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Zhao F, Balthazaar S, Hiremath SV, Nightingale TE, Panza GS. Enhancing Spinal Cord Injury Care: Using Wearable Technologies for Physical Activity, Sleep, and Cardiovascular Health. Arch Phys Med Rehabil 2024:S0003-9993(24)01076-1. [PMID: 38972475 DOI: 10.1016/j.apmr.2024.06.014] [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: 02/16/2024] [Revised: 06/13/2024] [Accepted: 06/24/2024] [Indexed: 07/09/2024]
Abstract
Wearable devices have the potential to advance health care by enabling real-time monitoring of biobehavioral data and facilitating the management of an individual's health conditions. Individuals living with spinal cord injury (SCI) have impaired motor function, which results in deconditioning and worsening cardiovascular health outcomes. Wearable devices may promote physical activity and allow the monitoring of secondary complications associated with SCI, potentially improving motor function, sleep, and cardiovascular health. However, several challenges remain to optimize the application of wearable technologies within this population. One is striking a balance between research-grade and consumer-grade devices in terms of cost, accessibility, and validity. Additionally, limited literature supports the validity and use of wearable technology in monitoring cardio-autonomic and sleep outcomes for individuals with SCI. Future directions include conducting performance evaluations of wearable devices to precisely capture the additional variation in movement and physiological parameters seen in those with SCI. Moreover, efforts to make the devices small, lightweight, and inexpensive for consumer ease of use may affect those with severe motor impairments. Overcoming these challenges holds the potential for wearable devices to help individuals living with SCI receive timely feedback to manage their health conditions and help clinicians gather comprehensive patient health information to aid in diagnosis and treatment.
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Affiliation(s)
- Fei Zhao
- Department of Health Care Sciences, Program of Occupational Therapy, Wayne State University, Detroit, MI; John D. Dingell VA Medical Center, Research and Development, Detroit, MI
| | - Shane Balthazaar
- School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom; International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada; Department of Cardiology, University Hospitals Birmingham National Health Service (NHS) Foundation Trust, Birmingham, United Kingdom
| | - Shivayogi V Hiremath
- Department of Health and Rehabilitation Sciences, Temple University, Philadelphia, PA
| | - Tom E Nightingale
- School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom; International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada.
| | - Gino S Panza
- Department of Health Care Sciences, Program of Occupational Therapy, Wayne State University, Detroit, MI; John D. Dingell VA Medical Center, Research and Development, Detroit, MI.
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de Groot S, Adriaansen JJE, Stolwijk-Swüste JM, Osterthun R, van den Berg-Emons RJG, Post MWM. Obesity in wheelchair users with long-standing spinal cord injury: prevalence and associations with time since injury and physical activity. Spinal Cord 2024; 62:378-386. [PMID: 38649757 DOI: 10.1038/s41393-024-00995-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 04/09/2024] [Accepted: 04/11/2024] [Indexed: 04/25/2024]
Abstract
STUDY DESIGN Secondary analysis of cross-sectional data from the ALLRISC cohort study. OBJECTIVES To investigate the prevalence of obesity and its association with time since injury (TSI) and physical activity (PA) in wheelchair users with long-standing (TSI > 10 years) spinal cord injury (SCI). SETTING Community, The Netherlands. METHODS Wheelchair users with SCI (N = 282) in TSI strata (10-19, 20-29, and ≥30 years) and divided in meeting SCI-specific exercise guidelines or not. Waist circumference (WC) and body mass index (BMI) were assessed. Participants were classified as being obese (WC > 102 cm for men, WC > 88 cm for women; BMI ≥ 25 kg/m2) or not. Logistic regression analyses were performed to investigate the associations between obesity and TSI and PA. RESULTS Almost half of the participants (45-47%) were classified as obese. TSI was significantly associated with obesity, the odds of being obese were 1.4 higher when having a 10 years longer TSI. Furthermore, the odds of being obese were 2.0 lower for participants who were meeting the exercise guidelines. CONCLUSIONS The prevalence of obesity is high in people with long-standing SCI. Those with a longer TSI and individuals who do not meet the exercise guidelines are more likely to be obese and need to be targeted for weight management interventions.
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Affiliation(s)
- Sonja de Groot
- Amsterdam Rehabilitation Research Center | Reade, Amsterdam, The Netherlands.
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands.
| | | | - Janneke M Stolwijk-Swüste
- Centre of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Centre, University Medical Centre Utrecht, Utrecht, The Netherlands
- Department of Spinal Cord Injury and Orthopedics, De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - Rutger Osterthun
- Rijndam Rehabilitation, Rotterdam, The Netherlands
- Department of Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Rita J G van den Berg-Emons
- Department of Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Marcel W M Post
- De Hoogstraat Rehabilitation, Utrecht, The Netherlands
- Centre for Rehabilitation, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
- Centre of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Centre, University Medical Centre Utrecht, Utrecht, The Netherlands
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Castan A, Úbeda-Colomer J, Chamarro A, Vidal J, Benito-Penalva J, Sauri J. Socio-ecological Barriers to Leisure Time Physical Activity in Spanish Wheelchair Users With Spinal Cord Injury: Associations With Sociodemographic Characteristics and Functional Independence. Arch Phys Med Rehabil 2024; 105:1239-1246. [PMID: 38417776 DOI: 10.1016/j.apmr.2024.02.719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 02/09/2024] [Accepted: 02/13/2024] [Indexed: 03/01/2024]
Abstract
OBJECTIVE (1) To assess prevalence and severity of socio-ecological barriers to leisure time physical activity (LTPA) in a sample of adults with spinal cord injury (SCI); (2) to examine the association of these barriers with sociodemographic characteristics and functional independence (FI); and (3) to explore which socio-ecological levels of barriers might be associated with LTPA. DESIGN Cross-sectional study. SETTING Neurorehabilitation Hospital specialized in SCI. PARTICIPANTS 207 wheelchair users with SCI living in the community who attended a comprehensive check-up (22.7% women, 47.5±10.7 mean age; N=207). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES The short version of the Barriers to Physical Activity Questionnaire for People with Mobility Impairments was used to measure socio-ecological barriers to LTPA. The Spinal Cord Independence Measure III was used to measure FI. The Physical Activity Recall Assessment for People with SCI was used to quantify LTPA. Several multiple linear regression models were computed to examine the associations between socio-ecological barriers and sociodemographic factors, LTPA and FI. RESULTS A high prevalence of barriers to LTPA was found. Seven of these barriers (2 intrapersonal, 3 organizational, and 2 community) were present for >60% of the participants. Intrapersonal and organizational barriers had a higher effect on participants with lower FI and women. Interpersonal barriers were higher for older participants and with lower FI, while community barriers were higher for unemployed participants. Finally, intrapersonal and interpersonal barriers were negatively associated with LTPA, and FI revealed as a moderator of the intrapersonal barriers-LTPA relation. CONCLUSIONS Given their high prevalence and their association with LTPA, the development of interventions targeting socio-ecological barriers to LTPA in people with SCI becomes crucial. The associations of these barriers with FI and sociodemographic characteristics should also be considered for these interventions to be as specific and effective as possible.
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Affiliation(s)
- Alex Castan
- Institut Guttmann Neurorehabilitation Hospital, University Institute attached to the Autonomous University of Barcelona, Badalona, Spain; Institute for Health Science Research Germans Trias i Pujol (IGTP), Badalona, Spain; Department of Basic, Developmental and Educational Psychology, Autonomous University of Barcelona (UAB), Spain.
| | - Joan Úbeda-Colomer
- University of Valencia, Department of Physical Education and Sports, Valencia, Spain
| | - Andrés Chamarro
- Department of Basic, Developmental and Educational Psychology, Autonomous University of Barcelona (UAB), Spain; Sports Research Institute, Autonomous University of Barcelona, Spain
| | - Joan Vidal
- Institut Guttmann Neurorehabilitation Hospital, University Institute attached to the Autonomous University of Barcelona, Badalona, Spain; Institute for Health Science Research Germans Trias i Pujol (IGTP), Badalona, Spain; Autonomous University of Barcelona (UAB), Cerdanyola del Vallès, Spain
| | - Jesús Benito-Penalva
- Institut Guttmann Neurorehabilitation Hospital, University Institute attached to the Autonomous University of Barcelona, Badalona, Spain; Institute for Health Science Research Germans Trias i Pujol (IGTP), Badalona, Spain; Autonomous University of Barcelona (UAB), Cerdanyola del Vallès, Spain
| | - Joan Sauri
- Institut Guttmann Neurorehabilitation Hospital, University Institute attached to the Autonomous University of Barcelona, Badalona, Spain; Institute for Health Science Research Germans Trias i Pujol (IGTP), Badalona, Spain; Autonomous University of Barcelona (UAB), Cerdanyola del Vallès, Spain
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Nataletti S, Banerjee A, Macaluso R, Prokup S, Jayaraman A, Wong AWK. Developing a mobile exercise program for individuals with Spinal Cord Injury: Stakeholder perceptions of app features and implementation determinants. Disabil Health J 2024:101667. [PMID: 38964938 DOI: 10.1016/j.dhjo.2024.101667] [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: 02/20/2024] [Revised: 05/28/2024] [Accepted: 06/23/2024] [Indexed: 07/06/2024]
Abstract
BACKGROUND Individuals with Spinal Cord Injury (SCI) often experience physical deconditioning, leading to long-term health challenges. While regular exercise can offer substantial health benefits, adherence to exercise guidelines among individuals with SCI is hindered by barriers such as inaccessibility. Exercise programs using the mobile application (App) tailored to individual needs present a promising solution for promoting exercise adherence among individuals with SCI. OBJECTIVE This study aimed to identify factors contributing to the successful implementation of an app-based home exercise program for individuals with SCI and gather user feedback on app preferences, functionality, and features. METHODS Guided by the Consolidated Framework for Implementation Research (CFIR), twenty-six clinicians completed an expert panel survey to rank factors influencing the implementation of an app-based intervention for increasing exercise adherence for individuals with SCI. CFIR-selected factors and app quality features obtained from the Mobile Application Rating Scale (MARS) framework were discussed in seven focus groups with 23 individuals with SCI, 6 caregivers, and 6 clinicians. RESULTS The expert survey identified adaptability, complexity, evidence strength/quality, relative advantage, knowledge/beliefs about the initiative, and execution as the key CFIR factors that affected the intervention's success. Major themes emerging from focus groups with individuals with SCI and caregivers included usability, instruction and guidelines, user-friendly interface, and clinician interaction. In contrast, clinicians mentioned themes such as the representation of the SCI population, time commitment, accessibility, and equipment. CONCLUSIONS The study highlights the significance of incorporating these determinants into future designs to develop app-based home exercise interventions for individuals with SCI.
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Affiliation(s)
- Sara Nataletti
- Max Näder Center for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL, 60611, USA; Department of Physical Medicine & Rehabilitation, Northwestern University, Chicago, IL, 60611, USA.
| | - Anushua Banerjee
- Max Näder Center for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL, 60611, USA.
| | - Rebecca Macaluso
- Max Näder Center for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL, 60611, USA.
| | - Sara Prokup
- Max Näder Center for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL, 60611, USA.
| | - Arun Jayaraman
- Max Näder Center for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL, 60611, USA; Department of Physical Medicine & Rehabilitation, Northwestern University, Chicago, IL, 60611, USA; Department of Physical Therapy & Human Movement Sciences, Northwestern University, Chicago, IL, 60611, USA.
| | - Alex W K Wong
- Department of Physical Medicine & Rehabilitation, Northwestern University, Chicago, IL, 60611, USA; Center for Rehabilitation Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL, 60611, USA; Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA.
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Arnold D, Gillespie J, Bennett M, Callender L, Sikka S, Hamilton R, Driver S, Swank C. Clinical Delivery of Overground Exoskeleton Gait Training in Persons With Spinal Cord Injury Across the Continuum of Care: A Retrospective Analysis. Top Spinal Cord Inj Rehabil 2024; 30:74-86. [PMID: 38433740 PMCID: PMC10906371 DOI: 10.46292/sci23-00001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2024]
Abstract
Background After spinal cord injury (SCI), inpatient rehabilitation begins and continues through outpatient therapy. Overground exoskeleton gait training (OEGT) has been shown to be feasible in both settings, yet its use as an intervention across the continuum has not yet been reported. Objectives This study describes OEGT for patients with SCI across the continuum and its effects on clinical outcomes. Methods Medical records of patients with SCI who completed at least one OEGT session during inpatient and outpatient rehabilitation from 2018 to 2021 were retrospectively reviewed. Demographic data, Walking Index for Spinal Cord Injury-II (WISCI-II) scores, and OEGT session details (frequency, "walk" time, "up" time, and step count) were extracted. Results Eighteen patients [male (83%), White (61%), aged 37.4 ± 15 years, with tetraplegia (50%), American Spinal Injury Association Impairment Scale A (28%), B (22%), C (39%), D (11%)] completed OEGT sessions (motor complete, 18.2 ± 10.3; motor incomplete, 16.7 ± 7.7) over approximately 18 weeks (motor complete, 15.1 ± 6.4; motor incomplete, 19.0 ± 8.2). Patients demonstrated improved OEGT session tolerance on device metrics including "walk" time (motor complete, 7:51 ± 4:42 to 24:50 ± 9:35 minutes; motor incomplete, 12:16 ± 6:01 to 20:01 ± 08:05 minutes), "up" time (motor complete, 16:03 ± 7:41 to 29:49 ± 12:44 minutes; motor incomplete, 16:38 ± 4:51 to 23:06 ± 08:50 minutes), and step count (motor complete, 340 ± 295.9 to 840.2 ± 379.4; motor incomplete, 372.3 ± 225.2 to 713.2 ± 272). Across therapy settings, patients with motor complete SCI experienced improvement in WISCI-II scores from 0 ± 0 at inpatient admission to 3 ± 4.6 by outpatient discharge, whereas the motor incomplete group demonstrated a change of 0.2 ± 0.4 to 9.0 ± 6.4. Conclusion Patients completed OEGT across the therapy continuum. Patients with motor incomplete SCI experienced clinically meaningful improvements in walking function.
