1
|
Eginyan G, Williams AM, Joseph KS, Lam T. Trunk muscle activity and kinematics during boxing and battle rope exercise in people with motor-complete spinal cord injury. J Spinal Cord Med 2024; 47:135-142. [PMID: 34874241 PMCID: PMC10795558 DOI: 10.1080/10790268.2021.2005993] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
CONTEXT Recovery of seated balance is a rehabilitation priority for people with motor-complete spinal cord injury (mcSCI). Previous research has demonstrated that people with mcSCI can voluntarily engage their trunk muscles during different exercise programs that have the potential to improve seated balance control. Boxing and battle rope exercises could offer another opportunity to improve seated balance for people with mcSCI, but it is unknown if this type of exercise engages trunk musculature and challenges seated balance. OBJECTIVE To describe the movement patterns of people with mcSCI compared to controls by characterizing the muscle activation patterns and kinematics of the trunk and upper-body during boxing and battle rope exercise. DESIGN Cross-sectional study. PARTICIPANTS 4 males with mcSCI between C7-T9, and 4 able-bodied controls. METHODS Participants performed different boxing and battle rope exercises while kinematics and electromyography (EMG) from the trunk and arms were recorded. OUTCOME MEASURES Trunk EMG amplitude, trunk and arm joint angles, and trunk curvature. RESULTS Boxing and battle ropes elicited higher relative EMG activity in people with mcSCI compared to controls (P < 0.001). Participants with mcSCI had similar upper-limb kinematics during the exercises to controls, but demonstrated reduced trunk rotation and increased trunk curvature. CONCLUSIONS These findings suggest that boxing and battle rope can elicit trunk activity in people with mcSCI, though they may adopt increased trunk curvatures. Future research should explore if such exercise programs may improve seated balance in people with mcSCI.
Collapse
Affiliation(s)
- Gevorg Eginyan
- School of Kinesiology, University of British Columbia, Vancouver, British Columbia, Canada
- Physical Activity Research Centre (PARC), International Collaboration On Repair Discoveries (ICORD), Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - Alison M.M. Williams
- School of Kinesiology, University of British Columbia, Vancouver, British Columbia, Canada
- Physical Activity Research Centre (PARC), International Collaboration On Repair Discoveries (ICORD), Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - Konrad S. Joseph
- School of Kinesiology, University of British Columbia, Vancouver, British Columbia, Canada
- Physical Activity Research Centre (PARC), International Collaboration On Repair Discoveries (ICORD), Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - Tania Lam
- School of Kinesiology, University of British Columbia, Vancouver, British Columbia, Canada
- Physical Activity Research Centre (PARC), International Collaboration On Repair Discoveries (ICORD), Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| |
Collapse
|
2
|
Wang Y, Dong T, Li X, Zhao H, Yang L, Xu R, Fu Y, Li L, Gai X, Qin D. Research progress on the application of transcranial magnetic stimulation in spinal cord injury rehabilitation: a narrative review. Front Neurol 2023; 14:1219590. [PMID: 37533475 PMCID: PMC10392830 DOI: 10.3389/fneur.2023.1219590] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 07/05/2023] [Indexed: 08/04/2023] Open
Abstract
Traumatic or non-traumatic spinal cord injury (SCI) can lead to severe disability and complications. The incidence of SCI is high, and the rehabilitation cycle is long, which increases the economic burden on patients and the health care system. However, there is no practical method of SCI treatment. Recently, transcranial magnetic stimulation (TMS), a non-invasive brain stimulation technique, has been shown to induce changes in plasticity in specific areas of the brain by regulating the activity of neurons in the stimulation site and its functionally connected networks. TMS is a new potential method for the rehabilitation of SCI and its complications. In addition, TMS can detect the activity of neural circuits in the central nervous system and supplement the physiological evaluation of SCI severity. This review describes the pathophysiology of SCI as well as the basic principles and classification of TMS. We mainly focused on the latest research progress of TMS in the physiological evaluation of SCI as well as the treatment of motor dysfunction, neuropathic pain, spasticity, neurogenic bladder, respiratory dysfunction, and other complications. This review provides new ideas and future directions for SCI assessment and treatment.
