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Zhou R, Chen J, Tang Y, Wei C, Yu P, Ding X, Zhu L, Yao J, Ouyang Z, Qiao J, Xiong S, Dong L, Yin T, Li H, Feng Y, Cheng L. Multi-omics uncovers immune-modulatory molecules in plasma contributing to resistance exercise-ameliorated locomotor disability after incomplete spinal cord injury. Genome Med 2025; 17:10. [PMID: 39910614 DOI: 10.1186/s13073-025-01434-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 04/11/2024] [Accepted: 01/24/2025] [Indexed: 02/07/2025] Open
Abstract
BACKGROUND Exercise rehabilitation therapy has garnered widespread recognition for its beneficial effects on the restoration of locomotor function in individuals with spinal cord injury (SCI). Notably, resistance exercise has demonstrated significant improvements in muscle strength, coordination, and overall functional recovery. However, to optimize clinical management and mimic exercise-like effects, it is imperative to obtain a comprehensive understanding of the molecular alterations that underlie these positive effects. METHODS We conducted a randomized controlled clinical trial investigating the effects of resistance exercise therapy for incomplete SCI. We integrated the analysis of plasma proteomics and peripheral blood mononuclear cells (PBMC) transcriptomics to explore the molecular and cellular changes induced by resistance exercise. Subsequently, we established a weight-loaded ladder-climbing mouse model to mimic the physiological effects of resistance exercise, and we analyzed the plasma proteome and metabolome, as well as the transcriptomes of PBMC and muscle tissue. Lastly, to confirm the transmissibility of the neuroprotective effects induced by resistance exercise, we intravenously injected plasma obtained from exercised male mice into SCI female mice during the non-acute phase. RESULTS Plasma proteomic and PBMC transcriptomic profiling underscored the notable involvement of the complement pathways and humoral immune response in the process of restoring locomotor function following SCI in the human trial. Moreover, it was emphasized that resistance exercise interventions could effectively modulate these pathways. Through employing plasma proteomic profiling and transcriptomic profiling of PBMC and muscle tissues in mice, our study revealed immunomodulatory responses that parallel those observed in human trials. In addition, our analysis of plasma metabolomics revealed an enhancement in lipid metabolism following resistance exercise. We observed that resistance exercise plasma exhibited significant effects in ameliorating locomotor disability after SCI via reducing demyelination and inhibiting neuronal apoptosis. CONCLUSIONS Our investigation elucidates the molecular alterations associated with resistance exercise therapy promoting recovery of locomotor function following incomplete SCI. Moreover, we demonstrate the direct neuroprotective effects delivered via exercise plasma injection, which facilitates spinal cord repair. Mechanistically, the comprehensive multi-omics analysis involving both human and mice reveals that the principal constituents responsible for the observed neuroprotective effects within the plasma are predominantly immunoregulatory factors, warranting further experimental validation. TRIAL REGISTRATION The study was retrospectively registered on 17 July, 2024, in Chinese Clinical Trial Registry (No.: ChiCTR2400087038) at https://www.chictr.org.cn/ .
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Affiliation(s)
- Ren Zhou
- Shanghai Institute of Hematology, State Key Laboratory of Medical Genomics, National Research Center for Translational Medicine at Shanghai, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Jibao Chen
- Department of Neurology and Neurological Rehabilitation, Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), Tongji University School of Medicine, Shanghai, 201619, China
| | - Yunhan Tang
- Shanghai Institute of Hematology, State Key Laboratory of Medical Genomics, National Research Center for Translational Medicine at Shanghai, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Chuijin Wei
- Shanghai Institute of Hematology, State Key Laboratory of Medical Genomics, National Research Center for Translational Medicine at Shanghai, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Ping Yu
- Shanghai Institute of Hematology, State Key Laboratory of Medical Genomics, National Research Center for Translational Medicine at Shanghai, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Xinmei Ding
- Department of General Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China
| | - Li'ao Zhu
- Department of Emergency, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China
| | - Jiajia Yao
- Department of Neurology and Neurological Rehabilitation, Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), Tongji University School of Medicine, Shanghai, 201619, China
| | - Zengqiang Ouyang
- Department of Neurology and Neurological Rehabilitation, Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), Tongji University School of Medicine, Shanghai, 201619, China
| | - Jing Qiao
- Shanghai Institute of Hematology, State Key Laboratory of Medical Genomics, National Research Center for Translational Medicine at Shanghai, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Shumin Xiong
- Shanghai Institute of Hematology, State Key Laboratory of Medical Genomics, National Research Center for Translational Medicine at Shanghai, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Liaoliao Dong
- Shanghai Institute of Hematology, State Key Laboratory of Medical Genomics, National Research Center for Translational Medicine at Shanghai, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Tong Yin
- Shanghai Institute of Hematology, State Key Laboratory of Medical Genomics, National Research Center for Translational Medicine at Shanghai, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Haiqing Li
- Department of Cardiac Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China.
| | - Ye Feng
- Department of Neurology and Neurological Rehabilitation, Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), Tongji University School of Medicine, Shanghai, 201619, China.
| | - Lin Cheng
- Shanghai Institute of Hematology, State Key Laboratory of Medical Genomics, National Research Center for Translational Medicine at Shanghai, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China.
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Chen LW, Islam MS, Harvey LA, Whitehead N, Hossain MS, Rahman E, Taoheed F, Urme NA, Glinsky JV. Strength training with electrical stimulation has no or little effect on the very weak muscles of patients with spinal cord injury: a randomised trial. J Physiother 2025; 71:42-47. [PMID: 39675950 DOI: 10.1016/j.jphys.2024.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Academic Contribution Register] [Received: 05/14/2024] [Revised: 10/13/2024] [Accepted: 11/20/2024] [Indexed: 12/17/2024] Open
Abstract
QUESTION Is electrical stimulation (ES) combined with strength training and usual care more effective than usual care alone in increasing the strength of very weak muscles in people with recent spinal cord injury (SCI)? DESIGN A randomised controlled trial with concealed allocation, intention-to-treat analysis and blinded outcome assessors. PARTICIPANTS Sixty participants with recent SCI were recruited from three SCI units in Australia and Bangladesh. INTERVENTIONS Participants were randomised to either a treatment or control group. A major muscle group of the upper or lower limb with Grade 1 or Grade 2 strength on a standard 6-point manual muscle test was selected. Participants in the experimental group received strength training combined with ES and usual care for the target muscle group over 8 weeks. Participants in the control group received only usual care. OUTCOME MEASURES Assessments were undertaken by a blinded assessor at baseline and 8 weeks. The primary outcome was voluntary muscle strength on a modified 13-point manual muscle test. The three secondary outcomes were participants' perceptions of strength, function and ability to perform self-selected goals. RESULTS The mean between-group difference for voluntary strength at 8 weeks was 0.7 out of 13 points (95% CI -0.7 to 2.1), where the clinically worthwhile treatment effect was deemed a priori as 1 point. None of the secondary outcomes demonstrated a clinically important effect. CONCLUSION Strength training combined with ES over 8 weeks has a negligible effect on the strength of very weak muscles in people with SCI. REGISTRATION ACTRN12621000197831.
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Affiliation(s)
- Lydia W Chen
- Department of Physiotherapy, Royal North Shore Hospital, Sydney, Australia; Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Md Shofiqul Islam
- Department of Physiotherapy, Bangladesh Health Professions Institute, the Academic Institute of the Centre for the Rehabilitation of the Paralysed, Dhaka, Bangladesh
| | - Lisa A Harvey
- Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; John Walsh Centre for Rehabilitation Research, Northern Sydney Local Health District, Sydney, Australia.
| | | | | | - Ehsanur Rahman
- Department of Physiotherapy and Rehabilitation, Jashore University of Science and Technology, Jashore, Bangladesh
| | - Farjana Taoheed
- Centre for the Rehabilitation of the Paralysed, Dhaka, Bangladesh
| | - Nadia Afrin Urme
- Department of Physiotherapy, Bangladesh Health Professions Institute, the Academic Institute of the Centre for the Rehabilitation of the Paralysed, Dhaka, Bangladesh
| | - Joanne V Glinsky
- Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; John Walsh Centre for Rehabilitation Research, Northern Sydney Local Health District, Sydney, Australia
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Glinsky JV, Harvey LA. Physiotherapy management of people with spinal cord injuries: an update. J Physiother 2024; 70:256-264. [PMID: 39370372 DOI: 10.1016/j.jphys.2024.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Academic Contribution Register] [Received: 09/16/2024] [Accepted: 09/19/2024] [Indexed: 10/08/2024] Open
Affiliation(s)
- Joanne V Glinsky
- Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; John Walsh Centre for Rehabilitation Research, Northern Sydney Local Health District, Sydney, Australia; Discipline of Physiotherapy, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
| | - Lisa A Harvey
- Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; John Walsh Centre for Rehabilitation Research, Northern Sydney Local Health District, Sydney, Australia
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Santos LV, Pereira ET, Suárez-Iglesias D, Ayán C, Oliveira CEPD, Moreira OC. Strength training as a non-pharmacological alternative to improve body composition, and quality of life in people with spinal cord injury: A systematic review. J Bodyw Mov Ther 2024; 39:285-292. [PMID: 38876640 DOI: 10.1016/j.jbmt.2024.03.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 04/12/2022] [Revised: 03/05/2024] [Accepted: 03/11/2024] [Indexed: 06/16/2024]
Abstract
INTRODUCTION Spinal cord injuries (SCI) have physiological, emotional, and economic consequences in the lives of affected people. Resistance training (RT) is efficient in improving several physiological factors, quality of life, and body composition. Due to the scarce literature on the analysis of isolated RT, the objective of this systematic review is to evaluate the effects of RT without the association of other techniques, in aspects related to the quality of life and body composition of people with SCI. EVIDENCE ACQUISITION The research was carried out in databases such as Pubmed, Cochrane, and Web of Science using the terms ("Spinal cord injury") AND (("Resistance Training") OR ("Strength training")). Given the lack of evidence on the subject, no deadline was set for the study to be eligible for analysis. EVIDENCE SYNTHESIS The search for the articles was carried out in November of 2023 and returned 470 results, of which 315 remained after the elimination of duplicates, with 281 being excluded after title analysis. A total of 34 abstracts were analyzed and 29 studies were excluded, leaving 5 complete articles for thorough analysis. CONCLUSIONS After analyzing the main results, we concluded that RT promotes significant improvements in body composition, pain, stress and depression symptoms, increased functionality, physical awareness, and quality of life.
