas, TX, 75246, USA.,Shepherd Center, Atlanta, GA, 30309, USA
| | - Erina Sarker
- Baylor Scott & White Institute for Rehabilitation, Dallas, TX, 75246, USA.,Baylor Scott & White Research Institute, Dallas, TX, 75246, USA
| | - Simon Driver
- Baylor Scott & White Institute for Rehabilitation, Dallas, TX, 75246, USA.,Baylor Scott & White Research Institute, Dallas, TX, 75246, USA
| | - Ross Shegog
- Health Promotion and Behavioral Sciences Department, UTHealth School of Public Health, Houston, TX, 77030, USA
| | - Suh-Jen Lin
- School of Physical Therapy, Institute of Health Sciences of Dallas, Texas Woman's University, Dallas, TX, 75235, USA
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110
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Itodo OA, Flueck JL, Raguindin PF, Stojic S, Brach M, Perret C, Minder B, Franco OH, Muka T, Stucki G, Stoyanov J, Glisic M. Physical activity and cardiometabolic risk factors in individuals with spinal cord injury: a systematic review and meta-analysis. Eur J Epidemiol 2022; 37:335-365. [PMID: 35391647 PMCID: PMC9187578 DOI: 10.1007/s10654-022-00859-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 03/07/2022] [Indexed: 11/29/2022]
Abstract
Physical inactivity in individuals with spinal cord injury (SCI) has been suggested to be an important determinant of increased cardiometabolic disease (CMD) risk. However, it remains unclear whether physically active SCI individuals as compared to inactive or less active individuals have truly better cardiometabolic risk profile. We aimed to systematically review and quantify the association between engagement in regular physical activity and/or exercise interventions and CMD risk factors in individuals with SCI. Four medical databases were searched and studies were included if they were clinical trials or observational studies conducted in adult individuals with SCI and provided information of interest. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was applied to rate the certainty of evidence. Of 5816 unique citations, 11 randomized clinical trials, 3 non-randomized trial and 32 cross-sectional studies comprising more than 5500 SCI individuals were included in the systematic review. In meta-analysis of RCTs and based on evidence of moderate certainty, physical activity in comparison to control intervention was associated with: (i) better glucose homeostasis profile [WMD of glucose, insulin and Assessment of Insulin Resistance (HOMA-IR) were - 3.26 mg/dl (95% CI - 5.12 to - 1.39), - 3.19 μU/ml (95% CI - 3.96 to - 2.43)] and - 0.47 (95% CI - 0.60 to - 0.35), respectively], and (ii) improved cardiorespiratory fitness [WMD of relative and absolute oxygen uptake relative (VO2) were 4.53 ml/kg/min (95% CI 3.11, 5.96) and 0.26 L/min (95% CI 0.21, 0.32) respectively]. No differences were observed in blood pressure, heart rate and lipids (based on evidence of low/moderate certainty). In meta-analysis of cross-sectional studies and based on the evidence of very low to low certainty, glucose [WMD - 3.25 mg/dl (95% CI - 5.36, - 1.14)], insulin [- 2.12 μU/ml (95% CI - 4.21 to - 0.03)] and total cholesterol [WMD - 6.72 mg/dl (95% CI - 13.09, - 0.34)] were lower and HDL [WMD 3.86 mg/dl (95% CI 0.66, 7.05)] and catalase [0.07 UgHb-1 (95% CI 0.03, 0.11)] were higher in physically active SCI individuals in comparison to reference groups. Based on limited number of cross-sectional studies, better parameters of systolic and diastolic cardiac function and lower carotid intima media thickness were found in physically active groups. Methodologically sound clinical trials and prospective observational studies are required to further elaborate the impact of different physical activity prescriptions alone or in combination with other life-style interventions on CMD risk factors in SCI individuals.
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Affiliation(s)
- Oche Adam Itodo
- Swiss Paraplegic Research, Guido A. Zäch Str. 1, 6207, Nottwil, Switzerland
- Graduate School for Health Sciences, University of Bern, Mittelstrasse 43, 3012, Bern, Switzerland
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Mittelstrasse 43, 3012, Bern, Switzerland
| | | | - Peter Francis Raguindin
- Swiss Paraplegic Research, Guido A. Zäch Str. 1, 6207, Nottwil, Switzerland
- Graduate School for Health Sciences, University of Bern, Mittelstrasse 43, 3012, Bern, Switzerland
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Mittelstrasse 43, 3012, Bern, Switzerland
| | - Stevan Stojic
- Swiss Paraplegic Research, Guido A. Zäch Str. 1, 6207, Nottwil, Switzerland
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Mittelstrasse 43, 3012, Bern, Switzerland
| | - Mirjam Brach
- Swiss Paraplegic Research, Guido A. Zäch Str. 1, 6207, Nottwil, Switzerland
| | - Claudio Perret
- Sports Medicine, Swiss Paraplegic Centre Nottwil, 6207, Nottwil, Switzerland
| | - Beatrice Minder
- Public Health and Primary Care Library, University Library of Bern, University of Bern, Bern, Switzerland
| | - Oscar H Franco
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Mittelstrasse 43, 3012, Bern, Switzerland
| | - Taulant Muka
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Mittelstrasse 43, 3012, Bern, Switzerland
| | - Gerold Stucki
- Swiss Paraplegic Research, Guido A. Zäch Str. 1, 6207, Nottwil, Switzerland
| | - Jivko Stoyanov
- Swiss Paraplegic Research, Guido A. Zäch Str. 1, 6207, Nottwil, Switzerland
| | - Marija Glisic
- Swiss Paraplegic Research, Guido A. Zäch Str. 1, 6207, Nottwil, Switzerland.
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Mittelstrasse 43, 3012, Bern, Switzerland.
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111
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Valentino SE, Hutchinson MJ, Goosey-Tolfrey VL, MacDonald MJ. The effects of perceptually regulated exercise training on cardiorespiratory fitness and peak power output in adults with spinal cord injury: a systematic review and meta-analysis. Arch Phys Med Rehabil 2022; 103:1398-1409. [DOI: 10.1016/j.apmr.2022.03.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 02/22/2022] [Accepted: 03/08/2022] [Indexed: 11/16/2022]
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112
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Warner MB, Mason BS, Goosey-Tolfrey VL, Webborn FSEM (UK) N. Physical Activity Levels and Shoulder Pain in Wheelchair Users during COVID-19 Restrictions. Disabil Health J 2022; 15:101326. [PMID: 35568672 PMCID: PMC9001177 DOI: 10.1016/j.dhjo.2022.101326] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 01/21/2022] [Accepted: 04/01/2022] [Indexed: 11/05/2022]
Abstract
Background Manual wheelchair users are at high risk of developing shoulder pain. However, it is not known if restrictions to limit the spread of the COVID-19 virus affected physical activity, wheelchair use and shoulder pain. Objective The aim of the study is to determine whether COVID-19 related restrictions caused changes in physical activity levels and the presence of shoulder pain in persons who use a wheelchair. Methods Manual wheelchair users completed a survey about the presence and severity of shoulder pain in a cross-sectional study design. Participants completed the Leisure Time Physical Activity Questionnaire and were asked about daily wheelchair activity before and during lockdown. A logistic regression examined the relationship between increase in shoulder pain severity and change in activity levels. Results Sixty respondents were included for analysis. There was no significant change in physical activity during lockdown. There was a significant reduction in number of hours of daily wheelchair use and number of chair transfers during lockdown. Of the respondents, 67% reported having shoulder pain and 22% reported their shoulder pain becoming more severe during lockdown. No significant relationship was observed between the change in activity levels and increasing severity of shoulder pain. Conclusion Restrictions to reduce the spread of the COVID-19 virus resulted in no changes in physical activity levels in a sample of adult manual wheelchair users; however, there was a reduced time using a wheelchair each day and fewer chair transfers. The changes in wheelchair activities were not related to the worsening of shoulder pain.
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113
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Dinwoodie M, Hoekstra F, Stelzer S, Ma JK, Martin Ginis KA. A dynamic analysis of physical activity barriers experienced by adults with spinal cord injury. Spinal Cord Ser Cases 2022; 8:37. [PMID: 35351871 PMCID: PMC8964746 DOI: 10.1038/s41394-022-00504-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 03/07/2022] [Accepted: 03/08/2022] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES To track and evaluate changes in the number and types of physical activity barriers experienced by adults with spinal cord injury (SCI) in response to a physical activity counselling intervention, using a newly-developed tracking and coding method. DESIGN A secondary analysis of data from a randomized controlled trial of a physical activity behavioural intervention (#NCT03111030). SETTING General community. PARTICIPANTS Adults with chronic SCI (n = 14). INTERVENTION An introductory behavioural coaching session followed by eight, weekly follow-up sessions were delivered in-person or by phone/video call. The interventionist utilized behaviour-change techniques tailored to individual participants' readiness for change, barriers, and preferences. Participants set goals for achieving the SCI exercise guidelines. Coaching sessions were audio-recorded and transcribed verbatim. MAIN OUTCOME MEASURE(S) Changes over time in the number of barriers reported within each level of a social-ecological model of influences on physical activity (intrapersonal, interpersonal, institutional, community, policy). RESULTS A total of 152 physical activity barriers were identified across 122 coaching sessions. Within each level of influence, the number of identified barriers decreased significantly over the intervention period. Intrapersonal barriers (e.g., lack of motivation, low self-efficacy) were most frequently reported and showed the greatest reductions over time. CONCLUSIONS Using a new coding method to track changes in physical activity barriers, this pilot project showed a significant decrease in barriers over the course of a counselling intervention. Understanding physical activity barrier dynamics can improve the design of physical activity-enhancing interventions. Dynamic barrier-tracking methods could also be used to improve intervention implementation and evaluation.
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Affiliation(s)
- Miranda Dinwoodie
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, BC, Canada
| | - Femke Hoekstra
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, BC, Canada.,International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada
| | - Shannon Stelzer
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, BC, Canada
| | - Jasmin K Ma
- Arthritis Research Canada, Vancouver, BC, Canada.,School of Kinesiology, University of British Columbia, University of British Columbia, Vancouver, BC, Canada
| | - Kathleen A Martin Ginis
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, BC, Canada. .,International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada. .,Department of Medicine, Division of Physical Medicine & Rehabilitation, University of British Columbia, Vancouver, BC, Canada. .,Centre for Chronic Disease Prevention and Management, University of British Columbia, Kelowna, BC, Canada.
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114
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Chiou SY, Clarke E, Lam C, Harvey T, Nightingale TE. Effects of Arm-Crank Exercise on Fitness and Health in Adults With Chronic Spinal Cord Injury: A Systematic Review. Front Physiol 2022; 13:831372. [PMID: 35392374 PMCID: PMC8982085 DOI: 10.3389/fphys.2022.831372] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 02/15/2022] [Indexed: 12/15/2022] Open
Abstract
Individuals with spinal cord injury (SCI) may benefit less from exercise training due to consequences of their injury, leading to lower cardiorespiratory fitness and higher risks of developing cardiovascular diseases. Arm-crank exercise (ACE) is the most common form of volitional aerobic exercise used by people with SCI outside a hospital. However, evidence regarding the specific effects of ACE alone on fitness and health in adults with SCI is currently lacking. Hence, this review aimed to determine the effects of ACE on cardiorespiratory fitness, body composition, cardiovascular disease (CVD) risk factors, motor function, health-related quality of life (QoL), and adverse events in adults with chronic SCI. Inclusion criteria were: inactive adults (≥18 years) with chronic SCI (>12 months post injury); used ACE alone as an intervention; measured at least one of the following outcomes; cardiorespiratory fitness, body composition, cardiovascular disease risk factors, motor function, health-related QoL, and adverse events. Evidence was synthesized and appraised using GRADE. Eighteen studies with a combined total of 235 participants having an injury between C4 to L3 were included. There was a moderate certainty of the body of evidence on ACE improving cardiorespiratory fitness. Exercise prescriptions from the included studies were 30-40 min of light to vigorous-intensity exercise, 3-5 times per week for 2-16 weeks. GRADE confidence ratings were very low for ACE improving body composition, CVD risks factors, motor function, or health-related QoL. No evidence suggests ACE increases the risk of developing shoulder pain or other injuries. Overall, this review recommends adults with chronic SCI should engage in regular ACE to improve cardiorespiratory fitness. More high-quality, larger-scale studies are needed to increase the level of evidence of ACE in improving cardiorespiratory fitness and to determine the effects of ACE on other outcomes. Systematic Review Registration: [https://www.crd.york.ac.uk/prospero/display_reco rd.php?ID=CRD42021221952], identifier [CRD42021221952].