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Affiliation(s)
- Dannae Arnold
- Baylor Scott and White Research Institute, Dallas, Texas
- Baylor Scott and White Institute for Rehabilitation, Dallas, Texas
| | - Jaime Gillespie
- Baylor Scott and White Research Institute, Dallas, Texas
- Baylor Scott and White Institute for Rehabilitation, Dallas, Texas
| | - Monica Bennett
- Baylor Scott and White Research Institute, Dallas, Texas
| | | | - Seema Sikka
- Baylor Scott and White Institute for Rehabilitation, Dallas, Texas
| | - Rita Hamilton
- Baylor Scott and White Institute for Rehabilitation, Dallas, Texas
| | - Simon Driver
- Baylor Scott and White Institute for Rehabilitation, Dallas, Texas
| | - Chad Swank
- Baylor Scott and White Research Institute, Dallas, Texas
- Baylor Scott and White Institute for Rehabilitation, Dallas, Texas
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Benitez-Albiter A, Anderson CP, Jones M, Park SS, Layec G, Park SY. Contributing Factors to Endothelial Dysfunction in Individuals with Spinal Cord Injuries. Pulse (Basel) 2024; 12:49-57. [PMID: 39022560 PMCID: PMC11250044 DOI: 10.1159/000539199] [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: 02/27/2024] [Accepted: 04/27/2024] [Indexed: 07/20/2024] Open
Abstract
Background Patients with spinal cord injuries (SCIs) are at a greater risk for the development of cardiovascular diseases (CVDs) than able-bodied individuals due to the high risk of endothelial dysfunction. Summary For instance, patients with SCIs lose autonomic control of the heart and vasculature, which results in severe fluctuations in blood pressure. These oscillations between hypotension and hypertension have been shown to damage blood vessel endothelial cells and may contribute to the development of atherosclerosis. Furthermore, the loss of skeletal muscle control results in skeletal muscle atrophy and inward remodeling of the conduit arteries. It has been shown that blood vessels in the legs are chronically exposed to high shear, while the aorta experiences chronically low shear. These alterations to shear forces may adversely impact endothelial vasodilatory capacity and promote inflammatory signaling and leukocyte adherence. Additionally, microvascular endothelial vasodilatory capacity is impaired in patients with an SCI, and this may precede changes in conduit artery endothelial function. Finally, due to immobility and a loss of skeletal muscle mass, patients with SCIs have a higher risk of metabolic disorders, inflammation, and oxidative stress. Key Messages Collectively, these factors may impair endothelium-dependent vasodilatory capacity, promote leukocyte adhesion and infiltration, promote the peroxidation of lipids, and ultimately support the development of atherosclerosis. Therefore, future interventions to prevent CVDs in patients with SCIs should focus on the management of endothelial health to prevent endothelial dysfunction and atherosclerosis.
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Affiliation(s)
| | - Cody P. Anderson
- School of Health and Kinesiology, University of Nebraska at Omaha, Omaha, NE, USA
| | - Matthew Jones
- School of Health and Kinesiology, University of Nebraska at Omaha, Omaha, NE, USA
| | - Sang-Seo Park
- Department of Physiology, Kyung Hee University, Seoul, Republic of Korea
| | - Gwenael Layec
- School of Health and Kinesiology, University of Nebraska at Omaha, Omaha, NE, USA
- Department of Cellular and Integrative Physiology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Song-Young Park
- School of Health and Kinesiology, University of Nebraska at Omaha, Omaha, NE, USA
- Department of Cellular and Integrative Physiology, University of Nebraska Medical Center, Omaha, NE, USA
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Gupta N, Kasula V, Sanmugananthan P, Panico N, Dubin AH, Sykes DAW, D'Amico RS. SmartWear body sensors for neurological and neurosurgical patients: A review of current and future technologies. World Neurosurg X 2024; 21:100247. [PMID: 38033718 PMCID: PMC10682285 DOI: 10.1016/j.wnsx.2023.100247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 10/24/2023] [Indexed: 12/02/2023] Open
Abstract
Background/objective Recent technological advances have allowed for the development of smart wearable devices (SmartWear) which can be used to monitor various aspects of patient healthcare. These devices provide clinicians with continuous biometric data collection for patients in both inpatient and outpatient settings. Although these devices have been widely used in fields such as cardiology and orthopedics, their use in the field of neurosurgery and neurology remains in its infancy. Methods A comprehensive literature search for the current and future applications of SmartWear devices in the above conditions was conducted, focusing on outpatient monitoring. Findings Through the integration of sensors which measure parameters such as physical activity, hemodynamic variables, and electrical conductivity - these devices have been applied to patient populations such as those at risk for stroke, suffering from epilepsy, with neurodegenerative disease, with spinal cord injury and/or recovering from neurosurgical procedures. Further, these devices are being tested in various clinical trials and there is a demonstrated interest in the development of new technologies. Conclusion This review provides an in-depth evaluation of the use of SmartWear in selected neurological diseases and neurosurgical applications. It is clear that these devices have demonstrated efficacy in a variety of neurological and neurosurgical applications, however challenges such as data privacy and management must be addressed.
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Affiliation(s)
- Nithin Gupta
- Campbell University School of Osteopathic Medicine, Lillington, NC, USA
| | - Varun Kasula
- Campbell University School of Osteopathic Medicine, Lillington, NC, USA
| | | | | | - Aimee H. Dubin
- Campbell University School of Osteopathic Medicine, Lillington, NC, USA
| | - David AW. Sykes
- Department of Neurosurgery, Duke University Medical School, Durham, NC, USA
| | - Randy S. D'Amico
- Lenox Hill Hospital, Department of Neurosurgery, New York, NY, USA
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Pelletier C. Exercise prescription for persons with spinal cord injury: a review of physiological considerations and evidence-based guidelines. Appl Physiol Nutr Metab 2023; 48:882-895. [PMID: 37816259 DOI: 10.1139/apnm-2023-0227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/12/2023]
Abstract
Persons with spinal cord injury (SCI) experience gains in fitness, physical and mental health from regular participation in exercise and physical activity. Due to changes in physiological function of the cardiovascular, nervous, and muscular systems, general population physical activity guidelines and traditional exercise prescription methods are not appropriate for the SCI population. Exercise guidelines specific to persons with SCI recommend progressive training beginning at 20 min of moderate to vigorous intensity aerobic exercise twice per week transitioning to 30 min three times per week, with strength training of the major muscle groups two times per week. These population-specific guidelines were designed considering the substantial barriers to physical activity for persons with SCI and can be used to frame an individual exercise prescription. Rating of perceived exertion (i.e., perceptually regulated exercise) is a practical way to indicate moderate to vigorous intensity exercise in community settings. Adapted exercise modes include arm cycle ergometry, hybrid arm-leg cycling, and recumbent elliptical equipment. Body weight-supported treadmill training and other rehabilitation modalities may improve some aspects of health and fitness for people with SCI if completed at sufficient intensity. Disability-specific community programs offer beneficial opportunities for persons with SCI to experience quality exercise opportunities but are not universally available.
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Affiliation(s)
- Chelsea Pelletier
- School of Health Sciences, Faculty of Human and Health Sciences, University of Northern British Columbia, Prince George, BC, Canada
- Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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Wouda MF, Gaupseth JA, Bengtson EI, Johansen T, Brembo EA, Lundgaard E. Exercise intensity during exergaming in wheelchair-dependent persons with SCI. Spinal Cord 2023; 61:338-344. [PMID: 37012335 PMCID: PMC10328826 DOI: 10.1038/s41393-023-00893-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 03/07/2023] [Accepted: 03/20/2023] [Indexed: 04/05/2023]
Abstract
STUDY DESIGN Cross-sectional study. OBJECTIVES It is challenging for persons with SCI, especially those who are wheelchair dependent, to find suitable and motivating aerobic exercise modes. Exergaming might be a good option, since it is relatively cheap and can be played at home, alone or with others. However, it is unknown if exergaming is performed at a sufficient exercise intensity. SETTING Sunnaas Rehabilitation Hospital, Norway. METHODS Twenty-two men and two women (n = 24) with chronic SCI (AIS A-C), all wheelchair users, were included during inpatient rehabilitation. All participant performed a maximal graded arm-crank test (pretest), while measuring peak oxygen uptake (VO2peak) and peak heart rate (HRpeak). The day after they had a practice playing session with three different exergames (X-box Kinect, Fruit Ninja; Nintendo Wii, Wii Sports Boxing; VR Oculus Rift, boxing). The following day, participants played each exergame for 15 min. During these 45 min of exergaming, exercise intensity, based on VO2peak and HRpeak from the pretest, was monitored. RESULTS Approximately 30 of the 45 min of exergaming was performed at moderate or high intensity. Participants exercised on average 24.5 min (95%CI 18.7-30.5) at moderate intensity (>50-80% VO2peak) and 6.6 min (95%CI 2.2-10.8) at high intensity (>80% VO2peak). CONCLUSIONS The participants were able to exercise at moderate or high intensity during exergaming in a considerable amount of time. Exergaming seems to be suitable for aerobic exercise at an intensity that can provide health benefits in wheelchair-dependent persons with SCI.
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Affiliation(s)
| | | | | | | | - Espen Andreas Brembo
- Centre for Health and Technology, University of South-Eastern Norway (USN), Drammen, Norway
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Mat Rosly M, Mat Rosly H. Home-based exergaming training effects for two individuals with spinal cord injury: A case report. Physiother Theory Pract 2023; 39:208-218. [PMID: 34842507 DOI: 10.1080/09593985.2021.2001881] [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: 12/16/2022]
Abstract
INTRODUCTION Exergaming is a type of serious game that requires active bodily movements for video gameplay. This game-based exercise is gaining interest as a form of leisure activity of moderate-vigorous dose intensity. OBJECTIVE This case report sought to assess the effects of exergaming training (i.e. Move Boxing, Move Tennis, and Move Gladiator Duel) on aerobic capacity, feasibility, enjoyment and motivation in two individuals with spinal cord injury (SCI). CASE DESCRIPTIONS Two males with SCI at the level of L4 and T10, aged 32 and 39, respectively, underwent home-based exergaming training sessions over a period of 12-18 weeks, conducted within moderate-vigorous intensity training zones for health improvements as recommended by health guidelines. Their peak oxygen consumption (VO2), physical activity levels and perceived enjoyment were evaluated before, during and after the completion of the training. OUTCOMES Participant peak VO2 improved (effect size g = 2.7) from their baseline values (Participant A: 16.0 ± 0.7 mL/kg/min to 41.7 ± 8.1 mL/kg/min; Participant B: 13.5 ± 0.8 mL/kg/min to 32.7 ± 5.2 mL/kg/min), with an increase in overall weekly physical activity levels. Both participants maintained a relatively high level of enjoyment scores throughout their training period (mean: 31.9 ± 3.2, p = .56, 95% CI 0.22-1.0). CONCLUSION A home-based exergaming training program improved aerobic capacity and level of physical activity, while maintaining adherence to the exercise within a relatively high perception of enjoyment for these two participants. The relatively high enjoyment scores maintained throughout the duration of the exergaming training period suggested its feasibility as a home-based exercise program and perceived as enjoyable by these individuals.
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Affiliation(s)
- Maziah Mat Rosly
- Department of Physiology, Faculty of Medicine, University of Malaya, Jalan Universiti, Kuala Lumpur, Malaysia
| | - Hadi Mat Rosly
- Department of Mechatronics Engineering, Faculty of Engineering International Islamic University, Jalan Gombak, Malaysia
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Eitivipart AC, Arora M, Quel de Oliveira C, Heard R, Middleton JW, Davis GM. Assessing physical activity and health-related quality of life in individuals with spinal cord injury: a national survey in Thailand. Disabil Rehabil 2022; 44:7048-7058. [PMID: 34592857 DOI: 10.1080/09638288.2021.1979665] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE This study sought to; (i) investigate the proportion of Thai individuals with spinal cord injury (Thai-SCI) who met SCI-specific physical activity (PA) guidelines, (ii) describe PA and health-related quality of life (HRQOL) of Thai-SCI across different sociodemographic strata, and, (iii) measure the variance in HRQOL associated with the intensity and volume of leisure-time physical activities (LTPA). METHODS Two surveys, measuring PA and HRQOL, were used in this study. Descriptive analysis, parametric and non-parametric tests for comparing two or more groups were used to analyse the data. The relationship between PA levels and HRQOL scores was investigated using Spearman's correlation coefficients. All statistical significance level in this study were set to alpha < 0.05. RESULTS From the 200 participants, 14.5% met aerobic, 20.5% met strength training and 13.5% met both aerobic and strength training SCI-specific PA guidelines. Sedentary Thai-SCI accounted for 49% of the study sample. Thai-SCI spent 132.0 ± 254.3 (mean ± SD) minutes per week on moderate-to-heavy intensity LTPA. Average Physical and Mental Component Summary (PCS and MCS scores) of Thai-SCI were 42.3 ± 7.6 and 49.3 ± 8.4 (mean ± SD), respectively. Increases in average LTPA of moderate-to-heavy intensities were weakly correlated with increases in PCS scores and its sub-domains (r = 0.1-0.3, n = 200, all p < 0.05). CONCLUSION The average time spent on moderate-to-heavy intensity ADLs and LTPA were below SCI-specific PA guidelines and the WHO global recommendations for PA. The proportion of Thai-SCI who were sedentary was high, suggesting immediate action and implementation of strategies to promote PA for Thai-SCI.IMPLICATIONS FOR REHABILITATIONThe proportion of Thai people with spinal cord injury with a sedentary lifestyle was high.Healthcare providers in Thailand must engage to a greater degree in health-related physical activity promotion to effectively deliver physical activity and exercise knowledge to their clients with spinal cord injury.Likely, structured programs of physical activity and exercise deployed by healthcare professionals with the appropriate knowledge and skills might reverse the current trend to sedentary lifestyle in this population.Interventions to improve participation in physical activity and health-related quality of life should be tailored to the individual needs of Thai individuals with a spinal cord injury and might be better delivered seperately.