Collapse
Affiliation(s)
- Yuhong Wang
- Department of Rehabilitation Medicine, The First People’s Hospital of Yunnan Province, Kunming, China
| | - Tingting Dong
- Department of Rehabilitation Medicine, The First People’s Hospital of Yunnan Province, Kunming, China
| | - Xiahuang Li
- Department of Neurosurgery, Mengzi People’s Hospital, Mengzi, China
| | - Huiyun Zhao
- Department of Rehabilitation Medicine, Dongchuan District People’s Hospital, Kunming, China
| | - Lili Yang
- Department of Rehabilitation Medicine, The First People’s Hospital of Yunnan Province, Kunming, China
| | - Rui Xu
- Department of Rehabilitation Medicine, The First People’s Hospital of Yunnan Province, Kunming, China
| | - Yi Fu
- Department of Pulmonary and Critical Care Medicine, Kunming Municipal Hospital of Traditional Chinese Medicine, Kunming, China
| | - Li Li
- Department of Emergency Trauma Surgery, The First People’s Hospital of Yunnan Province, Kunming, China
| | - Xuesong Gai
- Department of Rehabilitation Medicine, The First People’s Hospital of Yunnan Province, Kunming, China
| | - Dongdong Qin
- Key Laboratory of Traditional Chinese Medicine for Prevention and Treatment of Neuropsychiatric Diseases, Yunnan University of Chinese Medicine, Kunming, China
| |
Collapse
|
3
|
Shackleton C, Samejima S, Williams AM, Malik RN, Balthazaar SJ, Alrashidi A, Sachdeva R, Elliott SL, Nightingale TE, Berger MJ, Lam T, Krassioukov AV. Motor and autonomic concomitant health improvements with neuromodulation and exercise (MACHINE) training: a randomised controlled trial in individuals with spinal cord injury. BMJ Open 2023; 13:e070544. [PMID: 37451734 PMCID: PMC10351300 DOI: 10.1136/bmjopen-2022-070544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 06/21/2023] [Indexed: 07/18/2023] Open
Abstract
INTRODUCTION Motor and autonomic dysfunctions are widespread among people with spinal cord injury (SCI), leading to poor health and reduced quality of life. Exercise interventions, such as locomotor training (LT), can promote sensorimotor and autonomic recovery post SCI. Recently, breakthroughs in SCI research have reported beneficial effects of electrical spinal cord stimulation (SCS) on motor and autonomic functions. Despite literature supporting the independent benefits of transcutaneous SCS (TSCS) and LT, the effect of pairing TSCS with LT is unknown. These therapies are non-invasive, customisable and have the potential to simultaneously benefit both sensorimotor and autonomic functions. The aim of this study is to assess the effects of LT paired with TSCS in people with chronic SCI on outcomes of sensorimotor and autonomic function. METHODS AND ANALYSIS Twelve eligible participants with chronic (>1 year) motor-complete SCI, at or above the sixth thoracic segment, will be enrolled in this single-blinded, randomised sham-controlled trial. Participants will undergo mapping for optimisation of stimulation parameters and baseline assessments of motor and autonomic functions. Participants will then be randomly assigned to either LT+TSCS or LT+Sham stimulation for 12 weeks, after which postintervention assessments will be performed to determine the effect of TSCS on motor and autonomic functions. The primary outcome of interest is attempted voluntary muscle activation using surface electromyography. The secondary outcomes relate to sensorimotor function, cardiovascular function, pelvic organ function and health-related quality of life. Statistical analysis will be performed using two-way repeated measures Analysis of variance (ANOVAs) or Kruskal-Wallis and Cohen's effect sizes. ETHICS AND DISSEMINATION This study has been approved after full ethical review by the University of British Columbia's Research Ethics Board. The stimulator used in this trial has received Investigation Testing Authorisation from Health Canada. Trial results will be disseminated through peer-reviewed publications, conference presentations and seminars. TRIAL REGISTRATION NUMBER NCT04726059.