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Affiliation(s)
- Shin Yi Chiou
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
- Centre for Human Brain Health, University of Birmingham, Birmingham, United Kingdom
- MRC Versus Arthritis Centre for Musculoskeletal Ageing Research, University of Birmingham, Birmingham, United Kingdom
| | - Emma Clarke
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Chi Lam
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Tom Harvey
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Tom E. Nightingale
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
- Centre for Trauma Sciences Research, University of Birmingham, Birmingham, United Kingdom
- International Collaboration on Repair Discoveries, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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115
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Evaluating and Characterizing an Individually-Tailored Community Exercise Program for Older Adults With Chronic Neurological Conditions: A Mixed-Methods Study. J Aging Phys Act 2022; 30:1047-1060. [PMID: 35294924 DOI: 10.1123/japa.2021-0292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 01/10/2022] [Accepted: 02/04/2022] [Indexed: 11/18/2022]
Abstract
A mixed-methods approach was used to study an individually-tailored community exercise program for people with a range of chronic neurological conditions (e.g., stroke, spinal cord injury, brain injury, multiple sclerosis, Parkinson's disease) and abilities. The program was delivered to older adults (mean age: 62 ± 9 years) with chronic neurological conditions across a 12-week and an 8-week term. Participants attended 88% of sessions and completed 89% of prescribed exercises in those sessions. There were no adverse events. Clinically important improvements were achieved by all evaluated participants (n = 8) in at least one testing domain (grip strength, lower-extremity strength, aerobic endurance, and balance). Interviews with participants identified key program elements as support through supervision, social connection, individualized programming, and experiential learning. Findings provide insight into elements that enable a community exercise program to meet the needs of a complex and varied group. Further study will support positive long-term outcomes for people aging with neurological conditions.
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116
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Preliminary training volume and progression algorithm to tackle fragility fracture risk during exoskeleton-assisted overground walking in individuals with a chronic spinal cord injury. Spinal Cord Ser Cases 2022; 8:29. [PMID: 35260550 PMCID: PMC8904785 DOI: 10.1038/s41394-022-00498-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 02/17/2022] [Accepted: 02/20/2022] [Indexed: 11/08/2022] Open
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117
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Perceptions of physical activity and sedentary behaviour guidelines among end-users and stakeholders: a systematic review. Int J Behav Nutr Phys Act 2022; 19:21. [PMID: 35236360 PMCID: PMC8889734 DOI: 10.1186/s12966-022-01245-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 01/10/2022] [Indexed: 12/03/2022] Open
Abstract
Background Many of the world’s population, across all age groups and abilities, are not meeting or even aware of internationally recommended physical activity (PA) and sedentary behaviour (SB) guidelines. In order to enhance awareness and uptake, guidelines should be perceived positively by targeted users. The purpose of this study was to review the literature on end-user and stakeholder perceptions of PA and SB guidelines. Methods The electronic databases APA PsycInfo, CINAHL, MEDLINE, and SPORTDiscus, using EBSCOhost Research Platform, and Web of Science were searched from inception to June, 2021 with keyword synonyms for “perceptions”, “PA guidelines”, and “SB guidelines”. Studies of any design that collected stakeholder and/or end-user responses to a PA and/or SB guideline were included and assessed for risk of bias. The PA and/or SB guideline could be any type of official form (e.g., national documents, organizational guidelines, expert consensus statements, etc.) from any country, that targets individuals at the regional, provincial/statewide, national, or international level, and includes all types of guidelines (e.g., strength, aerobic, clinical, nonclinical, screen-time, sitting, etc.). Data were extracted and analyzed using thematic synthesis. Results After screening 1399 abstracts and applying citation screening, 304 full-texts were retrieved. A total of 31 articles met the inclusion criteria. End-users and stakeholders for PA guidelines across all age groups expressed the need for simplified language with more definitions, relatable examples and imagery, and quantification of PA behaviours. There was concern for the early years and child PA guidelines leading to guilt amongst parents and the SB guidelines, particularly the recommendations to limit screen-time, being unrealistic. General age group PA guidelines were not perceived as usable to populations with differing abilities, clinical conditions, and socioeconomic status. Guidelines that targeted clinical populations, such as persons with multiple sclerosis and persons with spinal cord injury, were well received. Conclusions There is a clear need to balance the evidence base with the pragmatic needs of translation and uptake so that the guidelines are not ignored or act as a barrier to actual engagement. Supplementary Information The online version contains supplementary material available at 10.1186/s12966-022-01245-9.
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118
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Cyr AK, Colorado BS, Uihlein MJ, Garlanger KL, Tarima SS, Lee K. Prevalence of lateral epicondylosis in veteran manual wheelchair users participating in adaptive sports. J Spinal Cord Med 2022; 45:238-244. [PMID: 32527209 PMCID: PMC8986268 DOI: 10.1080/10790268.2020.1771243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Objective: Determine the prevalence of lateral epicondylosis (LE) of the dominant elbow in manual wheelchair users based on ultrasound assessment and physical exam.Design: Prospective, cross-sectional.Setting: National Veteran Wheelchair Games 2018 and 2019 (event medical services).Participants: Manual wheelchair users who attended the National Veteran Wheelchair Games (n = 87).Interventions: Participants completed a questionnaire then underwent an ultrasound assessment and a physical exam of their dominant arm evaluating for common extensor tendinopathy (CET) or clinically LE.Main Outcome Measure: Prevalence of CET diagnosed by ultrasound criteria was compared with other diagnostic criteria with MaNemar test for paired binary data.Results: Forty-six percent (N = 40) of participants met diagnostic criteria for CET by ultrasound assessment and 17% (N = 15) of participants met criteria for LE based on physical exam. These values are dramatically higher than what has been reported in the able-bodied population where the prevalence is estimated to be <2%. Age and number of years of wheelchair use were significant predictors of ultrasound diagnosis of LE (P = 0.02, 95% confidence interval [CI] 1.01-1.11) and (P = 0.05, 95% CI 1.00-1.09), respectively. Association analysis based on odds ratio and CI found no association between ultrasound findings suggestive of LE with regular adaptive sport participation greater than 1.5 h per week.Conclusion: Compared to able-bodied population, there is an increased prevalence of both CET and LE in manual wheelchair users based on either ultrasound assessment or physical exam. CET is associated with increased age and increased years using a manual wheelchair. There is no association between the diagnosis of LE and participation in adaptive sport.
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Affiliation(s)
- Andrea K. Cyr
- Department of Physical Medicine and Rehabilitation, Medical College of Wisconsin, Milwaukee, Wisconsin, USA,Division of Spinal Cord Injury, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, Wisconsin, USA,Correspondence to: Andrea Cyr, Department of Physical Medicine and Rehabilitation, Medical College of Wisconsin, 4132 S Regal Manor Court, New Berlin, Milwaukee, Wisconsin53151, USA; Ph: 207-316-5100.
| | - Berdale S. Colorado
- Department of Orthopedic Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Michael J. Uihlein
- Department of Physical Medicine and Rehabilitation, Medical College of Wisconsin, Milwaukee, Wisconsin, USA,Division of Spinal Cord Injury, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, Wisconsin, USA
| | - Kristin L. Garlanger
- Department of Physical Medicine and Rehabilitation, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Sergey S. Tarima
- Institute for Health and Equity, Division of Biostatistics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Kenneth Lee
- Department of Physical Medicine and Rehabilitation, Medical College of Wisconsin, Milwaukee, Wisconsin, USA,Division of Spinal Cord Injury, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, Wisconsin, USA
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119
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Santino N, Larocca V, Hitzig SL, Guilcher SJ, Craven BC, Bassett-Gunter RL. Physical activity and life satisfaction among individuals with spinal cord injury: Exploring loneliness as a possible mediator. J Spinal Cord Med 2022; 45:173-179. [PMID: 32379551 PMCID: PMC8986296 DOI: 10.1080/10790268.2020.1754651] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Context: There has been no known research investigating the association between leisure time physical activity (LTPA), loneliness, and life satisfaction among people with spinal cord injury or dysfunction (SCI/D). The relationship between these constructs is worthy of consideration given the positive health impacts of LTPA, the negative health impacts of loneliness, and heightened negative effects of loneliness on life satisfaction for individuals with SCI/D.Objectives: To examine the relationship between LTPA and loneliness, and examine loneliness as a possible mediator of the relationship between LTPA and life satisfaction among individuals with SCI/D.Design and Participants: Community dwelling individuals with SCI/D (N = 170) participated in a telephone-based survey as part of a larger project.Measures: LTPA (i.e. The Leisure Time Physical Activity Questionnaire-SCI, UCLA Loneliness Scale-3, and the Life Satisfaction Questionnaire-11 were administered to the participants.Results: Significant bivariate relationships were observed between LTPA and life satisfaction (r = .18, P = .02), LTPA and loneliness (r = -.15, P = .045), and loneliness and life satisfaction (r = -.69, P < .001). Mediation analyses suggest that loneliness significantly mediated the relationship between LTPA and life satisfaction (indirect effect = .003, 95% bootstrap CI = .0004 to .0062, CSI = .113).Conclusion: This was the first study to show evidence of a negative association between LTPA and loneliness among people with SCI/D, and to establish a conceptual model for understanding the potential mediating role of loneliness in the relationship between LTPA and life satisfaction among people with SCI/D.
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Affiliation(s)
- Nicholas Santino
- School of Kinesiology & Health Science, Faculty of Health, York University, Toronto, Canada
| | - Victoria Larocca
- School of Kinesiology & Health Science, Faculty of Health, York University, Toronto, Canada
| | - Sander L. Hitzig
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Canada
- St. John’s Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Canada
- Department of Occupational Science & Occupational Therapy, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Sara J.T. Guilcher
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- MAP Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto, Canada
| | - B. Catharine Craven
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Neural Engineering & Therapeutics Team, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
- Division of Physiatry, Department of Medicine, University of Toronto, Toronto, Canada
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120
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Li Q, Wang B, Cheng B, Liu C, Li N, Dai G, Xiao H, Zhou L, ZhangBao J, Wang L, Zhao C, Lu J, Quan C, Li F. Efficacy and safety of rehabilitation exercise in neuromyelitis optica spectrum disorder during the acute phase: a prospective cohort study. Mult Scler Relat Disord 2022; 61:103726. [DOI: 10.1016/j.msard.2022.103726] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 01/28/2022] [Accepted: 03/04/2022] [Indexed: 12/12/2022]
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121
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Failli V, Kleitman N, Lammertse DP, Hsieh JTC, Steeves JD, Fawcett JW, Tuszynski MH, Curt A, Fehlings MG, Guest JD, Blight AR. Experimental Treatments for Spinal Cord Injury: What you Should Know. Top Spinal Cord Inj Rehabil 2022; 27:50-74. [PMID: 34108834 PMCID: PMC8152172 DOI: 10.46292/sci2702-50] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
| | | | | | | | - John D Steeves
- ICORD, University of British Columbia, Vancouver, Canada
| | - James W Fawcett
- Cambridge University Centre for Brain Repair, Cambridge, United Kingdom
| | - Mark H Tuszynski
- University of California - San Diego, Department of Neuroscience, La Jolla, California
| | - Armin Curt
- Spinal Cord Injury Center, University Hospital Balgrist, Zurich, Switzerland
| | - Michael G Fehlings
- University of Toronto Spine Program and Toronto Western Hospital, Toronto, Ontario, Canada
| | - James D Guest
- The Miami Project to Cure Paralysis, Miller School of Medicine, University of Miami, Miami, Florida
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122
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Hisham H, Justine M, Hasnan N, Manaf H. Effects of Paraplegia Fitness Integrated Training on Physical Function and Exercise Self-Efficacy and Adherence Among Individuals With Spinal Cord Injury. Ann Rehabil Med 2022; 46:33-44. [PMID: 35272438 PMCID: PMC8913273 DOI: 10.5535/arm.21127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 11/08/2021] [Indexed: 11/09/2022] Open
Abstract
Objective To determine the effects of the Paraplegia Fitness Integrated Training (PARAFiT) program, which is an integrated graded physical exercise and health education program for individuals with spinal cord injury (SCI). Methods This nonrandomized single-blind study included 44 participants, who were assigned to either an intervention (PARAFiT) group or an active control (conventional physiotherapy) group. The intervention group underwent the PARAFiT program (8 weeks), which consisted of circuit-based interval training, progressive upper limb resistance training, and health education sessions. During the unsupervised period, the intervention group continuously underwent health education program once a month for 2 months (8 weeks). Repeated-measures analysis of variance was used for the analysis. Results The intervention group presented with a higher level of physical activity than did the control group; however, the difference was not significant (p=0.36). Additionally, the intervention group presented with better exercise self-efficacy and cardiorespiratory fitness and stronger bilateral shoulder muscle and handgrip than did the control group (all p<0.05). Exercise adherence was higher in the intervention group than in the control group during both the supervised (80% vs. 75%) and unsupervised (40% vs. 20%) periods. Conclusion The PARAFiT program enhanced the level of physical activity, exercise self-efficacy, physical fitness, and exercise adherence among the patients with SCI. Future studies should incorporate guidelines for home-based exercises and regular monitoring to promote long-term adherence to exercise and physical activity among individuals with SCI.