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Affiliation(s)
- Lucas Vieira Santos
- Department of Physical Education, Federal University of Viçosa, Campus Viçosa, Viçosa, Minas Gerais State, Brazil
| | - Eveline Torres Pereira
- Department of Physical Education, Federal University of Viçosa, Campus Viçosa, Viçosa, Minas Gerais State, Brazil
| | - David Suárez-Iglesias
- Department of Physical Education and Sport, Institute of Biomedicine (IBIOMED) - University of León, León, Spain
| | - Carlos Ayán
- Department of Special Didactics, Faculty of Educational Sciences and Sports, University of Vigo, Campus A Xunqueira, Pontevedra, Spain
| | | | - Osvaldo Costa Moreira
- Institute of Biological Sciences and Health, Federal University of Viçosa, Campus Florestal, Florestal, Minas Gerais State, Brazil.
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Tharu NS, Wong AYL, Zheng YP. Transcutaneous Electrical Spinal Cord Stimulation Increased Target-Specific Muscle Strength and Locomotion in Chronic Spinal Cord Injury. Brain Sci 2024; 14:640. [PMID: 39061380 PMCID: PMC11274661 DOI: 10.3390/brainsci14070640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 06/10/2024] [Revised: 06/20/2024] [Accepted: 06/24/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND The recovery of locomotion is greatly prioritized, and neuromodulation has been emerging as a promising approach in recent times. STUDY DESIGN Single-subject research design. SETTINGS A laboratory at The Hong Kong Polytechnic University. OBJECTIVES To investigate the effects of augmenting activity-based therapy (ABT) to transcutaneous electrical spinal cord stimulation (TSCS) on enhancing specific lower limb muscle strength and improving locomotor ability in an individual with chronic incomplete spinal cord injury (iSCI). METHODS An individual with iSCI underwent two phases of treatment, ABT alone followed by combined ABT+TSCS, each for a period of 10 weeks. The TSCS stimulated T10-T11 and T12-L1 segments with a frequency of 30 Hz at an intensity between 105 mA and 130 mA. Manual muscle testing, 6 min walk test (6MWT), and surface electromyography (EMG) responses of specific lower limb muscles were measured. Additionally, spasticity and sensorimotor examinations were conducted every two weeks, while pain tolerance was recorded after each treatment session. RESULTS After the ABT+TSCS treatment, there was an increase in overall muscle strength grading (from 1.8 ± 0.3 to 2.2 ± 0.6 out of 5.0). The 6MWT showed a greater increase in walking distance (3.5 m to 10 m) after combined treatment than ABT alone. In addition, the EMG response of the anterior rectus femoris, biceps femoris, medial gastrocnemius, and tibialis anterior after ABT+TSCS increased more than after ABT alone. The spasticity grade was reduced (from 0.8 ± 0.7 to 0.5 ± 0.6) whereas the average lower limb motor score increased from 17 to 23 points. No adverse effects were reported. CONCLUSIONS ABT+TSCS increased the target-specific lower limb muscle strength and walking ability more than ABT alone in an individual with chronic iSCI.
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Affiliation(s)
- Niraj Singh Tharu
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong SAR, China;
| | - Arnold Yu Lok Wong
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China;
- Research Institute for Smart Ageing, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Yong-Ping Zheng
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong SAR, China;
- Research Institute for Smart Ageing, The Hong Kong Polytechnic University, Hong Kong SAR, China
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Tranter KE, Glinsky JV, Ben M, Patterson H, Blecher L, Chu J, Harvey LA. Using the benefit-harm trade-off method to determine the smallest worthwhile effect of intensive motor training on strength for people with spinal cord injury. Spinal Cord 2024; 62:314-319. [PMID: 38570578 PMCID: PMC11199133 DOI: 10.1038/s41393-024-00979-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 07/25/2023] [Revised: 03/05/2024] [Accepted: 03/07/2024] [Indexed: 04/05/2024]
Abstract
STUDY DESIGN Interviews using the benefit-harm trade-off method and an online survey. OBJECTIVES To determine the smallest worthwhile effect (SWE) of motor training on strength for people with spinal cord injury (SCI). SETTING SCI units, Australia. METHODS Forty people with recent SCI who had participated in motor training as part of their rehabilitation program (patient participants) and 37 physiotherapists (physiotherapist participants) working in SCI were recruited. The patient participants underwent an iterative process using the benefit-harm trade-off method to determine the SWE of motor training on strength. The physiotherapist participants were given an online survey to determine the SWE for five different scenarios. Both groups considered the SWE of a physiotherapy intervention involving an additional 12 h of motor training for 10 weeks on top of usual care. They were required to estimate the smallest improvement in strength (points on the Total Motor Score of the International Standards for Neurological Classification of SCI) to justify the effort and associated costs, risks or inconveniences of the motor training. RESULTS The median (interquartile range) smallest improvement in strength that patient and physiotherapist participants deemed worth the effort and associated costs, risks or inconveniences of the motor training was 3 (1-5) points, and 9 (7-13) points, respectively. CONCLUSIONS People with recent SCI are willing to devote 12 h a week for 10 weeks to motor training in addition to their usual care to gain small changes in strength. Physiotherapists wanted to see greater improvements to justify the intervention.
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Affiliation(s)
- Keira E Tranter
- John Walsh Centre for Rehabilitation Research, University of Sydney, Kolling Institute, Sydney, NSW, Australia
| | - Joanne V Glinsky
- John Walsh Centre for Rehabilitation Research, University of Sydney, Kolling Institute, Sydney, NSW, Australia
| | - Marsha Ben
- John Walsh Centre for Rehabilitation Research, University of Sydney, Kolling Institute, Sydney, NSW, Australia
| | | | - Lynn Blecher
- Prince of Wales Hospital, Sydney, NSW, Australia
| | - Jackie Chu
- John Walsh Centre for Rehabilitation Research, University of Sydney, Kolling Institute, Sydney, NSW, Australia
| | - Lisa A Harvey
- John Walsh Centre for Rehabilitation Research, University of Sydney, Kolling Institute, Sydney, NSW, Australia.
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Sørensen SL, Poulsen I, Harvey LA, Biering-Sørensen F, Nielsen JF. Robotic technology (ROBERT ®) to enhance muscle strength in the hip flexor muscles following spinal cord injury: a feasibility study. Spinal Cord Ser Cases 2024; 10:20. [PMID: 38600074 PMCID: PMC11006673 DOI: 10.1038/s41394-024-00630-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 04/03/2023] [Revised: 03/26/2024] [Accepted: 03/27/2024] [Indexed: 04/12/2024] Open
Abstract
STUDY DESIGN Feasibility study. OBJECTIVE To determine the feasibility of conducting a large trial designed to determine whether the ROBERT® can be used to increase the strength of the hip flexor muscles after spinal cord injury (SCI). The ROBERT® is a robotic device that provides assisted active movement while supporting the weight of the leg. Focus was on recruitment capability, suitability, and acceptability of the intervention and outcome measure. SETTING Specialised SCI centre in Denmark. METHODS All first-time admitted patients were screened to assess participant recruitment capability. Four people with SCI < 3 months tested a protocol consisting of 60 repetitions of hip flexion in supine conducted with the assistance of the ROBERT® three times a week for 4 weeks. Feasibility was assessed based on adherence to the protocol and completion rate and from the participants' perspectives. Maximal voluntary contraction (MVC) was accessed at baseline and four weeks. RESULTS The recruitment rate was 8% (7 months). The four participants completed 44 out of 48 sessions (92%). No adverse events occurred. One physiotherapist was required to set-up and supervise each session. The active exercise time varied from 7.5 to 17 min. The participants found the ROBERT® a good supplement to their usual rehabilitation. We were able to measure MVC in even very weak hip flexor muscles with a dynamometer MicroFET2 fixed to a frame. CONCLUSION The ROBERT® was feasible and acceptable. The participants perceived it as a supplement, not a replacement to usual physiotherapy. However, recruitment to the study was slow. TRIAL REGISTRATION ClinicalTrials.gov NCT05558254. Registered 28th September 2022.
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Affiliation(s)
- S L Sørensen
- Department of Neurology, Spinal Cord Injury Centre of Western Denmark, Regional Hospital Viborg, Viborg, Denmark.
