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Ettema S, Pennink GH, Buurke TJW, David S, van Bennekom CAM, Houdijk H. Clinical indications and protocol considerations for selecting initial body weight support levels in gait rehabilitation: a systematic review. J Neuroeng Rehabil 2024; 21:97. [PMID: 38849899 PMCID: PMC11157893 DOI: 10.1186/s12984-024-01389-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 05/20/2024] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND Body weight support (BWS) training devices are frequently used to improve gait in individuals with neurological impairments, but guidance in selecting an appropriate level of BWS is limited. Here, we aim to describe the initial BWS levels used during gait training, the rationale for this selection and the clinical goals aligned with BWS training for different diagnoses. METHOD A systematic literature search was conducted in PubMed, Embase and Web of Science, including terms related to the population (individuals with neurological disorders), intervention (BWS training) and outcome (gait). Information on patient characteristics, type of BWS device, BWS level and training goals was extracted from the included articles. RESULTS Thirty-three articles were included, which described outcomes using frame-based (stationary or mobile) and unidirectional ceiling-mounted devices on four diagnoses (multiple sclerosis (MS), spinal cord injury (SCI), stroke, traumatic brain injury (TBI)). The BWS levels were highest for individuals with MS (median: 75%, IQR: 6%), followed by SCI (median: 40%, IQR: 35%), stroke (median: 30%, IQR: 4.75%) and TBI (median: 15%, IQR: 0%). The included studies reported eleven different training goals. Reported BWS levels ranged between 30 and 75% for most of the training goals, without a clear relationship between BWS level, diagnosis, training goal and rationale for BWS selection. Training goals were achieved in all included studies. CONCLUSION Initial BWS levels differ considerably between studies included in this review. The underlying rationale for these differences was not clearly motivated in the included studies. Variation in study designs and populations does not allow to draw a conclusion on the effectiveness of BWS levels. Hence, it remains difficult to formulate guidelines on optimal BWS settings for different diagnoses, BWS devices and training goals. Further efforts are required to establish clinical guidelines and to experimentally investigate which initial BWS levels are optimal for specific diagnoses and training goals.
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Affiliation(s)
- Sanne Ettema
- Research and Development, Heliomare Rehabilitation, Wijk aan Zee, the Netherlands.
- Department of Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
| | - Geertje H Pennink
- Research and Development, Heliomare Rehabilitation, Wijk aan Zee, the Netherlands
- Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | - Tom J W Buurke
- Department of Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Department of Movement Sciences, KU Leuven, Leuven, Belgium
| | - Sina David
- Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | - Coen A M van Bennekom
- Research and Development, Heliomare Rehabilitation, Wijk aan Zee, the Netherlands
- Department of Public and Occupational Health, Amsterdam UMC, Amsterdam, the Netherlands
| | - Han Houdijk
- Department of Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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2
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Gibbs JC, Patsakos EM, Maltais DB, Wolfe DL, Gagnon DH, Craven BC. Rehabilitation interventions to modify endocrine-metabolic disease risk in individuals with chronic spinal cord injury living in the community (RIISC): A systematic search and review of prospective cohort and case-control studies. J Spinal Cord Med 2023; 46:6-25. [PMID: 33596167 PMCID: PMC9897753 DOI: 10.1080/10790268.2020.1863898] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
CONTEXT Endocrine-metabolic disease (EMD) is associated with functional disability, social isolation, hospitalization and even death in individuals living with a chronic spinal cord injury (SCI). There is currently very low-quality evidence that rehabilitation interventions can reduce EMD risk during chronic SCI. Non-randomized trials and alternative study designs are excluded from traditional knowledge synthesis. OBJECTIVE To characterize evidence from level 3-4 studies evaluating rehabilitation interventions for their effectiveness to improve EMD risk in community-dwelling adults with chronic SCI. METHODS Systematic searches of MEDLINE PubMed, EMBASE Ovid, CINAHL, Cochrane Database of Systematic Reviews, and PsychInfo were completed. All longitudinal trials, prospective cohort, case-control studies, and case series evaluating the effectiveness of rehabilitation/therapeutic interventions to modify/associate with EMD outcomes in adults with chronic SCI were eligible. Two authors independently selected studies and abstracted data. Mean changes from baseline were reported for EMD outcomes. The Downs and Black Checklist was used to rate evidence quality. RESULTS Of 489 articles identified, 44 articles (N = 842) were eligible for inclusion. Individual studies reported statistically significant effects of electrical stimulation-assisted training on lower-extremity bone outcomes, and the combined effects of exercise and dietary interventions to improve body composition and cardiometabolic biomarkers (lipid profiles, glucose regulation). In contrast, there were also reports of no clinically important changes in EMD outcomes, suggesting lower quality evidence (study bias, inconsistent findings). CONCLUSION Longitudinal multicentre pragmatic studies involving longer-term exercise and dietary intervention and follow-up periods are needed to fully understand the impact of these rehabilitation approaches to mitigate EMD risk. Our broad evaluation of prospective cohort and case-control studies provides new perspectives on alternative study designs, a multi-impairment paradigm approach of studying EMD outcomes, and knowledge gaps related to SCI rehabilitation.