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Tajali S, Fok KL, Theventhiran P, Ye G, Yokoyama H, Nakagawa K, Masani K. Development of a Coaching System for Functional Electrical Stimulation Rowing: A Feasibility Study in Able-Bodied Individuals. SENSORS 2022; 22:s22051813. [PMID: 35270960 PMCID: PMC8914784 DOI: 10.3390/s22051813] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 02/19/2022] [Accepted: 02/22/2022] [Indexed: 02/01/2023]
Abstract
Background: Functional electrical stimulation (FES) during rowing has substantial effects on cardiovascular health in individuals with spinal cord injuries. Currently, manual stimulation control where stimulation is operated by rowers is mostly utilized. However, it takes time to obtain the skill to initiate FES at the optimal timing. The purpose of this study was to develop a coaching system that helps rowers to initiate FES at the optimal timing. Methods: The optimal range for FES application was identified based on the electromyography of the left quadriceps in 10 able-bodied individuals (AB). Then, the effects of the coaching system on the timing of button-pressing, power, and work were investigated in 7 AB. Results: Vastus lateralis (VL) activation began consistently before the seat reached the anterior-most position. Therefore, seat position at the onset of VL was used as the variable to control the switch timing in the coaching system. The results revealed significantly higher power and work outputs in the coaching than the no-coaching condition (median power coaching: 19.10 W, power no-coaching: 16.48 W, p = 0.031; median work coaching: 109.74 J, work no-coaching: 65.25 J, p = 0.047). Conclusions: The coaching system can provide the optimal timing for FES, resulting in improved performance.
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Affiliation(s)
- Shirin Tajali
- KITE Research Institute, Toronto Rehabilitation Institute—University Health Network, Toronto, ON M4P 1E4, Canada; (S.T.); (K.L.F.); (P.T.); (G.Y.); (H.Y.); (K.N.)
| | - Kai Lon Fok
- KITE Research Institute, Toronto Rehabilitation Institute—University Health Network, Toronto, ON M4P 1E4, Canada; (S.T.); (K.L.F.); (P.T.); (G.Y.); (H.Y.); (K.N.)
- Institute of Biomedical Engineering, University of Toronto, 164 College Street, Toronto, ON M5S 3G9, Canada
| | - Pirashanth Theventhiran
- KITE Research Institute, Toronto Rehabilitation Institute—University Health Network, Toronto, ON M4P 1E4, Canada; (S.T.); (K.L.F.); (P.T.); (G.Y.); (H.Y.); (K.N.)
- Institute of Biomedical Engineering, University of Toronto, 164 College Street, Toronto, ON M5S 3G9, Canada
| | - Gongkai Ye
- KITE Research Institute, Toronto Rehabilitation Institute—University Health Network, Toronto, ON M4P 1E4, Canada; (S.T.); (K.L.F.); (P.T.); (G.Y.); (H.Y.); (K.N.)
- Institute of Biomedical Engineering, University of Toronto, 164 College Street, Toronto, ON M5S 3G9, Canada
| | - Hikaru Yokoyama
- KITE Research Institute, Toronto Rehabilitation Institute—University Health Network, Toronto, ON M4P 1E4, Canada; (S.T.); (K.L.F.); (P.T.); (G.Y.); (H.Y.); (K.N.)
- Graduate School of Arts and Sciences, The University of Tokyo, 3-8-1 Komaba, Meguro-ku, Tokyo 153-8902, Japan
| | - Kento Nakagawa
- KITE Research Institute, Toronto Rehabilitation Institute—University Health Network, Toronto, ON M4P 1E4, Canada; (S.T.); (K.L.F.); (P.T.); (G.Y.); (H.Y.); (K.N.)
- Faculty of Sport Sciences, Waseda University, Saitama 359-1192, Japan
| | - Kei Masani
- KITE Research Institute, Toronto Rehabilitation Institute—University Health Network, Toronto, ON M4P 1E4, Canada; (S.T.); (K.L.F.); (P.T.); (G.Y.); (H.Y.); (K.N.)
- Institute of Biomedical Engineering, University of Toronto, 164 College Street, Toronto, ON M5S 3G9, Canada
- Correspondence:
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Richley Geigle P, Ogonowska-Slodownik A, Smith JE, James K, Scott WH. Metabolic and cardiopulmonary impact of aquatic exercise and nutritional guidance for four individuals with chronic motor incomplete spinal cord injury: a case series. Physiother Theory Pract 2022:1-10. [PMID: 35196186 DOI: 10.1080/09593985.2022.2042632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Persons living with chronic spinal cord injury (SCI) demonstrate an increased risk of cardiovascular diseases. Purpose The aim of this report was to assess the cardiopulmonary and metabolic impact of prescribed aquatic exercise in combination with dietary guidance for four individuals experiencing chronic SCI. CASE DESCRIPTION We measured peak oxygen consumption (peak VO2), resting energy expenditure (REE), weight, food logs, fasting glucose, insulin and glycated hemoglobin (HbA1C) in four men with incomplete SCI, aged 34 to 63 years. INTERVENTION The men received a group aquatic exercise program three times per week for 10 weeks, and a weekly individual nutritional consultation by phone. OUTCOMES Peak VO2 increased by 7.9% and 34.4% in participants #3 and #4 and decreased by 12% and 16.4% in #1 and #2. Glucose values decreased by 19.6% and 14.2% for #1 and #3, and increased by 9.3% for both #2 and #4. Body mass decreased by 9.9%, 3.0% and 5.7% for participants #1, #2 and #3, but demonstrated no change for participant #4. Dietary guidance and education produced positive changes, including reduced fat, carbohydrate, daily sugar, and average calorie intake. CONCLUSION Moderate exercise with weekly nutritional guidance appeared to positively impact body mass and dietary selections with varied metabolic and cardiopulmonary results.
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Affiliation(s)
| | - Anna Ogonowska-Slodownik
- Faculty of Rehabilitation, Jozef Pilsudski University of Physical Education in Warsaw, Warsaw, Poland
| | | | | | - William H Scott
- Baltimore Veterans Administration Medical Center, Baltimore, MD, USA
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Vestergaard M, Jensen K, Juul-Kristensen B. Hybrid high-intensity interval training using functional electrical stimulation leg cycling and arm ski ergometer for people with spinal cord injuries: a feasibility study. Pilot Feasibility Stud 2022; 8:43. [PMID: 35193705 PMCID: PMC8862540 DOI: 10.1186/s40814-022-00997-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 01/31/2022] [Indexed: 11/22/2022] Open
Abstract
Aim The aim was to assess safety and feasibility of Hybrid High-Intensity Interval Training (HIIT) using Functional Electrical Stimulation (FES) leg cycling and arm ski ergometer in people with Spinal Cord Injuries (SCI). Method Eight outpatients (mean age 42.8 years; 7 men) with stable SCI paraplegia (mean 14.5 years since injury) participated in hybrid HIIT (90% peak watts; 4 × 4–min intervals), three times a week (over 8 weeks). Primary outcomes were Adverse Events (AE), participant acceptability, shoulder pain, training intensity (% peak watts), and attendance. Secondary outcomes were effect on peak oxygen uptake (VO2peak) during FES hybrid poling, mean watts, self-reported leisure time physical activity, quality of life, and fatigue. Results No serious AE occurred; acceptability with the training modality was high, while shoulder pain increased by 9% (SD 95.2). During training, 50% of the participants reached > 90% peak watts during the intervals, three with the legs (FES cycle) and one with the arms (Ski-Erg). Overall, mean training intensity (% peak watts) was 92% (SD 18.9) for legs and 82% (SD 10.3) for arms. Proportion of fulfilled training minutes was 82% (range 36–100%); one participant dropped out after 6 weeks due to back pain. Mean VO2peak increased by 17% (SD 17.5). Participants reported increased leisure time physical activity and health-related quality of life, besides reduced fatigue. Conclusion Hybrid HIIT was safe for people with SCI paraplegia. The majority of the criteria for feasibility were met with acceptable attendance rate, limited drop out, participants enjoyed training, and increased VO2peak and mean watts. However, the intensity of 90% peak watts was reached by < 60% of the participants despite high RPE ratings during training. The method of measuring and calculating intensity needs to be studied further before a study using this HIIT protocol is undertaken. Trial registration Clinicaltrials.gov, NCT04211311, registered 12 December 2019 retrospectively registered Supplementary Information The online version contains supplementary material available at 10.1186/s40814-022-00997-2.
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Koyama S, Tanabe S, Gotoh T, Taguchi Y, Katoh M, Saitoh E, Otaka Y, Hirano S. Wearable Power-Assist Locomotor for Gait Reconstruction in Patients With Spinal Cord Injury: A Retrospective Study. Front Neurorobot 2022; 16:775724. [PMID: 35250528 PMCID: PMC8894852 DOI: 10.3389/fnbot.2022.775724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 01/11/2022] [Indexed: 11/16/2022] Open
Abstract
Wearable robotic exoskeletons (WREs) have been developed from orthoses as assistive devices for gait reconstruction in patients with spinal cord injury. They can solve some problems encountered with orthoses, such as difficulty in independent walking and standing up and high energy consumption during walking. The Wearable Power-Assist Locomotor (WPAL), a WRE, was developed based on a knee–ankle–foot orthosis with a single medial hip joint. The WPAL has been updated seven times during the period from the beginning of its development, in 2005, to 2020. The latest version, launched as a commercialized model in 2016, is available for medical facilities. In this retrospective study, which included updated results from previous reports, all data were extracted from development research records from July 2007 to December 2020. The records were as follows: patient characteristics [the number of participants, injury level, and the American Spinal Injury Association Impairment Scale (AIS) score], the total number of WPAL trials when aggregating the cases with all the versions or only the latest version of the WPAL, and maximum walking performance (functional ambulation category [FAC], distance, and time of continuous walking). Thirty-one patients participated in the development research. The levels of spinal cord injury were cervical (C5–C8), upper thoracic (T3–T6), lower thoracic (T7–T12), and lumbar (L1) in 10, 5, 15, and 1 of the patients, respectively. The numbers of patients with AIS scores of A, B, C, and D were 20, 7, 4, and 0, respectively. The total number of WPAL trials was 1,785, of which 1,009 were used the latest version of the WPAL. Twenty of the patients achieved an FAC score of 4 after an average of 9 (median 8, range 2–22) WPAL trials. The continuous walking distance and time improved with the WPAL were compared to the orthosis. We confirmed that the WPAL improves walking independence in people with a wide range of spinal cord injuries, such as cervical spinal cord injuries. Further refinement of the WPAL will enable its long-term use at home.