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
| | - I Poulsen
- Department of Clinical Research, Copenhagen University Hospital, Amager and Hvidovre, Denmark
- Department of People and Technology, Roskilde University, Roskilde, Denmark
- Research Unit Nursing and Health Care, Health, Aarhus University, Aarhus, Denmark
| | - L A Harvey
- John Walsh Centre for Rehabilitation Research, Kolling Institute, Faculty of Medicine and Health, University of Sydney, St. Leonards, NSW, Australia
| | - F Biering-Sørensen
- Department for Brain- and Spinal Cord Injuries, Rigshospitalet, Copenhagen, Denmark
- Department for Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - J F Nielsen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Hammel Neurorehabilitation Centre and University Clinic, Aarhus University, Aarhus, Denmark
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Zawadka M, Gaweł M, Tomczyk-Warunek A, Turżańska K, Blicharski T. Relationship between Upper Limb Functional Assessment and Clinical Tests of Shoulder Mobility and Posture in Individuals Participating in Recreational Strength Training. J Clin Med 2024; 13:1028. [PMID: 38398339 PMCID: PMC10889156 DOI: 10.3390/jcm13041028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 01/15/2024] [Revised: 02/03/2024] [Accepted: 02/08/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND The upper limb is crucial for functioning in everyday life, thus comprehensive assessment is crucial for physically active people to monitor the effect of exercise and prevent injuries. The aim of this study was to analyse the relationship between upper limb function, shoulder mobility, and posture in individuals who participate in recreational strength training. METHODS Thirty-four subjects who engaged in strength training of the upper limbs were divided into two groups: Group 1 (exercise < 3 years) and Group 2 (exercise ≥ 3 years). Lateral scapular slide tests, head and clavicle posture evaluations, and shoulder mobility and closed kinetic chain tests were performed. RESULTS Group 1 had a greater flexion deficit in both shoulders than Group 2. There was greater external rotation in the non-dominant shoulder and a greater score of the closed kinetic chain test in Group 2 compared to Group 1. There were no statistically significant differences between groups regarding scapula, clavicle, and head posture. The closed kinetic chain test was correlated with a scapula position and symmetry in shoulder flexion in Group 2. CONCLUSIONS Long-term strength training of the upper limbs can be recommended to improve functional abilities in the closed kinetic chain, increase shoulder mobility, and reduce asymmetry.
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Affiliation(s)
- Magdalena Zawadka
- Department of Sports Medicine, Chair of Clinical Physiotherapy, Faculty of Health Sciences, Medical University of Lublin, Chodzki 15, 20-093 Lublin, Poland; (M.Z.); (M.G.)
| | - Marta Gaweł
- Department of Sports Medicine, Chair of Clinical Physiotherapy, Faculty of Health Sciences, Medical University of Lublin, Chodzki 15, 20-093 Lublin, Poland; (M.Z.); (M.G.)
| | - Agnieszka Tomczyk-Warunek
- Laboratory of Locomotor Systems Research, Department of Rehabilitation and Physiotherapy, Medical University of Lublin, Jaczewskiego 8, 20-954 Lublin, Poland
| | - Karolina Turżańska
- Department of Rehabilitation and Orthopaedics, Medical University of Lublin, Jaczewskiego 8, 20-954 Lublin, Poland;
| | - Tomasz Blicharski
- Department of Rehabilitation and Orthopaedics, Medical University of Lublin, Jaczewskiego 8, 20-954 Lublin, Poland;
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Ben M, Glinsky JV, Chu J, Spooren AI, Roberts S, Chen LW, Denis S, Lorusso M, Jorgensen V, Gollan EJ, Agostinello J, Van Laake-Geelen CCM, Lincoln C, Stolwijk JM, Bell C, Paddison S, Rainey D, Tranter K, Ilha J, Oostra K, Sherrington C, Harvey LA. Early and intensive Motor Training for people with spinal cord injuries (the SCI-MT Trial): description of the intervention. Spinal Cord 2023; 61:600-607. [PMID: 37468607 PMCID: PMC10645584 DOI: 10.1038/s41393-023-00911-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 02/21/2023] [Revised: 06/23/2023] [Accepted: 06/27/2023] [Indexed: 07/21/2023]
Abstract
STUDY DESIGN Descriptive. OBJECTIVES The primary objective is to describe the intervention that will be provided in a large multi-centre randomised controlled trial titled: Early and Intensive Motor Training for people with Spinal Cord Injuries (the SCI-MT Trial). The secondary objective is to describe the strategies that will be used to operationalise and standardise the Motor Training provided to participants while keeping the intervention person-centred. METHODS The paper focuses on the rationale and principles of Motor Training for people with spinal cord injuries (SCI). The description of the intervention is based on the Template for Intervention Description and Replication (TIDieR) checklist. Specifically, it addresses the following 6 criteria of the TIDieR checklist: why the effectiveness of Motor Training is being examined; what, how, where and when the Motor Training will be administered; and how much Motor Training will be provided. RESULTS A detailed intervention manual has been developed to help standardise the delivery of the intervention. CONCLUSIONS This paper describes the details of a complex intervention administered as part of a large randomised controlled trial. It will facilitate the subsequent interpretation of the trial results and enable the intervention to be reproduced in clinical practice and future trials.
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Affiliation(s)
- M Ben
- Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- John Walsh Centre for Rehabilitation Research, Northern Sydney Local Health District, St Leonards, Sydney, NSW, Australia
| | - J V Glinsky
- Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- John Walsh Centre for Rehabilitation Research, Northern Sydney Local Health District, St Leonards, Sydney, NSW, Australia
| | - J Chu
- Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- John Walsh Centre for Rehabilitation Research, Northern Sydney Local Health District, St Leonards, Sydney, NSW, Australia
| | | | - S Roberts
- Fiona Stanley Hospital, Murdoch, WA, Australia
| | - L W Chen
- Royal North Shore Hospital, St Leonards, NSW, Australia
| | - S Denis
- The Prince of Wales Hospital, Wales, NSW, Australia
| | - M Lorusso
- I.R.C.C.S. Foundation Santa Lucia, Rome, Italy
| | - V Jorgensen
- Sunnaas Rehabilitation Hospital, Nesodden, Norway
| | - E J Gollan
- The Princess Alexandra Hospital, Harlow, QLD, Australia
| | - J Agostinello
- The Royal Talbot Rehabilitation Centre, Kew Vic, VIC, Australia
| | - C C M Van Laake-Geelen
- Adelante Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, The Netherlands
- Department of Rehabilitation Medicine, Research School CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - C Lincoln
- Queen Elizabeth National Spinal Injures Unit, Glasgow, Scotland
| | - J M Stolwijk
- Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht Brain Center, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - C Bell
- Spinal Cord Injury Rehabilitation, Repat Health Precinct, Daw Park, SA, Australia
| | - S Paddison
- London Spinal Cord Injury Centre, Royal National Orthopaedic Hospital Trust, Middlesex, UK
| | - D Rainey
- Royal Rehab, Ryde, NSW, Australia
| | - K Tranter
- Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- John Walsh Centre for Rehabilitation Research, Northern Sydney Local Health District, St Leonards, Sydney, NSW, Australia
| | - J Ilha
- Universidade do Estado de Santa Catarina - UDESC, College of Health and Sport Science, Florianopolis, SC, Brazil
| | - K Oostra
- Ghent University Hospital, Ghent, Belgium
| | - C Sherrington
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - L A Harvey
- Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
- John Walsh Centre for Rehabilitation Research, Northern Sydney Local Health District, St Leonards, Sydney, NSW, Australia.
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Richings L, Nelson D, Goosey-Tolfrey V, Donnellan C, Booth V. Effectiveness of the "Evidence-Based Scientific Exercise Guidelines" in Increasing Cardiorespiratory Fitness, Cardiometabolic Health, and Muscle Strength in Acute Spinal Cord Injury Rehabilitation: A Systematic Review. Arch Rehabil Res Clin Transl 2023; 5:100278. [PMID: 37744200 PMCID: PMC10517363 DOI: 10.1016/j.arrct.2023.100278] [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] [Academic Contribution Register] [Indexed: 09/26/2023] Open
Abstract
Objective To determine the effect of exercise and physical activity interventions that meet current guideline recommendations on cardiorespiratory fitness, cardiometabolic health, and muscle strength in adults in the acute stage (<1 year post onset) of spinal cord injury (SCI) rehabilitation. Data Sources Six electronic databases (PubMed, CINAHL, SPORTDiscus, Google Scholar, National Institute Clinical Excellence, World Health Organization) were searched (January 2016-March 2022) to extend a previously published review. Study Selection Included studies implemented exercise interventions in the acute stage of SCI rehabilitation participants which met the exercise guidelines and measured cardiorespiratory fitness, cardiometabolic health, and strength outcomes. Data Extraction Titles and abstracts were screened against eligibility criteria and duplicates removed using EndNote X8. Full texts were independently assessed and results presented in a Preferred Reporting Items for Systematic Reviews and Meta-Analyses flowchart. Data extraction was completed on included studies by 2 reviewers (L.R. and V.B.) using a modified Cochrane Group form. Data Synthesis Data were synthesized, appraised using the Modified Downs & Black checklist and presented in narrative and tabular format. This review was registered on PROSPERO (Register ID:CRD42021249441). Of the 1255 studies, 4 were included, featuring 108 total participants <1-year post-SCI. Functional electrical stimulation cycle ergometry reduced muscle atrophy after 3 months training and increased lean body mass after 6 months. Resistance training increased muscle peak torque, perceived muscle strength and function. Aerobic exercise interventions did not increase cardiorespiratory fitness. Conclusions Interventions meeting the exercise guidelines did not increase cardiorespiratory fitness but were shown to improve cardiometabolic health and perceived muscle strength and function in adults in the acute stage of SCI rehabilitation. Further empirical research using standardized outcome measures are required to explore the effectiveness of aerobic exercise and strengthening interventions in acute stage of SCI rehabilitation to support the development of exercise guidelines.
