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Kang D, Eun SD, Park J. Pilot Study of Home-Based Virtual Reality Fitness Training in Post-Discharge Rehabilitation for Patients with Spinal Cord Injury: A Randomized Double-Blind Multicenter Trial. Life (Basel) 2024; 14:859. [PMID: 39063613 PMCID: PMC11278213 DOI: 10.3390/life14070859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2024] [Revised: 07/04/2024] [Accepted: 07/06/2024] [Indexed: 07/28/2024] Open
Abstract
Spinal cord injury (SCI) patients require continuous rehabilitation post-discharge to ensure optimal recovery. This study investigates the effectiveness of home-based virtual reality fitness training (VRFT) as a convenient and accessible rehabilitation method for SCI patients. This randomized, double-blind, multicenter trial will enroll 120 participants, assigning them to either an 8-week VRFT program (exercise group) or a control group engaging in regular daily activities. The outcomes measured include muscle function, cardiopulmonary fitness, body composition, and physical performance. Our study will determine the safety and feasibility of VRFT in a home setting for SCI patients and evaluate whether these patients can effectively participate in such a program post-discharge. The results of this study are expected to inform future exercise protocols for SCI rehabilitation, offering valuable insights into the utility of VRFT as a therapeutic tool.
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Affiliation(s)
- Dongheon Kang
- Department of Healthcare and Public Health Research, National Rehabilitation Center, Ministry of Health and Welfare, Seoul 01022, Republic of Korea;
| | - Seon-Deok Eun
- Department of Healthcare and Public Health Research, National Rehabilitation Center, Ministry of Health and Welfare, Seoul 01022, Republic of Korea;
| | - Jiyoung Park
- Department of Safety and Health, Wonkwang University, Iksan 54538, Republic of Korea
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2
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Martins EJ, Serrão P, Leonardi-Figueiredo MM, Ravanelli LS, Serenza FS, Mattiello S, Aagaard P, Mattiello-Sverzut A. Isokinetic arm and shoulder muscle torque-velocity characteristics in mobility limited children and adolescents with spina bifida. Physiother Theory Pract 2024; 40:962-972. [PMID: 36482746 DOI: 10.1080/09593985.2022.2150529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 10/28/2022] [Accepted: 11/14/2022] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Propulsive wheelchair capacity may be influenced by arm muscle performance.Objectives: To determine whether children and adolescent wheelchair-users with spina bifida show reduced arm muscle strength compared to their typically developing peers and to compare muscle strength data obtained by isokinetic and handheld dynamometry (HHD). METHODS Participants (mean age 12.5 ± 2.5 years) were assigned to spina bifida (SB; n = 11) or control (n = 22) groups. Isokinetic dynamometry was used to measure peak torque (PT) during dynamic (60°s-1 and 120°s-1) and isometric strength testing (MVIC) for shoulder and elbow flexors and extensors. HHD was used to measure MVIC of the same muscle groups. RESULTS SB showed reduced isokinetic PT for shoulder extensors at 60°s-1 and 120°s-1, shoulder flexor MVIC, and elbow flexors at 60°s-1 and MVIC; higher PT for shoulder flexors and elbow flexors at 120°s-1; and decreased MVIC for elbow flexors but not extensors compared to controls when assessed by HHD. The SB and control groups showed strong positive correlations between MVIC data obtained by the two devices for all muscle groups (r ≥ 0.81; p < .01), except for shoulder flexor MVIC in controls (r = 0.68; p < .01). CONCLUSION SB presented reduced levels of dynamic slow-speed and isometric shoulder and elbow muscle strength and greater dynamic high-speed shoulder and elbow flexor strength than controls possibly due to the exposure to self-sustained wheelchair ambulation. Exercise-based intervention protocols to increase slow-speed arm muscle strength should be considered in youth with SB. Strong positive correlations observed between muscle strength assessed by isokinetic dynamometry and HHD support the use of HHD in this clinical population.
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Affiliation(s)
- Emanuela J Martins
- Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Paula Serrão
- Department of Physiotherapy, Federal University of São Carlos, São Carlos, Brazil
| | | | - Letícia S Ravanelli
- Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Felipe S Serenza
- Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Stela Mattiello
- Department of Physiotherapy, Federal University of São Carlos, São Carlos, Brazil
| | - Per Aagaard
- Institute of Sports Science and Clinical Biomechanics, Muscle Physiology and Biomechanics Research Unit, University of Southern Denmark, Odense, Denmark
| | - Ana Mattiello-Sverzut
- Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
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Palermo AE, Kirk-Sanchez NJ, Garcia KL, Nash MS, Cahalin LP. Inspiratory Muscle Performance Is Related to Seated Balance Function in People With Spinal Cord Injury: An Observational Study. Arch Phys Med Rehabil 2022; 103:1303-1310. [PMID: 34922931 DOI: 10.1016/j.apmr.2021.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 11/14/2021] [Accepted: 11/16/2021] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To examine the relationship between inspiratory muscle performance (IMP) and functional sitting balance (FSB) in persons with chronic spinal cord injury (SCI). We hypothesized that a moderate correlation would be found between IMP and FSB and that individuals with better balance would have better IMP. DESIGN The SCI-specific modification of the Function in Sitting Test (FIST-SCI) measured FSB. The IMP measures included (1) maximal inspiratory pressure (MIP), (2) sustained MIP (SMIP), and (3) inspiratory duration. Upper extremity motor score (UEMS) and level of injury (LOI) were taken from International Standards for Neurological Classification of Spinal Cord Injury examinations. Spearman correlational analyses assessed relationships among these factors in the sample (N=37). Mann-Whitney U tests explored differences between 2 comparison group pairs (tetraplegia group [TG] vs paraplegia group [PG]; independent transfer group [ITG] vs assisted transfer group [ATG]). Regression analysis examined variables predictive of FSB in the TG. SETTING Research facility. PARTICIPANTS Volunteers with tetraplegia (n=21, American Spinal Injury Association Impairment Scale (AIS) A=8, B=7, C=6) and paraplegia (n=16, AIS A=9, B=4, C=3) (N=37). INTERVENTION Not applicable. MAIN OUTCOME MEASURES IMP, LOI, UEMS, FIST-SCI. RESULTS UEMS, MIP, SMIP, and LOI had moderate to high correlations with FIST-SCI scores (ρ=0.720 (P<.001), 0.480 (P=.003), 0.467 (P=.004), 0.527 (P=.001), respectively). UEMS, MIP, and FIST-SCI scores were higher in the PG and ITG than the TG and ATG, respectively (PG vs. TG P values=<.001, .008, .002, respectively, and ITG vs. ATG P values=<.001, .032, <.001, respectively). Further, SMIP and UEMS predicted FIST-SCI balance scores in the TG, accounting for 55% of total variance (P<.001) (FIST-SCI=11.88+0.03 [SMIP]+0.425 [UEMS]). CONCLUSIONS The relationship between IMP and balance appears preserved after SCI. FSB was predicted, in part, via UEMS and SMIP in the TG. Future research should focus on the effect of SCI-based breathing interventions on FSB.