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Affiliation(s)
- Soichiro Koyama
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Toyoake, Japan
| | - Shigeo Tanabe
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Toyoake, Japan
| | - Takeshi Gotoh
- Department of Rehabilitation, Fujita Health University Hospital, Toyoake, Japan
| | - Yuta Taguchi
- Department of Rehabilitation, Fujita Health University Hospital, Toyoake, Japan
| | - Masaki Katoh
- Department of Rehabilitation, Fujita Health University Hospital, Toyoake, Japan
| | - Eiichi Saitoh
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Yohei Otaka
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Satoshi Hirano
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Japan
- *Correspondence: Satoshi Hirano
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Acute physiological comparison of sub-maximal exercise on a novel adapted rowing machine and arm crank ergometry in people with a spinal cord injury. Spinal Cord 2022; 60:694-700. [PMID: 35110695 PMCID: PMC8810340 DOI: 10.1038/s41393-022-00757-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 01/19/2022] [Accepted: 01/20/2022] [Indexed: 12/01/2022]
Abstract
Study design Non-randomized crossover trial. Objectives The objective of this study was to assess the oxygen uptake during exercise using the Adapted ROWing machine (AROW) compared to the more commonly used Arm Crank Ergometry (ACE) for people with spinal cord injury/disease (SCI/D) with or without trunk stability. Setting Canada, Vancouver. Methods Participants were from a convenience sample of 14 adults with SCI/D (age 21–63 y) which include those with lumbar to low cervical impairments currently exercising at least once per week using cardiovascular exercise equipment at our Physical Activity Research Centre. The interventions were non-randomized steady-state exercise bouts at self-selected low and moderate workloads on the AROW and ACE for 5 min each. Our primary outcomes were the rate of oxygen consumption (mL/kg/min) and the Borg 0–10 Rating Scale of Perceived Exertion (RPE). Results A repeated measures two-way ANOVA (p < 0.05) indicated that exercising on the AROW resulted significantly greater oxygen consumption and perceived exertion than ACE at similar sub-maximal workloads which may be explained by the differences in efficiency between the devices (Partial eta squared = 0.84, F stat = 48.25; Partial eta squared = 0.86, F stat = 53.54). Conclusions We have demonstrated that this form of upper extremity exercise had a greater RPE and VO2 on the ACE at a given workload. Thus, the AROW could provide a functional upper extremity workout that can be used for daily exercise for those with varying levels of SCI.
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Afshari K, Ozturk ED, Yates B, Picard G, Taylor JA. Effect of hybrid FES exercise on body composition during the sub-acute phase of spinal cord injury. PLoS One 2022; 17:e0262864. [PMID: 35073366 PMCID: PMC8786191 DOI: 10.1371/journal.pone.0262864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 12/06/2021] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES To determine the Effect of Hybrid functional electrically stimulated (FES) Exercise on Body Composition during the Sub-acute Phase of Spinal Cord Injury (SCI). DESIGN Randomized Clinical Trial. SETTING Rehabilitation Hospital. PARTICIPANTS Patients within sub-acute phase (3-24 months) of SCI. INTERVENTIONS We investigated if high-intensity exercise training via the addition of functional electrically stimulated (FES) leg muscles, provides sufficient stimulus to mitigate against body composition changes in the sub-acute phase after SCI. MAIN OUTCOME MEASURES We explored potential effects of FES row training (FESRT) on body fat gain, lean mass loss, and cardiometabolic parameters and compared the effects of 6-month of FESRT (n = 18) to standard of care (SOC, n = 13). Those in SOC were crossed over to FESRT. RESULTS FESRT resulted in greater exercise capacity and a tendency for lesser total body fat accumulation with a significant increase in total and leg lean mass (p<0.05). In addition pelvis and total bone mineral density declines were significantly less (p<0.05). Compared to SOC, FESRT did not lead to any significant difference in insulin sensitivity or serum lipids. However, HbA1C levels were significantly decreased in SOC participants who crossed over to 6-month FESRT. CONCLUSION FESRT early after SCI provides a sufficient stimulus to mitigate against detrimental body composition changes. This may lead to prevention of losses in lean mass, including bone.
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Affiliation(s)
- Khashayar Afshari
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, United States of America
- Cardiovascular Research Laboratory, Spaulding Hospital Cambridge, Cambridge, MA, United States of America
- Spaulding Research Institute, Charlestown, MA, United States of America
| | - Erin D. Ozturk
- Cardiovascular Research Laboratory, Spaulding Hospital Cambridge, Cambridge, MA, United States of America
| | - Brandon Yates
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, United States of America
- Cardiovascular Research Laboratory, Spaulding Hospital Cambridge, Cambridge, MA, United States of America
- Spaulding Research Institute, Charlestown, MA, United States of America
| | - Glen Picard
- Cardiovascular Research Laboratory, Spaulding Hospital Cambridge, Cambridge, MA, United States of America
| | - J. Andrew Taylor
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, United States of America
- Cardiovascular Research Laboratory, Spaulding Hospital Cambridge, Cambridge, MA, United States of America
- Spaulding Research Institute, Charlestown, MA, United States of America
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Barriers and facilitators to changing bowel care practices after spinal cord injury: a Theoretical Domains Framework approach. Spinal Cord 2022; 60:664-673. [PMID: 34997189 PMCID: PMC9287175 DOI: 10.1038/s41393-021-00743-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 12/14/2021] [Accepted: 12/19/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Improvement to autonomic processes such as bladder, bowel and sexual function are prioritised by individuals with spinal cord injury (SCI). Bowel care is associated with high levels of dissatisfaction and decreased quality of life. Despite dissatisfaction, 71% of individuals have not changed their bowel care routine for at least 5 years, highlighting a disconnect between dissatisfaction with bowel care and changing routines to optimise bowel care. OBJECTIVE Using an integrated knowledge translation approach, we aimed to explore the barriers and facilitators to making changes to bowel care in individuals with SCI. METHODS Our approach was guided by the Behaviour Change Wheel and used the Theoretical Domains Framework (TDF). Semi-structured interviews were conducted with individuals with SCI (n = 13, mean age 48.6 ± 13.1 years) and transcribed verbatim (duration 31.9 ± 7.1 min). Barriers and facilitators were extracted, deductively coded using TDF domains and inductively analysed for themes within domains. RESULTS Changing bowel care after SCI was heavily influenced by four TDF domains: environmental context and resources (workplace flexibility, opportunity or circumstance, and access to resources); beliefs about consequences; social influences (perceived support and peer mentorship); and knowledge (knowledge of physiological processes and bowel care options). All intervention functions and policy categories were considered viable intervention options, with human (61%) and digital (33%) platforms preferred. CONCLUSIONS Modifying bowel care is a multi-factorial behaviour. These findings will support the systematic development and implementation of future interventions to both enable individuals with SCI to change their bowel care and to facilitate the optimisation of bowel care approaches.
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Hossain KMA, Sakel M, Saunders K, Kabir MF, Hasnat MAK. Rehabilitation of a young girl with acute transverse myelitis and prolonged lower motor neuron features: a longitudinal case report over 12 months. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2022. [DOI: 10.12968/ijtr.2020.0049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background This report describes an effective rehabilitation programme for a 13-year-old girl, diagnosed with acute transverse myelitis, as an example of best clinical practice. Case description Miss A was admitted to the National Institute of Neurosciences and Hospital in Dhaka, where she was diagnosed with acute transverse myelitis, in September 2018. She was discharged and referred for intensive rehabilitation over 3 months as an outpatient at the Centre for the Rehabilitation of the Paralysed in Bangladesh. The therapy team conducted a baseline assessment before starting treatment, which included the following outcome measures: the International Standards for Neurological Classification of Spinal Cord Injury Scale; Spinal Cord Independence Measure; and the Spinal Cord Injury Functional Ambulation Inventory. After 3 months, Miss A was discharged home to continue with a home exercise programme supported by her parents. Outcome measurements were repeated at 3-, 6- and 12-month time points. Results Miss A regained muscle power in her legs and normal sensation in S4/5 dermatomes, in addition to regaining voluntary anal muscle contraction. Her mobility and transfers improved so that she was able to transfer in and out of her wheelchair independently and use two elbow crutches to walk short distances outdoors. Conclusions This report shows that it is possible for a child who had been severely disabled by acute transverse myelitis to make substantial physical improvements up to 12 months after diagnosis when provided with effective rehabilitation. It also identifies that rehabilitation can provide multiple benefits and value for the individual patient, family, community and society.
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Affiliation(s)
- K M Amran Hossain
- Department of Physiotherapy, Bangladesh Health Professions Institute, Dhaka, Bangladesh
| | - Mohamed Sakel
- East Kent Neuro-Rehabilitation Service, East Kent Hospitals University NHS Foundation Trust, Canterbury, UK
- Department of Physiotherapy & Rehabilitation, Jashore University of Science & Technology, Jashore, Bangladesh
| | - Karen Saunders
- Department of Physiotherapy & Rehabilitation, Jashore University of Science & Technology, Jashore, Bangladesh
- School of Social Policy, Sociology and Social Research, University of Kent, Canterbury, UK
| | - M Feroz Kabir
- Department of Physiotherapy & Rehabilitation, Jashore University of Science & Technology, Jashore, Bangladesh
| | - M Abu Khayer Hasnat
- Spinal Cord Injury Unit, Centre for the Rehabilitation of the Paralysed, Savar, Dhaka, Bangladesh
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Santos LV, Pereira ET, Reguera-García MM, Oliveira CEPD, Moreira OC. Resistance Training and Muscle Strength in people with Spinal cord injury: A systematic review and meta-analysis. J Bodyw Mov Ther 2022; 29:154-160. [DOI: 10.1016/j.jbmt.2021.09.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 07/27/2021] [Accepted: 09/24/2021] [Indexed: 11/26/2022]
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Ravesloot C, Myers A, Santasier A, Ward B. Effects of an Exercise Intervention on Participation Reported by People with Disabilities: A Mixed Methods Randomized Trial. Disabil Health J 2022; 15:101272. [DOI: 10.1016/j.dhjo.2022.101272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 01/10/2022] [Accepted: 01/10/2022] [Indexed: 11/03/2022]
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Willig RM, Garcia I, da Silva NSL, Corredeira R, Carvalho J. The effectiveness of community-based upper body exercise programs in persons with chronic paraplegia and manual wheelchair users: A systematic review. J Spinal Cord Med 2022; 45:24-32. [PMID: 32644024 PMCID: PMC8890546 DOI: 10.1080/10790268.2020.1782608] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Context: Physical activity has been beneficial to health, functional independence and quality of life in individuals with spinal cord injury. However, there is no consensus concerning the effects of community-based upper-body exercise for people with paraplegia who use a manual wheelchair.Objective: Conduct a systematic review of evidence of upper-body exercise effects able to be developed in a community-setting, on both functional independence and quality of life, for individuals with chronic paraplegia who use a manual wheelchair.Methods: PubMed, Scopus, Ebsco, SportDiscus and Web of Science databases were browsed, searching for studies that combined words as paraplegia, exercise, functional independence and quality of life and their synonyms, published from January/1998 to December/2018 in English. PEDro scale and the Cochrane tool analyzed methodological quality and risk of bias, respectively.Results: Four studies were selected out of 4004. Studies conducted aerobic arm-ergometer and resistance training predominantly at home. Upper-limb functionality and wheelchair propulsion assessed functional independence, but only the first presented positive effects after resistance training. Resistance and aerobic arm-ergometer training seemed to improve health-related and subjective quality of life.Conclusion: Studies have shown low methodological quality and high risk of bias. Aerobic arm-ergometer and resistance training were the most upper-body exercises used. Resistance training improved functional independence while both types of exercise induced positive effects on quality of life. Future studies with uniform and high-quality methodology should be conducted with exercise in community-dwelling people with paraplegia who use a manual wheelchair.