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Affiliation(s)
- Jenna C. Gibbs
- Department of Kinesiology and Physical Education, Faculty of Education, McGill University, Montréal, QC, Canada
| | - Eleni M. Patsakos
- KITE, Toronto Rehabilitation Institute – University Health Network, Toronto, ON, Canada
| | - Desiree B. Maltais
- Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec City, QC, Canada
| | - Dalton L. Wolfe
- Parkwood Institute Research, Lawson Health Research Institute, London, ON, Canada
- Department of Physical Medicine and Rehabilitation, Western University, London, ON, Canada
| | - Dany H. Gagnon
- Centre intégré universitaire de santé et de services sociaux (CIUSSS) du Centre-Sud-de-l'Île-de-Montréal, Montréal, QC, Canada
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
| | - B. Catharine Craven
- KITE, Toronto Rehabilitation Institute – University Health Network, Toronto, ON, Canada
- Division of Physical Therapy and Rehabilitation, Department of Medicine, University of Toronto, Toronto, ON, Canada
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3
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Alajam RA, Alqahtani AS, Moon S, Sarmento CVM, Frederick J, Smirnova IV, Liu W. Effects of walking training on risk markers of cardiovascular disease in individuals with chronic spinal cord injury. J Spinal Cord Med 2022; 45:622-630. [PMID: 33443465 PMCID: PMC9246252 DOI: 10.1080/10790268.2020.1853332] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVE To investigate the effects of an 8-week walking training program on glycemic control, lipid profile, and inflammatory markers in individuals with chronic spinal cord injury (SCI). DESIGN A pilot, single-group, pretest-posttest study. SETTING A neuromuscular research laboratory. PARTICIPANTS Eleven participants with chronic SCI. INTERVENTION An 8-week walking training program using a treadmill, a body weight-supported system, and an assistive gait training device. OUTCOME MEASURES Levels of glycated hemoglobin (HbA1c), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), C-reactive protein (CRP), and interleukin-6 were assessed before and after the walking training. RESULTS Following the walking training, there was a statistically significant decrease in HbA1c level (P<0.01) of uncertain clinical significance. The lipid profile improved after training, as shown by a statistically and clinically significant increase in HDL-C level (P<0.01) and a statistically significant decrease in LDL-C level (P<0.1) of no clinical significance. The ratio of LDL-C to HDL-C was significantly reduced (P<0.01). In regard to inflammatory markers, concentrations of IL-6 showed a significant reduction after training (P=0.05) of unknown clinical significance, while those of CRP trended to decrease (P=0.13). CONCLUSION The findings of this pilot study suggest that an 8-week walking training program may produce favorable changes in risk markers of cardiovascular disease in individuals with chronic SCI as shown by clinically meaningful improvements in HDL-C, and small changes in the right direction, but uncertain clinical significance, in HbA1c, LDL-C and IL-6. A randomized controlled trial is needed to compare the effects of walking training on these outcome measures with those of other exercise modalities suitable for this population, and to see if more prolonged exercise exposure leads to favorable parameters of significant size to justify the exercise modality.
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Affiliation(s)
- Ramzi A. Alajam
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, Kansas, United States,Department of Physical Therapy, Jazan University, Jazan, Saudi Arabia,Corresponding author: Ramzi Alajam, Department of Physical Therapy, Faculty of Applied Medical Science, Jazan University, Jazan, Saudi Arabia;
| | - Abdulfattah S. Alqahtani
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, Kansas, United States,Department of Health Rehabilitation Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Sanghee Moon
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, Kansas, United States
| | - Caio V. M. Sarmento
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, Kansas, United States,Department of Physical Therapy, California State University, Fresno, California, United States
| | - Jason Frederick
- Department of Physical Medicine and Rehabilitation, University of Kansas Medical Center, Kansas City, Kansas, United States
| | - Irina V. Smirnova
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, Kansas, United States
| | - Wen Liu
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, Kansas, United States
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Rusu L, Paun E, Marin MI, Hemanth J, Rusu MR, Calina ML, Bacanoiu MV, Danoiu M, Danciulescu D. Plantar Pressure and Contact Area Measurement of Foot Abnormalities in Stroke Rehabilitation. Brain Sci 2021; 11:1213. [PMID: 34573233 PMCID: PMC8469353 DOI: 10.3390/brainsci11091213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 08/27/2021] [Accepted: 09/08/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Evaluation of plantar pressure in stroke patients is a parameter that could be used for monitoring and comparing how the timing of starting a rehabilitation program effects patient improvement. METHODS We performed the following clinical and functional evaluations: initial moment (T1), intermediate (T2), and final evaluation at one year (T3). At T1 we studied 100 stroke patients in two groups, A and B (each 50 patients). The first group, A, started rehabilitation in the first three months after having a stroke, and group B started after three months from the time of stroke. Due to the impediments observed during rehabilitation, we made biomechanic evaluation for two lots, I and II (each 25 patients). Assessment of the patient was carried out by clinical (neurologic examination), functional (using the Tinetti Functional Gait Assessment Test for classifying the gait), and biomechanical evaluation (maximal plantar pressure (Pmax), contact area (CA), and pressure distribution (COP)). RESULTS The Tinetti scale for gait had the following scores: for group A, from 1.34 at the initial moment (T1) to 10.64 at final evaluation (T3), and for group B, 3.08 at initial moment (T1) to 9 at final evaluation (T3). Distribution of COP in the left hemiparesis was uneven at T1 but evolved after rehabilitation. The right hemiparesis had uniform COP distribution even at T1, explained by motor dominance on the right side. CA and Pmax for lot I increased more than 100%, meaning that there is a possibility for favorable improvement if the patients start the rehabilitation program in the first three months after stroke. For lot II, increases of the parameters were less than lot I. DISCUSSIONS The recovery potential is higher for patients with right hemiparesis. Biomechanic evaluation showed diversity regarding compensatory mechanisms for the paretic and nonparetic lower limb. CONCLUSIONS CA and Pmax are relevant assessments for evaluating the effects on timing of starting a rehabilitation program after a stroke.