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Affiliation(s)
| | - David Nelson
- Lincoln International Institute for Rural Health, University of Lincoln, Lincoln, UK
| | - Victoria Goosey-Tolfrey
- Peter Harrison Centre for Disability Sport, School of Sport, Exercise & Health Sciences, Loughborough University, Loughborough, UK
| | | | - Vicky Booth
- Nottingham University Hospitals NHS Trust, Nottingham, UK
- School of Medicine, University of Nottingham, Nottingham, UK
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11
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Rosley N, Hasnan N, Hamzaid NA, Davis GM, Manaf H. Effects of a combined progressive resistance training and functional electrical stimulation-evoked cycling exercise on lower limb muscle strength of individuals with incomplete spinal cord injury: A randomized controlled study. Turk J Phys Med Rehabil 2023; 69:23-30. [PMID: 37201013 PMCID: PMC10186013 DOI: 10.5606/tftrd.2023.9418] [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] [Academic Contribution Register] [Received: 07/16/2021] [Accepted: 03/10/2022] [Indexed: 05/20/2023] Open
Abstract
Objectives This study was conducted to investigate the effects of combined progressive resistance training (PRT) and functional electrical stimulation-evoked leg cycling exercise (FES-LCE) on isometric peak torque and muscle volume in individuals with incomplete spinal cord injury. Patients and methods In the single-blind, randomized controlled trial performed between April 2015 and August 2016, 28 participants were randomized between two exercise interventions (FES-LCE+PRT and FES-LCE alone), and training was conducted over 12 weeks. The isometric muscle peak torque and muscle volume for both lower limbs were measured at the baseline and after 6 and 12 weeks. Linear mixed-model analysis of variance was performed to test the effects of FES-LCE+PRT versus FES-LCE on each outcome measure over time via an intention-to-treat analysis. Results Twenty-three participants (18 males, 5 females; mean age: 33.4±9.7 years; range 21 to 50 years) completed study (10 in the FES-LCE+PRT group, and 13 in the FES-LCE group). The 12-week pre-and posttraining change for left hamstrings' muscle peak torque in the FES-LCE+PRT group (mean difference=4.5±7.9 Nm, 45% change, p<0.05) was consistently higher than that in the FES-LCE group (mean difference=2.4±10.3 Nm, 4% change; p<0.018). The improvement in the right quadriceps muscle's peak torque of the FES-LCE+PRT group (mean difference=19±7.6 Nm, 31% change, p<0.05) was more significant compared to the FES-LCE group. The left muscle volume showed a remarkable increase after 12 weeks in the FES-LCE+PRT group (mean difference=0.3±9.3 L, 7% change, p<0.05). Conclusion The combination of PRT and FES-LCE was better in improving lower limb muscle strength and volume in chronic incomplete individuals with spinal cord injury.
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Affiliation(s)
- Nurhaida Rosley
- Physiotherapy programme, Faculty of Pharmacy and Health Sciences, Universiti Kuala Lumpur, Royal College of Medicine Perak, Perak, Malaysia
| | - Nazirah Hasnan
- Discipline of Rehabilitation Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Nur Azah Hamzaid
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur, Malaysia
| | - Glen M Davis
- Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Haidzir Manaf
- Clinical and Rehabilitation Exercise Research Group, Faculty of Health Sciences, Universiti Teknologi MARA, Puncak Alam Campus, Selangor, Malaysia
- Integrative Pharmacogenomics Institute, Universiti Teknologi MARA, Puncak Alam Campus, Selangor, Malaysia
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12
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Allen GM, Palermo AE, McNaughton KMD, Boswell-Ruys CL, Lee BB, Butler JE, Gandevia SC, McCaughey EJ. Effectiveness of Abdominal Functional Electrical Stimulation for Improving Bowel Function in People With a Spinal Cord Injury: A Study Protocol for a Double-Blinded Randomized Placebo-Controlled Clinical Trial. Top Spinal Cord Inj Rehabil 2022; 28:22-31. [PMID: 36457354 PMCID: PMC9678222 DOI: 10.46292/sci22-00008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Indexed: 11/17/2022]
Abstract
Background People with a spinal cord injury (SCI) have a high rate of bowel-related morbidity, even compared with people with other neurological disorders. These complications lower quality of life and place a financial burden on the health system. A noninvasive intervention that improves the bowel function of people with an SCI should reduce morbidity, improve quality of life, and lead to cost savings for health care providers. Objectives To investigate the effectiveness of noninvasive abdominal functional electrical stimulation (FES) for improving bowel function in people with a chronic SCI. Methods A prospective, double-blinded, 1:1 randomized, placebo-controlled intervention trial will be conducted with 80 adults with chronic SCI (>12 months since injury) above T8 single neurological level. The intervention will be a 45-minute abdominal FES (or placebo) session, 3 days per week, for 6 weeks. Main Study Parameters/Endpoints Primary endpoint is whole gut transit time before and after 6 weeks of abdominal FES. Secondary endpoints measured before and after 6 weeks of abdominal FES are (1) colonic transit time; (2) quality of life (EQ-5D-5L); (3) participant-reported bowel function (International SCI Bowel Function Basic Data Set Questionnaire and visual analogue scale); (4) respiratory function (forced vital capacity, forced expiratory volume in 1 second, peak expiratory flow, maximal inspiratory pressure, and maximal expiratory pressure); (5) bladder symptoms (Neurogenic Bladder Symptom Score); (6) daily bowel management diary; and (7) unplanned hospital visits. Conclusion Safety data will be collected, and a cost utility analysis using quality of life scores will be performed. Trial registration Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12621000386831.
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Affiliation(s)
- Gabrielle M Allen
- Neuroscience Research Australia, Randwick, New South Wales, Australia
- School of Medical Sciences, University of New South Wales, Kensington, New South Wales, Australia
| | - Anne E Palermo
- Neuroscience Research Australia, Randwick, New South Wales, Australia
- School of Medical Sciences, University of New South Wales, Kensington, New South Wales, Australia
| | - Keith M D McNaughton
- Neuroscience Research Australia, Randwick, New South Wales, Australia
- School of Medical Sciences, University of New South Wales, Kensington, New South Wales, Australia
| | - Claire L Boswell-Ruys
- Neuroscience Research Australia, Randwick, New South Wales, Australia
- School of Medical Sciences, University of New South Wales, Kensington, New South Wales, Australia
- Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Bonsan B Lee
- Neuroscience Research Australia, Randwick, New South Wales, Australia
- School of Medical Sciences, University of New South Wales, Kensington, New South Wales, Australia
- Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Jane E Butler
- Neuroscience Research Australia, Randwick, New South Wales, Australia
- School of Medical Sciences, University of New South Wales, Kensington, New South Wales, Australia
| | - Simon C Gandevia
- Neuroscience Research Australia, Randwick, New South Wales, Australia
- School of Medical Sciences, University of New South Wales, Kensington, New South Wales, Australia
- Prince of Wales Clinical School, University of New South Wales, Kensington, Australia
| | - Euan J McCaughey
- Neuroscience Research Australia, Randwick, New South Wales, Australia
- School of Medical Sciences, University of New South Wales, Kensington, New South Wales, Australia
- Queen Elizabeth National Spinal Injuries Unit, Queen Elizabeth University Hospital, Glasgow, Scotland
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13
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Hall B, Sikora M, Jonas D, Matthews E, Żebrowska A. Handcycling Training in Men with Spinal Cord Injury Increases Tolerance To High Intensity Exercise. J Hum Kinet 2022; 82:233-241. [PMID: 36196357 PMCID: PMC9465718 DOI: 10.2478/hukin-2022-0080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Academic Contribution Register] [Indexed: 11/20/2022] Open
Abstract
Individuals with spinal cord injury are characterised by reduced physical capacity as compared to able-bodied persons, and are at risk of developing cardiovascular disease. The study aimed to evaluate the differences in physiological responses to an exercise test in handcycling-trained vs. able-bodied-trained and non-trained men. Eight males with spinal cord injury who were trained in handcycling, eighteen able-bodied males who were trained in powerlifting, and fourteen physically active non-athletes performed a graded arm crank ergometer test. The following physiological indices were measured before and during the test: heart rate, oxygen uptake, and blood lactate concentrations. Aerobic capacity was significantly higher in athletes with spinal cord injury compared to able-bodied athletes (p<0.01) and the control group (p<0.01). The heart rate achieved by handcycling-trained athletes was significantly lower as compared to powerlifters (p<0.01), however, the oxygen pulse was significantly higher (p<0.05). Handcycling-trained athletes reached significantly higher peak power (Pmax) during the graded arm exercise in comparison with powerlifters, and significantly higher post exercise blood lactate concentration (p<0.05). The lactate threshold was observed at a significantly higher P in individuals with spinal cord injury compared to able-bodied-trained (p<0.05) and non-trained men (p<0.001). Athletes with spinal cord injury were found to have excellent aerobic capacity and better physiological adaptation to the maximal graded exercise test as compared to able-bodied-trained men. These findings emphasize the importance of regular physical exercise and its potential therapeutic role in the prevention of cardiovascular disease in patients with spinal cord injury.
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Affiliation(s)
- Barbara Hall
- School of Biological Sciences, Institute of Biotechnology, The University of Manchester, Manchester, The United Kingdom
| | - Marcin Sikora
- Institute of Sport Science, Academy of Physical Education in Katowice, Katowice, Poland
| | | | - Eleanor Matthews
- School of Biological Sciences, Institute of Biotechnology, The University of Manchester, Manchester, The United Kingdom
| | - Aleksandra Żebrowska
- Institute of Sport Science, Academy of Physical Education in Katowice, Katowice, Poland
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Stampas A, Hook M, Korupolu R, Jethani L, Kaner MT, Pemberton E, Li S, Francisco GE. Evidence of treating spasticity before it develops: a systematic review of spasticity outcomes in acute spinal cord injury interventional trials. Ther Adv Neurol Disord 2022; 15:17562864211070657. [PMID: 35198042 PMCID: PMC8859674 DOI: 10.1177/17562864211070657] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 07/29/2021] [Accepted: 12/13/2021] [Indexed: 12/09/2022] Open
Abstract
Introduction: Spasticity is a common consequence of spinal cord injury (SCI), estimated to affect up to 93% of people living with SCI in the community. Problematic spasticity affects around 35% people with SCI spasticity. The early period after injury is believed to be the most opportune time for neural plasticity after SCI. We hypothesize that clinical interventions in the early period could reduce the incidence of spasticity. To address this, we evaluated the spasticity outcomes of clinical trials with interventions early after SCI.Methods: We performed a systematic review of the literature between January 2000 and May 2021 to identify control trials, in humans and animals, that were performed early after SCI that included measures of spasticity in accordance with PRISMA guidelines.Results: Our search yielded 1,463 records of which we reviewed 852 abstracts and included 8 human trial peer-reviewed publications and 9 animal studies. The 9 animal trials largely supported the hypothesis that early intervention can reduce spasticity, including evidence from electrophysiological, behavioral, and histologic measures. Of the 8 human trials, only one study measured spasticity as a primary outcome with a sample size sufficient to test the hypothesis. In this study, neuromodulation of the spinal cord using electric stimulation of the common peroneal nerve reduced spasticity in the lower extremities compared to controls.Conclusion: Given the prevalence of problematic spasticity, there is surprisingly little research being performed in the early period of SCI that includes spasticity measures, and even fewer studies that directly address spasticity. More research on the potential for early interventions to mitigate spasticity is needed.