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Affiliation(s)
- Anne E Palermo
- Department of Physical Therapy, University of Miami Miller School of Medicine, Miami, Florida; Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, Florida.
| | - Neva J Kirk-Sanchez
- Department of Physical Therapy, University of Miami Miller School of Medicine, Miami, Florida
| | - Kelsey L Garcia
- Department of Physical Therapy, University of Miami Miller School of Medicine, Miami, Florida; Department of Rehabilitation, Jackson Health Systems, Miami, Florida
| | - Mark S Nash
- Department of Physical Therapy, University of Miami Miller School of Medicine, Miami, Florida; Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, Florida
| | - Lawrence P Cahalin
- Department of Physical Therapy, University of Miami Miller School of Medicine, Miami, Florida
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4
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Palermo AE, Cahalin LP, Garcia KL, Nash MS. Psychometric Testing and Clinical Utility of a Modified Version of the Function in Sitting Test for Individuals With Chronic Spinal Cord Injury. Arch Phys Med Rehabil 2020; 101:1961-1972. [PMID: 32673654 DOI: 10.1016/j.apmr.2020.06.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 06/23/2020] [Accepted: 06/30/2020] [Indexed: 01/16/2023]
Abstract
OBJECTIVES Seated balance (SB) is substantially compromised and greatly impacts the function of individuals living with a spinal cord injury (SCI). A clinically applicable criterion standard measure for SB does not exist for this population. Initial validation and reliability analysis of the Function in Sitting Test (FIST) in SCI has been published, but the authors of this study report that modifications to the tool may be necessary. This study aimed to explore the psychometrics and clinical utility of a modified version of the FIST to better measure SCI-specific functional tasks in sitting. DESIGN The FIST was modified (FIST-SCI) by an expert panel and used by 2 graders to evaluate the SB of individuals with chronic SCI (cSCI) on 2 separate days. The Motor Assessment Scale item 3 (MAS-SCI) was included as a comparison measure. SETTING Research facility. PARTICIPANTS Individuals with cSCI longer than 1 year (N=38) participated in the study. Injury levels of individuals participating in this study spanned C1 to T10 (American Spinal Injury Association Impairment Scale A, 17 subjects; B, 12 subjects; and C, 9 subjects). Thirteen individuals required assistance to transfer. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Validity, reliability, internal consistency, sensitivity, specificity, and responsiveness. RESULTS Validity testing found a moderate relationship between the MAS-SCI and the FIST-SCI (ρ, .522; P<.05). FIST-SCI scores distinguished individuals requiring assistance to transfer from those who were independent (t=4.51; P<.05). Inter- and intra-rater reliability were excellent (intraclass correlation coefficient (2,k)=.985 and .983, respectively) and internal consistency was excellent (α=.94). A FIST-SCI cutoff score of 45 or greater was 92% sensitive and specific in characterizing transfer ability. Standard error of the measure (1.3) and minimal detectable change (3.5) were similar to previous work. CONCLUSIONS Initial validity of the FIST-SCI is reported, but further assessment is required. Reliability is excellent in the cSCI population. FIST-SCI scores provide clinical insight into the seated functional ability of individuals with cSCI.
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Affiliation(s)
- Anne E Palermo
- University of Miami Miller School of Medicine, Department of Physical Therapy, The Miami Project to Cure Paralysis, Miami, FL.
| | - Lawrence P Cahalin
- University of Miami Miller School of Medicine, Department of Physical Therapy, The Miami Project to Cure Paralysis, Miami, FL
| | | | - Mark S Nash
- University of Miami Miller School of Medicine, Department of Physical Therapy, The Miami Project to Cure Paralysis, Miami, FL
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5
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Baumgart JK, Brurok B, Sandbakk Ø. Comparison of Peak Oxygen Uptake Between Upper-Body Exercise Modes: A Systematic Literature Review and Meta-Analysis. Front Physiol 2020; 11:412. [PMID: 32508667 PMCID: PMC7248246 DOI: 10.3389/fphys.2020.00412] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Accepted: 04/06/2020] [Indexed: 11/13/2022] Open
Abstract
Purpose: To compare peak oxygen uptake (VO2peak) between the asynchronous arm crank ergometry (ACE), and synchronous wheelchair ergometry (WERG), wheelchair treadmill (WTR), and upper-body poling (UBP) mode. Methods: PubMed, Scopus, CINAHL, and SPORTDiscus™ were systematically searched, and identified studies screened based on title, abstract, and thereafter full-text. Studies comparing VO2peak between ≥2 of the modes were included. A meta-analysis was performed by pooling the differences in VO2peak between upper-body exercise modes. The quality of the included studies was assessed and the level of evidence (LoE) established for each mode comparison. Meta-regression analyses investigated the effect of total body mass and participant-related characteristics (% of able-bodied participants, % of participants with tetraplegia and % of participants who are wheelchair athletes) on differences in VO2peak between modes. Results: Of the 19 studies included in this review, 14 studies investigated the difference in absolute and body-mass normalized VO2peak between ACE and WERG, and 5 studies examined the differences between ACE and WTR. No significant difference in absolute or body-mass normalized VO2peak was found between ACE and WERG (overall effect ±95% CI: 0.01 ± 0.06 L·min−1 and 0.06 ± 1.2 ml·kg−1·min−1, both p > 0.75; LoE: strong). No significant difference in absolute or body-mass normalized VO2peak was found between ACE and WTR (overall effect ±95% CI: −0.10 ± 0.18 L·min−1 and −1.8 ± 2.5 ml·kg−1·min−1, both p > 0.14; LoE: moderate). Absolute and/or body-mass normalized VO2peak did not differ between WERG and WTR in one study with 13 participants (LoE: limited) and between ACE and UBP in one study with 18 participants (LoE: moderate). In the meta-regression analyses, there was no significant effect of the investigated factors on differences in VO2peak. Conclusions: The differences between the asynchronous ACE and synchronous WERG propulsion, including possible differences in trunk involvement, do not seem to influence VO2peak. Therefore, ACE and WERG can be used interchangeably to test VO2peak. Possible differences in VO2peak in all other mode comparisons remain unclear due to the wide CIs and limited to moderate LoE.
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Affiliation(s)
- Julia Kathrin Baumgart
- Department of Neuromedicine and Movement Science, Centre for Elite Sports Research, Norwegian University of Science and Technology, Trondheim, Norway
| | - Berit Brurok
- Department of Neuromedicine and Movement Science, Centre for Elite Sports Research, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Physical Medicine and Rehabilitation, St. Olav's University Hospital, Trondheim, Norway
| | - Øyvind Sandbakk
- Department of Neuromedicine and Movement Science, Centre for Elite Sports Research, Norwegian University of Science and Technology, Trondheim, Norway
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Brizuela G, Sinz S, Aranda R, Martínez-Navarro I. The effect of arm-crank exercise training on power output, spirometric and cardiac function and level of autonomy in persons with tetraplegia. Eur J Sport Sci 2019; 20:926-934. [PMID: 31566476 DOI: 10.1080/17461391.2019.1674927] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Studies on the effects of exercise training in persons with cervical spinal cord injury (CSCI) are scarce. The aim of this study was to determine the effect of an 8-week stationary arm-crank exercise (ACE) training programme on the level of autonomy, exercise performance, pulmonary functional parameters and resting heart rate variability (HRV) in persons with CSCI. Quadriplegia Index of Function (QIF), arm-crank peak power output (Ppeak), spirometric variables, and HRV indices were measured before and after the training programme in a group of 11 persons with CSCI. ACE training increased Ppeak in both groups (p < 0.05), whereas maximum voluntary ventilation (MVV) and low frequency HRV (LF) improved only in the lower CSCI group (p < 0.05). Moreover, QIF and Ppeak were significantly correlated before (r = 0.88; p < 0.01) and after (r = 0.86; p < 0.01) the training period. However, no significant changes were found in the level of autonomy (QIF) as a result of the intervention. Therefore, stationary ACE training appears to be a feasible and effective method for aerobic exercise in persons with tetraplegia and a short-term intervention is able to significantly improve exercise capacity, cardiac autonomic regulation and respiratory muscle endurance, regardless of the absence of significant immediate changes in the level of autonomy.