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Affiliation(s)
- Ligia Rusu
- Sport Medicine and Physiotherapy Department, University of Craiova, 200585 Craiova, Romania
| | - Elvira Paun
- Sport Medicine and Physiotherapy Department, University of Craiova, 200585 Craiova, Romania
| | - Mihnea Ion Marin
- Faculty of Mechanics, University of Craiova, 200585 Craiova, Romania
| | - Jude Hemanth
- Department of ECE, Karunya Institute of Technology and Sciences, Coimbatore 641114, India
| | - Mihai Robert Rusu
- Sport Medicine and Physiotherapy Department, University of Craiova, 200585 Craiova, Romania
| | - Mirela Lucia Calina
- Sport Medicine and Physiotherapy Department, University of Craiova, 200585 Craiova, Romania
| | | | - Mircea Danoiu
- Sport Medicine and Physiotherapy Department, University of Craiova, 200585 Craiova, Romania
| | - Daniel Danciulescu
- Sport Medicine and Physiotherapy Department, University of Craiova, 200585 Craiova, Romania
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Alrashidi AA, Nightingale TE, Currie KD, Hubli M, MacDonald MJ, Hicks AL, Oh P, Craven BC, Krassioukov AV. Exercise Improves Cardiorespiratory Fitness, but Not Arterial Health, after Spinal Cord Injury: The CHOICES Trial. J Neurotrauma 2021; 38:3020-3029. [PMID: 34314235 DOI: 10.1089/neu.2021.0071] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Arterial stiffness, as measured by carotid-femoral pulse wave velocity (cfPWV), is elevated after spinal cord injury (SCI). In the uninjured population, exercise training has been shown to reduce arterial stiffness. In a randomized, multi-center clinical trial, we evaluated the impact of two exercise interventions on cardiovascular disease risk factors in persons with chronic SCI. A total of 46 adults with motor-complete SCI with neurological levels of injury between the fourth cervical and sixth thoracic spinal cord segments (C4-T6) were randomly assigned to either body-weight-supported treadmill training (BWSTT) or arm-cycle ergometer training (ACET). Participants trained 3 days per week for 24 weeks. Exercise session duration progressed gradually to reach 30 and 60 min for ACET and BWSTT, respectively. The primary outcome was arterial stiffness, assessed by cfPWV, and was measured at baseline, 12 weeks of training, and at 24 weeks. Secondary outcomes included cardiorespiratory fitness (CRF) and cardiometabolic health measures and were measured before and after completion of training. Fourteen participants per intervention arm completed the exercise intervention. Our results show no effect of either exercise intervention on arterial stiffness (p = 0.07) and cardiometabolic health measures (p > 0.36). However, peak oxygen uptake increased with ACET compared with BWSTT (p = 0.04). The findings of this trial demonstrate that although 24 weeks of upper-body exercise improved CRF in persons with motor-complete SCI ≥T6, neither intervention resulted in improvements in arterial stiffness or cardiometabolic health measures. ClinicalTrials.gov identifier: NCT01718977.
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Affiliation(s)
- Abdullah A Alrashidi
- International Collaboration on Repair Discoveries (ICORD), Vancouver, British Columbia, Canada.,Experimental Medicine, Department of Medicine, University of British Columbia (UBC), Vancouver, British Columbia, Canada.,Department of Physical Therapy, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Tom E Nightingale
- International Collaboration on Repair Discoveries (ICORD), Vancouver, British Columbia, Canada.,School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Katharine D Currie
- International Collaboration on Repair Discoveries (ICORD), Vancouver, British Columbia, Canada.,Department of Kinesiology, Michigan State University, East Lansing, Michigan, USA
| | - Michèle Hubli
- International Collaboration on Repair Discoveries (ICORD), Vancouver, British Columbia, Canada.,Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | | | - Audrey L Hicks
- Department of Kinesiology, McMaster University, Hamilton, Ontario, Canada
| | - Paul Oh
- Department of Medicine University Health Network, Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, Ontario, Canada
| | - Beverley Catharine Craven
- Department of Medicine University Health Network, Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, Ontario, Canada
| | - Andrei V Krassioukov
- International Collaboration on Repair Discoveries (ICORD), Vancouver, British Columbia, Canada.,Experimental Medicine, Department of Medicine, University of British Columbia (UBC), Vancouver, British Columbia, Canada.,Division of Physical Medicine and Rehabilitation, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,GF Strong Rehabilitation Center, Vancouver Coastal Health, Vancouver, British Columbia, Canada
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6
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Goldsmith JA, Ennasr AN, Farkas GJ, Gater DR, Gorgey AS. Role of exercise on visceral adiposity after spinal cord injury: a cardiometabolic risk factor. Eur J Appl Physiol 2021; 121:2143-2163. [PMID: 33891156 DOI: 10.1007/s00421-021-04688-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 04/10/2021] [Indexed: 12/30/2022]
Abstract
PURPOSE Visceral adipose tissue (VAT) is associated with cardiometabolic disease risk in able-bodied (AB) populations. However, the underlying mechanisms of VAT-induced disease risk are unknown in persons with spinal cord injury (SCI). Potential mechanisms of VAT-induced cardiometabolic dysfunction in persons with SCI include systemic inflammation, liver adiposity, mitochondrial dysfunction, and anabolic deficiency. Moreover, how exercise interventions impact these mechanisms associated with VAT-induced cardiometabolic dysfunction are still being explored. METHODS A search for relevant scientific literature about the effects of exercise on VAT and cardiometabolic health was conducted on the PubMed database. Literature from reference lists was also included when appropriate. RESULTS Both aerobic and resistance exercise training beneficially impact health and VAT mass via improving mitochondrial function, glucose effectiveness, and inflammatory signaling in SCI and AB populations. Specifically, aerobic exercise appears to also modulate cellular senescence in AB populations and animal models, while resistance exercise seems to augment anabolic signaling in persons with SCI. CONCLUSIONS The current evidence supports regular engagement in exercise to reduce VAT mass and the adverse effects on cardiometabolic health in persons with SCI. Future research is needed to further elucidate the precise mechanisms by which VAT negatively impacts health following SCI. This will likely facilitate the development of rehabilitation protocols that target VAT reduction in persons with SCI.