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Affiliation(s)
- Renata Matheus Willig
- Research Centre in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport Science, University of Porto, Porto, Portugal,Correspondence to: Renata Matheus Willig, Research Centre in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport Science, University of Porto, Rua Dr. Pláciso Costa, 91, Porto4200, Portugal; Ph: 351225074763; 351225500687.
| | - Ivo Garcia
- Faculty of Sport Science, University of Porto, Porto, Portugal
| | - Nádia Souza Lima da Silva
- Post-Graduate Program in Exercise Science and Sports, University of Rio de Janeiro State, Rio de Janeiro, Brazil
| | - Rui Corredeira
- Research Centre in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport Science, University of Porto, Porto, Portugal
| | - Joana Carvalho
- Research Centre in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport Science, University of Porto, Porto, Portugal
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Sutor TW, Ghatas MP, Goetz LL, Lavis TD, Gorgey AS. Exoskeleton Training and Trans-Spinal Stimulation for Physical Activity Enhancement After Spinal Cord Injury (EXTra-SCI): An Exploratory Study. FRONTIERS IN REHABILITATION SCIENCES 2022; 2:789422. [PMID: 35169770 PMCID: PMC8842517 DOI: 10.3389/fresc.2021.789422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 11/30/2021] [Indexed: 11/30/2022]
Abstract
After spinal cord injury (SCI) physical activity levels decrease drastically, leading to numerous secondary health complications. Exoskeleton-assisted walking (EAW) may be one way to improve physical activity for adults with SCI and potentially alleviate secondary health complications. The effects of EAW may be limited, however, since exoskeletons induce passive movement for users who cannot volitionally contribute to walking. Trans-spinal stimulation (TSS) has shown the potential to enable those with even the most severe SCI to actively contribute to movements during EAW. To explore the effects of EAW training on improving secondary health complications in persons with SCI, participants with chronic (n = 8) were enrolled in an EAW program 2-3 times per week for 12 weeks. Anthropometrics (seated and supine waist and abdominal circumferences (WC and AC), body composition assessment (dual exposure x-ray absorptiometry-derived body fat percent, lean mass and total mass for the total body, legs, and trunk), and peak oxygen consumption (VO2 during a 6-minute walk test [6MWT]) were assessed before and after 12 weeks of EAW training. A subset of participants (n = 3) completed EAW training with concurrent TSS, and neuromuscular activity of locomotor muscles was assessed during a 10-m walk test (10MWT) with and without TSS following 12 weeks of EAW training. Upon completion of 12 weeks of training, reductions from baseline (BL) were found in seated WC (-2.2%, P = 0.036), seated AC (-2.9%, P = 0.05), and supine AC (-3.9%, P = 0.017). Percent fat was also reduced from BL for the total body (-1.4%, P = 0.018), leg (-1.3%, P = 0.018), and trunk (-2%, P = 0.036) regions. No effects were found for peak VO2. The addition of TSS for three individuals yielded individualized responses but generally increased knee extensor activity during EAW. Two of three participants who received TSS were also able to initiate more steps without additional assistance from the exoskeleton during a 10MWT. In summary, 12 weeks of EAW training significantly attenuated markers of obesity relevant to cardiometabolic health in eight men with chronic SCI. Changes in VO2 and neuromuscular activity with vs. without TSS were highly individualized and yielded no overall group effects.
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Affiliation(s)
- Tommy W. Sutor
- Spinal Cord Injury and Disorders Center, Hunter Holmes McGuire Veteran Affairs Medical Center, Richmond, VA, United States
| | - Mina P. Ghatas
- Spinal Cord Injury and Disorders Center, Hunter Holmes McGuire Veteran Affairs Medical Center, Richmond, VA, United States
| | - Lance L. Goetz
- Spinal Cord Injury and Disorders Center, Hunter Holmes McGuire Veteran Affairs Medical Center, Richmond, VA, United States
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA, United States
| | - Timothy D. Lavis
- Spinal Cord Injury and Disorders Center, Hunter Holmes McGuire Veteran Affairs Medical Center, Richmond, VA, United States
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA, United States
| | - Ashraf S. Gorgey
- Spinal Cord Injury and Disorders Center, Hunter Holmes McGuire Veteran Affairs Medical Center, Richmond, VA, United States
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA, United States
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135
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Ma JK, Walden K, McBride CB, Le Cornu Levett C, Colistro R, Plashkes T, Thorson T, Shu H, Martin Ginis KA. Implementation of the spinal cord injury exercise guidelines in the hospital and community settings: Protocol for a type II hybrid trial. Spinal Cord 2022; 60:53-57. [PMID: 34376809 PMCID: PMC8353218 DOI: 10.1038/s41393-021-00685-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 07/27/2021] [Accepted: 07/28/2021] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Type II hybrid effectiveness-implementation trial protocol. OBJECTIVES To (1) evaluate the implementation of coordinated physical activity (PA) coaching delivered by physiotherapists and spinal cord injury (SCI) peers during the transition from in-hospital care to living in a community (implementation objective) and (2) assess the effect of coaching on PA behaviour and psychosocial predictors among people with SCI (effectiveness objective). SETTING Rehabilitation hospital and home/community settings in British Columbia, Canada. METHODS Implementation objective: PA coaches (physiotherapists and SCI peers) receive an implementation intervention including training, monitoring, feedback, and champion support. A Theoretical Domains Framework-based questionnaire is collected at baseline, post-training, 2, and 6 months follow-up and semi-structured interviews conducted at 6 months. Effectiveness objective: Using a quasi-experimental design, 55 adults with SCI are allocated to intervention (PA coaching, n = 30) or control (usual care, n = 25) groups. Participants in the intervention group are referred by physiotherapists to receive 11 SCI peer-delivered PA coaching sessions in the community. Control participants received usual care. Questionnaires assessing PA behaviour and psychosocial predictors are administered at baseline, 2-months, 6-months, and 1-year. Semi-structured interviews are conducted to assess intervention satisfaction at 6 months. Analyses include one-way (implementation objective) and two-way (effectiveness objective) repeated measures ANCOVAs for questionnaire-reported outcomes and thematic content analysis for interview data. Data are summarised using the reach effectiveness adoption implementation maintenance (RE-AIM) framework. ETHICS AND DISSEMINATION The University of British Columbia Clinical Research Ethics Board approved the protocol (#H19-02694), clinicaltrials.gov registration NCT04493606. Documentation of the adoption process will inform implementation in future sites.
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Affiliation(s)
- Jasmin K Ma
- University of British Columbia, Vancouver, BC, Canada.
- Arthritis Research Canada, Richmond, BC, Canada.
| | | | | | | | | | - Tova Plashkes
- GF Strong Rehabilitation Centre, Vancouver, BC, Canada
| | | | - Hattie Shu
- University of British Columbia, Vancouver, BC, Canada
| | - Kathleen A Martin Ginis
- Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- International Collaboration on Repair Discoveries (ICORD), Blusson Spinal Cord Centre (BSCC) University of British Columbia, Vancouver, BC, Canada
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, BC, Canada
- Centre for Chronic Disease Prevention and Management, University of British Columbia, Kelowna, BC, Canada
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136
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Hutchinson MJ, Goosey-Tolfrey VL. Rethinking aerobic exercise intensity prescription in adults with spinal cord injury: time to end the use of "moderate to vigorous" intensity? Spinal Cord 2022; 60:484-490. [PMID: 34880442 PMCID: PMC9209328 DOI: 10.1038/s41393-021-00733-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 11/19/2021] [Accepted: 11/23/2021] [Indexed: 11/13/2022]
Abstract
STUDY DESIGN Cohort study. OBJECTIVES To investigate and critique different methods for aerobic exercise intensity prescription in adults with spinal cord injury (SCI). SETTING University laboratory in Loughborough, UK. METHODS Trained athletes were split into those with paraplegia (PARA; n = 47), tetraplegia (TETRA; n = 20) or alternate health condition (NON-SCI; n = 67). Participants completed a submaximal step test with 3 min stages, followed by graded exercise test to exhaustion. Handcycling, arm crank ergometry or wheelchair propulsion were performed depending on the sport of the participant. Oxygen uptake (V̇O2), heart rate (HR), blood lactate concentration ([BLa]) and ratings of perceived exertion (RPE) on Borg's RPE scale were measured throughout. Lactate thresholds were identified according to log-V̇O2 plotted against log-[BLa] (LT1) and 1.5 mmol L-1 greater than LT1 (LT2). These were used to demarcate moderate (<LT1), heavy (>LT1, < LT2) and severe (>LT2) exercise intensity domains. RESULTS Associations between percentage of peak V̇O2 (%V̇O2peak) and HR (%HRpeak) with RPE differed between PARA and TETRA. At LT1 and LT2, %V̇O2peak and %HRpeak were significantly greater in TETRA compared to PARA and NON-SCI (P < 0.05). The variation in %V̇O2peak and %HRpeak at lactate thresholds resulted in large variability in the domain distribution at fixed %V̇O2peak and %HRpeak. CONCLUSIONS Fixed %V̇O2peak and %HRpeak should not be used for aerobic exercise intensity prescription in adults with SCI as the method does not lead to uniform exercise intensity domain distribution.
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Affiliation(s)
- Michael J. Hutchinson
- grid.6571.50000 0004 1936 8542Peter Harrison Centre for Disability Sport, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Victoria L. Goosey-Tolfrey
- grid.6571.50000 0004 1936 8542Peter Harrison Centre for Disability Sport, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
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Effects of Resistance Training on Oxidative Stress Markers and Muscle Damage in Spinal Cord Injured Rats. BIOLOGY 2021; 11:biology11010032. [PMID: 35053030 PMCID: PMC8772953 DOI: 10.3390/biology11010032] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 12/15/2021] [Accepted: 12/18/2021] [Indexed: 01/24/2023]
Abstract
Simple Summary Spinal Cord Injury is a devastating condition that compromises the individual’s health, quality of life and functional independence. Rats submitted to Spinal Cord Injury were evaluated after four weeks of resistance training. Analyses of levels of muscle damage and oxidative stress surgery were performed. Resistance training demonstrated increase antioxidative activity while decreased oxidative damage in injured rats, in addition to having presented changes in the levels of muscle damage in that same group. The results highlight that resistance training promoted a decrease in oxidative stress and a significant response in muscle damage markers. Abstract Background: Spinal cord injury (SCI) is a condition that affects the central nervous system, is characterized by motor and sensory impairments, and impacts individuals’ lives. The objective of this study was to evaluate the effects of resistance training on oxidative stress and muscle damage in spinal cord injured rats. Methodology: Forty Wistar rats were selected and divided equally into five groups: Healthy Control (CON), Sham (SHAM) SCI Untrained group (SCI-U), SCI Trained group (SCI- T), SCI Active Trained group (SCI- AT). Animals in the trained groups were submitted to an incomplete SCI at T9. Thereafter, they performed a protocol of resistance training for four weeks. Results: Significant differences in muscle damage markers and oxidative stress in the trained groups, mainly in SCI- AT, were found. On the other hand, SCI- U group presented higher levels of oxidative stress and biomarkers of LDH and AST. Conclusion: The results highlight that resistance training promoted a decrease in oxidative stress and a significative response in muscle damage markers.