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Affiliation(s)
- G Brizuela
- Department of Physical Education and Sports, Faculty of Physical Activity and Sport Sciences, University of Valencia, Valencia, Spain
| | - S Sinz
- Department of Physical Education and Sports, Faculty of Physical Activity and Sport Sciences, University of Valencia, Valencia, Spain
| | - R Aranda
- Department of Physical Education and Sports, Faculty of Physical Activity and Sport Sciences, University of Valencia, Valencia, Spain.,Sports Support Center - Valencian Sport Council, Valencia, Spain
| | - I Martínez-Navarro
- Department of Physical Education and Sports, Faculty of Physical Activity and Sport Sciences, University of Valencia, Valencia, Spain.,Vithas Sports Health Unit, 9 de Octubre Hospital, Valencia, Spain
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7
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Hutchinson MJ, MacDonald MJ, Eston R, Goosey-Tolfrey VL. Peak oxygen uptake measured during a perceptually-regulated exercise test is reliable in community-based manual wheelchair users. J Sports Sci 2018; 37:701-707. [PMID: 30547732 DOI: 10.1080/02640414.2018.1522941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
This study compares test-retest reliability and peak exercise responses from ramp-incremented (RAMP) and maximal perceptually-regulated (PRETmax) exercise tests during arm crank exercise in individuals reliant on manual wheelchair propulsion (MWP). Ten untrained participants completed four trials over 2-weeks (two RAMP (0-40 W + 5-10 W · min-1) trials and two PRETmax. PRETmax consisted of five, 2-min stages performed at Ratings of Perceived Exertion (RPE) 11, 13, 15, 17 and 20). Participants freely changed the power output to match the required RPE. Gas exchange variables, heart rate, power output, RPE and affect were determined throughout trials. The V̇O2peak from RAMP (14.8 ± 5.5 ml · kg-1 · min-1) and PRETmax (13.9 ± 5.2 ml · kg-1 · min-1) trials were not different (P = 0.08). Measurement error was 1.7 and 2.2 ml · kg-1 · min-1 and coefficient of variation 5.9% and 8.1% for measuring V̇O2peak from RAMP and PRETmax, respectively. Affect was more positive at RPE 13 (P = 0.02), 15 (P = 0.01) and 17 (P = 0.01) during PRETmax. Findings suggest that PRETmax can be used to measure V̇O2peak in participants reliant on MWP and leads to a more positive affective response compared to RAMP.
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Affiliation(s)
- Michael John Hutchinson
- a The Peter Harrison Centre for Disability Sport, School for Sport, Exercise and Health Sciences , Loughborough University , Loughborough , UK
| | - Maureen Jane MacDonald
- a The Peter Harrison Centre for Disability Sport, School for Sport, Exercise and Health Sciences , Loughborough University , Loughborough , UK.,b Exercise Metabolism Research Group, Department of Kinesiology , McMaster University , Hamilton , Canada
| | - Roger Eston
- c Alliance for Research in Exercise, Nutrition and Activity, Sansom Institute for Health Research, School of Health Sciences , University of South Australia , Adelaide , Australia
| | - Victoria Louise Goosey-Tolfrey
- a The Peter Harrison Centre for Disability Sport, School for Sport, Exercise and Health Sciences , Loughborough University , Loughborough , UK
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Maher JL, McMillan DW, Nash MS. Exercise and Health-Related Risks of Physical Deconditioning After Spinal Cord Injury. Top Spinal Cord Inj Rehabil 2018; 23:175-187. [PMID: 29339894 DOI: 10.1310/sci2303-175] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
A sedentary lifestyle occurring soon after spinal cord injury (SCI) may be in contrast to a preinjury history of active physical engagement and is thereafter associated with profound physical deconditioning sustained throughout the lifespan. This physical deconditioning contributes in varying degrees to lifelong medical complications, including accelerated cardiovascular disease, insulin resistance, osteopenia, and visceral obesity. Unlike persons without disability for whom exercise is readily available and easily accomplished, exercise options for persons with SCI are more limited. Depending on the level of injury, the metabolic responses to acute exercise may also be less robust than those accompanying exercise in persons without disability, the training benefits more difficult to achieve, and the risks of ill-considered exercise both greater and potentially irreversible. For exercise to ultimately promote benefit and not impose additional impairment, an understanding of exercise opportunities and risks if exercise is undertaken by those with SCI is important. The following monograph will thus address common medical challenges experienced by persons with SCI and typical modes and benefits of voluntary exercise conditioning.
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Affiliation(s)
- Jennifer L Maher
- The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, Florida
| | - David W McMillan
- The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, Florida.,Department of Kinesiology and Sports Sciences, University of Miami, Coral Gables, Florida
| | - Mark S Nash
- The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, Florida.,Departments of Neurological Surgery and Physical Medicine & Rehabilitation, University of Miami Miller School of Medicine, Miami, Florida
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Mat Rosly M, Halaki M, Mat Rosly H, Cuesta V, Hasnan N, Davis GM, Husain R. Exergaming for Individuals with Spinal Cord Injury: A Pilot Study. Games Health J 2017; 6:279-289. [DOI: 10.1089/g4h.2017.0028] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Maziah Mat Rosly
- Department of Physiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Clinical Exercise and Rehabilitation Unit, Discipline of Exercise and Sport Science, Faculty of Health Sciences, The University of Sydney, Sydney, Australia
| | - Mark Halaki
- Clinical Exercise and Rehabilitation Unit, Discipline of Exercise and Sport Science, Faculty of Health Sciences, The University of Sydney, Sydney, Australia
| | - Hadi Mat Rosly
- Department of Mechatronics Engineering, Faculty of Engineering, International Islamic University, Kuala Lumpur, Malaysia
| | - Victor Cuesta
- Graduate School of System Design and Management, Keio University, Yokohama, Japan
| | - Nazirah Hasnan
- Department of Rehabilitation Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Glen M. Davis
- Clinical Exercise and Rehabilitation Unit, Discipline of Exercise and Sport Science, Faculty of Health Sciences, The University of Sydney, Sydney, Australia
| | - Ruby Husain
- Department of Physiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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10
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Eerden S, Dekker R, Hettinga FJ. Maximal and submaximal aerobic tests for wheelchair-dependent persons with spinal cord injury: a systematic review to summarize and identify useful applications for clinical rehabilitation. Disabil Rehabil 2017. [DOI: 10.1080/09638288.2017.1287623] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Sophia Eerden
- Center for Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Rienk Dekker
- Department of Rehabilitation Medicine, Center for Rehabilitation, University Medical Center Groningen, Groningen, The Netherlands
- Center for Sports Medicine, University Medical Center Groningen, Groningen, The Netherlands
| | - Florentina J. Hettinga
- School of Biological Sciences, Centre of Sport and Exercise Science, University of Essex, Colchester, UK
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11
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Thoracoabdominal mobility is improved in subjects with tetraplegia after one year of wheelchair rugby training. Sci Sports 2016. [DOI: 10.1016/j.scispo.2016.04.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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12
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Pelletier CA, Miyatani M, Giangregorio L, Craven BC. Sarcopenic Obesity in Adults With Spinal Cord Injury: A Cross-Sectional Study. Arch Phys Med Rehabil 2016; 97:1931-1937. [PMID: 27282328 DOI: 10.1016/j.apmr.2016.04.026] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2016] [Accepted: 04/28/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To describe (1) the frequency and utility of clinically relevant spinal cord injury (SCI)-specific and general population thresholds for obesity and sarcopenic obesity; and (2) the fat and lean soft tissue distributions based on the neurologic level of injury and the American Spinal Injury Association Impairment Scale. DESIGN Cross-sectional. SETTING Tertiary SCI rehabilitation hospital. PARTICIPANTS Persons (N=136; men, n=100; women, n=36) with chronic (mean ± SD: 15.6±11.3y postinjury) tetraplegia (n=66) or paraplegia (n=70). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Body composition was assessed with anthropometrics and whole-body dual-energy x-ray absorptiometry. Muscle atrophy was quantified using a sarcopenia threshold of appendicular lean mass index (ALMI) (men, ≤7.26kg/m2; women, ≤5.5kg/m2). Obesity was defined by percentage body fat (men, ≥25%; women, ≥35%), visceral adipose tissue (≥130cm2), and SCI-specific obesity thresholds (body mass index [BMI] ≥22kg/m2; waist circumference ≥94cm). Sarcopenic obesity was defined as the presence of both sarcopenia and obesity. Groups were compared based on impairment characteristics using an analysis of covariance. RESULTS Sarcopenic obesity was prevalent in 41.9% of the sample. ALMI was lower among participants with motor-complete (6.2±1.3kg/m2) versus motor-incomplete (7.5±1.6kg/m2) injuries (P<.01). Whole-body fat was greater among participants with tetraplegia (28.8±11.2kg) versus paraplegia (24.1±8.7kg; P<.05). Compared with general population guidelines (20.6%), SCI-specific BMI thresholds identified all the participants with obesity (77.9%) based on percentage body fat (72.1%). CONCLUSIONS The observed frequency of sarcopenic obesity in this sample of individuals with chronic SCI is very high, and identification of obesity is dissimilar when using SCI-specific versus general population criteria.