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Affiliation(s)
- Jacob A Goldsmith
- Spinal Cord Injury and Disorders Center, Central Virginia VA Health Care System, 1201 Broad Rock Boulevard, Richmond, VA, 23249, USA
| | - Areej N Ennasr
- Spinal Cord Injury and Disorders Center, Central Virginia VA Health Care System, 1201 Broad Rock Boulevard, Richmond, VA, 23249, USA
| | - Gary J Farkas
- Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, Miami, FL, 33136, USA
| | - David R Gater
- Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, Miami, FL, 33136, USA
| | - Ashraf S Gorgey
- Spinal Cord Injury and Disorders Center, Central Virginia VA Health Care System, 1201 Broad Rock Boulevard, Richmond, VA, 23249, USA. .,Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA, 23298, USA.
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7
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Farrow M, Nightingale TE, Maher J, McKay CD, Thompson D, Bilzon JL. Effect of Exercise on Cardiometabolic Risk Factors in Adults With Chronic Spinal Cord Injury: A Systematic Review. Arch Phys Med Rehabil 2020; 101:2177-2205. [DOI: 10.1016/j.apmr.2020.04.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 03/27/2020] [Accepted: 04/11/2020] [Indexed: 12/14/2022]
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8
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Hicks AL. Locomotor training in people with spinal cord injury: is this exercise? Spinal Cord 2020; 59:9-16. [PMID: 32581307 DOI: 10.1038/s41393-020-0502-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 06/02/2020] [Accepted: 06/05/2020] [Indexed: 11/09/2022]
Abstract
Locomotor training holds tremendous appeal to people with spinal cord injury who are wheelchair dependent, as the reacquisition of gait remains one of the most coveted goals in this population. For the last few decades this type of training has remained primarily in the clinical environment, as it requires the use of expensive treadmills with bodyweight support or complex overhead suspension tracks to facilitate overground walking. The development of powered exoskeletons has taken locomotor training out of the clinic, both improving accessibility and providing a potential option for community ambulation in people with lower limb paralysis. A question that has yet to be answered, however, is whether or not locomotor training offers a sufficiently intense stimulus to induce improvements in fitness or health. As inactivity-related secondary health complications are a major source of morbidity and mortality in people with SCI, it would be important to characterize the potential of locomotor training to not only improve functional walking ability, but also improve health-related fitness. This narrative review will summarize the key literature in this area to determine whether locomotor training challenges the cardiovascular, muscular or metabolic systems enough to be considered a viable form of exercise.
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Affiliation(s)
- Audrey L Hicks
- Department of Kinesiology, McMaster University, Hamilton, ON, Canada.
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9
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Gorgey AS, Graham ZA, Chen Q, Rivers J, Adler RA, Lesnefsky EJ, Cardozo CP. Sixteen weeks of testosterone with or without evoked resistance training on protein expression, fiber hypertrophy and mitochondrial health after spinal cord injury. J Appl Physiol (1985) 2020; 128:1487-1496. [PMID: 32352341 DOI: 10.1152/japplphysiol.00865.2019] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
We investigated the effects of testosterone replacement therapy (TRT) with and without evoked resistance training (RT) on protein expression of key metabolic and hypertrophy regulators, muscle fiber cross-sectional area (CSA), and markers of mitochondrial health after spinal cord injury (SCI). Twenty-two men with chronic motor complete SCI were randomly assigned to either TRT + RT (n = 11) or TRT (n = 11) for 16 wk. TRT + RT men underwent twice weekly progressive RT using electrical stimulation with ankle weights. TRT was administered via testosterone patches (2-6 mg/day). Muscle biopsies were obtained before and after 16 wk from the right vastus lateralis. Expression of proteins associated with oxidative muscles and mechanical loading (PGC-1α and FAK), muscle hypertrophy (total and phosphorylated Akt, total and phosphorylated mTOR), and cellular metabolism (total and phosphorylated AMPK and GLUT4) were evaluated. Immunohistochemistry analysis was performed to measure fiber CSA and succinate dehydrogenase (SDH) activity as well as mitochondrial citrate synthase (CS) activity and complex III (CIII) activities. TRT + RT demonstrated a robust 27.5% increase in average fiber CSA compared with a -9% decrease following TRT only (P = 0.01). GLUT4 protein expression was elevated in the TRT + RT group compared with TRT only (P = 0.005). Total Akt (P = 0.06) and phosphorylated Akt Ser389 (P = 0.049) were also elevated in the TRT + RT group. Mitochondrial activity of SDH (P = 0.03) and CS (P = 0.006) increased in the TRT + RT group, with no changes in the TRT-only group. Sixteen weeks of TRT with RT resulted in fiber hypertrophy and beneficial changes in markers of skeletal muscle health and function.NEW & NOTEWORTHY Fiber cross-sectional area (CSA), protein expression, mitochondrial citrate synthase (CS), and succinate dehydrogenase (SDH) were measured following 16 wk of low-dose testosterone replacement therapy (TRT) with and without electrically evoked resistance training (RT) in men with spinal cord injury (SCI). Fiber CSA and protein expression of total GLUT4, total Akt, and phosphorylated Akt increased following TRT + RT but not in the TRT-only group. Mitochondrial CS and SDH increased after TRT + RT but not in TRT-only group.