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Affiliation(s)
- Aitthanatt Chachris Eitivipart
- Discipline of Exercise and Sport Sciences, Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Sydney, Australia.,Accessibility and Assistive Technology Research Team, Assistive Technology and Medical Devices Research Center, National Science and Technology Development Agency, Pathum Thani, Thailand
| | - Mohit Arora
- John Walsh Centre for Rehabilitation Research, The Kolling Institute, Royal North Shore Hospital, St. Leonards, Australia.,Faculty of Medicine and Health, Sydney Medical School-Northern, The University of Sydney, Sydney, Australia
| | - Camila Quel de Oliveira
- Discipline of Physiotherapy, Graduate School of Health, University of Technology Sydney, Sydney, Australia
| | - Robert Heard
- Discipline of Behavioural and Social Sciences in Health, Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Sydney, Australia
| | - James W Middleton
- John Walsh Centre for Rehabilitation Research, The Kolling Institute, Royal North Shore Hospital, St. Leonards, Australia.,Faculty of Medicine and Health, Sydney Medical School-Northern, The University of Sydney, Sydney, Australia
| | - Glen M Davis
- Discipline of Exercise and Sport Sciences, Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Sydney, Australia
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12
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Park A, Ryder S, Sevigny M, Monden KR, Battaglino RA, Nguyen N, Goldstein R, Morse LR. Association between weekly exercise minutes and resting IL-6 in adults with chronic spinal cord injury: findings from the fracture risk after spinal cord injury exercise study. Spinal Cord 2022; 60:917-921. [PMID: 35840744 DOI: 10.1038/s41393-022-00833-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 06/28/2022] [Accepted: 06/30/2022] [Indexed: 11/08/2022]
Abstract
STUDY DESIGN Cross-sectional study. OBJECTIVE To assess associations between weekly aerobic exercise minutes and resting interleukin-6 (IL-6), C-reactive protein (CRP), or leptin levels in adults with chronic spinal cord injury (SCI). SETTING Three hundred and forty-four community-dwelling men and women with SCI duration of > 1 year. METHODS CRP, IL-6, and leptin levels were quantified by ultra-sensitive enzyme-linked immunoassay. Smoking, medication use, comorbidities, and aerobic exercise minutes per week were assessed by self-reported questionnaire. Body composition was determined by whole-body dual-energy X-ray absorptiometry. Generalized linear models were used to assess associations. RESULTS In multivariable modeling, resting IL-6 levels were 0.001 pg/mL lower for every 1 min of weekly aerobic exercise. IL-6 levels increased with increasing android-to-gynoid fat ratio, in active/ever smokers compared to never smokers, and in individuals with skin pressure injuries compared to those without. IL-6 levels were lower in active ibuprofen users compared to nonusers. We found no association between weekly exercise minutes and CRP or leptin when designing similar models. CONCLUSIONS Increasing aerobic exercise minutes is associated with lower IL-6 levels in adults with chronic SCI when considering body composition, smoking, skin pressure injuries, and ibuprofen use. CRP and leptin did not demonstrate an association with exercise when considering the similar variables. The use of these biomarkers in assessing the therapeutic value of future exercise-related interventions will be paramount for meaningful health improvement among those with SCI. Although a large, prospective dataset, this cross-sectional study cannot assign causation. Future prospective studies are needed to confirm these findings.
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Affiliation(s)
- Andrew Park
- Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, CO, USA
- Craig Rehabilitation Hospital, Englewood, CO, USA
| | - Stephanie Ryder
- Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, CO, USA
- Rocky Mountain Regional Veteran Affairs SCI/D, Aurora, CO, USA
| | | | - Kimberley R Monden
- Department of Rehabilitation Medicine, University of Minnesota School of Medicine, Minneapolis, MN, USA
| | - Ricardo A Battaglino
- Department of Rehabilitation Medicine, University of Minnesota School of Medicine, Minneapolis, MN, USA
| | - Nguyen Nguyen
- Department of Rehabilitation Medicine, University of Minnesota School of Medicine, Minneapolis, MN, USA
| | - Richard Goldstein
- Department of Rehabilitation Medicine, University of Minnesota School of Medicine, Minneapolis, MN, USA
| | - Leslie R Morse
- Department of Rehabilitation Medicine, University of Minnesota School of Medicine, Minneapolis, MN, USA.
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13
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Alajam RA, Alqahtani AS, Moon S, Sarmento CVM, Frederick J, Smirnova IV, Liu W. Effects of walking training on risk markers of cardiovascular disease in individuals with chronic spinal cord injury. J Spinal Cord Med 2022; 45:622-630. [PMID: 33443465 PMCID: PMC9246252 DOI: 10.1080/10790268.2020.1853332] [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: 10/22/2022] Open
Abstract
OBJECTIVE To investigate the effects of an 8-week walking training program on glycemic control, lipid profile, and inflammatory markers in individuals with chronic spinal cord injury (SCI). DESIGN A pilot, single-group, pretest-posttest study. SETTING A neuromuscular research laboratory. PARTICIPANTS Eleven participants with chronic SCI. INTERVENTION An 8-week walking training program using a treadmill, a body weight-supported system, and an assistive gait training device. OUTCOME MEASURES Levels of glycated hemoglobin (HbA1c), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), C-reactive protein (CRP), and interleukin-6 were assessed before and after the walking training. RESULTS Following the walking training, there was a statistically significant decrease in HbA1c level (P<0.01) of uncertain clinical significance. The lipid profile improved after training, as shown by a statistically and clinically significant increase in HDL-C level (P<0.01) and a statistically significant decrease in LDL-C level (P<0.1) of no clinical significance. The ratio of LDL-C to HDL-C was significantly reduced (P<0.01). In regard to inflammatory markers, concentrations of IL-6 showed a significant reduction after training (P=0.05) of unknown clinical significance, while those of CRP trended to decrease (P=0.13). CONCLUSION The findings of this pilot study suggest that an 8-week walking training program may produce favorable changes in risk markers of cardiovascular disease in individuals with chronic SCI as shown by clinically meaningful improvements in HDL-C, and small changes in the right direction, but uncertain clinical significance, in HbA1c, LDL-C and IL-6. A randomized controlled trial is needed to compare the effects of walking training on these outcome measures with those of other exercise modalities suitable for this population, and to see if more prolonged exercise exposure leads to favorable parameters of significant size to justify the exercise modality.
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Affiliation(s)
- Ramzi A. Alajam
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, Kansas, United States,Department of Physical Therapy, Jazan University, Jazan, Saudi Arabia,Corresponding author: Ramzi Alajam, Department of Physical Therapy, Faculty of Applied Medical Science, Jazan University, Jazan, Saudi Arabia;
| | - Abdulfattah S. Alqahtani
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, Kansas, United States,Department of Health Rehabilitation Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Sanghee Moon
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, Kansas, United States
| | - Caio V. M. Sarmento
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, Kansas, United States,Department of Physical Therapy, California State University, Fresno, California, United States
| | - Jason Frederick
- Department of Physical Medicine and Rehabilitation, University of Kansas Medical Center, Kansas City, Kansas, United States
| | - Irina V. Smirnova
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, Kansas, United States
| | - Wen Liu
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, Kansas, United States
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14
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Farkas GJ, Burton AM, McMillan DW, Sneij A, Gater DR. The Diagnosis and Management of Cardiometabolic Risk and Cardiometabolic Syndrome after Spinal Cord Injury. J Pers Med 2022; 12:1088. [PMID: 35887592 PMCID: PMC9320035 DOI: 10.3390/jpm12071088] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 06/19/2022] [Accepted: 06/21/2022] [Indexed: 11/23/2022] Open
Abstract
Individuals with spinal cord injuries (SCI) commonly present with component risk factors for cardiometabolic risk and combined risk factors for cardiometabolic syndrome (CMS). These primary risk factors include obesity, dyslipidemia, dysglycemia/insulin resistance, and hypertension. Commonly referred to as "silent killers", cardiometabolic risk and CMS increase the threat of cardiovascular disease, a leading cause of death after SCI. This narrative review will examine current data and the etiopathogenesis of cardiometabolic risk, CMS, and cardiovascular disease associated with SCI, focusing on pivotal research on cardiometabolic sequelae from the last five years. The review will also provide current diagnosis and surveillance criteria for cardiometabolic disorders after SCI, a novel obesity classification system based on percent total body fat, and lifestyle management strategies to improve cardiometabolic health.
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Affiliation(s)
- Gary J. Farkas
- Department of Physical Medicine and Rehabilitation, School of Medicine, University of Miami Miller, Miami, FL 33136, USA; (A.S.); (D.R.G.J.)
- Christine E. Lynn Rehabilitation Center for the Miami Project to Cure Paralysis, Miami, FL 33136, USA;
| | - Adam M. Burton
- School of Medicine, University of Miami Miller, Miami, FL 33136, USA;
| | - David W. McMillan
- Christine E. Lynn Rehabilitation Center for the Miami Project to Cure Paralysis, Miami, FL 33136, USA;
- The Miami Project to Cure Paralysis, School of Medicine, University of Miami Miller, Miami, FL 33136, USA
| | - Alicia Sneij
- Department of Physical Medicine and Rehabilitation, School of Medicine, University of Miami Miller, Miami, FL 33136, USA; (A.S.); (D.R.G.J.)
- Christine E. Lynn Rehabilitation Center for the Miami Project to Cure Paralysis, Miami, FL 33136, USA;
| | - David R. Gater
- Department of Physical Medicine and Rehabilitation, School of Medicine, University of Miami Miller, Miami, FL 33136, USA; (A.S.); (D.R.G.J.)
- Christine E. Lynn Rehabilitation Center for the Miami Project to Cure Paralysis, Miami, FL 33136, USA;
- School of Medicine, University of Miami Miller, Miami, FL 33136, USA;
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15
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Vermaak C, Ferreira S, Terblanche E, Derman W. Physical activity promotion in persons with spinal cord injuries: Barriers and facilitators in low-resource communities. Afr J Disabil 2022; 11:988. [PMID: 35812772 PMCID: PMC9257716 DOI: 10.4102/ajod.v11i0.988] [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: 12/10/2021] [Accepted: 04/10/2022] [Indexed: 11/23/2022] Open
Abstract
Background A spinal cord injury is a devastating and life-changing event that presents the affected individual with multiple challenges throughout life. Physical activity can help mitigate some of these challenges; however, in low-resource communities where opportunities for physical activity are scarce, these challenges are often exacerbated and multiple. Objective This study aimed to identify the barriers and facilitators to physical activity, specifically in individuals with spinal cord injuries, in low-resourced communities. Methods A total of 57 adults (> 20 years) with a spinal cord injury living in the Western Cape, South Africa completed the self-developed research questionnaire. Results A total of 289 barriers and 290 facilitators were reported. The most frequently reported barriers were lack of transport (n = 35), impairment type (n = 32), lack of trained volunteers and appropriate programmes (n = 19 each) and lack of information received from therapists following discharge (n = 10). The most frequently reported facilitators were support from family (n = 38), the ‘enjoyment’ of physical activity and the fact that ‘it made me feel good’ (n = 37); safe and accessible facilities were reported by 25 participants and 12 participants reported that higher-quality programmes and better-trained staff would help them to be more physically active. Conclusion Individuals with a spinal cord injury face many barriers in being physically active. Yet it is evident that people with spinal cord injuries in low-resourced communities are eager to participate and improve their health and physical function. However, this will only realise if practitioners reduce the barriers to access, provide relevant training to staff and volunteers, educate their patients about the importance of physical activity post discharge, and create tailored programmes in safe and accessible community facilities.
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Affiliation(s)
- Candace Vermaak
- Division of Biokinetics, Department of Sport Science, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Suzanne Ferreira
- Institute of Sport and Exercise Medicine, Department of Sport Science, Faculty of Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Elmarie Terblanche
- Division of Sport Science, Department of Sport Science, Faculty of Medicine and Health Sciences, Stellenbosch University, cape Town, South Africa
| | - Wayne Derman
- Institute of Sport and Exercise Medicine, Department of Sport Science, Faculty of Health Sciences, Stellenbosch University, Cape Town, South Africa
- International Olympic Committee Research Center, Cape Town, South Africa
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16
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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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17
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Fossey MPM, Balthazaar SJT, Squair JW, Williams AM, Poormasjedi-Meibod MS, Nightingale TE, Erskine E, Hayes B, Ahmadian M, Jackson GS, Hunter DV, Currie KD, Tsang TSM, Walter M, Little JP, Ramer MS, Krassioukov AV, West CR. Spinal cord injury impairs cardiac function due to impaired bulbospinal sympathetic control. Nat Commun 2022; 13:1382. [PMID: 35296681 PMCID: PMC8927412 DOI: 10.1038/s41467-022-29066-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 02/20/2022] [Indexed: 02/08/2023] Open
Abstract
Spinal cord injury chronically alters cardiac structure and function and is associated with increased odds for cardiovascular disease. Here, we investigate the cardiac consequences of spinal cord injury on the acute-to-chronic continuum, and the contribution of altered bulbospinal sympathetic control to the decline in cardiac function following spinal cord injury. By combining experimental rat models of spinal cord injury with prospective clinical studies, we demonstrate that spinal cord injury causes a rapid and sustained reduction in left ventricular contractile function that precedes structural changes. In rodents, we experimentally demonstrate that this decline in left ventricular contractile function following spinal cord injury is underpinned by interrupted bulbospinal sympathetic control. In humans, we find that activation of the sympathetic circuitry below the level of spinal cord injury causes an immediate increase in systolic function. Our findings highlight the importance for early interventions to mitigate the cardiac functional decline following spinal cord injury. By combining experimental models with prospective clinical studies, the authors show that spinal cord injury causes a rapid reduction in cardiac function that precedes structural changes, and that the loss of descending sympathetic control is the major cause of reduced cardiac function following spinal cord injury.