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138
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Benning NH, Knaup P, Rupp R. Measurement Performance of Activity Measurements with Newer Generation of Apple Watch in Wheelchair Users with Spinal Cord Injury. Methods Inf Med 2021; 60:e103-e110. [PMID: 34856623 PMCID: PMC8714299 DOI: 10.1055/s-0041-1740236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background
The level of physical activity (PA) of people with spinal cord injury (SCI) has an impact on long-term complications. Currently, PA is mostly assessed by interviews. Wearable activity trackers are promising tools to objectively measure PA under everyday conditions. The only off-the-shelf, wearable activity tracker with specific measures for wheelchair users is the Apple Watch.
Objectives
This study analyzes the measurement performance of Apple Watch Series 4 for wheelchair users and compares it with an earlier generation of the device.
Methods
Fifteen participants with subacute SCI during their first in-patient phase followed a test course using their wheelchair. The number of wheelchair pushes was counted manually by visual inspection and with the Apple Watch. Difference between the Apple Watch and the rater was analyzed with mean absolute percent error (MAPE) and a Bland–Altman plot. To compare the measurement error of Series 4 and an older generation of the device a
t
-test was calculated using data for Series 1 from a former study.
Results
The average of differences was 12.33 pushes (
n
= 15), whereas participants pushed the wheelchair 138.4 times on average (range 86–271 pushes). The range of difference and the Bland–Altman plot indicate an overestimation by Apple Watch. MAPE is 9.20% and the
t
-test, testing for an effect of Series 4 on the percentage of error compared with Series 1, was significant with
p
< 0.05.
Conclusion
Series 4 shows a significant improvement in measurement performance compared with Series 1. Series 4 can be considered as a promising data source to capture the number of wheelchair pushes on even grounds. Future research should analyze the long-term measurement performance during everyday conditions of Series 4.
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Affiliation(s)
- Nils-Hendrik Benning
- Institute of Medical Informatics, Heidelberg University Hospital, Heidelberg, Germany
| | - Petra Knaup
- Institute of Medical Informatics, Heidelberg University Hospital, Heidelberg, Germany
| | - Rüdiger Rupp
- Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany
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139
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Nash MS, Farkas GJ, Tiozzo E, Gater DR. Exercise to mitigate cardiometabolic disorders after spinal cord injury. Curr Opin Pharmacol 2021; 62:4-11. [PMID: 34864560 DOI: 10.1016/j.coph.2021.10.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 10/21/2021] [Indexed: 01/14/2023]
Abstract
The cardiometabolic disorder (CMD) is a syndrome caused by coalescing of cardiovascular, endocrine, pro-thrombotic, and inflammatory health risks. Together, these risks confer a hazard as health-threatening as coronary artery disease or type2 diabetes, whether an individual has a diagnosis of coronary disease or diabetes, or not. CMD is most often defined by three or more of five clinically assessed risk components, notably obesity, insulin resistance, hypertension, hypertriglyceridemia, and depressed high-density lipoprotein cholesterol. Evidence currently suggests that worldwide CMD is expanding at a pandemic rate, and it is known that people living with spinal cord injuries (SCI) qualify for the diagnosis at more than 50% of the prevalence of a non-disabled cohort. A recent evidence-based guideline warned of the current state of CMD following SCI and recommended early lifestyle intervention incorporating exercise and prudent nutrition as a first-line disease countermeasure. This monograph will define the CMD following SCI, explore its underlying pathophysiology, and provide evidence that recommends exercise for CMD health hazards after SCI.
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Affiliation(s)
- Mark S Nash
- Department of Neurological Surgery, The University of Miami Miller School of Medicine, Miami, FL 33136, USA; Department of Physical Medicine & Rehabilitation, The University of Miami Miller School of Medicine, Miami, FL 33136, USA; Department of Physical Therapy, The University of Miami Miller School of Medicine, Miami, FL 33136, USA; The Miami Project to Cure Paralysis, The University of Miami Miller School of Medicine, Miami, FL 33136, USA.
| | - Gary J Farkas
- Department of Physical Medicine & Rehabilitation, The University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Eduard Tiozzo
- Department of Physical Medicine & Rehabilitation, The University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - David R Gater
- Department of Neurological Surgery, The University of Miami Miller School of Medicine, Miami, FL 33136, USA; Department of Physical Medicine & Rehabilitation, The University of Miami Miller School of Medicine, Miami, FL 33136, USA; The Miami Project to Cure Paralysis, The University of Miami Miller School of Medicine, Miami, FL 33136, USA
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140
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Handlery R, Shover E, Chhoun T, Durant L, Handlery K, Harrington SE, Stock MS, Fritz SL. We Don't Know Our Own Strength: A Survey of Strength Training Attitudes, Behaviors, and Knowledge in Physical Therapists and Physical Therapist Students. Phys Ther 2021; 101:6358618. [PMID: 34473297 DOI: 10.1093/ptj/pzab204] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 06/18/2021] [Accepted: 07/27/2021] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Strength training is frequently utilized by physical therapists; however, there has been discussion about whether physical therapists utilize strength training adequately. The purpose of this study was to describe and compare the strength training attitudes, behaviors, and knowledge of physical therapists and physical therapy students and to determine how participant characteristics influenced knowledge scores. METHODS An anonymous survey was created in 3 rounds. For round 1, researchers used textbooks to create items assessing demographics, attitudes, behaviors, and knowledge regarding strength training. Rounds 2 and 3 consisted of feedback from 7 content experts until 80% consensus was reached; items were added, removed, or edited based on feedback. The final survey was distributed through social media, list servs, and email targeting physical therapists and students based in the United States. Response frequencies for all items were reported. Overall knowledge scores were calculated by summing correct responses for each item, with a maximum score of 13; scores <70% were considered low. Binomial logistic regression determined which characteristics (demographics, attitudes, or behaviors) influenced whether participants adequately utilized strength training principles (scored ≥70% on knowledge items). RESULTS There were 777 physical therapist and 648 student participants. Nearly 90% of therapists and students reported frequently prescribing strength training. Over 48% of therapists felt their professional education did not prepare them to apply strength training (compared with 24% of students), and 68% believed that strength training is inadequately applied in physical therapy (compared with 40% of students). Sixty-two percent of therapists and 55% of students scored ≥70% for knowledge items. Additional strength training education and regular participation in strength training increased the odds of scoring ≥70% on knowledge items. CONCLUSION Physical therapists and physical therapy students frequently prescribe strength training despite similarly low knowledge scores. To increase knowledge, greater emphasis on strength training in professional education, continuing education, participation in strength training, or all 3 is warranted. IMPACT Strength training is an important intervention used in physical therapy and must be used appropriately to improve the health of patients. According to these findings, strength training education may not currently be optimal, as demonstrated by low knowledge scores by both therapists and students. Further work is needed to determine how knowledge of strength training relates to patient outcomes and also how best to implement strength training in physical therapy education and practice.
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Affiliation(s)
- Reed Handlery
- Arkansas Colleges of Health Education, School of Physical Therapy, Fort Smith, Arkansas, USA
| | - Emma Shover
- Department of Exercise Science, Physical Therapy Program, University of South Carolina, Columbia, South Carolina, USA
| | - Thavi Chhoun
- Department of Exercise Science, Physical Therapy Program, University of South Carolina, Columbia, South Carolina, USA
| | - Lauren Durant
- Department of Exercise Science, Physical Therapy Program, University of South Carolina, Columbia, South Carolina, USA
| | - Kaci Handlery
- Department of Exercise Science, Physical Therapy Program, University of South Carolina, Columbia, South Carolina, USA
| | - Shana E Harrington
- Department of Exercise Science, Physical Therapy Program, University of South Carolina, Columbia, South Carolina, USA
| | - Matt S Stock
- School of Kinesiology and Physical Therapy, University of Central Florida, Orlando, Florida, USA
| | - Stacy L Fritz
- Department of Exercise Science, Physical Therapy Program, University of South Carolina, Columbia, South Carolina, USA
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141
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Selph SS, Skelly AC, Wasson N, Dettori JR, Brodt ED, Ensrud E, Elliot D, Dissinger KM, McDonagh M. Physical Activity and the Health of Wheelchair Users: A Systematic Review in Multiple Sclerosis, Cerebral Palsy, and Spinal Cord Injury. Arch Phys Med Rehabil 2021; 102:2464-2481.e33. [PMID: 34653376 DOI: 10.1016/j.apmr.2021.10.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 09/10/2021] [Accepted: 10/02/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To understand the benefits and harms of physical activity in people who may require a wheelchair with a focus on people with multiple sclerosis (MS), cerebral palsy (CP), and spinal cord injury (SCI). DATA SOURCES Searches were conducted in MEDLINE, Cumulative Index to Nursing and Allied Health, PsycINFO, Cochrane CENTRAL, and Embase (January 2008 through November 2020). STUDY SELECTION Randomized controlled trials, nonrandomized trials, and cohort studies of observed physical activity (at least 10 sessions on 10 days) in participants with MS, CP, and SCI. DATA EXTRACTION We conducted dual data abstraction, quality assessment, and strength of evidence. Measures of physical functioning are reported individually where sufficient data exist and grouped as "function" where data are scant. DATA SYNTHESIS No studies provided evidence for prevention of cardiovascular conditions, development of diabetes, or obesity. Among 168 included studies, 44% enrolled participants with MS (38% CP, 18% SCI). Studies in MS found walking ability may be improved with treadmill training and multimodal exercises; function may be improved with treadmill, balance exercises, and motion gaming; balance is likely improved with balance exercises and may be improved with aquatic exercises, robot-assisted gait training (RAGT), motion gaming, and multimodal exercises; activities of daily living (ADL), female sexual function, and spasticity may be improved with aquatic therapy; sleep may be improved with aerobic exercises and aerobic fitness with multimodal exercises. In CP, balance may be improved with hippotherapy and motion gaming; function may be improved with cycling, treadmill, and hippotherapy. In SCI, ADL may be improved with RAGT. CONCLUSIONS Depending on population and type of exercise, physical activity was associated with improvements in walking, function, balance, depression, sleep, ADL, spasticity, female sexual function, and aerobic capacity. Few harms of physical activity were reported in studies. Future studies are needed to address evidence gaps and to confirm findings.
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Affiliation(s)
- Shelley S Selph
- Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon.
| | | | - Ngoc Wasson
- Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon
| | | | | | - Erik Ensrud
- Department of Medicine, Oregon Health and Science University, Portland, Oregon
| | - Diane Elliot
- Department of Medicine, Oregon Health and Science University, Portland, Oregon
| | - Kristin M Dissinger
- Department of Medicine, Oregon Health and Science University, Portland, Oregon
| | - Marian McDonagh
- Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon
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142
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Predicting physical activity intensity using raw accelerometer signals in manual wheelchair users with spinal cord injury. Spinal Cord 2021; 60:149-156. [PMID: 34819608 DOI: 10.1038/s41393-021-00728-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 10/23/2021] [Accepted: 10/26/2021] [Indexed: 11/08/2022]
Abstract
STUDY DESIGN Cross-sectional validation study. OBJECTIVES The performance of previously published physical activity (PA) intensity cutoff thresholds based on proprietary ActiGraph counts for manual wheelchair users (MWUs) with spinal cord injury (SCI) was initially evaluated using an out-of-sample dataset of 60 individuals with SCI. Two types of PA intensity classification models based on raw accelerometer signals were developed and evaluated. SETTING Research institutions in Pittsburgh PA, Birmingham AL, and Bronx NY. METHODS Data were collected from 60 MWUs with SCI who followed a structured activity protocol while wearing an ActiGraph activity monitor on their dominant wrist and portable metabolic cart which measured criterion PA intensity. Data was used to assess published models as well as develop and assess custom models using recall, specificity, precision, as well as normalized Mathew's correlation coefficient (nMCC). RESULTS All the models performed well for predicting sedentary vs non-sedentary activity, yielding an nMCC of 0.87-0.90. However, all models demonstrated inadequate performance for predicting moderate to vigorous PA (MVPA) with an nMCC of 0.76-0.82. CONCLUSIONS The mean absolute deviation (MAD) cutoff threshold yielded the best performance for predicting sedentary vs non-sedentary PA and may be used for tracking daily sedentary activity. None of the models displayed strong performance for MVPA vs non-MVPA. Future studies should investigate combining physiological measures with accelerometry to yield better prediction accuracies for MVPA.