Collapse
Affiliation(s)
- Claire Shackleton
- International Collaboration on Repair Discoveries, Department of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
- Department of Medicine, Division of Physical Medicine and Rehabilitation, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Soshi Samejima
- International Collaboration on Repair Discoveries, Department of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
- Department of Medicine, Division of Physical Medicine and Rehabilitation, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Alison Mm Williams
- International Collaboration on Repair Discoveries, Department of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
- School of Kinesiology, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Raza N Malik
- International Collaboration on Repair Discoveries, Department of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
- Department of Medicine, Division of Physical Medicine and Rehabilitation, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Shane Jt Balthazaar
- International Collaboration on Repair Discoveries, Department of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
- Division of Cardiology, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Abdullah Alrashidi
- International Collaboration on Repair Discoveries, Department of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
- Department of Physical Therapy, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Rahul Sachdeva
- International Collaboration on Repair Discoveries, Department of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
- Department of Medicine, Division of Physical Medicine and Rehabilitation, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Stacy L Elliott
- International Collaboration on Repair Discoveries, Department of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
- GF Strong Rehabilitation Centre, Vancouver Coastal Health Authority, Vancouver, British Columbia, Canada
- Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Thomas E Nightingale
- International Collaboration on Repair Discoveries, Department of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
- School of Sport, Exercise and Rehabilitation Sciences and Centre for Trauma Science Research, University of Birmingham, Birmingham, UK
- Centre for Trauma Science Research, University of Birmingham, Birmingham, UK
| | - Michael J Berger
- International Collaboration on Repair Discoveries, Department of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
- Department of Medicine, Division of Physical Medicine and Rehabilitation, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Tania Lam
- International Collaboration on Repair Discoveries, Department of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
- School of Kinesiology, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Andrei V Krassioukov
- International Collaboration on Repair Discoveries, Department of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
- Department of Medicine, Division of Physical Medicine and Rehabilitation, The University of British Columbia, Vancouver, British Columbia, Canada
- GF Strong Rehabilitation Centre, Vancouver Coastal Health Authority, Vancouver, British Columbia, Canada
| |
Collapse
|
4
|
Vucic S, Stanley Chen KH, Kiernan MC, Hallett M, Benninger DH, Di Lazzaro V, Rossini PM, Benussi A, Berardelli A, Currà A, Krieg SM, Lefaucheur JP, Long Lo Y, Macdonell RA, Massimini M, Rosanova M, Picht T, Stinear CM, Paulus W, Ugawa Y, Ziemann U, Chen R. Clinical diagnostic utility of transcranial magnetic stimulation in neurological disorders. Updated report of an IFCN committee. Clin Neurophysiol 2023; 150:131-175. [PMID: 37068329 PMCID: PMC10192339 DOI: 10.1016/j.clinph.2023.03.010] [Citation(s) in RCA: 32] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 02/28/2023] [Accepted: 03/09/2023] [Indexed: 03/31/2023]
Abstract
The review provides a comprehensive update (previous report: Chen R, Cros D, Curra A, Di Lazzaro V, Lefaucheur JP, Magistris MR, et al. The clinical diagnostic utility of transcranial magnetic stimulation: report of an IFCN committee. Clin Neurophysiol 2008;119(3):504-32) on clinical diagnostic utility of transcranial magnetic stimulation (TMS) in neurological diseases. Most TMS measures rely on stimulation of motor cortex and recording of motor evoked potentials. Paired-pulse TMS techniques, incorporating conventional amplitude-based and threshold tracking, have established clinical utility in neurodegenerative, movement, episodic (epilepsy, migraines), chronic pain and functional diseases. Cortical hyperexcitability has emerged as a diagnostic aid in amyotrophic lateral sclerosis. Single-pulse TMS measures are of utility in stroke, and myelopathy even in the absence of radiological changes. Short-latency afferent inhibition, related to central cholinergic transmission, is reduced in Alzheimer's disease. The triple stimulation technique (TST) may enhance diagnostic utility of conventional TMS measures to detect upper motor neuron involvement. The recording of motor evoked potentials can be used to perform functional mapping of the motor cortex or in preoperative assessment of eloquent brain regions before surgical resection of brain tumors. TMS exhibits utility in assessing lumbosacral/cervical nerve root function, especially in demyelinating neuropathies, and may be of utility in localizing the site of facial nerve palsies. TMS measures also have high sensitivity in detecting subclinical corticospinal lesions in multiple sclerosis. Abnormalities in central motor conduction time or TST correlate with motor impairment and disability in MS. Cerebellar stimulation may detect lesions in the cerebellum or cerebello-dentato-thalamo-motor cortical pathways. Combining TMS with electroencephalography, provides a novel method to measure parameters altered in neurological disorders, including cortical excitability, effective connectivity, and response complexity.