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Affiliation(s)
- Mary P M Fossey
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada.,Experimental Medicine, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Shane J T Balthazaar
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada.,Experimental Medicine, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Jordan W Squair
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada
| | - Alexandra M Williams
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada.,Department of Cellular and Physiological Sciences, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | | | - Tom E Nightingale
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada.,School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK.,Centre for Trauma Sciences Research, University of Birmingham, Edgabaston, Birmingham, UK
| | - Erin Erskine
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada.,Department of Cellular and Physiological Sciences, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Brian Hayes
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada
| | - Mehdi Ahmadian
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada.,School of Kinesiology, Faculty of Education, University of British Columbia, Vancouver, BC, Canada
| | - Garett S Jackson
- Faculty of Health and Social Development, University of British Columbia, Kelowna, BC, Canada
| | - Diana V Hunter
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada
| | - Katharine D Currie
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada
| | - Teresa S M Tsang
- Division of Cardiology, University of British Columbia, Vancouver General and University of British Columbia Hospital Echocardiography Department, Vancouver, BC, Canada
| | - Matthias Walter
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada.,Department of Urology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Jonathan P Little
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, BC, Canada
| | - Matt S Ramer
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada.,Department of Zoology, Faculty of Science, University of British Columbia, Vancouver, BC, Canada
| | - Andrei V Krassioukov
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada. .,Experimental Medicine, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada. .,Division of Physical Medicine and Rehabilitation, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada. .,GF Strong Rehabilitation Centre, Vancouver Coastal Health, Vancouver, BC, Canada.
| | - Christopher R West
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada. .,Department of Cellular and Physiological Sciences, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
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18
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Soriano JE, Squair JW, Cragg JJ, Thompson J, Sanguinetti R, Vaseghi B, Emery CA, Grant C, Charbonneau R, Larkin-Kaiser KA, Phillips AA, Dujic Z. A national survey of physical activity after spinal cord injury. Sci Rep 2022; 12:4405. [PMID: 35292668 PMCID: PMC8924215 DOI: 10.1038/s41598-022-07927-5] [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: 08/17/2021] [Accepted: 12/28/2021] [Indexed: 11/11/2022] Open
Abstract
Physical activity is a powerful modifiable risk factor for disease and mortality. Physical activity levels in people with spinal cord injury (SCI) have not been quantified relative to uninjured individuals in a large population-based sample. We aimed to quantify and compare physical activity in people with and without SCI, and to examine the associations between physical activity, lifestyle, and socioeconomic factors. The 2010 Canadian Community Health Survey (n > 57,000) was used, which includes three measures that assess physical activity levels (i.e., leisure time activity frequency, leisure time activity intensity, and transportation time activity intensity). Bivariable and multivariable logistic regressions were performed and odds ratios (ORs) with corresponding 95% confidence intervals (CIs) were estimated. The odds of physical activity in people with SCI were 0.43 (95% CI 0.3–0.61), 0.53 (95% CI 0.36–0.75), and 0.42 (95% CI 0.28–0.61), across the three measures of physical activity, respectively. These differences persisted after adjustment for lifestyle, comorbidities, and socioeconomic factors. Physical activity is reduced in the SCI population compared with the general population. This knowledge is important to direct future research and guide the allocation of health care resources.
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Affiliation(s)
- Jan Elaine Soriano
- Departments of Physiology and Pharmacology, Cardiac Sciences & Clinical Neurosciences, Libin Cardiovascular Institute of Alberta, Hotchkiss Brain Institute, University of Calgary, 93 Heritage Medical Research Building, 3310 Hospital Dr NW, Calgary, AB, T2N 4N1, Canada
| | - Jordan W Squair
- Departments of Physiology and Pharmacology, Cardiac Sciences & Clinical Neurosciences, Libin Cardiovascular Institute of Alberta, Hotchkiss Brain Institute, University of Calgary, 93 Heritage Medical Research Building, 3310 Hospital Dr NW, Calgary, AB, T2N 4N1, Canada.,MD/PhD Training Program, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Jacquelyn J Cragg
- International Collaboration On Repair Discoveries (ICORD), University of British Columbia, Faculty of Pharmaceutical Sciences, 2405 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Jennifer Thompson
- Departments of Physiology and Pharmacology, Cardiac Sciences & Clinical Neurosciences, Libin Cardiovascular Institute of Alberta, Hotchkiss Brain Institute, University of Calgary, 93 Heritage Medical Research Building, 3310 Hospital Dr NW, Calgary, AB, T2N 4N1, Canada.,University of Calgary, 78 Heritage Medical Research Building, 3310 Hospital Dr NW, Calgary, AB, T2N 4N1, Canada
| | - Rafael Sanguinetti
- Cumming School of Medicine, University of Calgary, 93 Heritage Medical Research Building, 3310 Hospital Dr NW, Calgary, AB, T2N 4N1, Canada
| | - Bita Vaseghi
- Departments of Physiology and Pharmacology, Cardiac Sciences & Clinical Neurosciences, Libin Cardiovascular Institute of Alberta, Hotchkiss Brain Institute, University of Calgary, 93 Heritage Medical Research Building, 3310 Hospital Dr NW, Calgary, AB, T2N 4N1, Canada.,International Collaboration On Repair Discoveries (ICORD), University of British Columbia, Faculty of Pharmaceutical Sciences, 2405 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Carolyn A Emery
- Sport Injury Prevention Research Centre, Faculty of Kinesiology and Departments of Pediatric and Community Health Sciences, Cumming School of Medicine, University of Calgary, 2500 University Dr NW, Calgary, AB, T2N 1N4, Canada
| | - Christopher Grant
- Division of Physical Medicine & Rehabilitation, Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Foothills Medical Centre, 1403 29th Street NW, Calgary, AB, T2N 2T9, Canada
| | - Rebecca Charbonneau
- Division of Physical Medicine & Rehabilitation, Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Foothills Medical Centre, 1403 29th Street NW, Calgary, AB, T2N 2T9, Canada
| | - Kelly A Larkin-Kaiser
- Departments of Physiology and Pharmacology, Cardiac Sciences & Clinical Neurosciences, Libin Cardiovascular Institute of Alberta, Hotchkiss Brain Institute, University of Calgary, 93 Heritage Medical Research Building, 3310 Hospital Dr NW, Calgary, AB, T2N 4N1, Canada
| | - Aaron A Phillips
- Departments of Physiology and Pharmacology, Cardiac Sciences & Clinical Neurosciences, Libin Cardiovascular Institute of Alberta, Hotchkiss Brain Institute, University of Calgary, 93 Heritage Medical Research Building, 3310 Hospital Dr NW, Calgary, AB, T2N 4N1, Canada.
| | - Zeljko Dujic
- Department of Integrative Physiology, School of Medicine, University of Split, Šoltanska 2, 21000, Split, Croatia.
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19
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dos Santos e Santos C, Welch BA, Edwards SR, Harris KK, Duncan BC, Himel AR, Grayson BE. Immune and Metabolic Biomarkers in a Rodent Model of Spinal Cord Contusion. Global Spine J 2022; 12:110-120. [PMID: 32964731 PMCID: PMC8965303 DOI: 10.1177/2192568220950337] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
STUDY DESIGN Basic science animal research study. OBJECTIVES Using T10 spinal contused rats, we sought to identify molecular and circulating, metabolic and immune biomarkers during the subchronic and chronic recovery periods that may inform us concerning neurorehabilitation. METHODS Gene expression of the cord and ELISA were performed in 28 and 100 days in T10 injured rats and compared to sham-injured rats. Hundred-day injured rats were placed on either a low-fat or high-fat diet following the recovery phase. Linear regression analysis was performed between markers and locomotor score, body weight, body composition, and blood cholesterol and triglycerides. RESULTS Gene expression in the thoracic cord for complement marker, C1QC, dendritic cell marker, ITGAX, and cholesterol biosynthesis genes, FDFT1, HMCGR, LDLR, and SREBP1, were significantly associated with BBB score, body weight, composition, and other metabolic parameters. Circulating levels of these proteins, however, did not vary by injury or predict the level of locomotor recovery. CONCLUSIONS Identification of reliable circulating biomarkers that are durable and based on level of spinal injury are complicated by immune and metabolic comorbidities. Continued work is necessary to identify stable markers of disease progression.
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Affiliation(s)
| | | | | | | | | | | | - Bernadette E. Grayson
- University of Mississippi Medical Center, Jackson, MS, USA,Bernadette E. Grayson, University of Mississippi Medical Center, Department of Neurobiology and Anatomical Sciences, 2500 North State Street, Jackson, MS 39216, USA.
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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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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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22
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Changes in body composition during and after inpatient rehabilitation in people with recent spinal cord injury. Spinal Cord Ser Cases 2021; 7:88. [PMID: 34584070 DOI: 10.1038/s41394-021-00446-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 09/07/2021] [Accepted: 09/07/2021] [Indexed: 11/08/2022] Open
Abstract
STUDY DESIGN Prospective cohort study. OBJECTIVES To investigate changes in body composition parameters in people with recent spinal cord injury (SCI) during their first inpatient rehabilitation and up to 1 year after discharge and whether those potential changes over time varied between different personal and lesion characteristics groups. SETTING Rehabilitation center, the Netherlands. METHODS People with recent SCI (≥18 years; n = 53) were tested around admission (T0) and discharge (T1) of inpatient rehabilitation. A sub-group (n = 19) was measured 1 year after discharge (T2). Personal and lesion characteristics were registered at T0. Anthropometry (height, body mass, body mass index, and waist circumference) was performed at T0, T1, and T2. Bioelectrical impedance analysis (BIA) was measured at T0 and T1. RESULTS During inpatient rehabilitation, no significant changes in all body composition parameters were found. During the first year after discharge, body mass index (26.8 kg/m2) significantly increased compared with the level at both admission (25.4 kg/m2; p = 0.01, 95% CI: 0.32-2.52) and discharge (25.1 kg/m2; p = 0.02, 95% CI: 0.26-3.00). People with paraplegia showed an increase in absolute waist circumference (6.5%) compared with people with tetraplegia who showed a net decrease (-5.5%) in the year after discharge (p = 0.047, 95% CI: 0.27-33.62). CONCLUSIONS A stable body composition during inpatient rehabilitation is followed by an increased BMI in the year after discharge in people with recent SCI. People with paraplegia showed an increase in absolute waist circumference compared with people with tetraplegia who showed a net decrease in the year after discharge.
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Kouwijzer I, Valent LJ, Post MW, Wilders LM, Grootoonk A, van der Woude LH, de Groot S. The Course of Physical Capacity in Wheelchair Users During Training for the HandbikeBattle and at 1-Yr Follow-up. Am J Phys Med Rehabil 2021; 100:858-865. [PMID: 33278130 PMCID: PMC8360672 DOI: 10.1097/phm.0000000000001658] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aims of this study were (1) to compare physical capacity at 1-yr follow-up with physical capacity before and after the training period for the HandbikeBattle event and (2) to identify determinants of the course of physical capacity during follow-up. DESIGN This was a prospective observational study. Former rehabilitation patients (N = 33) with health conditions such as spinal cord injury or amputation were included. A handcycling/arm crank graded exercise test was performed before (January, T1) and after the training period (June, T2) and at 1-yr follow-up (June, T4). Outcomes were peak power output (W) and peak oxygen uptake (L/min). Determinants were sex (male/female); age (years); classification; physical capacity, musculoskeletal pain, exercise stage of change, and exercise self-efficacy at T1; and HandbikeBattle participation at T4. RESULTS Multilevel regression analyses showed that peak power output and peak oxygen uptake increased during the training period and did not significantly change during follow-up (T1: 112 ± 37 W, 1.70 ± 0.48 L/min; T2: 130 ± 40 W, 2.07 ± 0.59 L/min; T4: 126 ± 42 W, 2.00 ± 0.57 L/min). Participants who competed again in the HandbikeBattle showed slight improvement in physical capacity during follow-up, whereas participants who did not compete again showed a decrease. CONCLUSION Physical capacity showed an increase during the training period and remained stable after 1-yr follow-up. Being (repeatedly) committed to a challenge might facilitate long-term exercise maintenance.