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Affiliation(s)
- Ashraf S Gorgey
- Spinal Cord Injury and Disorders Center, Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, Virginia.,Virginia Commonwealth University, Department of Physical Medicine and Rehabilitation, Richmond, Virginia
| | - Zachary A Graham
- Birmingham Veterans Affairs Medical Center, Birmingham, Alabama.,Department of Cell, Developmental, and Integrative Biology, University of Alabama-Birmingham, Birmingham, Alabama
| | - Qun Chen
- Medical Service, Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, Virginia.,Division of Cardiology, Department of Internal Medicine, Pauley Heart Center Virginia Commonwealth University, Richmond, Virginia
| | - Jeannie Rivers
- Surgery Service, Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, Virginia
| | - Robert A Adler
- Endocrinology Service, Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, Virginia.,Endocrine Division, Virginia Commonwealth University School of Medicine¸ Richmond, Virginia
| | - Edward J Lesnefsky
- Medical Service, Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, Virginia.,Division of Cardiology, Department of Internal Medicine, Pauley Heart Center Virginia Commonwealth University, Richmond, Virginia
| | - Christopher P Cardozo
- Center for the Medical Consequences of Spinal Cord Injury, James J. Peters Veterans Affairs Medical Center, Bronx, New York.,Icahn School of Medicine at Mt. Sinai, New York, New York
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10
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Graham ZA, Siedlik JA, Harlow L, Sahbani K, Bauman WA, Tawfeek HA, Cardozo CP. Key Glycolytic Metabolites in Paralyzed Skeletal Muscle Are Altered Seven Days after Spinal Cord Injury in Mice. J Neurotrauma 2019; 36:2722-2731. [PMID: 30869558 DOI: 10.1089/neu.2018.6144] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Spinal cord injury (SCI) results in rapid muscle atrophy and an oxidative-to-glycolytic fiber-type shift. Those with chronic SCI are more at risk for developing insulin resistance and reductions in glucose clearance than able-bodied individuals, but how glucose metabolism is affected after SCI is not well known. An untargeted metabolomics approach was utilized to investigate changes in whole-muscle metabolites at an acute (7-day) and subacute (28-day) time frame after a complete T9 spinal cord transection in 20-week-old female C57BL/6 mice. Two hundred one metabolites were detected in all samples, and 83 had BinBase IDs. A principal components analysis showed the 7-day group as a unique cluster. Further, 36 metabolites were altered after 7- and/or 28-day post-SCI (p values <0.05), with 12 passing further false discovery rate exclusion criteria; of those 12 metabolites, three important glycolytic molecules-glucose and downstream metabolites pyruvic acid and lactic acid-were reduced at 7 days compared to those values in sham and/or 28-day animals. These changes were associated with altered expression of proteins associated with glycolysis, as well as monocarboxylate transporter 4 gene expression. Taken together, our data suggest an acute disruption of skeletal muscle glucose uptake at 7 days post-SCI, which leads to reduced pyruvate and lactate levels. These levels recover by 28 days post-SCI, but a reduction in pyruvate dehydrogenase protein expression at 28 days post-SCI implies disruption in downstream oxidation of glucose.
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Affiliation(s)
- Zachary A Graham
- National Center for the Medical Consequences of Spinal Cord Injury, James J. Peters VA Medical Center, Bronx, New York.,Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Lauren Harlow
- National Center for the Medical Consequences of Spinal Cord Injury, James J. Peters VA Medical Center, Bronx, New York
| | - Karim Sahbani
- National Center for the Medical Consequences of Spinal Cord Injury, James J. Peters VA Medical Center, Bronx, New York
| | - William A Bauman
- National Center for the Medical Consequences of Spinal Cord Injury, James J. Peters VA Medical Center, Bronx, New York.,Medical Service, James J. Peters VA Medical Center, Bronx, New York.,Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.,Department of Rehabilitation Medicine and Human Performance, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Hesham A Tawfeek
- National Center for the Medical Consequences of Spinal Cord Injury, James J. Peters VA Medical Center, Bronx, New York.,Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Christopher P Cardozo
- National Center for the Medical Consequences of Spinal Cord Injury, James J. Peters VA Medical Center, Bronx, New York.,Medical Service, James J. Peters VA Medical Center, Bronx, New York.,Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.,Department of Rehabilitation Medicine and Human Performance, Icahn School of Medicine at Mount Sinai, New York, New York
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11
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Gorman PH, Scott W, VanHiel L, Tansey KE, Sweatman WM, Geigle PR. Comparison of peak oxygen consumption response to aquatic and robotic therapy in individuals with chronic motor incomplete spinal cord injury: a randomized controlled trial. Spinal Cord 2019; 57:471-481. [DOI: 10.1038/s41393-019-0239-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 12/14/2018] [Accepted: 01/02/2019] [Indexed: 01/17/2023]
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Krassioukov AV, Currie KD, Hubli M, Nightingale TE, Alrashidi AA, Ramer L, Eng JJ, Ginis KAM, MacDonald MJ, Hicks A, Ditor D, Oh P, Verrier MC, Craven BC. Effects of exercise interventions on cardiovascular health in individuals with chronic, motor complete spinal cord injury: protocol for a randomised controlled trial [Cardiovascular Health/Outcomes: Improvements Created by Exercise and education in SCI (CHOICES) Study]. BMJ Open 2019; 9:e023540. [PMID: 30612110 PMCID: PMC6326283 DOI: 10.1136/bmjopen-2018-023540] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Recent studies demonstrate that cardiovascular diseases and associated complications are the leading cause of morbidity and mortality in individuals with spinal cord injury (SCI). Abnormal arterial stiffness, defined by a carotid-to-femoral pulse wave velocity (cfPWV) ≥10 m/s, is a recognised risk factor for heart disease in individuals with SCI. There is a paucity of studies assessing the efficacy of conventional training modalities on arterial stiffness and other cardiovascular outcomes in this population. Therefore, this study aims to compare the efficacy of arm cycle ergometry training (ACET) and body weight-supported treadmill training (BWSTT) on