Collapse
Affiliation(s)
- Steve Vucic
- Brain, Nerve Research Center, The University of Sydney, Sydney, Australia.
| | - Kai-Hsiang Stanley Chen
- Department of Neurology, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan
| | - Matthew C Kiernan
- Brain and Mind Centre, The University of Sydney; and Department of Neurology, Royal Prince Alfred Hospital, Australia
| | - Mark Hallett
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health, Bethesda, Maryland, United States
| | - David H Benninger
- Department of Neurology, University Hospital of Lausanne (CHUV), Switzerland
| | - Vincenzo Di Lazzaro
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico of Rome, Rome, Italy
| | - Paolo M Rossini
- Department of Neurosci & Neurorehab IRCCS San Raffaele-Rome, Italy
| | - Alberto Benussi
- Centre for Neurodegenerative Disorders, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Alfredo Berardelli
- IRCCS Neuromed, Pozzilli; Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Antonio Currà
- Department of Medico-Surgical Sciences and Biotechnologies, Alfredo Fiorini Hospital, Sapienza University of Rome, Terracina, LT, Italy
| | - Sandro M Krieg
- Department of Neurosurgery, Technical University Munich, School of Medicine, Klinikum rechts der Isar, Munich, Germany
| | - Jean-Pascal Lefaucheur
- Univ Paris Est Creteil, EA4391, ENT, Créteil, France; Clinical Neurophysiology Unit, Henri Mondor Hospital, AP-HP, Créteil, France
| | - Yew Long Lo
- Department of Neurology, National Neuroscience Institute, Singapore General Hospital, Singapore, and Duke-NUS Medical School, Singapore
| | | | - Marcello Massimini
- Dipartimento di Scienze Biomediche e Cliniche, Università degli Studi di Milano, Milan, Italy; Istituto Di Ricovero e Cura a Carattere Scientifico, Fondazione Don Carlo Gnocchi, Milan, Italy
| | - Mario Rosanova
- Department of Biomedical and Clinical Sciences University of Milan, Milan, Italy
| | - Thomas Picht
- Department of Neurosurgery, Charité-Universitätsmedizin Berlin, Cluster of Excellence: "Matters of Activity. Image Space Material," Humboldt University, Berlin Simulation and Training Center (BeST), Charité-Universitätsmedizin Berlin, Germany
| | - Cathy M Stinear
- Department of Medicine Waipapa Taumata Rau, University of Auckland, Auckland, Aotearoa, New Zealand
| | - Walter Paulus
- Department of Neurology, Ludwig-Maximilians-Universität München, München, Germany
| | - Yoshikazu Ugawa
- Department of Human Neurophysiology, School of Medicine, Fukushima Medical University, Japan
| | - Ulf Ziemann
- Department of Neurology and Stroke, Eberhard Karls University of Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany; Hertie Institute for Clinical Brain Research, Eberhard Karls University of Tübingen, Otfried-Müller-Straße 27, 72076 Tübingen, Germany
| | - Robert Chen
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital-UHN, Division of Neurology-University of Toronto, Toronto Canada
| |
Collapse
|
5
|
Eginyan G, Zhou X, Williams AMM, Lam T. Effects of motor stimulation of the tibial nerve on corticospinal excitability of abductor hallucis and pelvic floor muscles. FRONTIERS IN REHABILITATION SCIENCES 2023; 3:1089223. [PMID: 36726808 PMCID: PMC9884817 DOI: 10.3389/fresc.2022.1089223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 12/26/2022] [Indexed: 01/18/2023]
Abstract
Introduction Peripheral nerve stimulation can modulate the excitability of corticospinal pathways of muscles in the upper and lower limbs. Further, the pattern of peripheral nerve stimulation (continuous vs. intermittent) may be an important factor determining the modulation of this corticospinal excitability. The pelvic floor muscles (PFM) are crucial for maintaining urinary continence in humans, and share spinal segmental innervation with the tibial nerve. We explored the idea of whether the neuromodulatory effects of tibial nerve stimulation (TibNS) could induce effects on somatic pathways to the PFM. We evaluated the effects of two patterns of stimulation (intermittent vs. continuous) on corticospinal excitability of the PFM compared to its effect on the abductor hallucis (AH) muscle (which is directly innervated by the tibial nerve). We hypothesized that intermittent TibNS would increase, while continuous stimulation would decrease, the excitability of both AH and PFM. Methods Twenty able-bodied adults (20-33 years of age) enrolled in this study. TibNS was delivered either intermittently (1 ms pulses delivered at 30Hz with an on:off duty cycle of 600:400 ms, for 60 min), or continuously (1 ms pulses delivered at 30Hz for 36 min) just above the motor threshold of the AH. We randomized the order of the stimulation pattern and tested them on separate days. We used surface electromyography (EMG) to record motor-evoked responses (MEP) in the PFM and AH following transcranial magnetic stimulation (TMS). We generated stimulus-response (SR) curves to quantify the changes in peak-to-peak MEP amplitude relative to TMS intensity to assess changes in corticospinal excitability pre- and post-stimulation. Results and Conclusion We found that TibNS increased corticospinal excitability only to AH, with no effects in PFM. There was no difference in responses to continuous vs. intermittent stimulation. Our results indicate a lack of effect of TibNS on descending somatic pathways to the PFM, but further investigation is required to explore other stimulation parameters and whether neuromodulatory effects may be spinal in origin.