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Chapman RM, Moschetti WE, Van Citters DW. Is clinically measured knee range of motion after total knee arthroplasty ‘good enough?’: A feasibility study using wearable inertial measurement units to compare knee range of motion captured during physical therapy versus at home. MEDICINE IN NOVEL TECHNOLOGY AND DEVICES 2021. [DOI: 10.1016/j.medntd.2021.100085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Hoevenaars D, Holla JFM, Te Loo L, Koedijker JM, Dankers S, Houdijk H, Visser B, Janssen TWJ, de Groot S, Deutekom M. Mobile App (WHEELS) to Promote a Healthy Lifestyle in Wheelchair Users With Spinal Cord Injury or Lower Limb Amputation: Usability and Feasibility Study. JMIR Form Res 2021; 5:e24909. [PMID: 34379056 PMCID: PMC8386360 DOI: 10.2196/24909] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 03/01/2021] [Accepted: 05/08/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Maintaining a healthy lifestyle is important for wheelchair users' well-being, as it can have a major impact on their daily functioning. Mobile health (mHealth) apps can support a healthy lifestyle; however, these apps are not necessarily suitable for wheelchair users with spinal cord injury or lower limb amputation. Therefore, a new mHealth app (WHEELS) was developed to promote a healthy lifestyle for this population. OBJECTIVE The objectives of this study were to develop the WHEELS mHealth app, and explore its usability, feasibility, and effectiveness. METHODS The WHEELS app was developed using the intervention mapping framework. Intervention goals were determined based on a needs assessment, after which behavior change strategies were selected to achieve these goals. These were applied in an app that was pretested on ease of use and satisfaction, followed by minor adjustments. Subsequently, a 12-week pre-post pilot study was performed to explore usability, feasibility, and effectiveness of the app. Participants received either a remote-guided or stand-alone intervention. Responses to semistructured interviews were analyzed using content analysis, and questionnaires (System Usability Score [SUS], and Usefulness, Satisfaction, and Ease) were administered to investigate usability and feasibility. Effectiveness was determined by measuring outcomes on physical activity, nutrition, sleep quality (Pittsburgh Sleep Quality Index), body composition, and other secondary outcomes pre and post intervention, and by calculating effect sizes (Hedges g). RESULTS Sixteen behavior change strategies were built into an app to change the physical activity, dietary, sleep, and relaxation behaviors of wheelchair users. Of the 21 participants included in the pilot study, 14 participants completed the study. The interviews and questionnaires showed a varied user experience. Participants scored a mean of 58.6 (SD 25.2) on the SUS questionnaire, 5.4 (SD 3.1) on ease of use, 5.2 (SD 3.1) on satisfaction, and 5.9 (3.7) on ease of learning. Positive developments in body composition were found on waist circumference (P=.02, g=0.76), fat mass percentage (P=.004, g=0.97), and fat-free mass percentage (P=.004, g=0.97). Positive trends were found in body mass (P=.09, g=0.49), BMI (P=.07, g=0.53), daily grams of fat consumed (P=.07, g=0.56), and sleep quality score (P=.06, g=0.57). CONCLUSIONS The WHEELS mHealth app was successfully developed. The interview outcomes and usability scores are reasonable. Although there is room for improvement, the current app showed promising results and seems feasible to deploy on a larger scale.
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Affiliation(s)
- Dirk Hoevenaars
- Faculty of Behavioural and Movement Sciences, Vrije Universiteit, Amsterdam, Netherlands.,Amsterdam Rehabilitation Research Center, Reade, Amsterdam, Netherlands
| | - Jasmijn F M Holla
- Amsterdam Rehabilitation Research Center, Reade, Amsterdam, Netherlands.,Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Haarlem, Netherlands.,Center for Adapted Sports Amsterdam, Amsterdam Institute of Sport Science, Amsterdam, Netherlands
| | - Leonie Te Loo
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Haarlem, Netherlands
| | - Johan M Koedijker
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Haarlem, Netherlands
| | - Sarah Dankers
- Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
| | - Han Houdijk
- Center for Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen, Netherlands.,Department of Research and Development, Heliomare Rehabilitation Center, Wijk aan Zee, Netherlands
| | - Bart Visser
- Center for Adapted Sports Amsterdam, Amsterdam Institute of Sport Science, Amsterdam, Netherlands.,Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
| | - Thomas W J Janssen
- Faculty of Behavioural and Movement Sciences, Vrije Universiteit, Amsterdam, Netherlands.,Amsterdam Rehabilitation Research Center, Reade, Amsterdam, Netherlands.,Center for Adapted Sports Amsterdam, Amsterdam Institute of Sport Science, Amsterdam, Netherlands
| | - Sonja de Groot
- Faculty of Behavioural and Movement Sciences, Vrije Universiteit, Amsterdam, Netherlands.,Amsterdam Rehabilitation Research Center, Reade, Amsterdam, Netherlands.,Center for Adapted Sports Amsterdam, Amsterdam Institute of Sport Science, Amsterdam, Netherlands
| | - Marije Deutekom
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Haarlem, Netherlands.,Center for Adapted Sports Amsterdam, Amsterdam Institute of Sport Science, Amsterdam, Netherlands.,Faculty of Sports and Nutrition, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
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Ely MR, Singh TK, Baggish AL, Taylor JA. Reductions in Cardiac Structure and Function 24 Months After Spinal Cord Injury: A Cross-Sectional Study. Arch Phys Med Rehabil 2021; 102:1490-1498. [PMID: 33556347 PMCID: PMC8339187 DOI: 10.1016/j.apmr.2021.01.070] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 12/11/2020] [Accepted: 01/10/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine the alterations in cardiac structure and function that occur in the months after spinal cord injury (SCI). STUDY DESIGN Cross-sectional SETTING: Rehabilitation Hospital PARTICIPANTS: Volunteers (N=29; 4 women, 25 men) between 3 and 24 months after SCI. MAIN OUTCOME MEASURES Transthoracic echocardiography was performed on each volunteer. The relationships between time since injury and neurologic and sensory levels of injury to cardiac structure and function were assessed via multiple linear regression. RESULTS Time since injury was most strongly associated with reductions in left ventricular end diastolic volume (r2=0.156; P=.034), end systolic volume (r2=0.141; P=.045), and mass (r2=0.138; P=.047). These structural changes were paralleled by reduced stroke volume (r2=0.143; P=.043) and cardiac output (r2=0.317; P=<.001). The reductions in left ventricular structure and systolic function were not differentially affected by neurologic or sensory levels of injury (P=.084-.921). CONCLUSIONS These results suggest progressive reductions in left ventricular structure and systolic function between 3 and 24 months after SCI that occur independent of neurologic and sensory levels of injury.
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Affiliation(s)
- Matthew R Ely
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Cambridge, Massachusetts, United States.
| | - Tamanna K Singh
- Cardiovascular Performance Program, Harvard Medical School, Cambridge, Massachusetts, United States
| | - Aaron L Baggish
- Cardiovascular Performance Program, Harvard Medical School, Cambridge, Massachusetts, United States
| | - J Andrew Taylor
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Cambridge, Massachusetts, United States
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Validity of Two Wheelchair-Mounted Devices for Estimating Wheelchair Speed and Distance Traveled. Adapt Phys Activ Q 2021; 38:435-451. [PMID: 33819912 DOI: 10.1123/apaq.2020-0122] [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: 06/23/2020] [Revised: 11/05/2020] [Accepted: 12/15/2020] [Indexed: 11/18/2022] Open
Abstract
This study evaluated the validity of two wheelchair-mounted devices-the Cateye® and Wheeler-for monitoring wheelchair speed and distance traveled. Speed estimates were validated against a calibrated treadmill at speeds from 1.5 to 10 km/hr. Twenty-five wheelchair users completed a course of known distance comprising a sequence of everyday wheelchair activities. Speed estimate validity was very good (mean absolute percentage error ≤ 5%) for the Wheeleri at all speeds and for the Cateye at speeds >3 km/hr but not speeds <3 km/hr (mean absolute percentage error > 20%). Wheeleri distance estimates were good (mean absolute percentage error < 10%) for linear pushing activities and general maneuvering but poor for confined-space maneuvering. Cateye estimates were good for continuous linear propulsion but poor for discontinuous pushing and maneuvering (both general and confined space). Both devices provided valid estimates of speed and distance for typical wheelchair-based exercise activities. However, the Wheeleri provided more accurate estimates of speed and distance during typical everyday wheelchair activities.
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Ochoa C, Cole M, Froehlich-Grobe K. Feasibility of an Internet-Based Intervention to Promote Exercise for People With Spinal Cord Injury: Observational Pilot Study. JMIR Rehabil Assist Technol 2021; 8:e24276. [PMID: 34106086 PMCID: PMC8235292 DOI: 10.2196/24276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 03/29/2021] [Accepted: 04/13/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND People with spinal cord injury (SCI) are less likely to be physically active and have higher chronic disease risk than those in the general population due to physical and metabolic changes that occur postinjury. Few studies have investigated approaches to promote increased physical activity (PA) for people with SCI despite evidence that they face unique barriers, including lack of accessible transportation and exercise equipment. To address these obstacles, we adapted an evidence-based phone-delivered intervention that promoted increased PA among people with SCI into a web-based platform, titled the Workout on Wheels internet intervention (WOWii). The adapted program provides participants with weekly skill-building information and activities, basic exercise equipment, and ongoing support through weekly group videoconferencing. OBJECTIVE This pilot study was conducted to assess the feasibility of using a web-based and virtual format to deliver the WOWii program in a randomized controlled trial. METHODS We assessed the feasibility of the web-based program by delivering an abbreviated, 4-week version to 10 participants with SCI. Rates of weekly videoconference attendance, activity completion, and exercise activity as tracked by an arm-based activity monitor were recorded for all participants. RESULTS Participants averaged 3.3 of 4 (83%) weekly group videoconferences attended, 3.4 of 4 (85%) web-based module activities completed, and 2.3 of 4 (58%) weeks of using the arm-based activity monitor. The majority of the sample (9/10, 90%) synced their arm-based PA monitor at least once, and overall engagement as an average of each component across the 4 weeks was 75%. CONCLUSIONS The intervention had sufficiently high levels of engagement to be used in a full randomized controlled trial to test its effectiveness in improving levels of PA among people with SCI. The knowledge we gained from this pilot study informed improvements that were made in the full randomized controlled trial.
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Affiliation(s)
- Christa Ochoa
- Baylor Scott & White Institute for Rehabilitation, Baylor Scott & White Research Institute, Baylor Scott & White Health, Dallas, TX, United States
| | - Maria Cole
- Baylor Scott & White Institute for Rehabilitation, Baylor Scott & White Research Institute, Baylor Scott & White Health, Dallas, TX, United States
| | - Katherine Froehlich-Grobe
- Baylor Scott & White Institute for Rehabilitation, Baylor Scott & White Research Institute, Baylor Scott & White Health, Dallas, TX, United States.,Craig Hospital, Englewood, CO, United States
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Declerck L, Stoquart G, Lejeune T, Vanderthommen M, Kaux JF. Barriers to development and expansion of adaptive physical activity and sports for individuals with a physical disability in sports clubs and centres. Sci Sports 2021. [DOI: 10.1016/j.scispo.2020.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Kouwijzer I, Valent LJM, van Bennekom CAM, Post MWM, van der Woude LHV, de Groot S. Training for the HandbikeBattle: an explorative analysis of training load and handcycling physical capacity in recreationally active wheelchair users. Disabil Rehabil 2020; 44:2723-2732. [PMID: 33147423 DOI: 10.1080/09638288.2020.1839974] [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: 10/23/2022]
Abstract
PURPOSE (1) to analyze training characteristics of recreationally active wheelchair users during handcycle training, and (2) to examine the associations between training load and change in physical capacity. METHODS Former rehabilitation patients (N = 60) with health conditions such as spinal cord injury or amputation were included. Participants trained for five months. A handcycling/arm crank graded exercise test was performed before and after the training period. Outcomes: peak power output per kg (POpeak/kg) and peak oxygen uptake per kg (VO2peak/kg). Training load was defined as Training Impulse (TRIMP), which is rating of perceived exertion (sRPE) multiplied by duration of the session, in arbitrary units (AU). Training intensity distribution (TID) was also determined (time in zone 1, RPE ≤4; zone 2, RPE 5-6; zone 3, RPE ≥7). RESULTS Multilevel regression analyses showed that TRIMPsRPE was not significantly associated with change in physical capacity. Time in zone 2 (RPE 5-6) was significantly associated with ΔVO2peak, %ΔVO2peak, ΔVO2peak/kg and %ΔVO2peak/kg. CONCLUSION Training at RPE 5-6 was the only determinant that was significantly associated with improvement in physical capacity. Additional controlled studies are necessary to demonstrate causality and gather more information about its usefulness, and optimal handcycle training regimes for recreationally active wheelchair users.IMPLICATIONS FOR REHABILITATIONMonitoring of handcycle training load is important to structure the training effort and intensity over time and to eventually optimize performance capacity. This is especially important for relatively untrained wheelchair users, who have a low physical capacity and a high risk of overuse injuries and shoulder pain.Training load can be easily calculated by multiplying the intensity of the training (RPE 0-10) with the duration of the training in minutes.Results on handcycle training at RPE 5-6 intensity in recreationally active wheelchair users suggests to be promising and should be further investigated with controlled studies.