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Affiliation(s)
- Chelsea A Pelletier
- Toronto Rehabilitation Institute-University Health Network, Brain and Spinal Cord Rehabilitation Program, Toronto, Ontario, Canada.
| | - Masae Miyatani
- Toronto Rehabilitation Institute-University Health Network, Brain and Spinal Cord Rehabilitation Program, Toronto, Ontario, Canada
| | - Lora Giangregorio
- Toronto Rehabilitation Institute-University Health Network, Brain and Spinal Cord Rehabilitation Program, Toronto, Ontario, Canada; Department of Kinesiology, University of Waterloo, Waterloo, Ontario, Canada
| | - B Catharine Craven
- Toronto Rehabilitation Institute-University Health Network, Brain and Spinal Cord Rehabilitation Program, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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Totosy de Zepetnek JO, Au JS, Hol AT, Eng JJ, MacDonald MJ. Predicting peak oxygen uptake from submaximal exercise after spinal cord injury. Appl Physiol Nutr Metab 2016; 41:775-81. [PMID: 27363732 DOI: 10.1139/apnm-2015-0670] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The purpose of this study was to determine the validity of the 6-min arm ergometry test (6MAT) in predicting peak oxygen consumption (V̇O2peak) in individuals with chronic spinal cord injury (SCI). Fifty-two individuals with chronic SCI (age, 38 ± 10 years; American Spinal Injury Association Impairment Scale (AIS), A-D; neurological level of injury (NLI), C1-L2; years post-injury (YPI), 13 ± 10 years) completed an incremental arm ergometry V̇O2peak test and a submaximal 6MAT. Oxygen consumption (V̇O2) data from both tests were used to create a predictive equation with regression analysis. Subsequently, a cross-validation group comprising an additional 10 individuals with SCI (age, 39 ± 13 years; AIS, A-D; NLI, C3-L3; YPI, 9 ± 9 years) were used to determine the predictive power of the equation. All participants were able to complete both the V̇O2peak and 6MAT assessments. Regression analysis yielded the following equation to predict V̇O2peak from end-stage 6MAT V̇O2: V̇O2peak (mL·kg(-1)·min(-1)) = 1.501(6MAT V̇O2) - 0.940. Correlation between measured and predicted V̇O2peak was excellent (r = 0.89). No significant difference was found between measured (17.41 ± 7.44 mL·kg(-1)·min(-1)) and predicted (17.42 ± 6.61 mL·kg(-1)·min(-1)) V̇O2peak (p = 0.97). When cross-validated with a sample of 10 individuals with SCI, correlation between measured and predicted V̇O2peak remained high (r = 0.89), with no differences between measured (18.81 ± 8.35 mL·kg(-1)·min(-1)) and predicted (18.73 ± 7.27 mL·kg(-1)·min(-1)) V̇O2peak (p = 0.75). Results suggest that 6MAT V̇O2 can be used to predict V̇O2peak among individuals with chronic SCI. The 6MAT should be used as a clinical tool for assessing aerobic capacity when peak exercise testing is not feasible.
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Affiliation(s)
| | - Jason S Au
- a Department of Kinesiology, McMaster University, Hamilton, ON L8S 4L8, Canada
| | - Adrienne T Hol
- b Department of Physical Therapy, University of British Columbia, Vancouver, BC V6T 1Z3, Canada.,c Rehabilitation Research Program, GF Strong Rehab Centre, Vancouver Coastal Health, Vancouver, BC V5Z 2G9, Canada
| | - Janice J Eng
- b Department of Physical Therapy, University of British Columbia, Vancouver, BC V6T 1Z3, Canada.,c Rehabilitation Research Program, GF Strong Rehab Centre, Vancouver Coastal Health, Vancouver, BC V5Z 2G9, Canada
| | - Maureen J MacDonald
- a Department of Kinesiology, McMaster University, Hamilton, ON L8S 4L8, Canada
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Yanci J, Granados C, Otero M, Badiola A, Olasagasti J, Bidaurrazaga-Letona I, Iturricastillo A, Gil S. Sprint, agility, strength and endurance capacity in wheelchair basketball players. Biol Sport 2014; 32:71-8. [PMID: 25729153 PMCID: PMC4314607 DOI: 10.5604/20831862.1127285] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Revised: 04/15/2014] [Accepted: 05/24/2014] [Indexed: 11/13/2022] Open
Abstract
The aims of the present study were, firstly, to determine the reliability and reproducibility of an agility T-test and Yo-Yo 10 m recovery test; and secondly, to analyse the physical characteristics measured by sprint, agility, strength and endurance field tests in wheelchair basketball (WB) players. 16 WB players (33.06 ± 7.36 years, 71.89 ± 21.71 kg and sitting body height 86.07 ± 6.82 cm) belonging to the national WB league participated in this study. Wheelchair sprint (5 and 20 m without ball, and 5 and 20 m with ball) agility (T-test and pick-up test) strength (handgrip and maximal pass) and endurance (Yo-Yo 10 m recovery test) were performed. T-test and Yo-Yo 10 m recovery test showed good reproducibility values (intraclass correlation coefficient, ICC = 0.74-0.94). The WB players' results in 5 and 20 m sprints without a ball were 1.87 ± 0.21 s and 5.70 ± 0.43 s and with a ball 2.10 ± 0.30 s and 6.59 ± 0.61 s, being better than those reported in the literature. Regarding the pick-up test results (16.05 ± 0.52 s) and maximal pass (8.39 ± 1.77 m), players showed worse values than those obtained in elite players. The main contribution of the present study is the characterization of the physical performance profile of WB players using a field test battery. Furthermore, we demonstrated that the agility T-test and the aerobic Yo-Yo 10 m recovery test are reliable; consequently they may be appropriate instruments for measuring physical fitness in WB.