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Affiliation(s)
| | | | - Radha Korupolu
- Department of Physical Medicine and Rehabilitation, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Lavina Jethani
- Department of Physical Medicine and Rehabilitation, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Mahmut T. Kaner
- Department of Physical Medicine and Rehabilitation, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Erinn Pemberton
- McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Sheng Li
- Department of Physical Medicine and Rehabilitation, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
- TIRR Memorial Hermann, Houston, TX, USA
| | - Gerard E. Francisco
- Department of Physical Medicine and Rehabilitation, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
- TIRR Memorial Hermann, Houston, TX, USA
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Hossain KMA, Sakel M, Saunders K, Kabir MF, Hasnat MAK. Rehabilitation of a young girl with acute transverse myelitis and prolonged lower motor neuron features: a longitudinal case report over 12 months. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2022. [DOI: 10.12968/ijtr.2020.0049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Indexed: 11/11/2022]
Abstract
Background This report describes an effective rehabilitation programme for a 13-year-old girl, diagnosed with acute transverse myelitis, as an example of best clinical practice. Case description Miss A was admitted to the National Institute of Neurosciences and Hospital in Dhaka, where she was diagnosed with acute transverse myelitis, in September 2018. She was discharged and referred for intensive rehabilitation over 3 months as an outpatient at the Centre for the Rehabilitation of the Paralysed in Bangladesh. The therapy team conducted a baseline assessment before starting treatment, which included the following outcome measures: the International Standards for Neurological Classification of Spinal Cord Injury Scale; Spinal Cord Independence Measure; and the Spinal Cord Injury Functional Ambulation Inventory. After 3 months, Miss A was discharged home to continue with a home exercise programme supported by her parents. Outcome measurements were repeated at 3-, 6- and 12-month time points. Results Miss A regained muscle power in her legs and normal sensation in S4/5 dermatomes, in addition to regaining voluntary anal muscle contraction. Her mobility and transfers improved so that she was able to transfer in and out of her wheelchair independently and use two elbow crutches to walk short distances outdoors. Conclusions This report shows that it is possible for a child who had been severely disabled by acute transverse myelitis to make substantial physical improvements up to 12 months after diagnosis when provided with effective rehabilitation. It also identifies that rehabilitation can provide multiple benefits and value for the individual patient, family, community and society.
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Affiliation(s)
- K M Amran Hossain
- Department of Physiotherapy, Bangladesh Health Professions Institute, Dhaka, Bangladesh
| | - Mohamed Sakel
- East Kent Neuro-Rehabilitation Service, East Kent Hospitals University NHS Foundation Trust, Canterbury, UK
- Department of Physiotherapy & Rehabilitation, Jashore University of Science & Technology, Jashore, Bangladesh
| | - Karen Saunders
- Department of Physiotherapy & Rehabilitation, Jashore University of Science & Technology, Jashore, Bangladesh
- School of Social Policy, Sociology and Social Research, University of Kent, Canterbury, UK
| | - M Feroz Kabir
- Department of Physiotherapy & Rehabilitation, Jashore University of Science & Technology, Jashore, Bangladesh
| | - M Abu Khayer Hasnat
- Spinal Cord Injury Unit, Centre for the Rehabilitation of the Paralysed, Savar, Dhaka, Bangladesh
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Santos LV, Pereira ET, Reguera-García MM, Oliveira CEPD, Moreira OC. Resistance Training and Muscle Strength in people with Spinal cord injury: A systematic review and meta-analysis. J Bodyw Mov Ther 2022; 29:154-160. [DOI: 10.1016/j.jbmt.2021.09.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 05/10/2021] [Revised: 07/27/2021] [Accepted: 09/24/2021] [Indexed: 11/26/2022]
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Abal del Blanco J, Taboada-Iglesias Y. Effects of resistance exercise in patients with spasticity: Systematic review. APUNTS SPORTS MEDICINE 2021. [DOI: 10.1016/j.apunsm.2021.100356] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Indexed: 01/04/2023]
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Krogh S, Aagaard P, Jønsson AB, Figlewski K, Kasch H. Effects of repetitive transcranial magnetic stimulation on recovery in lower limb muscle strength and gait function following spinal cord injury: a randomized controlled trial. Spinal Cord 2021; 60:135-141. [PMID: 34504284 PMCID: PMC8428490 DOI: 10.1038/s41393-021-00703-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 02/14/2021] [Revised: 08/23/2021] [Accepted: 08/24/2021] [Indexed: 11/25/2022]
Abstract
Study design Randomized sham-controlled clinical trial. Objectives The objective of this study is to investigate the effects of repetitive transcranial magnetic stimulation (rTMS) compared to sham stimulation, on the development of lower limb muscle strength and gait function during rehabilitation of spinal cord injury (SCI). Setting SCI rehabilitation hospital in Viborg, Denmark. Methods Twenty individuals with SCI were randomized to receive rTMS (REAL, n = 11) or sham stimulation (SHAM, n = 9) and usual care for 4 weeks. rTMS (20 Hz, 1800 pulses per session) or sham stimulation was delivered over leg M1 Monday–Friday before lower limb resistance training or physical therapy. Lower limb maximal muscle strength (MVC) and gait function were assessed pre- and post intervention. Lower extremity motor score (LEMS) was assessed at admission and at discharge. Results One individual dropped out due to seizure. More prominent increases in total leg (effect size (ES): 0.40), knee flexor (ES: 0.29), and knee extensor MVC (ES: 0.34) were observed in REAL compared to SHAM; however, repeated-measures ANOVA revealed no clear main effects for any outcome measure (treatment p > 0.15, treatment × time p > 0.76, time p > 0.23). LEMS improved significantly for REAL at discharge, but not for SHAM, and REAL demonstrated greater improvement in LEMS than SHAM (p < 0.02). Similar improvements in gait performance were observed between groups. Conclusions High-frequency rTMS may increase long-term training-induced recovery of lower limb muscle strength following SCI. The effect on short-term recovery is unclear. Four weeks of rTMS, when delivered in conjunction with resistance training, has no effect on recovery of gait function, indicating a task-specific training effect.
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Affiliation(s)
- Søren Krogh
- Spinal Cord Injury Center of Western Denmark, Regional Hospital Viborg, Viborg, Denmark. .,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
| | - Per Aagaard
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Anette Bach Jønsson
- Spinal Cord Injury Center of Western Denmark, Regional Hospital Viborg, Viborg, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Krystian Figlewski
- Spinal Cord Injury Center of Western Denmark, Regional Hospital Viborg, Viborg, Denmark
| | - Helge Kasch
- Spinal Cord Injury Center of Western Denmark, Regional Hospital Viborg, Viborg, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Neto FR, Dorneles JR, Carneiro Leão Veloso JH, Gonçalves CW, Gomes Costa RR. Peak Torque Prediction Using Handgrip and Strength Predictors in Men and Women With Motor Complete Spinal Cord Injury. Top Spinal Cord Inj Rehabil 2021; 27:49-59. [PMID: 34456546 PMCID: PMC8370701 DOI: 10.46292/sci20-00027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To establish predictive equations for peak torque of muscle groups with totally and partially preserved innervation in individuals with motor complete spinal cord injury (SCI), based on hand dynamometry and strength predictor variables. METHODS The cross-sectional study conducted at a rehabilitation hospital consecutively recruited 108 men and women with SCI. All participants performed maximum peak torque tests for shoulder abduction/adduction (isokinetic), trunk flexion/extension (isometric), and handgrip strength testing (hand dynamometer) to establish predictive peak torque equations. The primary outcomes were peak torque variables. Handgrip strength, age, injury level, time since injury, age at injury, body mass, height, body mass index, and physical activity level were the secondary outcomes used as strength predictor variables. RESULTS Handgrip strength was a predictor variable for shoulder abduction/adduction peak torque. The best predictive models for shoulder abduction/adduction peak torque exhibited R 2 = 0.57 and R 2 = 0.60, respectively (p ≤ .05). Injury level showed the highest significant predictive capacity for trunk flexion/extension peak torque models (R 2 = 0.38 and R 2 = 0.29; p ≤ .05). CONCLUSION Shoulder abduction/adduction peak torque predictive equations may be an alternative for use in an accessible strength tool (hand dynamometry) to evaluate training and rehabilitation programs. Trunk flexion/extension peak torque equations exhibited moderate correlations and high standard error of the estimates and should be used with caution.