reducing arterial stiffness in individuals with chronic motor complete, high-level (above the sixth thoracic segment) SCI. METHODS AND ANALYSIS This is a multicentre, randomised, controlled, clinical trial. Eligible participants will be randomly assigned (1:1) into either ACET or BWSTT groups. Sixty participants with chronic (>1 year) SCI will be recruited from three sites in Canada (Vancouver, Toronto and Hamilton). Participants in each group will exercise three times per week up to 30 min and 60 min for ACET and BWSTT, respectively, over the period of 6 months. The primary outcome measure will be change in arterial stiffness (cfPWV) from baseline. Secondary outcome measures will include comprehensive assessments of: (1) cardiovascular parameters, (2) autonomic function, (3) body composition, (4) blood haematological and metabolic profiles, (5) cardiorespiratory fitness and (6) quality of life (QOL) and physical activity outcomes. Outcome measures will be assessed at baseline, 3 months, 6 months and 12 months (only QOL and physical activity outcomes). Statistical analyses will apply linear-mixed modelling to determine the training (time), group (ACET vs BWSTT) and interaction (time × group) effects on all outcomes. ETHICS AND DISSEMINATION Ethical approval was obtained from all three participating sites. Primary and secondary outcome data will be submitted for publication in peer-reviewed journals and widely disseminated. TRIAL REGISTRATION NUMBER NCT01718977; Pre-results. TRIAL STATUS Recruitment for this study began on January 2013 and the first participant was randomized on April 2013. Recruitment stopped on October 2018.
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Affiliation(s)
- Andrei V Krassioukov
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, British Columbia, Canada
- Faculty of Medicine, Division of Physical Medicine and Rehabilitation, University of British Columbia, Vancouver, British Columbia, Canada
- GF Strong Rehabilitation Centre, Vancouver Coastal Health, Vancouver, British Columbia, Canada
| | - Katharine D Currie
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Kinesiology, Michigan State University, East Lansing, Michigan, USA
| | - Michèle Hubli
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, British Columbia, Canada
- Balgrist University Hospital, University of Zurich, Zurich, Swaziland
| | - Tom E Nightingale
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, British Columbia, Canada
- Faculty of Medicine, Division of Physical Medicine and Rehabilitation, University of British Columbia, Vancouver, British Columbia, Canada
| | - Abdullah A Alrashidi
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, British Columbia, Canada
- Faculty of Medicine, Experimental Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Physical Therapy Department, King Fahd Medical City, Riyadh, Saudi Arabia
| | - Leanne Ramer
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, British Columbia, Canada
- Biomedical Physiology and Kinesiology, Simon Fraser University, Vancouver, British Columbia, Canada
| | - Janice J Eng
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, British Columbia, Canada
- GF Strong Rehabilitation Centre, Vancouver Coastal Health, Vancouver, British Columbia, Canada
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kathleen A Martin Ginis
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, British Columbia, Canada
- Southern Medical Program, School of Health & Exercise Sciences, University of British Columbia, Kelowna, British Columbia, Canada
| | | | - Audrey Hicks
- Spinal Cord Injury Centre, McMaster University, Hamilton, Ontario, Canada
| | - Dave Ditor
- Department of Kinesiology, Faculty of Applied Health Sciences, Brock University, St. Catharines, Ontario, Canada
| | - Paul Oh
- Department of Medicine University Health Network, Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, Ontario, Canada
| | - Molly C Verrier
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Beverly Catharine Craven
- Department of Medicine University Health Network, Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, Ontario, Canada
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Gorgey AS, Witt O, O’Brien L, Cardozo C, Chen Q, Lesnefsky EJ, Graham ZA. Mitochondrial health and muscle plasticity after spinal cord injury. Eur J Appl Physiol 2018; 119:315-331. [DOI: 10.1007/s00421-018-4039-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Accepted: 11/22/2018] [Indexed: 01/15/2023]
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Nightingale TE, Metcalfe RS, Vollaard NB, Bilzon JL. Exercise Guidelines to Promote Cardiometabolic Health in Spinal Cord Injured Humans: Time to Raise the Intensity? Arch Phys Med Rehabil 2017; 98:1693-1704. [DOI: 10.1016/j.apmr.2016.12.008] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 12/15/2016] [Indexed: 10/20/2022]
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McKnight LL, France J, Wright D, Davenport G, Shoveller AK. Dietary mannoheptulose does not alter glucose or lipid metabolism in adult Labrador Retrievers. J Anim Physiol Anim Nutr (Berl) 2017; 102:e122-e131. [PMID: 28444793 DOI: 10.1111/jpn.12713] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 02/10/2017] [Indexed: 11/30/2022]
Abstract
Mannoheptulose (MH), a glycolytic inhibitor, has been preliminarily investigated as a novel functional food ingredient for dogs. This study aimed to determine the effects of dietary MH, delivered as an extract of un-ripened avocados, on fatty acid and glucose kinetics in healthy adult Labrador Retriever dogs (n = 12 dogs). The study was a double-blindcrossover with each dog receiving both dietary treatments, control (CON) and MH (400 mg/kg of diet), in random order. Glucose and glycerol plasma turnover (Ra) and oxidation (Ox) were measured in fasting and in response to repeated meal feeding ("fed") with stable isotope tracers (U-13 C-glucose, 1,1,2,3,3-D5 -glycerol) and indirect calorimetry. Palmitate Ra and Ox were examined during repeated meal feeding only using an oral bolus of U-13 C-K2 -palmitate and indirect calorimetry. MH had no discernible effect on fasting glucose Ra (677, 722 SEM 36 μmol/min, CON, MH) or Ox (107, 109 μmol/min, CON, MH SEM 10 μmol/min) or fed glucose Ra (2913, 3626 SEM 644 μmol/min, CON, MH) or Ox (951, 936 SEM 174 μmol/min, CON, MH). Glycerol Ra, an index of the rate of lipolysis, was not different between dietary treatments (Fast 162, 113 SEM 35 μmol/min CON, MH; Fed 172, 135 SEM 21 μmol/min, CON, MH). Similarly, palmitate oxidation was not impacted by MH feeding (1966, 2276 SEM 79 μmol/min, CON, MH). Together, these findings do not support MH as a novel functional food ingredient at least at the dietary dose tested.