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Affiliation(s)
- J Yanci
- Department of Physical Education and Sport, Faculty of Physical Activity and Sports Science, University of the Basque Country, UPV/EHU, Vitoria-Gasteiz, Spain
| | - C Granados
- Department of Physical Education and Sport, Faculty of Physical Activity and Sports Science, University of the Basque Country, UPV/EHU, Vitoria-Gasteiz, Spain
| | - M Otero
- Department of Physical Education and Sport, Faculty of Physical Activity and Sports Science, University of the Basque Country, UPV/EHU, Vitoria-Gasteiz, Spain
| | - A Badiola
- Department of Physical Education and Sport, Faculty of Physical Activity and Sports Science, University of the Basque Country, UPV/EHU, Vitoria-Gasteiz, Spain
| | - J Olasagasti
- Guipuzcoa Adapted Sport Federation, San Sebastián, Spain
| | - I Bidaurrazaga-Letona
- Department of Physical Education and Sport, Faculty of Physical Activity and Sports Science, University of the Basque Country, UPV/EHU, Vitoria-Gasteiz, Spain
| | - A Iturricastillo
- Department of Physical Education and Sport, Faculty of Physical Activity and Sports Science, University of the Basque Country, UPV/EHU, Vitoria-Gasteiz, Spain
| | - Sm Gil
- Department of Physical Education and Sport, Faculty of Physical Activity and Sports Science, University of the Basque Country, UPV/EHU, Vitoria-Gasteiz, Spain
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Simmons OL, Kressler J, Nash MS. Reference fitness values in the untrained spinal cord injury population. Arch Phys Med Rehabil 2014; 95:2272-8. [PMID: 25007709 DOI: 10.1016/j.apmr.2014.06.015] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Revised: 06/02/2014] [Accepted: 06/23/2014] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Establish reference values of cardiorespiratory fitness applicable to the general, untrained spinal cord injury (SCI) population. DESIGN Data were retroactively obtained from 12 studies (May 2004 to May 2012). SETTING An institution-affiliated applied physiology research laboratory. PARTICIPANTS A total of 153 men and 26 women (age, 18-55y) with chronic SCI (N=179) were included. Participants were not involved in training activities for 1 or more months before testing and were able to complete a progressive resistance exercise test to determine peak oxygen consumption (Vo2peak). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE Percentile ranking (poor<20%; fair; 20%-40%; average, 40%-60%; good, 60%-80%; excellent, 80%-100%) used to establish reference values. RESULTS Reference cardiorespiratory fitness values based on functional classification as paraplegic or tetraplegic were established (paraplegic: median, 16.0mL·kg(-1)·min(-1); range, 1.4-35.2mL·kg(-1)·min(-1); tetraplegic: median, 8.8mL·kg(-1)·min(-1); range, 1.5-21.5mL·kg(-1)·min(-1)) for untrained men and women. For the primary outcome measure (Vo2peak), persons with paraplegia had significantly higher values than did persons with tetraplegia (P<.001). Although men had higher values than did women, these differences did not reach significance (P=.256). Regression analysis revealed that motor level of injury was associated with 22.3% of the variability in Vo2peak (P<.001), and an additional 8.7% was associated with body mass index (P<.001). No other measure accounted for additional significant variability. CONCLUSIONS Established reference fitness values will allow investigators/clinicians to stratify the relative fitness of subjects/patients from the general SCI population. Key determinants are motor level of injury and body habitus, yet most variability in aerobic capacity is not associated with standard measures of SCI status or demographic characteristics.
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Affiliation(s)
| | | | - Mark S Nash
- University of Miami Miller School of Medicine, Miami, FL
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Mayson TA, Harris SR. Functional electrical stimulation cycling in youth with spinal cord injury: A review of intervention studies. J Spinal Cord Med 2014; 37:266-77. [PMID: 24621033 PMCID: PMC4064576 DOI: 10.1179/2045772313y.0000000183] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
CONTEXT Preliminary research suggests that functional electrical stimulation cycling (FESC) might be a promising intervention for youth with spinal cord injury (SCI). OBJECTIVE To review the evidence on FESC intervention in youth with SCI. METHODS Systematic literature searches were conducted during December 2012. Two reviewers independently selected titles, abstracts, and full-text articles. Of 40 titles retrieved, six intervention studies met inclusion criteria and were assessed using American Academy for Cerebral Palsy and Developmental Medicine Levels of Evidence and Conduct Questions for Group Design. RESULTS The study results were tabulated based on levels of evidence, with outcomes categorized according to the International Classification of Functioning, Disability, and Health framework. Evidence from the six included studies suggests that FESC is safe for youth with SCI, with no increase in knee/hip injury or hip displacement. Results from one level II randomized controlled trial suggest that a thrice weekly, 6-month FESC program can positively influence VO2 levels when compared with passive cycling, as well as quadriceps strength when compared with electrical stimulation and passive cycling. CONCLUSIONS FESC demonstrates limited yet encouraging results as a safe modality to mitigate effects of inactivity in youth with SCI. More rigorous research involving a greater number of participants is needed before clinicians can be confident of its effectiveness.
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Affiliation(s)
- Tanja A. Mayson
- Correspondence to: Tanja A. Mayson, Therapy Department, Sunny Hill Health Centre for Children, 3644 Slocan St. Vancouver, BC, Canada, V5M 3E8.
| | - Susan R. Harris
- Department of Physical Therapy, University of British Columbia, Friedman Building, Vancouver, BC, Canada
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Fekete C, Siegrist J, Reinhardt JD, Brinkhof MWG. Is financial hardship associated with reduced health in disability? The case of spinal cord injury in Switzerland. PLoS One 2014; 9:e90130. [PMID: 24587239 PMCID: PMC3938582 DOI: 10.1371/journal.pone.0090130] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Accepted: 01/27/2014] [Indexed: 11/26/2022] Open
Abstract
Objective To investigate socioeconomic inequalities in a comprehensive set of health indicators among persons with spinal cord injury in a wealthy country, Switzerland. Methods Observational cross-sectional data from 1549 participants of the Swiss Spinal Cord Injury Cohort Study (SwiSCI), aged over 16 years, and living in Switzerland were analyzed. Socioeconomic circumstances were operationalized by years of formal education, net equivalent household income and financial hardship. Health indicators including secondary conditions, comorbidities, pain, mental health, participation and quality of life were used as outcomes. Associations between socioeconomic circumstances and health indicators were evaluated using ordinal regressions. Results Financial hardship was consistently associated with more secondary conditions (OR 3.37, 95% CI 2.18–5.21), comorbidities (OR 2.88, 95% CI 1.83–4.53) and pain (OR 3.32, 95% CI 2.21–4.99), whereas mental health (OR 0.23, 95% CI 0.15–0.36), participation (OR 0.30, 95% CI 0.21–0.43) and quality of life (OR 0.22, 95% CI 0.15–0.33) were reduced. Persons with higher education reported better mental health (OR 1.04, 95% CI 1.00–1.07) and higher quality of life (OR 1.06, 95% CI 1.02–1.09); other health indicators were not associated with education. Household income was not related to any of the studied health indicators when models were controlled for financial hardship. Conclusions Suffering from financial hardship goes along with significant reductions in physical health, functioning and quality of life, even in a wealthy country with comprehensive social and health policies.
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Affiliation(s)
| | - Johannes Siegrist
- Senior Professorship for Work Stress Research, Faculty of Medicine, University of Duesseldorf, Life Science Center, Duesseldorf, Germany
| | - Jan D. Reinhardt
- Swiss Paraplegic Research, Nottwil, Switzerland
- Institute for Disaster Management and Reconstruction, Sichuan University and Hong Kong Polytechnic University, Chengdu, Sichuan Province, China
| | - Martin W. G. Brinkhof
- Swiss Paraplegic Research, Nottwil, Switzerland
- Department of Health Sciences and Health Policy, University of Lucerne, Lucerne, Switzerland
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Aerobic Capacity, Orthostatic Tolerance, and Exercise Perceptions at Discharge From Inpatient Spinal Cord Injury Rehabilitation. Arch Phys Med Rehabil 2013; 94:2013-9. [DOI: 10.1016/j.apmr.2013.05.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Revised: 05/11/2013] [Accepted: 05/15/2013] [Indexed: 11/22/2022]
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Determination of normative values for 20 min exercise of wheelchair propulsion by spinal cord injury patients. Spinal Cord 2013; 51:755-60. [DOI: 10.1038/sc.2013.89] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Revised: 07/23/2013] [Accepted: 07/25/2013] [Indexed: 11/08/2022]
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Litchke LG, Lloyd LK, Schmidt EA, Russian CJ, Reardon RF. Effects of concurrent respiratory resistance training on health-related quality of life in wheelchair rugby athletes: a pilot study. Top Spinal Cord Inj Rehabil 2013; 18:264-72. [PMID: 23459144 DOI: 10.1310/sci1803-264] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
PURPOSE To compare the effects of 9 weeks of training with a concurrent flow resistance (CFR) device versus a concurrent pressure threshold resistance (CPTR) device on health-related quality of life (HRQoL) in wheelchair rugby (WR) athletes. METHOD Twenty-four male WR athletes (22 with tetraplegia, 1 with a spastic cerebral palsy, and 1 with congenital upper and lower limb deformities) were matched by lesion level, completeness of injury, and rugby classification prior to being randomly assigned to 1 of 3 groups: (1) CPTR (n=8), (2) CFR (n=8), or (3) controls (CON, n=8). Pre/post testing included assessment of HRQoL as measured by the Short-Form Health Survey Version 2.0 (SF-36v2). Manufacturer protocol guidelines for the CFR and CPTR groups were followed for breathing exercises. RESULTS Sixteen participants completed the study (CPTR=4, CFR=5, CON=7). The Mann-Whitney U rank order revealed significantly greater reductions in bodily pain (P = .038) and improvements in vitality (P = .028) for CFR versus CON. CONCLUSION Results from this study suggest that training with a CFR device improves some aspects of HRQoL (eg, vitality and bodily pain) in WR athletes. Further research with a larger sample size is needed to examine the impact of these devices on improving HRQoL for wheelchair athletes.