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Xiang XN, Zong HY, Ou Y, Yu X, Cheng H, Du CP, He HC. Exoskeleton-assisted walking improves pulmonary function and walking parameters among individuals with spinal cord injury: a randomized controlled pilot study. J Neuroeng Rehabil 2021; 18:86. [PMID: 34030720 PMCID: PMC8146689 DOI: 10.1186/s12984-021-00880-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 01/26/2021] [Accepted: 05/19/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Exoskeleton-assisted walking (EAW) is expected to improve the gait of spinal cord injury (SCI) individuals. However, few studies reported the changes of pulmonary function (PF) parameters after EAW trainings. Hence, we aimed to explore the effect of EAW on PF parameters, 6-min walk test (6MWT) and lower extremity motor score (LEMS) in individuals with SCI and to compare those with conventional trainings. METHODS In this prospective, single-center, single-blinded randomized controlled pilot study, 18 SCI participants were randomized into the EAW group (n = 9) and conventional group (n = 9) and received 16 sessions of 50-60 min training (4 days/week, 4 weeks). Pulmonary function parameters consisting of the forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), forced expiratory flow (FEF), peak expiratory flow, and maximal voluntary ventilation, 6MWT with assisted devices and LEMS were reported pre- and post-training. RESULTS Values of FVC (p = 0.041), predicted FVC% (p = 0.012) and FEV1 (p = 0.013) were significantly greater in EAW group (FVC: 3.8 ± 1.1 L; FVC% pred = 94.1 ± 24.5%; FEV1: 3.5 ± 1.0 L) compared with conventional group (FVC: 2.8 ± 0.8 L; FVC% pred = 65.4 ± 17.6%; FEV1: 2.4 ± 0.6 L) after training. Participants in EAW group completed 6MWT with median 17.3 m while wearing the exoskeleton. There was no difference in LEMS and no adverse event. CONCLUSIONS The current results suggest that EAW has potential benefits to facilitate PF parameters among individuals with lower thoracic neurological level of SCI compared with conventional trainings. Additionally, robotic exoskeleton helped walking. TRIAL REGISTRATION Registered on 22 May 2020 at Chinese Clinical Trial Registry (ChiCTR2000033166). http://www.chictr.org.cn/edit.aspx?pid=53920&htm=4 .
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Affiliation(s)
- Xiao-Na Xiang
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China.,School of Rehabilitation Sciences, West China School of Medicine, Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China.,Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China
| | - Hui-Yan Zong
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China
| | - Yi Ou
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China
| | - Xi Yu
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China.,School of Rehabilitation Sciences, West China School of Medicine, Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China
| | - Hong Cheng
- University of Electronic Science and Technology of China, Chengdu, 611731, Sichuan, People's Republic of China
| | - Chun-Ping Du
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China.
| | - Hong-Chen He
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China. .,School of Rehabilitation Sciences, West China School of Medicine, Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China. .,Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China.
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21
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Strengthening the Case for Cluster Set Resistance Training in Aged and Clinical Settings: Emerging Evidence, Proposed Benefits and Suggestions. Sports Med 2021; 51:1335-1351. [PMID: 33983613 DOI: 10.1007/s40279-021-01455-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Accepted: 03/16/2021] [Indexed: 12/13/2022]
Abstract
Resistance training (RT) is a fundamental component of exercise prescription aimed at improving overall health and function. RT techniques such as cluster set (CS) configurations, characterized by additional short intra-set or inter-repetition rest intervals, have been shown to maintain acute muscular force, velocity, and 'power' outputs across a RT session, and facilitate positive longer-term neuromuscular adaptations. However, to date CS have mainly been explored from a human performance perspective despite potential for application in health and clinical exercise settings. Therefore, this current opinion piece aims to highlight emerging evidence and provide a rationale for why CS may be an advantageous RT technique for older adults, and across several neurological, neuromuscular, cardiovascular and pulmonary settings. Specifically, CS may minimize acute fatigue and adverse physiologic responses, improve patient tolerance of RT and promote functional adaptations (i.e., force, velocity, and power). Moreover, we propose that CS may be a particularly useful exercise rehabilitation technique where injury or illness, persistent fatigue, weakness and dysfunction exist. We further suggest that CS offer an alternative RT strategy that can be easily implemented alongside existing exercise/rehabilitation programs requiring no extra cost, minimal upskilling and/or time commitment for the patient and professional. In light of the emerging evidence and likely efficacy in clinical exercise practice, future research should move toward further direct investigation of CS-based RT in a variety of adverse health conditions and across the lifespan given the already demonstrated benefits in healthy populations.
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Physiotherapy interventions for the treatment of spasticity in people with spinal cord injury: a systematic review. Spinal Cord 2021; 59:236-247. [PMID: 33564117 DOI: 10.1038/s41393-020-00610-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 09/06/2020] [Revised: 12/20/2020] [Accepted: 12/21/2020] [Indexed: 11/08/2022]
Abstract
STUDY DESIGN Systematic review. OBJECTIVE To determine the effectiveness of physiotherapy interventions for the treatment of spasticity in people with spinal cord injuries. SETTING Not applicable. METHODS A comprehensive search was undertaken to identify all randomised controlled trials of physiotherapy interventions that included an assessor-reported (objective) or participant-reported (subjective) measure of spasticity. Only trials that provided a physiotherapy intervention on more than one occasion were included. The susceptibility to bias of each trial was rated on the PEDro scale. Data were extracted to derive mean between-group differences (95% CI) for each trial. RESULTS Twenty-eight trials were identified but only 17 provided useable data. Seven trials compared a physiotherapy intervention to no intervention (or a sham intervention) and 10 trials compared one physiotherapy intervention to another physiotherapy intervention. The median (IQR) PEDro score of the 17 trials was 6/10 (6-8). The most commonly used assessor- and participant-reported measures of spasticity were the Ashworth scale and Spinal Cord Injury Spasticity Evaluation Tool, respectively. Only one trial demonstrated a treatment effect. This trial compared continuous passive motion of the ankle to no treatment on the Ashworth scale. The remaining 16 trials were either inconclusive or indicated that the treatment was ineffective for reducing spasticity. CONCLUSIONS There is no high-quality evidence to indicate that physiotherapy interventions decrease spasticity but this may reflect a lack of research on the topic. Future trials should focus on participant-reported measures of spasticity that distinguish between the immediate, short-term and long-term effects of any physiotherapy intervention.
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23
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Kurnakova KA, Plishchenko IK, Ponomarenko GN. [Physical factors in the rehabilitation of patients with the consequences of spinal cord injuries: scientometric analysis of evidence-based research]. VOPROSY KURORTOLOGII, FIZIOTERAPII, I LECHEBNOĬ FIZICHESKOĬ KULTURY 2020; 97:80-91. [PMID: 33054012 DOI: 10.17116/kurort20209705180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Academic Contribution Register] [Indexed: 11/17/2022]
Abstract
PURPOSE OF THE STUDY Conduct scientometric analysis of evidence-based studies of physical methods of treating patients with the spinal cord injury (SCI) consequences. MATERIAL AND METHODS Data from a scientometric analysis of evidence-based studies published from January 2014 to December 2019 on the use of therapeutic physical factors in the rehabilitation of patients with SCI are presented in the article. RESULTS Groups of effective technologies, including physical activity, pulsed electrotherapy and robotic mechanotherapy are identified. Significant effects of applied technologies in patients with spinal trauma are shown. Promising groups of physical therapies requiring additional evidence-based research are identified. Recommendations on the use of therapeutic physical factors in the treatment of patients with SCI are proposed. CONCLUSION A trend towards an increase in the number of randomized controlled trials to assess the effectiveness and expand the range of physical and rehabilitation medicine technologies used in the rehabilitation of patients with SCI are identified. Monitoring of technologies with proven effectiveness is necessary to improve the quality of rehabilitation measures in patients with SCI.
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Affiliation(s)
- K A Kurnakova
- Federal Scientific Center of Rehabilitation of the Disabled named after G.A. Albrecht, Saint-Petersburg, Russia
| | - I K Plishchenko
- Federal Scientific Center of Rehabilitation of the Disabled named after G.A. Albrecht, Saint-Petersburg, Russia
| | - G N Ponomarenko
- Federal Scientific Center of Rehabilitation of the Disabled named after G.A. Albrecht, Saint-Petersburg, Russia.,North-Western State Medical University named after I.I. Mechnikov, Saint-Petersburg, Russia
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24
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Roquilly A, Vigué B, Boutonnet M, Bouzat P, Buffenoir K, Cesareo E, Chauvin A, Court C, Cook F, de Crouy AC, Denys P, Duranteau J, Fuentes S, Gauss T, Geeraerts T, Laplace C, Martinez V, Payen JF, Perrouin-Verbe B, Rodrigues A, Tazarourte K, Prunet B, Tropiano P, Vermeersch V, Velly L, Quintard H. French recommendations for the management of patients with spinal cord injury or at risk of spinal cord injury. Anaesth Crit Care Pain Med 2020; 39:279-289. [PMID: 32229270 DOI: 10.1016/j.accpm.2020.02.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVES To update the French guidelines on the management of trauma patients with spinal cord injury or suspected spinal cord injury. DESIGN A consensus committee of 27 experts was formed. A formal conflict-of-interest (COI) policy was developed at the outset of the process and enforced throughout. The entire guidelines process was conducted independently of any industrial funding (i.e. pharmaceutical, medical devices). The authors were advised to follow the rules of the Grading of Recommendations Assessment, Development and Evaluation (GRADE®) system to guide assessment of quality of evidence. The potential drawbacks of making strong recommendations in the presence of low-quality evidence were emphasised. METHODS The committee studied twelve questions: (1) What are the indications and arrangements for spinal immobilisation? (2) What are the arrangements for pre-hospital orotracheal intubation? (3) What are the objectives of haemodynamic resuscitation during the lesion assessment, and during the first few days in hospital? (4) What is the best way to manage these patients to improve their long-term prognosis? (5) What is the place of corticosteroid therapy in the initial phase? (6) What are the indications for magnetic resonance imaging in the lesion assessment phase? (7) What is the optimal time for surgical management? (8) What are the best arrangements for orotracheal intubation in the hospital environment? (9) What are the specific conditions for weaning these patients from mechanical ventilation for? (10) What are the procedures for analgesic treatment of these patients? (11) What are the specific arrangements for installing and mobilising these patients? (12) What is the place of early intermittent bladder sampling in these patients? Each question was formulated in a PICO (Patients, Intervention, Comparison, Outcome) format and the evidence profiles were produced. The literature review and recommendations were made according to the GRADE® Methodology. RESULTS The experts' work synthesis and the application of the GRADE method resulted in 19 recommendations. Among the recommendations formalised, 2 have a high level of evidence (GRADE 1+/-) and 12 have a low level of evidence (GRADE 2+/-). For 5 recommendations, the GRADE method could not be applied, resulting in expert advice. After two rounds of scoring and one amendment, strong agreement was reached on all the recommendations. CONCLUSIONS There was significant agreement among experts on strong recommendations to improve practices for the management of patients with spinal cord injury.