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143
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Mehta S, Ahrens J, Abu-Jurji Z, Marrocco SL, Upper R, Loh E, Cornell S, Wolfe DL. Feasibility of a virtual service delivery model to support physical activity engagement during the COVID-19 pandemic for those with spinal cord injury. J Spinal Cord Med 2021; 44:S256-S265. [PMID: 34779728 PMCID: PMC8604449 DOI: 10.1080/10790268.2021.1970885] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND The current pandemic has reduced access to safe, monitored physical activity (PA) programs for persons with spinal cord injury (SCI). The use of telerehabilitation has the potential for continuing activity engagement without risking virus exposure. The present study evaluates the feasibility and efficacy of an online group-based PA program for persons with SCI. METHODS This preliminary pre-post study delivered an online group-based PA program to persons with SCI. The program consisted of 1-hour sessions twice weekly for six weeks. Online PA satisfaction questionnaires were assessed at post-treatment. Psychosocial subscales from the NeuroQOL-SF were assessed. RESULTS Participants were adult females between 3 and 32 years post-injury, 1 tetraplegic and 3 paraplegics (n = 4). All participants were highly satisfied with the online instruction, overall content, and videoconferencing platform. Participants stated that the online program was beneficial for their overall physical and psychosocial wellbeing. The program resulted in improvement in anxiety and satisfaction with social roles and activities. CONCLUSION The current pilot study demonstrates the acceptability and limited efficacy of an online PA program for those with SCI. The program resulted in improved overall perceived wellbeing and satisfaction with social roles and activities. These results have important implications for the clinical implementation of online PA programs in a hospital and community setting.
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Affiliation(s)
- Swati Mehta
- Parkwood Institute Research, Lawson Health Research Institute, LondonON, Canada,Department of Physical Medicine and Rehabilitation, Western University, LondonON, Canada,Correspondence to: Swati Mehta, Parkwood Research Institute, 550 Wellington Road South, London, ONN6C 0A7, Canada; Ph (519) 685 4292 x 42359.
| | - Jess Ahrens
- Parkwood Institute Research, Lawson Health Research Institute, LondonON, Canada
| | - Zeina Abu-Jurji
- Parkwood Institute Research, Lawson Health Research Institute, LondonON, Canada
| | | | - Randy Upper
- Parkwood Institute Research, Lawson Health Research Institute, LondonON, Canada
| | - Eldon Loh
- Parkwood Institute Research, Lawson Health Research Institute, LondonON, Canada,Department of Physical Medicine and Rehabilitation, Western University, LondonON, Canada
| | - Stephanie Cornell
- Parkwood Institute Research, Lawson Health Research Institute, LondonON, Canada,Parkwood Institute, St. Joseph’s Health Care London, LondonON, Canada
| | - Dalton L. Wolfe
- Parkwood Institute Research, Lawson Health Research Institute, LondonON, Canada,Department of Physical Medicine and Rehabilitation, Western University, LondonON, Canada
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Mickens MN, Perrin P, Goldsmith JA, Khalil RE, Carter Iii WE, Gorgey AS. Leisure-time physical activity, anthropometrics, and body composition as predictors of quality of life domains after spinal cord injury: an exploratory cross-sectional study. Neural Regen Res 2021; 17:1369-1375. [PMID: 34782584 PMCID: PMC8643047 DOI: 10.4103/1673-5374.327356] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The objective of the current work was to examine the relationships between quality of life (QOL) domains in persons with spinal cord injury (SCI) and their levels of weekly leisure-time physical activity (LTPA), anthropometric variables, and body composition variables. This exploratory cross-sectional study consisted of baseline data collected as part of a randomized clinical trial at a VA Medical Center and SCI center. A convenience sample of 36 community-dwelling persons with SCI participated in the current study. Outcome measures included the World Health Organization Quality of Life Short Form (WHOQOL-BREF), Leisure-Time Physical Activity Questionnaire for People with Spinal Cord Injury (LTPAQ-SCI), anthropomorphic measures (waist, hip, and abdominal circumference), and dual-energy x-ray absorptiometry (DXA) to quantify regional and total body composition. Multiple regression models suggested that engagement in LTPA accounted for 35.7% of the variance in physical health QOL, 33.5% in psychological QOL, 14.2% in social relationships QOL, and 38.2% in environmental QOL. Anthropometric measures accounted for 11.3%, 3.1%, 12.0%, and 6.7% of the variance in these QOL indices, respectively, and DXA indices accounted for 18.7%, 17.5%, 27.4%, and 21.9%. Within these models, the number of minutes of heavy LTPA per day uniquely predicted physical health QOL, the number of mild LTPA days per week uniquely predicted psychological QOL, and the amount of mild LTPA per day uniquely predicted environmental QOL. Bivariate analyses also suggested that android and trunk fat, as well as supine waist and abdominal circumferences, were positively associated with social relationships QOL. Encouraging individuals with SCI to engage in LTPA may robustly enhance multiple aspects of QOL while reducing the risk for cardiovascular and metabolic morbidities associated with SCI. Moreover, this may lead to a further understanding of how QOL may impact longitudinal intervention trials. The study protocol and procedures were reviewed and approved by the McGuire VA Research Institutional Review Board (IRB# 02152, approval date August 9, 2015; IRB# 02375, approval date May 2, 2018).
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Affiliation(s)
- Melody N Mickens
- Division of Physical Medicine and Rehabilitation, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Paul Perrin
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Jacob A Goldsmith
- Spinal Cord Injury & Disorders; Hunter Holmes McGuire VA Medical Center, Richmond, VA, USA
| | - Refka E Khalil
- Spinal Cord Injury & Disorders; Hunter Holmes McGuire VA Medical Center, Richmond, VA, USA
| | - William E Carter Iii
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Ashraf S Gorgey
- Spinal Cord Injury & Disorders; Hunter Holmes McGuire VA Medical Center; Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
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145
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Soriano JE, Romac R, Squair JW, Barak OF, Sarafis ZK, Lee AH, Coombs GB, Vaseghi B, Grant C, Charbonneau R, Mijacika T, Krassioukov A, Ainslie PN, Larkin-Kaiser KA, Phillips A, Dujic Z. Passive leg cycling increases activity of the cardiorespiratory system in people with tetraplegia. Appl Physiol Nutr Metab 2021; 47:269-277. [PMID: 34739759 DOI: 10.1139/apnm-2021-0523] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Individuals with cervical spinal cord injury (SCI) are at an increased risk for cardiovascular disease. Exercise is well-established for preventing cardiovascular disease, however, there are limited straightforward and safe exercise approaches for increasing the activity of the cardiorespiratory system after cervical SCI. The objective of this study was to investigate the cardiorespiratory response to passive leg cycling in people with cervical SCI. Beat-by-beat blood pressure, heart rate, and cerebral blood flow were measured before and throughout 10 minutes of cycling in 11 people with SCI. Femoral artery flow-mediated dilation was also assessed before and immediately after passive cycling. Safety was monitored throughout all study visits. Passive cycling elevated systolic blood pressure (5±2 mmHg), mean arterial pressure (5±3 mmHg), stroke volume (2.4±0.8 mL), heart rate (2±1 beats/min) and cardiac output (0.3±0.07 L/min; all p<0.05). Minute ventilation (0.67±0.23 L/min), tidal volume (70±30 mL) and end-tidal PO2 (2.6±1.23 mmHg) also increased (all p<0.05). Endothelial function was improved immediately after exercise (1.62±0.13%, p<0.01). Passive cycling resulted in one incidence of autonomic dysreflexia. Therefore, passive leg cycling increased the activity of the cardiorespiratory system, improved endothelial function, indicating it may be a beneficial exercise intervention for the cardiovascular and respiratory systems in people with cervical SCI. Novelty: ● Passive leg cycling increases the activity of the cardiorespiratory system and improves markers of cardiovascular health in cervical SCI. ● Passive leg cycling exercise is an effective, low-cost, practical, alternative exercise modality for people with cervical SCI.
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Affiliation(s)
- Jan Elaine Soriano
- University of Calgary, 2129, Departments of Physiology and Pharmacology, Cardiac Sciences & Clinical Neurosciences, Calgary, Alberta, Canada;
| | - Rinaldo Romac
- Clinical Hospital Center Split, Department of Neurology, Split, Croatia;
| | - Jordan W Squair
- University of Calgary, 2129, Departments of Physiology and Pharmacology, Cardiac Sciences & Clinical Neurosciences, Calgary, Alberta, Canada.,University of British Columbia, Faculty of Medicine, Vancouver, British Columbia, Canada;
| | - Otto F Barak
- University of Novi Sad, 84981, Faculty of Medicine, Novi Sad, Serbia;
| | - Zoe K Sarafis
- University of British Columbia, Faculty of Medicine , Vancouver, Canada.,ETH Zurich, 27219, Department of Health Sciences and Technology, Zurich, Switzerland;
| | - Amanda Hx Lee
- University of British Columbia, Faculty of Medicine , Vancouver, British Columbia, Canada.,University of British Columbia, Department of Experimental Medicine, Vancouver, British Columbia, Canada;
| | - Geoff B Coombs
- The University of British Columbia Okanagan, 97950, Centre for Heart, Lung, and Vascular Health, Kelowna, British Columbia, Canada;
| | - Bita Vaseghi
- University of Calgary, 2129, Departments of Physiology and Pharmacology, Cardiac Sciences & Clinical Neurosciences, Calgary, Alberta, Canada.,University of British Columbia, Faculty of Medicine, Vancouver, British Columbia, Canada;
| | - Christopher Grant
- University of Calgary, 2129, Department of Clinical Neurosciences, Calgary, Alberta, Canada;
| | - Rebecca Charbonneau
- University of Calgary, 2129, Department of Clinical Neurosciences, Calgary, Alberta, Canada;
| | - Tanja Mijacika
- University of Split, 74422, Department of Integrative Physiology, Split, Croatia;
| | - Andrei Krassioukov
- University of British Columbia, Faculty of Medicine, Vancouver, British Columbia, Canada.,The University of British Columbia, 8166, Division of Physical Medicine & Rehabilitation, Vancouver, British Columbia, Canada.,G F Strong Rehabilitation Hospital, 103221, Vancouver, British Columbia, Canada;
| | - Philip N Ainslie
- University of British Columbia, Centre for Heart, Lung and Vascular Health, Kelowna, British Columbia, Canada;
| | - Kelly A Larkin-Kaiser
- University of Calgary, Departments of Physiology and Pharmacology, Cardiac Sciences, & Clinical Neurosciences, Calgary, Alberta, Canada;
| | - Aaron Phillips
- University of Calgary, 2129, Departments of Physiology and Pharmacology, Cardiac Sciences & Clinical Neurosciences, Calgary, Canada, T2N 1N4;
| | - Zeljko Dujic
- University of Split School of Medicine, Department of Integrative Physiology, Split, Splitsko-dalmatinska, Croatia;
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146
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Alves EDS, dos Santos RVT, de Lira FS, Almeida AA, Edwards K, Benvenutti M, Tufik S, De Mello MT. Effects of intensity-matched exercise at different intensities on inflammatory responses in able-bodied and spinal cord injured individuals. J Spinal Cord Med 2021; 44:920-930. [PMID: 32298225 PMCID: PMC8725751 DOI: 10.1080/10790268.2020.1752976] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Objective: To compare the effects of intensity-matched acute exercise at different intensities on proinflammatory and anti-inflammatory cytokines between able-bodied (AB) and spinal cord injured (SCI) individuals.Design: Non-Randomized Controlled Trial.Setting: Community settings in São Paulo - Brazil.Participants: Eight AB and nine SCI paraplegic.Interventions: Participants underwent three exercise sessions at different relative intensities: at ventilatory threshold 1 intensity (VT1), 15% below VT1, and 15% above VT1. Similar energy expenditures were established from exercises with different intensities for each volunteer. The AB group was tested on a conventional treadmill, whereas the SCI group was tested on a treadmill adapted for wheelchair use. Blood samples were collected at baseline, immediately after, and 30 min after the exercise sessions.Outcome measures: Interleukin 1 receptor antagonist, interleukin 1 beta, interleukin 2, interleukin 4, interleukin 6, interleukin 10 and tumoral necrosis factor alpha were measured.Results: When groups were compared, interleukin - 2 was found higher, whereas interleukin - 4 and interleukin - 10 were found lower in the SCI group at all collection times in the three exercise intensities (all P < 0.05). Interleukin - 1 receptor antagonist was found higher immediately after exercise at VT1, 15% above VT1 and 30 min after 15% below VT1 in the AB group (all P < 0.05). In the AB group, an increase in interleukin - 6 immediately after the exercise at VT1 compared with baseline was found (P = 0.01).Conclusion: Individuals with SCI may have to perform physical exercise at a higher volume or energy expenditure than AB individuals to obtain similar anti-inflammatory benefits of acute exercise.Trial registration: Uniform Trial Number identifier: U1111-1232-8142.