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Abstract
Individuals with spinal cord injury (SCI) tend to report poorer quality of life (QOL) than people without a physical disability. Leisure-time physical activity (LTPA) has been shown to improve the QOL of people with and without disabilities and chronic conditions. The purpose of this systematic review was to examine the LTPA-QOL relationship among people with SCI by focusing on both objective and subjective QOL for both global QOL and domain-specifc (physical, psychological, social) QOL. Results suggest that LTPA is significantly associated with increases in both objective and subjective QOL in global QOL and all three QOL domains, with relatively few studies demonstrating a negative or nonsignificant relationship. Recommendations for future QOL research and interventions are discussed.
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Jung DW, Park DS, Lee BS, Kim M. Development of a motor driven rowing machine with automatic functional electrical stimulation controller for individuals with paraplegia; a preliminary study. Ann Rehabil Med 2012; 36:379-85. [PMID: 22837974 PMCID: PMC3400878 DOI: 10.5535/arm.2012.36.3.379] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2011] [Accepted: 05/09/2012] [Indexed: 11/18/2022] Open
Abstract
Objective To examine the cardiorespiratory responses of patients with spinal cord injury (SCI) paraplegia using a motor driven rowing machine. Method Ten SCI patients with paraplegia [A (n=6), B (n=1), and C (n=3) by the American Spinal Injury Association impairment scale] were selected. Two rowing techniques were used. The first used a fixed seat with rowing achieved using only upper extremity movement (fixed rowing). The second used an automatically moving seat, facilitating active upper extremity movement and passive lower extremity movement via the motorized seat (motor rowing). Each patient performed two randomly assigned rowing exercise stress tests 1-3 days apart. The work rate (WR), time, respiratory exchange ratio (R), oxygen consumption (VO2), heart rate (HR), metabolic equivalents (METs), and rating of perceived exertion (RPE) were recorded. Results WR, time, VO2, and METs were significantly higher after the motor rowing test than after fixed motor rowing test (p<0.05). HR after motor rowing was significantly lower than fixed rowing (p<0.05). Conclusion Cardiorespiratory responses as VO2, HR and METs can be elicited by the motor rowing for people with paraplegic SCI.
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Affiliation(s)
- Da-Woon Jung
- Department of Motor and Cognitive Function Rehabilitation, National Rehabilitation Research Institute, Seoul 142-884, Korea
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Van de Velde D, Bracke P, Van Hove G, Josephsson S, Devisch I, Vanderstraeten G. The illusion and the paradox of being autonomous, experiences from persons with spinal cord injury in their transition period from hospital to home. Disabil Rehabil 2011; 34:491-502. [PMID: 21978173 DOI: 10.3109/09638288.2011.608149] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To open a discourse on the concept of autonomy as a precursor for participation in individuals with Spinal Cord Injury (SCI) by exploring the experiences about their perceived autonomy in their transition period from hospital to home. METHOD Based on the 'grounded theory' approach; in-depth, semi structured interviews were conducted with 11 SCI-patients. A theoretical sampling strategy was used and the data was analysed according to the constant comparative method. RESULTS To capture this complexity of autonomy, the results have been structured in themes with regard to the self of the patient and his independency. The analysis showed four different typologies of how autonomy is perceived; (1) the active agent, (2) the active follower, (3) the passive follower and (4) the passive victim. CONCLUSION Rehabilitation professionals can help individuals in disconnecting their internalised ideal of independency to avoid the illusion of being autonomous and can gain insight in the patients' typology and empower patients to avoid the paradox of being autonomous. If the ultimate goal of rehabilitation is participation; empowering the patient to achieve a 'sense of agency' instead of autonomy is the central goal for rehabilitation professionals. Empowerment and agency are key topics for the patient to gain mastery over his own life.
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Affiliation(s)
- Dominique Van de Velde
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium.
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Abstract
STUDY DESIGN Meta-analytic costeffectiveness analysis. OBJECTIVE Our goal was to compare the results of different management strategies for trauma patients in whom the cervical spine was not clinically evaluable due to impaired consciousness, endotracheal intubation, or painful distracting injuries. SUMMARY OF BACKGROUND DATA We performed a structured literature review related to cervical spine trauma, radiographic clearance techniques (plain radiography, flexion/extension, CT, and MRI), and complications associated with semirigid collar use. METHODS Meta-analytic techniques were used to pool data from multiple sources to calculate pooled mean estimates of sensitivities and specificities of imaging techniques for cervical spinal clearance, rates of complications from various clearance strategies and from empirical use of semirigid collars. A decision analysis model was used to compare outcomes and costs among these strategies. RESULTS Slightly more than 7.5% of patients who are clinically unevaluable have cervical spine injuries, and 42% of these injuries are associated with spinal instability. Sensitivity of plain radiography or fluoroscopy for spinal clearance was 57% (95% CI: 57%-60%). Sensitivities for CT and MRI alone were 83% (82%-84%) and 87% (84%-89%), respectively. Complications associated with collar use ranged from 1.3% (2 days) to 7.1% (10 days) but were usually minor and short-lived. Quadriplegia resulting from spinal instability missed by a clearance test had enormous impacts on longevity, quality of life, and costs. These impacts overshadowed the effects of prolonged collar application, even when the incidence of quadriplegia was extremely low. CONCLUSION As currently used, neuroimaging studies for cervical spinal clearance in clinically unevaluable patients are not cost-effective compared with empirical immobilization in a semirigid collar.
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Johnston TE, Smith BT, Mulcahey MJ, Betz RR, Lauer RT. A randomized controlled trial on the effects of cycling with and without electrical stimulation on cardiorespiratory and vascular health in children with spinal cord injury. Arch Phys Med Rehabil 2009; 90:1379-88. [PMID: 19651272 DOI: 10.1016/j.apmr.2009.02.018] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2008] [Revised: 02/18/2009] [Accepted: 02/24/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To examine the cardiorespiratory/vascular effects of cycling with and without functional electrical stimulation (FES) in children with spinal cord injury (SCI). DESIGN Randomized controlled trial. SETTING Pediatric referral hospital. PARTICIPANTS Children with SCI (N=30), ages 5 to 13 years, with injury levels from C4 to T11, and American Spinal Injury Association grades A, B, or C. INTERVENTIONS Children were randomly assigned to 1 of 3 groups: FES leg cycling exercise, passive leg cycling, or noncycling control group receiving electrical stimulation therapy. After receiving instruction on the use of the equipment, children exercised for 1 hour 3 times per week for 6 months at home with parental supervision. MAIN OUTCOME MEASURES Oxygen uptake (Vo(2)) during an incremental arm ergometry test, resting heart rate, forced vital capacity, and a fasting lipid profile. RESULTS There were no differences (P>.05) between groups after 6 months of exercise when comparing pre- and postvalues. However, there were differences between groups for some variables when examining percent change. The FES cycling group showed an improvement (P=.035) in Vo(2) (16.2%+/-25.0%) as compared with the passive cycling group (-28.7%+/-29.1%). For lipid levels, the electrical stimulation-only group showed declines (P=.032) in cholesterol levels (-17.1%+/-8.5%) as compared with the FES cycling group (4.4%+/-20.4%). CONCLUSIONS Cycling with FES led to gains in Vo(2), whereas electrical stimulation alone led to improvements in cholesterol.