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Affiliation(s)
- L L McKnight
- Department of Animal Biosciences, Centre for Nutrition Modelling, University of Guelph, Guelph, ON, Canada
| | - J France
- Department of Animal Biosciences, Centre for Nutrition Modelling, University of Guelph, Guelph, ON, Canada
| | - D Wright
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, ON, Canada
| | - G Davenport
- Procter and Gamble Pet Care, Lewisburg, OH, USA
| | - A K Shoveller
- Department of Animal Biosciences, Centre for Nutrition Modelling, University of Guelph, Guelph, ON, Canada
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Singh H, Shah M, Flett HM, Craven BC, Verrier MC, Musselman KE. Perspectives of individuals with sub-acute spinal cord injury after personalized adapted locomotor training. Disabil Rehabil 2017; 40:820-828. [PMID: 28084843 DOI: 10.1080/09638288.2016.1277395] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE Locomotor training after incomplete spinal cord injury can improve walking function, and cardiovascular and muscle health. Participants' perspectives about locomotor training, however, have not been extensively studied. This study describes the experiences of individuals with sub-acute incomplete spinal cord injury who completed personalized adapted locomotor training; a locomotor-focused rehabilitation tailored to individual goals. Specifically, we examined how participation in this training impacted their lives and what challenges they encountered. MATERIALS AND METHODS Following inpatient rehabilitation, seven participants completed 74-197 h of personalized adapted locomotor training. Using conventional content analysis, themes were identified from post-training interviews. Trustworthiness was enhanced through analysis trials, verbatim quotes, and triangulation. RESULTS Three themes emerged: motives for participating, perceived benefits, and perceived challenges. Beliefs that higher intensity leads to quicker recovery of prior function motivated participation. Physical and psychological health improvements, favorable training structure, and empowerment to self-manage their rehabilitation were perceived benefits. Neglect of other commitments, acquiring extra services to participate (e.g. accessible transportation), limited transferability to daily walking, and a rigid training structure were perceived challenges. Program recommendations were formed from the perceived challenges. CONCLUSIONS Personalized adapted locomotor training was positively regarded by participants. Addressing the perceived challenges may improve the training experience. Implications for Rehabilitation Personalized adapted locomotor training (PALT) is a high-intensity locomotor therapy tailored to an individual's goals. The experiences of individuals with iSCI highlight the impact of PALT on physical and psychological well-being. PALT has the potential to improve physical functioning and facilitate transitions from inpatient rehabilitation to community living. Findings suggest the need for adaptation of PALT to suit the unique needs of each individual.
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Affiliation(s)
- Hardeep Singh
- a Toronto Rehabilitation Institute, University Health Network , Toronto , Canada.,b Rehabilitation Sciences Institute, University of Toronto , Toronto , Canada
| | - Meeral Shah
- a Toronto Rehabilitation Institute, University Health Network , Toronto , Canada
| | - Heather M Flett
- a Toronto Rehabilitation Institute, University Health Network , Toronto , Canada.,c Department of Physical Therapy , Faculty of Medicine, University of Toronto , Toronto , Canada
| | - B Catherine Craven
- a Toronto Rehabilitation Institute, University Health Network , Toronto , Canada.,b Rehabilitation Sciences Institute, University of Toronto , Toronto , Canada.,d Division of Physical Medicine and Rehabilitation, Faculty of Medicine , University of Toronto , Toronto , Canada
| | - Mary C Verrier
- a Toronto Rehabilitation Institute, University Health Network , Toronto , Canada.,b Rehabilitation Sciences Institute, University of Toronto , Toronto , Canada.,c Department of Physical Therapy , Faculty of Medicine, University of Toronto , Toronto , Canada
| | - Kristin E Musselman
- a Toronto Rehabilitation Institute, University Health Network , Toronto , Canada.,b Rehabilitation Sciences Institute, University of Toronto , Toronto , Canada.,c Department of Physical Therapy , Faculty of Medicine, University of Toronto , Toronto , Canada
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Kozlowski AJ, Bryce TN, Dijkers MP. Time and Effort Required by Persons with Spinal Cord Injury to Learn to Use a Powered Exoskeleton for Assisted Walking. Top Spinal Cord Inj Rehabil 2015; 21:110-21. [PMID: 26364280 DOI: 10.1310/sci2102-110] [Citation(s) in RCA: 97] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Powered exoskeletons have been demonstrated as being safe for persons with spinal cord injury (SCI), but little is known about how users learn to manage these devices. OBJECTIVE To quantify the time and effort required by persons with SCI to learn to use an exoskeleton for assisted walking. METHODS A convenience sample was enrolled to learn to use the first-generation Ekso powered exoskeleton to walk. Participants were given up to 24 weekly sessions of instruction. Data were collected on assistance level, walking distance and speed, heart rate, perceived exertion, and adverse events. Time and effort was quantified by the number of sessions required for participants to stand up, walk for 30 minutes, and sit down, initially with minimal and subsequently with contact guard assistance. RESULTS Of 22 enrolled participants, 9 screen-failed, and 7 had complete data. All of these 7 were men; 2 had tetraplegia and 5 had motor-complete injuries. Of these, 5 participants could stand, walk, and sit with contact guard or close supervision assistance, and 2 required minimal to moderate assistance. Walk times ranged from 28 to 94 minutes with average speeds ranging from 0.11 to 0.21 m/s. For all participants, heart rate changes and reported perceived exertion were consistent with light to moderate exercise. CONCLUSIONS This study provides preliminary evidence that persons with neurological weakness due to SCI can learn to walk with little or no assistance and light to somewhat hard perceived exertion using a powered exoskeleton. Persons with different severities of injury, including those with motor complete C7 tetraplegia and motor incomplete C4 tetraplegia, may be able to learn to use this device.