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Affiliation(s)
- Ingrid Kouwijzer
- Research and Development, Heliomare Rehabilitation Center, Wijk aan Zee, The Netherlands.,University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, Groningen, The Netherlands.,Amsterdam Rehabilitation Research Center
- Reade, Amsterdam, The Netherlands
| | - Linda J M Valent
- Research and Development, Heliomare Rehabilitation Center, Wijk aan Zee, The Netherlands
| | - Coen A M van Bennekom
- Research and Development, Heliomare Rehabilitation Center, Wijk aan Zee, The Netherlands.,Amsterdam UMC, University of Amsterdam, Department of Public and Occupational Health, Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | | | - Marcel W M Post
- Center of Excellence for Rehabilitation Medicine, UMCU Brain Center, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands.,University of Groningen, University Medical Center Groningen, Center for Rehabilitation, Groningen, The Netherlands
| | - Lucas H V van der Woude
- University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, Groningen, The Netherlands.,University of Groningen, University Medical Center Groningen, Center for Rehabilitation, Groningen, The Netherlands
| | - Sonja de Groot
- University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, Groningen, The Netherlands.,Amsterdam Rehabilitation Research Center
- Reade, Amsterdam, The Netherlands.,Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, The Netherlands
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Kraaijenbrink C, Vegter R, de Groot S, Arnet U, Valent L, Verellen J, van Breukelen K, Hettinga F, Perret C, Abel T, Goosey-Tolfrey V, van der Woude L. Biophysical aspects of handcycling performance in rehabilitation, daily life and recreational sports; a narrative review. Disabil Rehabil 2020; 43:3461-3475. [DOI: 10.1080/09638288.2020.1815872] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Cassandra Kraaijenbrink
- Center for Human Movement Sciences Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Movement Science, Institute for Sport Science, University of Münster, Münster, Germany
| | - Riemer Vegter
- Center for Human Movement Sciences Groningen, University Medical Center Groningen, Groningen, The Netherlands
- European Research Group in Disability Sport (ERGiDS)
| | - Sonja de Groot
- Center for Human Movement Sciences Groningen, University Medical Center Groningen, Groningen, The Netherlands
- European Research Group in Disability Sport (ERGiDS)
- Amsterdam Rehabilitation Research Center, Reade, Amsterdam, The Netherlands
| | | | - Linda Valent
- Heliomare Rehabilitation Center, Wijk aan Zee, The Netherlands
| | | | - Kees van Breukelen
- Handcycling Ergonomic Advisor (Sport)Wheelchair and Handbike Shop RD Mobility, Rijswijk, The Netherlands
- International Classifier for Handcycling, Wheelchairrugby, Wheelchairbasketball, Wheelchairhandball and PowerChair Hockey
| | | | - Claudio Perret
- European Research Group in Disability Sport (ERGiDS)
- Swiss Paraplegic Centre, Institute of Sports Medicine, Nottwil, Switzerland
| | - Thomas Abel
- European Research Group in Disability Sport (ERGiDS)
- Sports Sciences Center, University of Cologne, Cologne, Germany
| | - Victoria Goosey-Tolfrey
- European Research Group in Disability Sport (ERGiDS)
- School of Sports, Exercise and Health Sciences, Peter Harrison Center for Disability Sports, Loughborough University, Loughborough, UK
| | - Lucas van der Woude
- Center for Human Movement Sciences Groningen, University Medical Center Groningen, Groningen, The Netherlands
- European Research Group in Disability Sport (ERGiDS)
- Center for Rehabilitation, Groningen, The Netherlands
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Postma K, Bussmann JBJ, van Diemen T, Post MWM, Dekkers J, van Nes IJW, Osterthun R, van den Berg-Emons RJG. Physical Activity and Sedentary Behavior From Discharge to 1 Year After Inpatient Rehabilitation in Ambulatory People With Spinal Cord Injury: A Longitudinal Cohort Study. Arch Phys Med Rehabil 2020; 101:2061-2070. [PMID: 32750374 DOI: 10.1016/j.apmr.2020.06.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 04/23/2020] [Accepted: 06/29/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To evaluate changes in duration of physical activity (PA) and sedentary behavior (SB) from discharge to 1 year after inpatient rehabilitation in ambulatory people with spinal cord injury (SCI). DESIGN Longitudinal cohort study with objective measurements of physical behavior at discharge and at 6 and 12 months post discharge. SETTING Three rehabilitation centers and the participant's home environment. PARTICIPANTS Participants (N=47) with ambulatory function were consecutively recruited from the self-management and self-efficacy in patients with SCI cohort (age 18 years or older, recent SCI, expected inpatient stay ≥4wk). Mean age was 54.5±12.9 years, all had incomplete lesions, 53% were men, 49% had tetraplegia, and 51% were community ambulators at discharge. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Duration (min) of PA (summed duration of walking, cycling, running, and wheeling) and SB (sitting/lying). RESULTS Mean duration of PA increased by 21 min/d (95% confidence interval, 7-35) and SB decreased by 64 min/d (95% confidence interval, -94 to -35) from discharge to 6 months after inpatient rehabilitation. No changes were found in the second half-year. One year after discharge mean PA was 116±59 min/d and mean SB was 665±121 min/d. The increase in PA was the result of an almost doubling of time spent walking. Variability in physical behavior and its change was large. Older age and lower ambulation level were associated with lower PA, lower ambulation level with higher SB, and tetraplegia was associated with a reduced increase in PA. CONCLUSIONS At group level, duration of PA and SB improved following inpatient rehabilitation in ambulatory people with SCI. However, there were large differences between individuals. Levels 1 year after discharge were still unfavorable, particularly regarding SB.
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Affiliation(s)
- Karin Postma
- Rijndam Rehabilitation, Rotterdam; Department of Rehabilitation Medicine, Erasmus MC University Medical Center Rotterdam, Rotterdam.
| | - Johannes B J Bussmann
- Department of Rehabilitation Medicine, Erasmus MC University Medical Center Rotterdam, Rotterdam
| | - Tijn van Diemen
- Department of Rehabilitation, Sint Maartenskliniek, Nijmegen; Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht
| | - Marcel W M Post
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht; Department of Rehabilitation Medicine, Center for Rehabilitation, University of Groningen, University Medical Center Groningen, Groningen
| | - Jos Dekkers
- Dutch Spinal Cord Injury Association, Nijkerk, The Netherlands
| | | | - Rutger Osterthun
- Rijndam Rehabilitation, Rotterdam; Department of Rehabilitation Medicine, Erasmus MC University Medical Center Rotterdam, Rotterdam
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Wouda MF, Lundgaard E, Becker F, Strøm V. Changes in cardiorespiratory fitness and activity levels over the first year after discharge in ambulatory persons with recent incomplete spinal cord injury. Spinal Cord 2020; 59:354-360. [PMID: 32647328 PMCID: PMC7943418 DOI: 10.1038/s41393-020-0514-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 06/24/2020] [Accepted: 06/26/2020] [Indexed: 11/12/2022]
Abstract
Study design Secondary analysis of a clinical trial. Objectives To investigate changes in cardiorespiratory fitness (CRF) and activity level in ambulatory persons with SCI during the first year after discharge from inpatient rehabilitation. Setting Sunnaas Rehabilitation Hospital, Nesoddtangen, Norway. Methods Thirty persons with incomplete SCI, all community walkers (25 males and 5 females, 18–69 years old) were recruited to a clinical trial of a 12 weeks home-based aerobic exercise program of either high or moderate intensity. During the last week of inpatient rehabilitation (baseline), participants performed a maximal exercise test on a treadmill (peak oxygen uptake; peak VO2) and a 6-min walking test (6MWT). Also, total daily energy expenditure (TDEE) and daily amount of steps were measured continuously during 7 days in the participants’ homes. All tests were repeated after 3 and 12 months (post tests). Results Twenty of the 30 clinical trial participants performed baseline and both posttests and are included in this secondary analysis. We found no statistically significant between-group differences in the time course over the first year of either peak VO2, 6MWT, or physical activity outcomes. Therefore, data from both exercise groups and the control group were merged for secondary analyses, revealing statistically significant increase over time in peak VO2, 6MWT, and TDEE. The increase over time in the average daily steps did not reach statistical significance. Conclusions Ambulatory persons with SCI were able to increase their CRF levels over the first year after discharge from inpatient rehabilitation, despite a minimal increase in activity levels.
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Affiliation(s)
- Matthijs F Wouda
- Department of Research, Sunnaas Rehabilitation Hospital, Oslo, Norway.
| | - Eivind Lundgaard
- Department of Research, Sunnaas Rehabilitation Hospital, Oslo, Norway
| | - Frank Becker
- Department of Research, Sunnaas Rehabilitation Hospital, Oslo, Norway.,University of Oslo, Institute of Clinical Medicine, Oslo, Norway
| | - Vegard Strøm
- Department of Research, Sunnaas Rehabilitation Hospital, Oslo, Norway
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Changes in Quality of Life During Training for the HandbikeBattle and Associations With Cardiorespiratory Fitness. Arch Phys Med Rehabil 2020; 101:1017-1024. [DOI: 10.1016/j.apmr.2019.12.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 11/18/2019] [Accepted: 12/24/2019] [Indexed: 11/23/2022]
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Ferri-Caruana A, Millán-González L, García-Massó X, Pérez-Nombela S, Pellicer-Chenoll M, Serra-Añó P. Accelerometer assessment of physical activity in individuals with paraplegia who do and do not participate in physical exercise. J Spinal Cord Med 2020; 43:234-240. [PMID: 30547733 PMCID: PMC7054936 DOI: 10.1080/10790268.2018.1550597] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVE Our main goal was to measure physical activity (PA) in people with paraplegia. Secondarily, we aimed to establish the relationship between being engaged in physical exercise (PE) and reaching the recommended moderate-to-vigorous physical activity (MVPA) level. We further analyzed the effect of being engaged in PE on the PA levels. DESIGN Descriptive cross-sectional. SETTING Spanish associations for individuals with spinal cord injury. PARTICIPANTS Ninety-six manual wheelchair users with chronic paraplegia. INTERVENTIONS Participants wore a wrist accelerometer for one week. OUTCOME MEASURES Levels of PA and sedentary behavior. In addition, participants were classified into two groups, exercisers (EG) and non-exercisers (NEG) to analyze the effect of PE enrollment on the variables. RESULTS For all participants, a mean (SD) of 5,341.70 (966.4) minutes per week were spent engaged in sedentary behaviors, 2,188.99 (723.9) minutes were spent engaged in light activity, and 206.24 (180.0) minutes were spent engaged in MVPA. There was a significant relationship between PE and reaching the minimum levels of MVPA recommended [x2 (1) = 25.03, P < 0.01]. NEG showed a greater number of minutes per week for sedentary behavior [t (94) = 2.50, P < 0.05, r = 0.25]. The EG spent more than twice as much time doing MVPA than the NEG (263.8 min vs 114.3 min, respectively). CONCLUSIONS MVPA levels are low in manual wheelchair users who are not regular exercisers, but most of those who self-reported being regular exercisers reach the minimum levels recommended for health benefits. Sedentary behavior is a concern in this population.
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Affiliation(s)
- Ana Ferri-Caruana
- Departament d'Educació Física i Esports, Universitat de València, València, Spain
| | - Luis Millán-González
- Departament d'Educació Física i Esports, Universitat de València, València, Spain
| | - Xavier García-Massó
- Departament de Didàctica de l'Expressió Musical, Plàstica i Corporal, Universitat de València, Valencia, Spain
| | - Soraya Pérez-Nombela
- Departamento de Enfermería, Fisioterapia y Terapia Ocupacional, Universidad de Castilla La Mancha, Toledo, Spain
| | | | - Pilar Serra-Añó
- Departament de Fisioteràpia, Universitat de València, València, Spain
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36
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Abonie US, Edwards AM, Hettinga FJ. Optimising activity pacing to promote a physically active lifestyle in medical settings: A narrative review informed by clinical and sports pacing research. J Sports Sci 2020; 38:590-596. [DOI: 10.1080/02640414.2020.1721254] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Ulric S. Abonie
- School of Sport, Rehabilitation and Exercise Science, University of Essex, Colchester, UK
- Department of Physiotherapy and Rehabilitation Sciences, University of Health and Allied Sciences, Ho, Ghana
| | - Andrew M. Edwards
- School of Human and Life Sciences, Canterbury Christ Church University, Canterbury, UK
| | - Florentina J. Hettinga
- School of Sport, Rehabilitation and Exercise Science, University of Essex, Colchester, UK
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne, UK
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Ma JK, Cheifetz O, Todd KR, Chebaro C, Phang SH, Shaw RB, Whaley KJ, Martin Ginis KA. Co-development of a physiotherapist-delivered physical activity intervention for adults with spinal cord injury. Spinal Cord 2020; 58:778-786. [PMID: 31969687 DOI: 10.1038/s41393-020-0422-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 01/11/2020] [Accepted: 01/13/2020] [Indexed: 11/09/2022]
Abstract
STUDY DESIGNS Cross-sectional survey, semi-structured interview, and randomized-controlled trial. OBJECTIVES Optimal spinal cord injury (SCI)-specific PA intervention strategies appropriate for the physiotherapist setting are unknown. The purpose of this paper is to describe the rigorous co-development process of a theory-based, physiotherapist-led PA intervention for people with SCI and assess its feasibility for implementation in the rehabilitation setting. SETTING Community. METHODS Co-development of the intervention included (1) a review of the literature; (2) key informant interviews with people with SCI (n = 26); (3) a national online survey of physiotherapists' barriers, needs, and preferences (n = 239); (4) a review of the evidence and recommendations for the intervention from a stakeholder expert panel (n = 13); and (5) a randomized controlled trial of intervention training and its effects on implementation determinants amongst physiotherapists (n = 20). RESULTS Almost 300 people with SCI and physiotherapists were engaged in the intervention development process. Optimal intervention delivery should be tailored and include (1) education on safety, PA guidelines, and behaviour change techniques, (2) referral to other peers, local programmes, and health professionals, and (3) adapted exercise prescriptions. Following intervention implementation training, physiotherapists demonstrated stronger tested and perceived knowledge, skills, resources, and confidence for promoting PA to people with SCI, ps < 0.05. CONCLUSIONS This development process serves as an example methodology for using theory to co-create a leisure-time physical activity behaviour change intervention tailored for people with SCI.