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Affiliation(s)
- Therese E Johnston
- Department of Physical Therapy, University of the Sciences in Philadelphia, Philadelphia, PA 19104, USA.
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Mason BS, van der Woude LH, Goosey-Tolfrey VL. Influence of Glove Type on Mobility Performance for Wheelchair Rugby Players. Am J Phys Med Rehabil 2009; 88:559-70. [DOI: 10.1097/phm.0b013e3181aa41c5] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Haisma JA, van der Woude LH, Stam HJ, Bergen MP, Sluis TA, de Groot S, Dallmeijer AJ, Bussmann JB. Prognostic Models for Physical Capacity at Discharge and 1 Year Postdischarge From Rehabilitation in Persons With Spinal Cord Injury. Arch Phys Med Rehabil 2007; 88:1694-703. [DOI: 10.1016/j.apmr.2007.07.044] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2007] [Revised: 07/25/2007] [Accepted: 07/28/2007] [Indexed: 11/27/2022]
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Widman LM, Abresch RT, Styne DM, McDonald CM. Aerobic fitness and upper extremity strength in patients aged 11 to 21 years with spinal cord dysfunction as compared to ideal weight and overweight controls. J Spinal Cord Med 2007; 30 Suppl 1:S88-96. [PMID: 17874693 PMCID: PMC2031980 DOI: 10.1080/10790268.2007.11754611] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVE To determine whether the aerobic fitness, upper extremity strength, and body composition in groups of adolescents with mobility impairment due to thoracic and upper lumbar spinal cord injury (SCI) or spina bifida (SB) are significantly different from those in groups of adolescents without mobility impairment who are of normal weight (CTRL) or overweight (OW). SUBJECTS One hundred fifteen total subjects were evaluated including 59 female (19 SB, 9 SCI, 17 OW, and 14 CTRL) and 56 male (18 SB, 10 SCI, 8 OW, and 20 CTRL) participants aged 11 to 21 years. METHODS Aerobic fitness was assessed using a ramp protocol with a magnetically braked arm ergometer. Heart rate and oxygen uptake (VO2) were recorded. Peak isokinetic upper arm and shoulder strength values were determined with a dynamometer. Body composition was estimated using dual energy x-ray absorptiometry (DEXA). Male and female subjects were categorized as overweight if their percent body fat by DEXA exceeded 25% and 30%, respectively. Results were analyzed with an ANOVA using the Bonferroni correction. Significance was accepted at P < 0.05. RESULTS The percent body fat of both the male and female SB and SCI subjects was significantly higher than CTRL but was not different than OW. In general, the shoulder extension and flexion strength in both the SB and SCI males and females was significantly lower than that of the CTRL and OW. The SCI and SB subjects had significantly reduced aerobic capacity (VO2/kg) compared to the CTRL subjects but were not different than the OW subjects. During the maximal exercise test, the SB and SCI subjects reached exhaustion at significantly lower workloads than the CTRL and OW subjects. CONCLUSIONS Patients age 11 to 21 years with SB and SCI had reduced aerobic capacity that was associated with being overweight and having reduced upper extremity strength. These data suggest that interventions to increase strength and fitness and to manage weight should be recommended in this population.
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Affiliation(s)
- Lana M Widman
- University of California Davis School of Medicine, Davis, California
| | - Richard Ted Abresch
- University of California Davis School of Medicine, Davis, California
- Please address correspondence to R. Ted Abresch, Department of Physical Medicine and Rehabilitation, University of California Davis, One Shields Avenue, TB191, Davis, CA, 95616; phone: 530.752.9085; fax: 530.752.3468 (e-mail: )
| | - Dennis M Styne
- University of California Davis School of Medicine, Davis, California
| | - Craig M McDonald
- University of California Davis School of Medicine, Davis, California
- Shriners Hospitals for Children Northern California, Sacramento, California
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Haisma JA, Bussmann JB, Stam HJ, Sluis TA, Bergen MP, Dallmeijer AJ, de Groot S, van der Woude LH. Changes in Physical Capacity During and After Inpatient Rehabilitation in Subjects With a Spinal Cord Injury. Arch Phys Med Rehabil 2006; 87:741-8. [PMID: 16731207 DOI: 10.1016/j.apmr.2006.02.032] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2005] [Accepted: 02/20/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To assess changes in physical capacity and its determinants in persons with a spinal cord injury. DESIGN Prospective cohort study. Measurements at the start of active rehabilitation (t1), 3 months later (t2), at discharge (t3), and 1 year after discharge (t4). SETTING Eight rehabilitation centers in The Netherlands. PARTICIPANTS A total of 186 subjects at t1 and 123 subjects at t4. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Peak aerobic power output (POpeak), peak oxygen uptake (V(O2)peak), muscle strength of the upper extremity (manual muscle test, handheld dynamometry), and respiratory function (forced expiratory flow per second, forced vital capacity). RESULTS Random coefficient analysis demonstrated that the POpeak, V(O2)peak, strength, and respiratory function improved during inpatient rehabilitation, and that V(O2)peak, strength, and respiratory function continued to improve after discharge. Age, sex, and level and completeness of lesion were determinants of the change in components of physical capacity. CONCLUSIONS Physical capacity improves during inpatient rehabilitation, and some components continue to improve after discharge. Subpopulations have a different level of (change in) physical capacity. The components of physical capacity are related; intervention studies are needed to confirm whether training 1 component could improve another component.
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Affiliation(s)
- Janneke A Haisma
- Department of Rehabilitation Medicine, Erasmus MC, University Medical Center, 3000 CA Rotterdam, The Netherlands.
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Haisma JA, van der Woude LHV, Stam HJ, Bergen MP, Sluis TAR, Bussmann JBJ. Physical capacity in wheelchair-dependent persons with a spinal cord injury: a critical review of the literature. Spinal Cord 2006; 44:642-52. [PMID: 16534502 DOI: 10.1038/sj.sc.3101915] [Citation(s) in RCA: 134] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Review of publications. OBJECTIVE To assess the level of physical capacity (peak oxygen uptake, peak power output, muscle strength of the upper extremity and respiratory function) in wheelchair-dependent persons with a spinal cord injury (SCI). SETTING Erasmus MC, University Medical Centre Rotterdam, The Netherlands. METHODS Pubmed (Medline) search of publications from 1980 onwards. Studies were systematically assessed. Weighted means were calculated for baseline values. RESULTS In tetraplegia, the weighted mean for peak oxygen uptake was 0.89 l/min for the wheelchair exercise test (WCE) and 0.87 l/min for arm-cranking or hand-cycling (ACE). The peak power output was 26 W (WCE) and 40 W (ACE). In paraplegia, the peak oxygen uptake was 2.10 l/min (WCE) and 1.51 l/min (ACE), whereas the peak power output was 74 W (ACE) and 85 W (WCE). In paraplegia, muscle strength of the upper extremity and respiratory function were comparable to that in the able-bodied population. In tetraplegia muscle strength varied greatly, and respiratory function was reduced to 55-59% of the predicted values for an age-, gender- and height-matched able-bodied population. CONCLUSIONS Physical capacity is reduced and varies in SCI. The variation between results is caused by population and methodological differences. Standardized measurement of physical capacity is needed to further develop comparative values for clinical practice and rehabilitation research.