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Affiliation(s)
- A Roquilly
- Anaesthesiology and Intensive Care Unit, Hôtel-Dieu, Nantes University Hospital, Nantes, France.
| | - B Vigué
- Anaesthesiology and Intensive Care Unit, Bicêtre University Hospital, AP-HP, Le Kremlin-Bicêtre, France
| | - M Boutonnet
- Hôpital d'instruction des armées Percy, Clamart, France
| | - P Bouzat
- Grenoble Alps Trauma Centre, Department of Anaesthesia and Critical Care, Grenoble University Hospital, Grenoble, France
| | - K Buffenoir
- Neurosurgery department, Nantes University Hospital, Nantes, France
| | - E Cesareo
- Edouard-Herriot University Hospital, Lyon, France
| | - A Chauvin
- Anaesthesiology and Intensive Care Unit, Lariboisière Hospital, AP-HP, Paris, France
| | - C Court
- Orthopaedic Surgery Department, Spine and Bone Tumor Unit, Bicêtre University Hospital, Le Kremlin-Bicêtre, France
| | - F Cook
- Unité de réanimation chirurgicale polyvalente et de polytraumatologie, Albert-Chenevier-Henri-Mondor University Hospital, Créteil, France
| | - A C de Crouy
- Unité SRPR/Réanimation chirurgicale, Bicêtre University Hospital, Le Kremlin-Bicêtre, France
| | - P Denys
- Orthopaedic department, Spine and Bone Tumor Unit. Bicêtre University Hospital, Le Kremlin Bicêtre, France
| | - J Duranteau
- Anaesthesiology and Intensive Care Unit, Bicêtre University Hospital, AP-HP, Le Kremlin-Bicêtre, France
| | - S Fuentes
- Aix-Marseille University, AP-HM, Department of Neurosurgery, University Hospital Timone, Marseille, France
| | - T Gauss
- Post-Intensive Care Rehabilitation Unit, Bicêtre University Hospital, Le Kremlin Bicêtre, France
| | - T Geeraerts
- Anaesthesiology and Critical Care Department, Toulouse University Hospital, University of Toulouse 3-Paul Sabatier, Toulouse, France
| | - C Laplace
- Anaesthesiology and Intensive Care Unit, Bicêtre University Hospital, AP-HP, Le Kremlin-Bicêtre, France
| | - V Martinez
- Neuro Urology Unit, Department of Physical Medicine and Rehabilitation. Raymond Poincaré University Hospital, Garches, France
| | - J F Payen
- Department of Anaesthesia and Critical Care, Grenoble Alps University Hospital, 38000 Grenoble, France
| | - B Perrouin-Verbe
- Department of Neurological Physical Medicine and Rehabilitation, Nantes University Hospital, Nantes, France
| | - A Rodrigues
- Anaesthesiology and Intensive Care Unit, Bicêtre University Hospital, AP-HP, Le Kremlin-Bicêtre, France
| | - K Tazarourte
- Emergency department, Edouard-Herriot University Hospital, 69003 Lyon, France
| | - B Prunet
- Department of Anaesthesia and Critical Care, Val-de-Grâce Hospital, Paris, France
| | - P Tropiano
- Aix-Marseille University, AP-HM, Orthopaedic and traumatic surgery, University Hospital Timone, Marseille, France
| | - V Vermeersch
- Anaesthesiology and Intensive Care Unit, Brest University Hospital, Brest, France
| | - L Velly
- Aix Marseille University, AP-HM, Department of Anaesthesiology and Critical Care Medicine, University Hospital Timone, Marseille, France
| | - H Quintard
- Intensive Care Unit, Nice University Hospital, Pasteur 2 Hospital, Nice, France
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25
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Chen LW, Glinsky JV, Islam MS, Hossain M, Boswell-Ruys CL, Kataria C, Redhead J, Xiong Y, Gollan E, Costa PD, Denis S, Ben M, Chaudhary L, Wang J, Hasnat MAK, Yeomans J, Gandevia SC, Harvey LA. The effects of 10,000 voluntary contractions over 8 weeks on the strength of very weak muscles in people with spinal cord injury: a randomised controlled trial. Spinal Cord 2020; 58:857-864. [PMID: 32086442 PMCID: PMC7402990 DOI: 10.1038/s41393-020-0439-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 08/20/2019] [Revised: 01/27/2020] [Accepted: 02/04/2020] [Indexed: 01/30/2023]
Abstract
Study design A multi-centred, single-blinded randomised controlled trial. Objectives To determine the effect of 10,000 voluntary contractions over 8 weeks on the strength of very weak muscles in people with spinal cord injury (SCI). Settings Seven hospitals in Australia and Asia. Methods One hundred and twenty people with recent SCI undergoing inpatient rehabilitation were randomised to either a Treatment or Control Group. One major muscle group from an upper or lower limb was selected if the muscle had grade 1 or grade 2 strength on a standard six-point manual muscle test. Participants allocated to the Treatment Group performed 10,000 isolated contractions of the selected muscle group, as well as usual care in 48 sessions over 8 weeks. Participants allocated to the Control Group received usual care alone. Participants were assessed at baseline and 8 weeks by a blinded assessor. The primary outcome was voluntary muscle strength on a 13-point manual muscle test. There were three secondary outcomes capturing therapists’ and participants’ perceptions of strength and function. Results The mean between-group difference of voluntary strength at 8 weeks was 0.4/13 points (95% confidence interval −0.5 to 1.4) in favour of the Treatment Group. There were no notable between-group differences on any secondary outcome. Conclusion Ten thousand isolated contractions of very weak muscles in people with SCI over 8 weeks has either no or a very small effect on voluntary strength.
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Affiliation(s)
- Lydia W Chen
- John Walsh Centre for Rehabilitation Research, Faculty of Medicine and Health Sciences, University of Sydney, St Leonards, NSW, Australia.,Spinal Injuries Unit, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Joanne V Glinsky
- John Walsh Centre for Rehabilitation Research, Faculty of Medicine and Health Sciences, University of Sydney, St Leonards, NSW, Australia
| | - Md Shofiqul Islam
- Centre for the Rehabilitation of the Paralysed, Savar, Dhaka, Bangladesh
| | - Muzaffor Hossain
- Centre for the Rehabilitation of the Paralysed, Savar, Dhaka, Bangladesh
| | - Claire L Boswell-Ruys
- Spinal Injuries Unit, Prince of Wales Hospital, Randwick, NSW, Australia.,Neuroscience Research Australia (NeuRA), University of New South Wales, Randwick, NSW, Australia
| | - Chitra Kataria
- Indian Spinal Injuries Centre, Sector-C, Vasant Kunj, Delhi, India
| | - Jason Redhead
- Spinal Injuries Unit, Royal Rehab, Ryde, NSW, Australia
| | - Yuan Xiong
- Guangdong Work Injury Rehabilitation Hospital, Guangdong, China
| | - Emilie Gollan
- Queensland Spinal Cord Injuries Service, Metro South Health, Brisbane, QLD, Australia
| | - Punam D Costa
- Centre for the Rehabilitation of the Paralysed, Savar, Dhaka, Bangladesh
| | - Sophie Denis
- Spinal Injuries Unit, Prince of Wales Hospital, Randwick, NSW, Australia
| | - Marsha Ben
- NSW Spinal Outreach Service, Ryde, NSW, Australia
| | - Lovely Chaudhary
- Indian Spinal Injuries Centre, Sector-C, Vasant Kunj, Delhi, India
| | - Jun Wang
- Guangdong Work Injury Rehabilitation Hospital, Guangdong, China
| | | | - Jayne Yeomans
- Spinal Injuries Unit, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Simon C Gandevia
- Neuroscience Research Australia (NeuRA), University of New South Wales, Randwick, NSW, Australia
| | - Lisa A Harvey
- John Walsh Centre for Rehabilitation Research, Faculty of Medicine and Health Sciences, University of Sydney, St Leonards, NSW, Australia.
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26
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Bye E, Glinsky J, Yeomans J, Hungerford A, Patterson H, Chen L, Harvey L. The inter-rater reliability of the 13-point manual muscle test in people with spinal cord injury. Physiother Theory Pract 2019; 37:1126-1131. [PMID: 31674263 DOI: 10.1080/09593985.2019.1685033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Indexed: 10/25/2022]
Abstract
Objective: To determine the inter-rater reliability of the 13-point manual muscle test (MMT) in two upper limb muscle groups of people with tetraplegiaSetting: The study was conducted at three spinal cord injury (SCI) units.Participants: Sixty people with complete or incomplete tetraplegia.Methods: The inter-rater reliability of the 13-point MMT was investigated. Strength of the elbow flexors and/or wrist extensors in people with tetraplegia was measured by two physiotherapists on the same day.Results: The weighted kappa coefficient (95% confidence interval) reflecting the agreement between the two strength assessments by two different assessors for the wrist extensors and elbow flexors were 0.96 (0.93 to 0.99) and 0.94 (0.89 to 0.99), respectively. Repeat measurements by different physiotherapists were within 1 of 13 points of each other 82% of the time for wrist extensors and 87% of the time for the elbow flexors.Conclusion: The 13-point MMT is a reliable measure of strength in the wrist extensors and elbow flexors of people with tetraplegia.