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Affiliation(s)
- Eduardo da Silva Alves
- Departamento de Ciências da Saúde, Universidade Estadual de Santa Cruz – (UESC). Ilhéus, BA, Brazil,Departamento de Psicobiologia, Universidade Federal de São Paulo – (UNIFESP), São Paulo, SP, Brazil,Centro de Estudos em Psicobiologia e Exercício - CEPE, Belo Horizonte, Brazil,Correspondence to: Eduardo da Silva Alves, Universidade Estadual de Santa Cruz (UESC), Campus Soane Nazaré de Andrade, Rodovia Jorge Amado, km 16, Bairro Salobrinho CEP 45662-900. Ilhéus-Bahia; Ph: 55 73 991655851.
| | | | - Fábio Santos de Lira
- Department of Physical Education, Universidade Estadual Paulista (UNESP), Presidente Prudente, SP, Brazil
| | | | - Kate Edwards
- Faculty of Health Sciences, University of Sydney, Sydney, Australia
| | - Mateus Benvenutti
- Departamento de Biociências e Fisiopatologia, Universidade Estadual de Maringá – UEM, Maringá, Brazil
| | - Sergio Tufik
- Departamento de Psicobiologia, Universidade Federal de São Paulo – (UNIFESP), São Paulo, SP, Brazil
| | - Marco Túlio De Mello
- Centro de Estudos em Psicobiologia e Exercício - CEPE, Belo Horizonte, Brazil,Escola de Educação Física, Fisioterapia e Terapia Ocupacional, Universidade Federal de Minas Gerais - UFMG, Belo Horizonte, Brazil
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147
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Todd KR, Van Der Scheer JW, Walsh JJ, Jackson GS, Dix GU, Little JP, Kramer JLK, Martin Ginis KA. The Impact of Sub-maximal Exercise on Neuropathic Pain, Inflammation, and Affect Among Adults With Spinal Cord Injury: A Pilot Study. FRONTIERS IN REHABILITATION SCIENCES 2021; 2:700780. [PMID: 36188763 PMCID: PMC9397724 DOI: 10.3389/fresc.2021.700780] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 09/29/2021] [Indexed: 06/16/2023]
Abstract
Introduction: Persons with spinal cord injury (SCI) often report high levels of neuropathic pain (NP) and poor well-being, which may result from increased inflammation. This study examined the impact of sub-maximal aerobic exercise on NP, inflammation and psychological affect among adults with SCI. Methods: Eight active adults with tetraplegia (n-4, AIS A-C) and paraplegia (n = 4, AIS A-C) performed 30-min of arm-crank aerobic exercise and reported their ratings of perceived exertion (RPE) each minute. Measures of NP, affect, and inflammatory cytokines (IL-6, IL-10, IL-1ra, TNF-α) were taken pre-(T0), immediately post-(T1), and 90-min post-exercise (T2). Results: NP decreased between T0 and T1 for tetraplegics (-60%, d = 0.47; CI = -0.32, 2.02) and paraplegics (-16%, d = 0.15; CI = -0.30, 0.90). Correlations between change in cytokines and change in NP were medium-to large for tetraplegics (rs ranged from -0.820 to 0.965) and paraplegics (rs ranged from -0.598 to 0.833). However, the pattern of correlations between change in cytokines and affect was inconsistent between groups. Lower baseline levels of IL-1ra predicted greater decreases in NP immediately post-exercise (r = 0.83, p = 0.01). Conclusion: Sub-maximal exercise can positively impact NP for some persons with SCI. Further experimental research should identify the optimal exercise intensity to reduce NP for persons with SCI, in addition to understanding biomarkers which may predict changes in NP. Clinical Trial Registration: www.ClinicalTrials.gov, identifier NCT03955523.
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Affiliation(s)
- Kendra R. Todd
- Department of Kinesiology, University of British Columbia, Kelowna, BC, Canada
- International Collaboration on Repair Discoveries, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
| | - Jan W. Van Der Scheer
- The Healthcare Improvement Studies Institute, University of Cambridge, Cambridge, United Kingdom
| | - Jeremy J. Walsh
- Department of Kinesiology, University of British Columbia, Kelowna, BC, Canada
- Department of Kinesiology, McMaster University, Hamilton, ON, Canada
| | - Garett S. Jackson
- Department of Kinesiology, University of British Columbia, Kelowna, BC, Canada
| | - Gabriel U. Dix
- Department of Kinesiology, University of British Columbia, Kelowna, BC, Canada
- International Collaboration on Repair Discoveries, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
| | | | - John L. K. Kramer
- International Collaboration on Repair Discoveries, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
- Department of Anesthesiology, Pharmacology, and Therapeutics, University of British Columbia, Vancouver, BC, Canada
| | - Kathleen A. Martin Ginis
- Department of Kinesiology, University of British Columbia, Kelowna, BC, Canada
- International Collaboration on Repair Discoveries, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
- Department of Medicine, Division of Physical Medicine and Rehabilitation, University of British Columbia, Vancouver, BC, Canada
- Centre for Chronic Disease Prevention and Management, University of British Columbia, Kelowna, BC, Canada
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148
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A qualitative interview study on how people with incomplete spinal cord injury experience high-intensity walking exercise. Spinal Cord Ser Cases 2021; 7:92. [PMID: 34611134 PMCID: PMC8492776 DOI: 10.1038/s41394-021-00456-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 09/24/2021] [Accepted: 09/24/2021] [Indexed: 11/08/2022] Open
Abstract
STUDY DESIGN Qualitative, in-depth research interviews. OBJECTIVE To provide new insight into how people with a recent incomplete spinal cord injury (SCI) experience high-intensity walking exercise after discharge from subacute inpatient rehabilitation. SETTING Informants for this interview study participated in a previous randomized controlled trial (RCT) that was conducted at Sunnaas Rehabilitation Hospital, Norway. METHODS Four individual face-to-face interviews were conducted with the participants in natural setting. The interviews were analyzed through systematic text condensation and discussed in the context of experiences of bodily changes. RESULTS Four themes emerged that described positive but also challenging bodily experiences related to performing high-intensity walking exercise: "Expectations and motivation"-reasons for participating, "Challenging bodily changes"-impacts on walking ability, "Adaptation strategies"-achieving the high-intensity target level, and "Integrating exercise into a new daily life"-combining participation, new body and new life. CONCLUSIONS This study indicates the importance of participating in a specific exercise program at discharge from subacute inpatient rehabilitation for ambulant people with SCI. However, high-intensity walking exercise may be too demanding to perform during this time period. The insights from the study provide new knowledge that can contribute to improving clinical rehabilitation practice.
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149
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Krogh S, Aagaard P, Jønsson AB, Figlewski K, Kasch H. Effects of repetitive transcranial magnetic stimulation on recovery in lower limb muscle strength and gait function following spinal cord injury: a randomized controlled trial. Spinal Cord 2021; 60:135-141. [PMID: 34504284 PMCID: PMC8428490 DOI: 10.1038/s41393-021-00703-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 08/23/2021] [Accepted: 08/24/2021] [Indexed: 11/25/2022]
Abstract
Study design Randomized sham-controlled clinical trial. Objectives The objective of this study is to investigate the effects of repetitive transcranial magnetic stimulation (rTMS) compared to sham stimulation, on the development of lower limb muscle strength and gait function during rehabilitation of spinal cord injury (SCI). Setting SCI rehabilitation hospital in Viborg, Denmark. Methods Twenty individuals with SCI were randomized to receive rTMS (REAL, n = 11) or sham stimulation (SHAM, n = 9) and usual care for 4 weeks. rTMS (20 Hz, 1800 pulses per session) or sham stimulation was delivered over leg M1 Monday–Friday before lower limb resistance training or physical therapy. Lower limb maximal muscle strength (MVC) and gait function were assessed pre- and post intervention. Lower extremity motor score (LEMS) was assessed at admission and at discharge. Results One individual dropped out due to seizure. More prominent increases in total leg (effect size (ES): 0.40), knee flexor (ES: 0.29), and knee extensor MVC (ES: 0.34) were observed in REAL compared to SHAM; however, repeated-measures ANOVA revealed no clear main effects for any outcome measure (treatment p > 0.15, treatment × time p > 0.76, time p > 0.23). LEMS improved significantly for REAL at discharge, but not for SHAM, and REAL demonstrated greater improvement in LEMS than SHAM (p < 0.02). Similar improvements in gait performance were observed between groups. Conclusions High-frequency rTMS may increase long-term training-induced recovery of lower limb muscle strength following SCI. The effect on short-term recovery is unclear. Four weeks of rTMS, when delivered in conjunction with resistance training, has no effect on recovery of gait function, indicating a task-specific training effect.
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Affiliation(s)
- Søren Krogh
- Spinal Cord Injury Center of Western Denmark, Regional Hospital Viborg, Viborg, Denmark. .,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
| | - Per Aagaard
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Anette Bach Jønsson
- Spinal Cord Injury Center of Western Denmark, Regional Hospital Viborg, Viborg, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Krystian Figlewski
- Spinal Cord Injury Center of Western Denmark, Regional Hospital Viborg, Viborg, Denmark
| | - Helge Kasch
- Spinal Cord Injury Center of Western Denmark, Regional Hospital Viborg, Viborg, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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150
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Health Promotion and Wellness in Neurologic Physical Therapy: Strategies to Advance Practice. J Neurol Phys Ther 2021; 46:103-117. [PMID: 34507339 DOI: 10.1097/npt.0000000000000376] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND PURPOSE Neurologic physical therapy (PT) can assist people with neurologic conditions and injuries to optimize their health and well-being by addressing barriers at the individual, relationship, community, and societal levels. The purpose of this special interest article is to provide consensus-driven strategies to address barriers to implementing health promotion and wellness (HPW)-related neurologic PT practice. SUMMARY OF KEY POINTS Environmental scan, literature review, and expert input were used to determine barriers and develop strategies. Barriers include lack of time; low knowledge, self-efficacy, and awareness; client complexity; and lack of HPW resources; as well as concerns regarding payment and scope of practice. Four key strategies emerged: (1) develop and disseminate a consensus-based scope of practice for HPW in neurologic PT; (2) increase knowledge of resources related to HPW; (3) promote delivery models for HPW-related neurologic PT; and (4) encourage advocacy, community building and partnership along the continuum of care. RECOMMENDATIONS FOR CLINICAL PRACTICE Clinicians should practice to their full scope of HPW-related PT practice. This includes optimizing movement, including physical activity and fitness, as well as reinforcing the importance of healthy sleep, nutrition, stress, and smoking cessation. These activities address primary, secondary, and tertiary prevention. Clinicians are encouraged to report their experiences with HPW-focused delivery models and outcomes. Additional research is needed to understand the full impact of HPW on PT practice (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A364).
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