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Affiliation(s)
- Jasmin K Ma
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, BC, Canada. .,International Collaboration on Repair Discoveries (ICORD), Blusson Spinal Cord Centre (BSCC), University of British Columbia, Vancouver, BC, Canada.
| | - Oren Cheifetz
- Hematology/Oncology Program, Hamilton Health Sciences, Hamilton, ON, Canada
| | - Kendra R Todd
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, BC, Canada.,International Collaboration on Repair Discoveries (ICORD), Blusson Spinal Cord Centre (BSCC), University of British Columbia, Vancouver, BC, Canada
| | - Carole Chebaro
- Neurocore Physiotherapy & Pilates Centre, Richmond Hill, ON, Canada
| | | | - Robert B Shaw
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, BC, Canada.,International Collaboration on Repair Discoveries (ICORD), Blusson Spinal Cord Centre (BSCC), 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), Blusson Spinal Cord Centre (BSCC), University of British Columbia, Vancouver, BC, Canada.,Department of Medicine, Faculty of Medicine, University of British Columbia, Kelowna, BC, Canada
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38
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Declerck L, Kaux JF, Vanderthommen M, Lejeune T, Stoquart G. The Effect of Adaptive Sports on Individuals with Acquired Neurological Disabilities and Its Role in Rehabilitation: A Systematic Review. Curr Sports Med Rep 2019; 18:458-473. [PMID: 31834178 DOI: 10.1249/jsr.0000000000000662] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The aims of this systematic review were to report on the feasibility of adaptive sports for individuals with acquired central neurological lesion; to analyze the effects of this approach according to the domains of the International Classification of Functioning, Health and Disability (ICF); and to emit guiding points for future research. Two authors searched PubMed, Scopus, Cochrane, Pedro, and SPORTdiscus for eligible trials. Data concerning demographics, outcome measures, results, and conclusions were extracted, and a qualitative synthesis was performed. Adaptive sports seem to be a feasible, efficient, and cost-effective complement to conventional rehabilitation. Significant effects were found on all domains of the ICF, except "environmental factors." Key factors, such as intervention volume, intensity, and type, play a determining role. This review is the first to expose the beneficial effects of adaptive sports practice among individuals with neurological lesions by relying on prospective evidence.
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Affiliation(s)
- Louise Declerck
- Neuromusculoskeletal Laboratory, Institute of Experimental and Clinical Research, Brussels, BELGIUM
| | - Jean-François Kaux
- Department of Sport and Rehabilitation Sciences, University of Liège, Liège, BELGIUMSportS, FIFA Medical Centre of Excellence, IOC Research Centre for Prevention of Injury and Protection of Athlete Health, FIMS Clinical Centre of Sports Medicine, University and University Hospital of Liège, Liège, BELGIUM.,SportS, FIFA Medical Centre of Excellence, IOC Research Centre for Prevention of Injury and Protection of Athlete Health, FIMS Clinical Centre of Sports Medicine, University and University Hospital of Liège, Liège, BELGIUM
| | - Marc Vanderthommen
- Department of Sport and Rehabilitation Sciences, University of Liège, Liège, BELGIUMSportS, FIFA Medical Centre of Excellence, IOC Research Centre for Prevention of Injury and Protection of Athlete Health, FIMS Clinical Centre of Sports Medicine, University and University Hospital of Liège, Liège, BELGIUM
| | - Thierry Lejeune
- Neuromusculoskeletal Laboratory, Institute of Experimental and Clinical Research, Brussels, BELGIUM.,Department of Physical Medicine and Rehabilitation, University Clinic of Saint-Luc, Brussels, BELGIUM.,Louvain Bionics, Catholic University of Louvain, Louvain-La-Neuve, BELGIUM
| | - Gaëtan Stoquart
- Neuromusculoskeletal Laboratory, Institute of Experimental and Clinical Research, Brussels, BELGIUM.,Department of Physical Medicine and Rehabilitation, University Clinic of Saint-Luc, Brussels, BELGIUM.,Louvain Bionics, Catholic University of Louvain, Louvain-La-Neuve, BELGIUM
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39
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Shin JC, Han EY, Cho KH, Im SH. Improvement in Pulmonary Function with Short-term Rehabilitation Treatment in Spinal Cord Injury Patients. Sci Rep 2019; 9:17091. [PMID: 31745108 PMCID: PMC6863911 DOI: 10.1038/s41598-019-52526-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 10/15/2019] [Indexed: 11/15/2022] Open
Abstract
Cervical and upper thoracic spinal cord injury causes impairments in respiratory muscle performance, leading to variable degrees of pulmonary dysfunction and rendering deep breathing difficult for affected individuals. In this retrospective study, we investigated the effects of self-directed respiratory muscle training in this context by assessing pulmonary function relative to spinal cord injury characteristics. A total of 104 spinal cord injury patients (tetraplegia/paraplegia; 65/39, acute/subacute/chronic; 14/42/48) were admitted for short-term (4–8 weeks) in-patient clinical rehabilitation. Initial evaluation revealed a compromised pulmonary function with a percentage of predicted value of 62.0 and 57.5 in forced vital capacity in supine and forced vital capacity in sitting positions, respectively. Tetraplegic patients had more compromised pulmonary function compared with paraplegic patients. At follow-up evaluation, the percentage of predicted value of forced vital capacity in supine and sitting position improved overall on average by 11.7% and 12.7%, respectively. The peak cough flow improved by 22.7%. All assessed pulmonary function parameters improved significantly in all subgroups, with the greatest improvements found in patients with tetraplegia and subacute spinal cord injury. Therefore, short-term self-directed respiratory muscle training should be incorporated into all spinal cord injury rehabilitation regimens, especially for patients with tetraplegia and subacute spinal cord injury, as well as those with chronic spinal cord injury.
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Affiliation(s)
- Ji Cheol Shin
- Department and Research Institute of Rehabilitation Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Eun Young Han
- Department of Rehabilitation Medicine, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Republic of Korea
| | - Kye Hee Cho
- Department of Rehabilitation Medicine, CHA Gumi Medical Center, CHA University, Gumi, Gyeongsangbukdo, Republic of Korea
| | - Sang Hee Im
- Department and Research Institute of Rehabilitation Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
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40
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Leving MT, de Groot S, Woldring FAB, Tepper M, Vegter RJK, van der Woude LHV. Motor learning outcomes of handrim wheelchair propulsion during active spinal cord injury rehabilitation in comparison with experienced wheelchair users. Disabil Rehabil 2019; 43:1429-1442. [PMID: 31656102 DOI: 10.1080/09638288.2019.1668484] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE To investigate changes in wheelchair propulsion technique and mechanical efficiency across first five weeks of active inpatient spinal cord injury rehabilitation and to compare the outcomes at discharge with experienced wheelchair users with spinal cord injury. METHODS Eight individuals with recent spinal cord injury performed six weekly submaximal exercise tests. The first and last measurement additionally contained a wheelchair circuit and peak graded exercise test. Fifteen experienced individuals performed all above-mentioned tests on one occasion. RESULTS Mechanical efficiency and propulsion technique did not change during the five weeks of inpatient rehabilitation. Peak power output during peak graded test and performance time on the wheelchair circuit improved between the first and the last week. No difference in propulsion technique, peak power output, and performance time was found between the persons with a recent injury and the experienced group. Mechanical efficiency was higher after the correction for the difference in relative power output in the experienced group. CONCLUSION The group with a recent injury did not improve mechanical efficiency and propulsion technique over the period of active rehabilitation, despite significant improvements on the wheelchair circuit and in work capacity. The only significant difference between the groups was found in mechanical efficiency.Implications for rehabilitationThe lack of time-dependent changes in mechanical efficiency and propulsion technique in the group with a recent spinal cord injury, combined with the lack of differences in technique, work capacity and on the wheelchair circuit between the groups, suggest that important adaptations of motor learning may happen even earlier in rehabilitation and emphasize that the group in active rehabilitation was relatively skilled.Standardized observational analyses of handrim wheelchair propulsion abilities during early spinal cord injury rehabilitation provide detailed understanding of wheelchair technique, skill as well as wheelchair propulsion capacity.Measurement of external power output is critical to interpretation of gross efficiency, propulsion technique, and capacity.Wheelchair quality and body weight - next to wheelchair fitness and skill - require careful consideration both in early rehabilitation as well as in the chronic phase of spinal cord injury.
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Affiliation(s)
- Marika T Leving
- Center for Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Sonja de Groot
- Center for Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Amsterdam Rehabilitation Research Center
- Reade, Amsterdam, The Netherlands
| | - Ferry A B Woldring
- Center for Rehabilitation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Marga Tepper
- Center for Rehabilitation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Riemer J K Vegter
- Center for Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Lucas H V van der Woude
- Center for Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Center for Rehabilitation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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41
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Williams AMM, Chisholm AE, Lynn A, Malik RN, Eginyan G, Lam T. Arm crank ergometer "spin" training improves seated balance and aerobic capacity in people with spinal cord injury. Scand J Med Sci Sports 2019; 30:361-369. [PMID: 31621945 DOI: 10.1111/sms.13580] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 09/16/2019] [Accepted: 10/08/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND There is some evidence that upper-body training modalities can improve not only aerobic capacity but also seated balance in people with spinal cord injury (SCI), even in those classified with motor-complete paralysis above T6. Here, we evaluated the effect of arm crank ergometry (ACE) "spin" training on trunk muscle recruitment and its effects on seated balance and aerobic capacity. METHODS Eight individuals with high-level complete and 6 with either a low-level complete or a motor-incomplete SCI participated in this study. Participants completed 5 weeks of a group ACE "spin" training protocol which featured modulations in cadence and resistance as well as back-supported and unsupported bouts. Surface electromyography was used to confirm trunk muscle recruitment during unsupported ACE. Changes in aerobic capacity (peak oxygen consumption) and seated balance control (center of pressure parameters) were assessed at pre- and post-intervention. RESULTS Unsupported ACE was effective for eliciting trunk muscle activity (P < .05). Following training, peak oxygen consumption significantly improved by an average of 16% (P = .005). Static sitting balance significantly improved from pre- to post-intervention, but only when tested with eyes closed as measured by a reduction in area (P = .047) and velocity of center of pressure (P = .013). No significant changes were observed in static sitting balance with eyes open or in dynamic sitting balance. CONCLUSION Group ACE "spin" classes may benefit not only aerobic fitness but also static seated balance control in people with SCI.
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Affiliation(s)
- Alison M M Williams
- School of Kinesiology, University of British Columbia, Vancouver, British Columbia, Canada.,Physical Activity Research Centre (PARC), International Collaboration On Repair Discoveries, Vancouver Costal Health Research Institute, Vancouver, British Columbia, Canada
| | - Amanda E Chisholm
- School of Kinesiology, University of British Columbia, Vancouver, British Columbia, Canada.,Physical Activity Research Centre (PARC), International Collaboration On Repair Discoveries, Vancouver Costal Health Research Institute, Vancouver, British Columbia, Canada
| | - Andrea Lynn
- School of Kinesiology, University of British Columbia, Vancouver, British Columbia, Canada.,Physical Activity Research Centre (PARC), International Collaboration On Repair Discoveries, Vancouver Costal Health Research Institute, Vancouver, British Columbia, Canada
| | - Raza N Malik
- School of Kinesiology, University of British Columbia, Vancouver, British Columbia, Canada.,Physical Activity Research Centre (PARC), International Collaboration On Repair Discoveries, Vancouver Costal Health Research Institute, Vancouver, British Columbia, Canada
| | - Gevorg Eginyan
- School of Kinesiology, University of British Columbia, Vancouver, British Columbia, Canada.,Physical Activity Research Centre (PARC), International Collaboration On Repair Discoveries, Vancouver Costal Health Research Institute, Vancouver, British Columbia, Canada
| | - Tania Lam
- School of Kinesiology, University of British Columbia, Vancouver, British Columbia, Canada.,Physical Activity Research Centre (PARC), International Collaboration On Repair Discoveries, Vancouver Costal Health Research Institute, Vancouver, British Columbia, Canada
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42
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Brizuela G, Sinz S, Aranda R, Martínez-Navarro I. The effect of arm-crank exercise training on power output, spirometric and cardiac function and level of autonomy in persons with tetraplegia. Eur J Sport Sci 2019; 20:926-934. [PMID: 31566476 DOI: 10.1080/17461391.2019.1674927] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Studies on the effects of exercise training in persons with cervical spinal cord injury (CSCI) are scarce. The aim of this study was to determine the effect of an 8-week stationary arm-crank exercise (ACE) training programme on the level of autonomy, exercise performance, pulmonary functional parameters and resting heart rate variability (HRV) in persons with CSCI. Quadriplegia Index of Function (QIF), arm-crank peak power output (Ppeak), spirometric variables, and HRV indices were measured before and after the training programme in a group of 11 persons with CSCI. ACE training increased Ppeak in both groups (p < 0.05), whereas maximum voluntary ventilation (MVV) and low frequency HRV (LF) improved only in the lower CSCI group (p < 0.05). Moreover, QIF and Ppeak were significantly correlated before (r = 0.88; p < 0.01) and after (r = 0.86; p < 0.01) the training period. However, no significant changes were found in the level of autonomy (QIF) as a result of the intervention. Therefore, stationary ACE training appears to be a feasible and effective method for aerobic exercise in persons with tetraplegia and a short-term intervention is able to significantly improve exercise capacity, cardiac autonomic regulation and respiratory muscle endurance, regardless of the absence of significant immediate changes in the level of autonomy.
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Affiliation(s)
- G Brizuela
- Department of Physical Education and Sports, Faculty of Physical Activity and Sport Sciences, University of Valencia, Valencia, Spain
| | - S Sinz
- Department of Physical Education and Sports, Faculty of Physical Activity and Sport Sciences, University of Valencia, Valencia, Spain
| | - R Aranda
- Department of Physical Education and Sports, Faculty of Physical Activity and Sport Sciences, University of Valencia, Valencia, Spain.,Sports Support Center - Valencian Sport Council, Valencia, Spain
| | - I Martínez-Navarro
- Department of Physical Education and Sports, Faculty of Physical Activity and Sport Sciences, University of Valencia, Valencia, Spain.,Vithas Sports Health Unit, 9 de Octubre Hospital, Valencia, Spain
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Harris KK, Himel AR, Duncan BC, Grill RJ, Grayson BE. Energy balance following diets of varying fat content: metabolic dysregulation in a rodent model of spinal cord contusion. Physiol Rep 2019; 7:e14207. [PMID: 31456327 PMCID: PMC6712238 DOI: 10.14814/phy2.14207] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 07/28/2019] [Indexed: 12/20/2022] Open
Abstract
Within the spinal cord injured (SCI) population, metabolic dysfunction may be exacerbated. Models of cord injury coupled with metabolic stressors have translational relevance to understand disease progression in this population. In the present study, we used a rat model of thoracic SCI at level T10 (tSCI) and administered diets comprised of either 9% or 40% butterfat to create a unique model system to understand the physiology of weight regulation following cord injury. SCI rats that recovered on chow for 28 days had reduced body mass, lean mass, and reduced fat mass but no differences in percentage of lean or fat mass composition. Following 12 weeks on either low-fat diet (LFD) or high-fat diet (HFD), SCI rats maintained on LFD did not gain weight at the same rate as SCI animals maintained on HFD. LFD-SCI had reduced feed conversion efficiency in comparison to Sham-LFD whereas tSCI-HFD were equivalent to Sham-HFD rats. Although SCI rats still maintained lower lean body mass, by the end of the study HFD-fed rats had higher body fat percentage than LFD-fed rats. Macronutrient selection testing demonstrated SCI rats had a significant preference for protein over Sham rats. Analysis of metabolic cage activity showed tSCI rats had elevated energy expenditure, despite reduced locomotor activity. Muscle triglycerides and cholesterol were reduced only in LFD-tSCI rats. These data suggest that consumption of HFD by tSCI rats alters the trajectory of metabolic dysfunction in the context of spinal cord disease progression.