Collapse
Affiliation(s)
- Gevorg Eginyan
- International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC, Canada,School of Kinesiology, University of British Columbia (UBC), Vancouver, BC, Canada
| | - Xueqing Zhou
- International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC, Canada,School of Kinesiology, University of British Columbia (UBC), Vancouver, BC, Canada
| | - Alison M. M. Williams
- International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC, Canada,School of Kinesiology, University of British Columbia (UBC), Vancouver, BC, Canada
| | - Tania Lam
- International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC, Canada,School of Kinesiology, University of British Columbia (UBC), Vancouver, BC, Canada,Correspondence: Tania Lam
| |
Collapse
|
6
|
Arora T, Desai N, Kirshblum S, Chen R. Utility of transcranial magnetic stimulation in the assessment of spinal cord injury: Current status and future directions. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:1005111. [PMID: 36275924 PMCID: PMC9581184 DOI: 10.3389/fresc.2022.1005111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 09/16/2022] [Indexed: 11/06/2022]
Abstract
Comprehensive assessment following traumatic spinal cord injury (SCI) is needed to improve prognostication, advance the understanding of the neurophysiology and better targeting of clinical interventions. The International Standards for Neurological Classification of Spinal Cord Injury is the most common clinical examination recommended for use after a SCI. In addition, there are over 30 clinical assessment tools spanning across different domains of the International Classification of Functioning, Disability, and Health that have been validated and recommended for use in SCI. Most of these tools are subjective in nature, have limited value in predicting neurologic recovery, and do not provide insights into neurophysiological mechanisms. Transcranial magnetic stimulation (TMS) is a non-invasive neurophysiology technique that can supplement the clinical assessment in the domain of body structure and function during acute and chronic stages of SCI. TMS offers a better insight into neurophysiology and help in better detection of residual corticomotor connectivity following SCI compared to clinical assessment alone. TMS-based motor evoked potential and silent period duration allow study of excitatory and inhibitory mechanisms following SCI. Changes in muscle representations in form of displacement of TMS-based motor map center of gravity or changes in the map area can capture neuroplastic changes resulting from SCI or following rehabilitation. Paired-pulse TMS measures help understand the compensatory reorganization of the cortical circuits following SCI. In combination with peripheral stimulation, TMS can be used to study central motor conduction time and modulation of spinal reflexes, which can be used for advanced diagnostic and treatment purposes. To strengthen the utility of TMS in SCI assessment, future studies will need to standardize the assessment protocols, address population-specific concerns, and establish the psychometric properties of TMS-based measurements in the SCI population.