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Affiliation(s)
- J A Haisma
- Department of Rehabilitation Medicine, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
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Scelza WM, Kalpakjian CZ, Zemper ED, Tate DG. Perceived barriers to exercise in people with spinal cord injury. Am J Phys Med Rehabil 2005; 84:576-83. [PMID: 16034226 DOI: 10.1097/01.phm.0000171172.96290.67] [Citation(s) in RCA: 159] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To identify barriers to physical fitness faced by individuals with spinal cord injury preventing them from participating in a physical fitness program. DESIGN In this cross-sectional study, a survey of barriers to exercise was administered to 72 individuals with spinal cord injury. RESULTS Although 73.6% of the participants expressed an interest in an exercise program, less than half (45.8%) were currently active in an exercise program. Less than half (47.2%) reported that their physician had recommended an exercise program for them. The most frequently cited concerns about barriers to exercise fell into three areas: (1) intrapersonal or intrinsic (e.g., lack of motivation, lack of energy, lack of interest), (2) resources (e.g., cost of an exercise program, not knowing where to exercise), and (3) structural or architectural (e.g., accessibility of facilities and knowledgeable instructors). More individuals with tetraplegia reported concerns over exercise being too difficult and that health concerns kept them from exercising. Greater number of concerns was significantly related to higher levels of perceived stress. CONCLUSIONS People with spinal cord injury face multiple barriers to physical fitness in functional, psychological, and architectural domains. Identification of these barriers can facilitate the participation of individuals with spinal cord injury in an exercise program, improving long-term health and wellness.
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Affiliation(s)
- William M Scelza
- Department of Physical Medicine and Rehabilitation, University of Michigan Health System, Ann Arbor, Michigan 48108, USA
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Zoeller RF, Riechman SE, Dabayebeh IM, Goss FL, Robertson RJ, Jacobs PL. Relation Between Muscular Strength and Cardiorespiratory Fitness in People With Thoracic-Level Paraplegia. Arch Phys Med Rehabil 2005; 86:1441-6. [PMID: 16003678 DOI: 10.1016/j.apmr.2004.11.032] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To determine the relation between muscular strength, aerobic power (V O2 peak), submaximal blood lactate accumulation, and endurance performance in people with thoracic-level paraplegia. DESIGN Participants performed tests of isokinetic strength, a graded exercise test, and 2 endurance performance tests. A Latin square counterbalanced design was used to determine the order of testing. SETTING Research laboratory in a university setting. PARTICIPANTS Ten adult male volunteers with thoracic-level paraplegia. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES The relations between strength, V O2 peak, submaximal blood lactate accumulation, and endurance were determined by correlation analysis. RESULTS Shoulder flexion strength correlated with V O2 peak and power output at V O2 peak. Shoulder strength accounted for 68.4% of the variation in performance time. Greater isokinetic elbow flexion and extension strength was associated with higher V O2 and power output at a blood lactate concentration of 4 mmol/L (flexion) and with a greater power output at V O2 peak (extension). CONCLUSIONS These findings suggest that in this population, greater muscular strength is associated with greater aerobic power and endurance. Greater muscular strength could exert a positive influence on exercise performance by enabling higher levels of cardiorespiratory stress as the result of reduced or delayed local muscle fatigue.
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Affiliation(s)
- Robert F Zoeller
- Department of Exercise Science and Health Promotion, Florida Atlantic University, Davie, FL 33314, USA.
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Rimaud D, Calmels P, Devillard X. Réentraînement a l'effort chez le blesse médullaire. ACTA ACUST UNITED AC 2005; 48:259-69. [PMID: 15914262 DOI: 10.1016/j.annrmp.2004.12.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2004] [Accepted: 12/20/2004] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Individualised exercise training programs in spinal cord injury (SCI) individuals are considered highly effective for improving and maintaining capacity for physical activity, as well as for reducing cardiovascular risk. However, no consensus exists on the type, intensity, and frequency of the training programs for SCI. OBJECTIVE To review the literature about training program characteristics for SCI and describe their efficacy, limits, and results, with the aim of proposing specific recommendations. METHODS Query using Medline and Embase databases. Ninety-nine references were found, including the following: Clinical studies examining physical endurance capacity of individuals with SCI, physiological responses to maximal exercise, or cardiovascular differences between sedentary and wheelchair-trained subjects; Articles? investigating the effects of training programmes for SCI. RESULTS Various combinations of training intensity, duration, frequency, type, and ergometers have been proposed for SCI. Whatever the characteristics of the training program, a review of 25 cardiorespiratory training studies involving SCI subjects revealed an average improvement of 9% to 99% in VO2max, 19% to 118% in power output, and a decrease in submaximal values after 4 to 36 weeks of training. DISCUSSION - CONCLUSION Wheelchair ergometers seems to be interesting for SCI because it mimics closely the daily motor tasks of wheelchair users and allows for adjustment of the wheelchair. Both continuous and interval training programmes are appropriate, but intermittent exercise intensities may be more beneficial since they mimic the intermittent nature of daily activity patterns. Furthermore, on the basis of the results of these studies, we recommend that training at or above 70% of maximum heart rate, for 30 minutes of rhythmic exercise, three days per week during eight weeks, will provide a sound of basis for design of an endurance exercise programme for people with SCI.
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Affiliation(s)
- D Rimaud
- Unité PPEH-GIP E2S EA 3062, faculté de médecine Jacques-Lisfranc, université Jean-Monnet service de médecine physique et de réadaptation, hôpital Bellevue CHU, 42055 Saint-Etienne cedex 02, France.
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Hammell KW. Exploring quality of life following high spinal cord injury: a review and critique. Spinal Cord 2004; 42:491-502. [PMID: 15263890 DOI: 10.1038/sj.sc.3101636] [Citation(s) in RCA: 97] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Review. OBJECTIVES To explore the concept of quality of life (QOL), critique the practice and problems of assessing QOL following spinal cord injury (SCI) and to review the findings of studies into QOL for people with SCI both below and above the level of C4. METHODS Relevant articles were identified from the Medline and CINAHL databases for approximately the period 1990-2003, cross-indexing 'spinal cord injury' or 'quadriplegia/tetraplegia' with 'quality of life', 'life satisfaction', 'social adjustment' or 'psychological adaptation'. This search was augmented through papers identified in reference lists. Articles were excluded if they were designed solely to examine the impact of a specific intervention upon QOL; or if they examined satisfaction with various life domains without explicitly linking these to perceptions of QOL. Papers were also accessed that addressed the philosophical and epistemological issues involved in QOL conceptions and assessment. RESULTS Review of the literature highlights the philosophical and methodological difficulties associated with the quantitative measurement of a qualitative experience; and with the assessment of life domains chosen by researchers. Analysis of QOL research undertaken among people with all levels of SCI demonstrates that dissatisfaction with life following injury arises primarily from social disadvantage. However, little research has been conducted specifically to ascertain perceptions of QOL among people with high SCI. CONCLUSIONS Ensuring the relevance of future research into QOL following high SCI requires qualitative methodology and mixed methods. Further research is needed to determine how rehabilitation professionals can act on the findings of their QOL assessments and enhance the QOL experienced by people with spinal cord injury in the context of their environments. SPONSORSHIP The early phase of this study was supported by: University of British Columbia Graduate Fellowship; Rick Hansen Man in Motion Foundation (studentship); Social Sciences and Humanities Research Council of Canada: doctoral fellowship.
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