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Affiliation(s)
- Kwamie K. Harris
- Department of Neurobiology and Anatomical SciencesUniversity of Mississippi Medical CenterJacksonMississippi
| | - Alexandra R. Himel
- Department of Neurobiology and Anatomical SciencesUniversity of Mississippi Medical CenterJacksonMississippi
| | - Brittany C. Duncan
- Department of Neurobiology and Anatomical SciencesUniversity of Mississippi Medical CenterJacksonMississippi
| | - Raymond J. Grill
- Department of Neurobiology and Anatomical SciencesUniversity of Mississippi Medical CenterJacksonMississippi
| | - Bernadette E. Grayson
- Department of Neurobiology and Anatomical SciencesUniversity of Mississippi Medical CenterJacksonMississippi
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Cerebrovascular function is preserved during mild hyperthermia in cervical spinal cord injury. Spinal Cord 2019; 57:979-984. [DOI: 10.1038/s41393-019-0321-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 06/24/2019] [Accepted: 06/25/2019] [Indexed: 02/02/2023]
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45
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Physical Exercise for Individuals With Spinal Cord Injury: Systematic Review Based on the International Classification of Functioning, Disability, and Health. J Sport Rehabil 2019; 28:505-516. [DOI: 10.1123/jsr.2017-0185] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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46
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Graham ZA, Siedlik JA, Harlow L, Sahbani K, Bauman WA, Tawfeek HA, Cardozo CP. Key Glycolytic Metabolites in Paralyzed Skeletal Muscle Are Altered Seven Days after Spinal Cord Injury in Mice. J Neurotrauma 2019; 36:2722-2731. [PMID: 30869558 DOI: 10.1089/neu.2018.6144] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Spinal cord injury (SCI) results in rapid muscle atrophy and an oxidative-to-glycolytic fiber-type shift. Those with chronic SCI are more at risk for developing insulin resistance and reductions in glucose clearance than able-bodied individuals, but how glucose metabolism is affected after SCI is not well known. An untargeted metabolomics approach was utilized to investigate changes in whole-muscle metabolites at an acute (7-day) and subacute (28-day) time frame after a complete T9 spinal cord transection in 20-week-old female C57BL/6 mice. Two hundred one metabolites were detected in all samples, and 83 had BinBase IDs. A principal components analysis showed the 7-day group as a unique cluster. Further, 36 metabolites were altered after 7- and/or 28-day post-SCI (p values <0.05), with 12 passing further false discovery rate exclusion criteria; of those 12 metabolites, three important glycolytic molecules-glucose and downstream metabolites pyruvic acid and lactic acid-were reduced at 7 days compared to those values in sham and/or 28-day animals. These changes were associated with altered expression of proteins associated with glycolysis, as well as monocarboxylate transporter 4 gene expression. Taken together, our data suggest an acute disruption of skeletal muscle glucose uptake at 7 days post-SCI, which leads to reduced pyruvate and lactate levels. These levels recover by 28 days post-SCI, but a reduction in pyruvate dehydrogenase protein expression at 28 days post-SCI implies disruption in downstream oxidation of glucose.
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Affiliation(s)
- Zachary A Graham
- National Center for the Medical Consequences of Spinal Cord Injury, James J. Peters VA Medical Center, Bronx, New York.,Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Lauren Harlow
- National Center for the Medical Consequences of Spinal Cord Injury, James J. Peters VA Medical Center, Bronx, New York
| | - Karim Sahbani
- National Center for the Medical Consequences of Spinal Cord Injury, James J. Peters VA Medical Center, Bronx, New York
| | - William A Bauman
- National Center for the Medical Consequences of Spinal Cord Injury, James J. Peters VA Medical Center, Bronx, New York.,Medical Service, James J. Peters VA Medical Center, Bronx, New York.,Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.,Department of Rehabilitation Medicine and Human Performance, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Hesham A Tawfeek
- National Center for the Medical Consequences of Spinal Cord Injury, James J. Peters VA Medical Center, Bronx, New York.,Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Christopher P Cardozo
- National Center for the Medical Consequences of Spinal Cord Injury, James J. Peters VA Medical Center, Bronx, New York.,Medical Service, James J. Peters VA Medical Center, Bronx, New York.,Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.,Department of Rehabilitation Medicine and Human Performance, Icahn School of Medicine at Mount Sinai, New York, New York
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47
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van den Akker LE, Holla JFM, Dadema T, Visser B, Valent LJ, de Groot S, Dallinga JM, Deutekom M. Determinants of physical activity in wheelchair users with spinal cord injury or lower limb amputation: perspectives of rehabilitation professionals and wheelchair users. Disabil Rehabil 2019; 42:1934-1941. [DOI: 10.1080/09638288.2019.1577503] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Lizanne E. van den Akker
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Haarlem, The Netherlands
| | - Jasmijn F. M. Holla
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Haarlem, The Netherlands
- Amsterdam Rehabilitation Research Centre, Reade, Amsterdam, The Netherlands
| | - Tessa Dadema
- Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Bart Visser
- Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Linda J. Valent
- Department of Research and Development, Heliomare Rehabilitation Centre, Wijk aan Zee, The Netherlands
| | - Sonja de Groot
- Amsterdam Rehabilitation Research Centre, Reade, Amsterdam, The Netherlands
- Centre for Human Movement Sciences, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Joan M. Dallinga
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Haarlem, The Netherlands
- Faculty of Sports and Nutrition, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Marije Deutekom
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Haarlem, The Netherlands
- Faculty of Sports and Nutrition, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
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48
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Kooijmans H, Post M, Motazedi E, Spijkerman D, Bongers-Janssen H, Stam H, Bussman H. Exercise self-efficacy is weakly related to engagement in physical activity in persons with long-standing spinal cord injury. Disabil Rehabil 2019; 42:2903-2909. [PMID: 30907149 DOI: 10.1080/09638288.2019.1574914] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Aims: Many people with a long-standing spinal cord injury have an inactive lifestyle. Although exercise self-efficacy is considered a key determinant of engaging in exercise, the relationship between exercise self-efficacy and physical activity remains unclear. Therefore, this study examines the relationship between exercise self-efficacy and the amount of physical activity in persons with long-standing spinal cord injury.Methods: This cross-sectional study included 268 individuals (aged 28-65 years) with spinal cord injury ≥ 10 years and using a wheelchair. Physical activity was measured with the Physical Activity Scale for Individuals with Physical Disabilities. Exercise self-efficacy was assessed with the Spinal cord injury Exercise Self-Efficacy Scale. Univariate and multivariable regression analyses were performed to test for the association between exercise self-efficacy and physical activity, controlling for supposed confounders.Results: Univariate regression analysis revealed that exercise self-efficacy was significantly related to the level of daily physical activity (β = 0.05; 95% CI 0.04-0.07; 15% explained variance; p < 0.001). In multivariable regression analysis exercise self-efficacy remained, explaining a significant additional amount of the variance (2%; p < 0.001) of physical activity.Conclusion: Exercise-self efficacy is a weak but independent explanatory factor of the level of physical activity among persons with long-standing spinal cord injury. Longitudinal trials are needed to study the impact of interventions targeting an increase of exercise self-efficacy on the amount of physical activity performed.Implications for rehabilitationPre-intervention levels of exercise-self-efficacy might mediate the effectiveness of interventions that aim at increasing physical activities in people with a long-standing spinal cord injury.Enhancing exercise-self efficacy may improve levels of physical activity, even in people with a long-standing spinal cord injury.When it comes to enhancing physical activity, efforts to enhance non-structured daily physical activities such as household activities and gardening might be as important as efforts to enhance sports and other physical exercise.
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Affiliation(s)
| | - Marcel Post
- De Hoogstraat Center of Excellence in Rehabilitation Medicine, Utrecht, Netherlands
| | - Ehsan Motazedi
- Plant Sciences Group, Wageningen University and Research, Wageningen, Netherlands
| | | | | | - Henk Stam
- Erasmus MC, Rehabilitation Medicine, Rotterdam, Netherlands
| | - Hans Bussman
- Erasmus MC, Rehabilitation Medicine, Rotterdam, Netherlands
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49
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Best KL, Routhier F, Sweet SN, Lacroix E, Arbour-Nicitopoulos KP, Borisoff JF. Smartphone-Delivered Peer Physical Activity Counseling Program for Individuals With Spinal Cord Injury: Protocol for Development and Pilot Evaluation. JMIR Res Protoc 2019; 8:e10798. [PMID: 30901001 PMCID: PMC6450480 DOI: 10.2196/10798] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 08/15/2018] [Accepted: 09/14/2018] [Indexed: 12/21/2022] Open
Abstract
Background Leisure-time physical activity (LTPA) is a critical component of a healthy lifestyle for individuals with spinal cord injury (SCI). However, most individuals are not sufficiently active to accrue health benefits. The Active Living Lifestyles program for individuals with SCI who use manual wheelchairs (ALLWheel) targets important psychological factors that are associated with LTPA uptake and adherence while overcoming some barriers associated with participation restrictions. Objective The goal of the paper is to describe the protocol for the development and evaluation of the ALLWheel program for individuals with SCI who use manual wheelchairs. Methods The first three stages of the Medical Research Council framework for developing and evaluating complex interventions (ie, preclinical, modeling, exploratory) are described. The preclinical phase will consist of scoping and systematic reviews and review of theory. The intervention will be modeled by expert opinions and consensus through focus groups and Delphi surveys with individuals with SCI, clinicians, and community partners. Finally, the feasibility and potential influence of the ALLWheel program on LTPA and psychological outcomes will be evaluated. Results This project is funded by the Craig H Neilsen Foundation, the Fonds de Recherche du Québec–Santé, and the Canadian Disability Participation Project and is currently underway. Conclusions Using peer trainers and mobile phone technology may help to cultivate autonomy-supportive environments that also enhance self-efficacy. Following a framework for developing and evaluating a novel intervention that includes input from stakeholders at all stages will ensure the final product (ie, a replicable intervention) is desirable to knowledge users and ready for evaluation in a randomized controlled trial. If effective, the ALLWheel program has the potential to reach a large number of individuals with SCI to promote LTPA uptake and adherence. International Registered Report Identifier (IRRID) DERR1-10.2196/10798
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Affiliation(s)
- Krista L Best
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Institut de Réadaptation en Déficience Physique de Québec, Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale National, Quebec, QC, Canada.,Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec, QC, Canada
| | - François Routhier
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Institut de Réadaptation en Déficience Physique de Québec, Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale National, Quebec, QC, Canada.,Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec, QC, Canada
| | - Shane N Sweet
- Department of Kinesiology & Physical Education, McGill University, Montreal, QC, Canada.,Centre de Recherche Interdisciplinaire en Réadaptation du Montréal Métropolitain, Montreal, QC, Canada
| | - Emilie Lacroix
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Institut de Réadaptation en Déficience Physique de Québec, Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale National, Quebec, QC, Canada
| | | | - Jaimie F Borisoff
- Rehabilitation Engineering Design Laboratory, British Columbia Institute of Technology, Burnaby, BC, Canada.,International Collaboration on Repair Discoveries, Vancouver Coastal Health, Vancouver, BC, Canada
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50
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DelGrande B, LaCoppola C, Moriello G, Sanicola K. Outcomes following an adaptive rock climbing program in a person with an incomplete spinal cord injury: A case report. Physiother Theory Pract 2019; 36:1466-1475. [PMID: 30870058 DOI: 10.1080/09593985.2019.1587799] [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: 10/27/2022]
Abstract
Purpose: The purpose of this case report was to document outcomes following a rock climbing program for an individual with an incomplete spinal cord injury (SCI). Case Description: The participant was a 61 year-old male who sustained a C6 cervical AIS D SCI. Initially, he was only able to climb 30% of the rock wall with assistance and was unable to climb unassisted. Intervention: Outcome measures included muscle strength, arm girth, the Mini-Balance Evaluation Systems Test (Mini-BESTest), distance climbed, climbing performance, and the Quality of Life Profile for Adults with Physical Disabilities. The intervention included two 90-min sessions per week for 19 weeks. One session comprised traditional physical therapy and the second took place at an indoor rock climbing gym. Outcomes: Following the intervention, he was able to climb 100% of the wall with assistance and 48% unassisted. He made improvements in all categories of the quality of life scale, while changes in muscle strength and arm girth varied. No improvements were noted in balance. Conclusions: A task-based physical therapy program focusing on strengthening and rock climbing-specific activities improved the rock climbing ability of an individual with an incomplete cervical SCI.
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Affiliation(s)
- Brittany DelGrande
- Department of Physical Therapy, Glens Falls Hospital , Glens Falls, NY, USA
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