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Affiliation(s)
- Elizabeth Bye
- John Walsh Centre for Rehabilitation Research, Sydney Medical School/Northern, University of Sydney, St Leonards, NSW, Australia.,Spinal Injury Unit, Prince of Wales Hospital, Randwick, NSW, Australia
| | - Joanne Glinsky
- John Walsh Centre for Rehabilitation Research, Sydney Medical School/Northern, University of Sydney, St Leonards, NSW, Australia
| | - Jayne Yeomans
- Spinal Injury Unit, Royal North Shore Hospital, St Leonards, NSW, Australia
| | | | - Helen Patterson
- Spinal Injury Unit, Prince of Wales Hospital, Randwick, NSW, Australia
| | - Lydia Chen
- John Walsh Centre for Rehabilitation Research, Sydney Medical School/Northern, University of Sydney, St Leonards, NSW, Australia.,Spinal Injury Unit, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Lisa Harvey
- John Walsh Centre for Rehabilitation Research, Sydney Medical School/Northern, University of Sydney, St Leonards, NSW, Australia
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27
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Torres-Espín A, Beaudry E, Fenrich K, Fouad K. Rehabilitative Training in Animal Models of Spinal Cord Injury. J Neurotrauma 2019; 35:1970-1985. [PMID: 30074874 DOI: 10.1089/neu.2018.5906] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Indexed: 02/06/2023] Open
Abstract
Rehabilitative motor training is currently one of the most widely used approaches to promote moderate recovery following injuries of the central nervous system. Such training is generally applied in the clinical setting, whereas it is not standard in preclinical research. This is a concern as it is becoming increasingly apparent that neuroplasticity enhancing treatments require training or some form of activity as a co-therapy to promote functional recovery. Despite the importance of training and the many open questions regarding its mechanistic consequences, its use in preclinical animal models is rather limited. Here we review approaches, findings and challenges when training is applied in animal models of spinal cord injury, and we suggest recommendations to facilitate the integration of training using an appropriate study design, into pre-clinical studies.
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Affiliation(s)
- Abel Torres-Espín
- Faculty of Rehabilitation Medicine and Institute for Neuroscience and Mental Health, University of Alberta , Edmonton, Alberta, Canada
| | - Eric Beaudry
- Faculty of Rehabilitation Medicine and Institute for Neuroscience and Mental Health, University of Alberta , Edmonton, Alberta, Canada
| | | | - Karim Fouad
- Faculty of Rehabilitation Medicine and Institute for Neuroscience and Mental Health, University of Alberta , Edmonton, Alberta, Canada
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28
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Aravind N, Harvey LA, Glinsky JV. Physiotherapy interventions for increasing muscle strength in people with spinal cord injuries: a systematic review. Spinal Cord 2019; 57:449-460. [PMID: 30723256 DOI: 10.1038/s41393-019-0242-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 06/28/2018] [Revised: 12/20/2018] [Accepted: 12/24/2018] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN A systematic review. OBJECTIVE The aim of this review was to determine the effectiveness of physiotherapy (PT) interventions for increasing voluntary muscle strength in people with spinal cord injuries (SCI). METHODS We included randomised controlled trials of PT interventions for people with SCI. We were interested in two comparisons: PT interventions compared with sham or no intervention, and PT interventions compared to each other. The outcome of interest was voluntary strength of muscles directly affected by SCI. All included studies were rated according to the Cochrane Risk of Bias Tool and results of similar trials were pooled using meta-analyses where possible. RESULTS Twenty-six trials met the inclusion criteria and provided useable data. A statistically significant between-group difference was found in four comparisons, namely, resistance training versus no intervention (standardised mean difference (SMD) = 0.64; 95% CI, 0.22-1.07; p = 0.003); resistance training combined with electrical stimulation versus no intervention (mean difference (MD) = 14 Nm; 95% CI, 1-27; p = 0.03); a package of PT interventions versus no intervention (MD = 4.8/50 points on the Lower Extremity Motor Score (LEMS); 95% CI 1.9-7.7; p = 0.01); and robotic gait training versus overground gait training (MD = 3.1/50 points on the LEMS; 95% CI, 1.3-5.0; p = 0.0008). CONCLUSION There is evidence that a small number of PT interventions increase voluntary strength in muscles directly affected by SCI.
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Affiliation(s)
- Nisha Aravind
- John Walsh Centre for Rehabilitation Research, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Lisa A Harvey
- John Walsh Centre for Rehabilitation Research, Sydney Medical School, University of Sydney, Sydney, Australia.
| | - Joanne V Glinsky
- John Walsh Centre for Rehabilitation Research, Sydney Medical School, University of Sydney, Sydney, Australia
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29
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A preliminary investigation of mechanisms by which short-term resistance training increases strength of partially paralysed muscles in people with spinal cord injury. Spinal Cord 2019; 57:770-777. [PMID: 31092897 DOI: 10.1038/s41393-019-0284-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 09/27/2018] [Revised: 04/16/2019] [Accepted: 04/23/2019] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Pretest-posttest design. OBJECTIVES To investigate mechanisms by which short-term resistance training (6 weeks) increases strength of partially paralysed muscles in people with spinal cord injury (SCI). SETTING Community-based setting, Sydney, Australia. PARTICIPANTS Ten community-dwelling people with partial paralysis of elbow flexor, elbow extensor, knee flexor or knee extensor muscles following SCI (range 5 months to 14 years since injury). METHODS Muscle architecture and strength were assessed before and after participants underwent a six week strength-training program targeting one partially paralysed muscle group. The outcome of primary interest was physiological cross sectional area (PCSA) of the trained muscle group measured using magnetic resonance imaging (MRI) and diffusion tensor imaging (DTI). Other outcomes were changes in mean muscle fascicle length, muscle volume, pennation angle, isometric strength and muscle strength graded on a 13-point scale. RESULTS The mean increase in maximal isometric muscle strength was 14% (95% CI, -3 to 30%) and 1.5 points (95% CI, 0.5 to 2.5) on the 13-point manual muscle test. There was no evidence of a change in muscle architecture. CONCLUSION This study is the first to examine the mechanisms by which voluntary strength training increases strength of partially paralysed muscles in people with SCI. The data suggest that strength gains produced by six weeks of strength training are not caused by changes in muscle architecture. This suggests short-term strength gains are due to increased neural drive or an increase in specific muscle tension.
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30
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Ben Moussa Zouita A, Souissi M, Sghaier Z, Dziri C, Ben Salah FZ, Miri I. Évaluation du travail de la musculation en circuit training chez l’enfant paralysé cérébral. Sci Sports 2018. [DOI: 10.1016/j.scispo.2018.03.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Indexed: 10/16/2022]
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31
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Franz M, Richner L, Wirz M, von Reumont A, Bergner U, Herzog T, Popp W, Bach K, Weidner N, Curt A. Physical therapy is targeted and adjusted over time for the rehabilitation of locomotor function in acute spinal cord injury interventions in physical and sports therapy. Spinal Cord 2017; 56:158-167. [PMID: 29057989 DOI: 10.1038/s41393-017-0007-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 04/19/2017] [Revised: 08/20/2017] [Accepted: 08/20/2017] [Indexed: 01/26/2023]
Abstract
STUDY DESIGN Prospective observational multicenter study. OBJECTIVES Investigation of content, duration and adjustment of physical therapy for the rehabilitation of ambulation in acute spinal cord injury (SCI). SETTING European Multicenter Study of SCI (EMSCI). METHODS Physical therapy interventions during acute in-patient rehabilitation of eighty incomplete SCI patients (AIS B, C, D all lesion levels) were recorded using the SCI - Intervention Classification System. Mobility was documented using the Spinal Cord Independence Measurement (SCIM III), demographics and clinical data were retrieved from the EMSCI database. RESULTS Overall recovery of locomotor function was categorized into three outcome groups (G1-G3). Of 76 initial wheelchair-using patients, 53.9% remained wheelchair user (G1), 25% regained moderate (G2) and 21.1% good walking (G3) capability. Strength training was the most frequently applied intervention of body function/-structure across all outcome groups (about 30% of all interventions), while interventions focusing on muscle tone and respiration were predominantly applied in wheelchair-dependent patients. Activity-focused interventions of transfer, transition, sitting were trained most intensively in outcome group G1, while walking and swimming were increasingly trained in patients with moderate and good walking outcomes. Physical therapy interventions of assistive and active trainings as well as corresponding training environments changed with the recovery of locomotor function. CONCLUSIONS Physical therapy of locomotor function is targeted to individual patients' conditions and becomes adjusted to the progress of ambulation. Although the involved clinical sites were not following explicitly standardized rehabilitation programs, common patterns can be discerned which may form the basis of prospective standardized programs.
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Affiliation(s)
- Martina Franz
- University Hospital Balgrist, Spinal Cord Injury Center, Forchstrasse, Zurich, Switzerland.
| | - Lea Richner
- University Hospital Balgrist, Spinal Cord Injury Center, Forchstrasse, Zurich, Switzerland
| | - Markus Wirz
- Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Anne von Reumont
- Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany.,European Multi-Center Study in Spinal Cord Injury (EMSCI), Zurich, Switzerland
| | - Ulla Bergner
- European Multi-Center Study in Spinal Cord Injury (EMSCI), Zurich, Switzerland.,BG Hospital, Center for Spinal Cord Injuries, Murnau am Staffelsee, Germany
| | - Tanja Herzog
- University Hospital Balgrist, Spinal Cord Injury Center, Forchstrasse, Zurich, Switzerland
| | - Werner Popp
- University Hospital Balgrist, Spinal Cord Injury Center, Forchstrasse, Zurich, Switzerland
| | - Kathrin Bach
- Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany.,European Multi-Center Study in Spinal Cord Injury (EMSCI), Zurich, Switzerland
| | - Norbert Weidner
- Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany.,European Multi-Center Study in Spinal Cord Injury (EMSCI), Zurich, Switzerland
| | - Armin Curt
- University Hospital Balgrist, Spinal Cord Injury Center, Forchstrasse, Zurich, Switzerland.,European Multi-Center Study in Spinal Cord Injury (EMSCI), Zurich, Switzerland
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