Collapse
Affiliation(s)
- Tarun Arora
- Krembil Research Institute, University Health Network, Toronto, ON, Canada,Correspondence: Tarun Arora Robert Chen
| | - Naaz Desai
- Krembil Research Institute, University Health Network, Toronto, ON, Canada
| | - Steven Kirshblum
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, United States,Kessler Institute for Rehabilitation, West Orange, NJ, United States,Kessler Foundation, West Orange, NJ, United States,Rutgers New Jersey Medical School, Newark, NJ, United States
| | - Robert Chen
- Krembil Research Institute, University Health Network, Toronto, ON, Canada,Edmond J. Safra Program in Parkinson’s Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, ON, Canada,Division of Neurology, University of Toronto, Toronto, ON, Canada,Correspondence: Tarun Arora Robert Chen
| |
Collapse
|
7
|
Williams AMM, Sato-Klemm M, Deegan EG, Eginyan G, Lam T. Characterizing Pelvic Floor Muscle Activity During Walking and Jogging in Continent Adults: A Cross-Sectional Study. Front Hum Neurosci 2022; 16:912839. [PMID: 35845247 PMCID: PMC9279930 DOI: 10.3389/fnhum.2022.912839] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 06/10/2022] [Indexed: 11/13/2022] Open
Abstract
IntroductionThe pelvic floor muscles (PFM) are active during motor tasks that increase intra-abdominal pressure, but little is known about how the PFM respond to dynamic activities, such as gait. The purpose of this study was to characterize and compare PFM activity during walking and jogging in continent adults across the entire gait cycle.Methods17 able-bodied individuals (8 females) with no history of incontinence participated in this study. We recorded electromyography (EMG) from the abdominal muscles, gluteus maximus (GM), and PFM while participants performed attempted maximum voluntary contractions (aMVC) of all muscles and completed 60–70 strides in four gait conditions: slow walk (1 km/h); regular walk (self-selected comfortable pace); transition walk (self-selected fastest walking pace); jog (same speed as transition walking). We quantified activity throughout the whole gait cycle (%aMVCGC) and during periods of bursting (%aMVCBR) for each participant, and analyzed the timing of PFM bursting periods to explore when the PFM were most active in the gait cycle. We also conducted a phase metric analysis on the PFM and GM burst timings. We performed a Spearman's rank-order correlation to examine the effect of speed on %aMVCGC, %aMVCBR, and phase metric score, and used the Wilcoxon Signed-Rank test to evaluate the effect of gait modality, matched for speed (walking vs. jogging), on these variables.ResultsThe PFM were active throughout the gait cycle, with bursts typically occurring during single-leg support. The PFM and GM were in phase for 44–69% of the gait cycle, depending on condition. There was a positive correlation between gait speed and both %aMVCGC and %aMVCBR (p < 0.001). Phase metric scores were significantly higher during jogging than transition walking (p = 0.005), but there was no difference between gait modality on %aMVCGC or %aMVCBR (p = 0.059). Where possible we disaggregated data by sex, although were unable to make statistical comparisons due to low sample sizes.ConclusionThe PFM are active during walking and jogging, with greater activity at faster speeds and with bursts in activity around single-leg support. The PFM and GM co-activate during gait, but are not completely in phase with each other.
Collapse
Affiliation(s)
- Alison M. M. Williams
- School of Kinesiology, University of British Columbia, Vancouver, BC, Canada
- International Collaboration on Repair Discoveries, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
| | - Maya Sato-Klemm
- School of Kinesiology, University of British Columbia, Vancouver, BC, Canada
- International Collaboration on Repair Discoveries, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
| | - Emily G. Deegan
- School of Kinesiology, University of British Columbia, Vancouver, BC, Canada
- International Collaboration on Repair Discoveries, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
| | - Gevorg Eginyan
- School of Kinesiology, University of British Columbia, Vancouver, BC, Canada
- International Collaboration on Repair Discoveries, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
| | - Tania Lam
- School of Kinesiology, University of British Columbia, Vancouver, BC, Canada
- International Collaboration on Repair Discoveries, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
- *Correspondence: Tania Lam
| |
Collapse
|
8
|
Sato-Klemm M, Williams AMM, Mortenson WB, Lam T. Knowledge, Attitudes, and Practice of Pelvic Floor Muscle Training in People With Spinal Cord Injury: A Cross-Sectional Survey. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:893038. [PMID: 36189004 PMCID: PMC9397781 DOI: 10.3389/fresc.2022.893038] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 05/13/2022] [Indexed: 06/01/2023]
Abstract
BACKGROUND There is emerging evidence that pelvic floor muscle training (PFMT) may be useful for treating some urogenital conditions in people with spinal cord injury (SCI). Future clinical investigations would benefit from understanding the extent to which people with SCI are aware of and practicing PFMT, and their attitude toward this therapy. OBJECTIVE The goal of this study was to assess the knowledge, attitudes, and practices related to PFMT among people with SCI. METHODS We distributed an internet survey internationally via SCI related organizations for 2 months. We used descriptive statistics to summarize each survey item, and Chi-square and Mann-Whitney U tests to explore the differences in results between sexes and level of motor-function. RESULTS Complete data from 153 respondents were analyzed. Sixty-two percent of respondents were female and 71% reported having complete paralysis. More than half of respondents reported being aware of PFMT (63%); more females than males reported knowledge of PFMT (p = 0.010). Females (p = 0.052) and people with partial paralysis (p = 0.008) reported a stronger belief that they would benefit from PFMT. Few people with SCI had practiced PFMT (20%), and of those who practiced, most of them had SCI resulting in partial paralysis (p = 0.023). CONCLUSIONS While people with SCI may be aware of and have favorable attitudes toward PFMT, few had practiced PFMT and there were notable differences in attitudes toward PFMT depending on the sex and level of motor function of the respondents.
Collapse
Affiliation(s)
- Maya Sato-Klemm
- School of Kinesiology, University of British Columbia, Vancouver, BC, Canada
- International Collaboration on Repair Discoveries (ICORD), Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
| | - Alison M. M. Williams
- School of Kinesiology, University of British Columbia, Vancouver, BC, Canada
- International Collaboration on Repair Discoveries (ICORD), Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
| | - W. Ben Mortenson
- International Collaboration on Repair Discoveries (ICORD), Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
- Occupational Science and Occupational Therapy Department, University of British Columbia, Vancouver, BC, Canada
- Rehabilitation Research Program, GF Strong Rehabilitation Centre, Vancouver, BC, Canada
| | - Tania Lam
- School of Kinesiology, University of British Columbia, Vancouver, BC, Canada
- International Collaboration on Repair Discoveries (ICORD), Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
| |
Collapse
|
9
|
Zhou X, Williams AMM, Lam T. Effects of Exercise-Based Interventions on Urogenital Outcomes in Persons with Spinal Cord Injury: A Systematic Review and Meta-Analysis. J Neurotrauma 2021; 38:1225-1241. [PMID: 33499737 DOI: 10.1089/neu.2020.7454] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
In this systematic review, objectives were to investigate dropout rates, adverse events, and effects of exercise-based therapies on urogenital function and quality of life (QoL) in persons with spinal cord injury (SCI). Database searches were conducted on MEDLINE, EMBASE, and CINAHL for studies examining any form of exercise intervention on urogenital function and/or QoL in adults with SCI. Quality of publications was evaluated using the Joanna Briggs Institute critical evaluation tools. When possible, Hedges' g was calculated for overall effect sizes. Subgroup analyses were conducted on sex and injury severity. Ten studies (228 participants) were included in this review. Three studies examined pelvic floor muscle training, and seven studies examined locomotor training. Overall quality of evidence was low because of small sample sizes and non-randomized designs in most studies. Dropout rates ranged from 12% to 25%, and adverse events were reported only in some studies investigating locomotor training. For lower urinary tract (LUT) outcomes, urodynamic findings were mixed despite moderately positive changes in maximum bladder capacity (g = 0.50) and bladder compliance (g = 0.37). Fairly consistent, but small, improvements were observed in LUT symptoms, primarily bladder awareness and incontinence. LUT QoL improved in most cases. Fewer data were available for sexual outcomes, and only minor improvements were reported. Subgroup analyses, based on sex and severity of injury, were inconclusive. There is some indication for the potential benefit of exercise on urogenital outcomes in persons with SCI, but there is insufficient evidence given the number of studies and heterogeneity of outcome measures.
Collapse
Affiliation(s)
- Xueqing Zhou
- School of Kinesiology, University of British Columbia, Vancouver, British Columbia, Canada.,International Collaboration On Repair Discoveries (ICORD), Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - Alison M M Williams
- School of Kinesiology, University of British Columbia, Vancouver, British Columbia, Canada.,International Collaboration On Repair Discoveries (ICORD), Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - Tania Lam
- School of Kinesiology, University of British Columbia, Vancouver, British Columbia, Canada.,International Collaboration On Repair Discoveries (ICORD), Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| |
Collapse
|