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Affiliation(s)
- Allan J Kozlowski
- Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, New York New York
| | - Thomas N Bryce
- Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, New York New York
| | - Marcel P Dijkers
- Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, New York New York
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McKnight LL, Flickinger EA, Davenport GM, France J, Shoveller AK. Dietary mannoheptulose has differential effects on fasting and post-prandial glucose oxidation in Labrador Retrievers. JOURNAL OF APPLIED ANIMAL RESEARCH 2014. [DOI: 10.1080/09712119.2014.978775] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Dutra CMR, Dutra CMR, Moser ADDL, Manffra EF. Treino locomotor com suporte parcial de peso corporal na reabilitação da lesão medular: revisão da literatura. FISIOTERAPIA EM MOVIMENTO 2013. [DOI: 10.1590/s0103-51502013000400019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUÇÃO: O treino locomotor com suporte de peso corporal (TLSP) é utilizado há aproximadamente 20 anos no campo da reabilitação em pacientes que sofrem de patologias neurológicas. O TLSP favorece melhoras osteomusculares, cardiovasculares e psicológicas, pois desenvolve ao máximo o potencial residual do organismo, proporcionando a reintegração na convivência familiar, profissional e social. OBJETIVO: Identificar as principais modalidades de TLSP e seus parâmetros de avaliação com a finalidade de contribuir com o estabelecimento de evidências confiáveis para as práticas reabilitativas de pessoas com lesão medular. MATERIAIS E MÉTODOS: Foram analisados artigos originais, publicados entre 2000 e 2011, que envolvessem treino de marcha após a lesão medular, com ou sem suporte parcial de peso corporal, e tecnologias na assistência do treino, como biofeedback e estimulação elétrica funcional, entre outras. RESULTADOS: A maioria dos participantes dos estudos era do sexo masculino; os níveis de lesão variavam de C3 a L3; ASIA teve pontuações de A a D; os tempos de lesão variaram entre 0,3 meses a 33 anos. Também se verificou que não há consenso em relação ao protocolo de TLSP. CONCLUSÃO: O treino locomotor com suporte de peso corporal mostra-se viável na reabilitação de pacientes que sofrem de uma patologia neurológica como a lesão medular. Independentemente do protocolo de treino utilizado, os benefícios referentes ao aumento da força muscular, manutenção ou aumento da densidade óssea, diminuição da frequência cardíaca e aumento do condicionamento físico estão presentes
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Devries MC, Samjoo IA, Hamadeh MJ, McCready C, Raha S, Watt MJ, Steinberg GR, Tarnopolsky MA. Endurance training modulates intramyocellular lipid compartmentalization and morphology in skeletal muscle of lean and obese women. J Clin Endocrinol Metab 2013; 98:4852-62. [PMID: 24081737 DOI: 10.1210/jc.2013-2044] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
CONTEXT The accumulation of intramyocellular lipids (IMCLs) and mitochondrial dysfunction in skeletal muscle have been associated with insulin resistance in obesity. Endurance training (ET) increases mitochondrial content/activity and IMCL content in young, active men and women. We have previously shown that ET alters the size, number, and physical juxtaposition of IMCLs and mitochondria. OBJECTIVE The purpose of this study was to determine the effects of obesity and ET on mitochondrial function, IMCL content, and IMCL-mitochondria juxtaposition in sedentary lean and obese women. DESIGN, SETTING, SUBJECTS, INTERVENTION, AND MAIN OUTCOME MEASURES: Obese (n = 11) and lean (n = 12), sedentary women were recruited using local advertisements and underwent 12 weeks of ET in our training facility at McMaster University. Blood and muscle biopsy samples (vastus lateralis) were collected before and after ET to measure IMCL and mitochondrial ultrastructure, mitochondrial oxidative capacity, lipid oxidation capacity, and lipid metabolism by-products. RESULTS Obese women were insulin resistant (homeostasis model assessment of insulin resistance) compared with lean women. ET did not change body weight but increased mitochondrial oxidative and β-oxidation capacity in both groups. ET mediated reorganization of the muscle architecture, whereby IMCL content in the subsarcolemmal region was reduced with a concomitant increase in intermyofibrillar IMCLs. ET increased the percentage of IMCLs in direct contact with mitochondria and did not alter diacylglycerol and ceramide content in either group. CONCLUSIONS ET mediated positive changes in mitochondrial function and lipid oxidation and induced intracellular IMCL reorganization, which is reflective of greater IMCL turnover capacity in both lean and obese women.
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Affiliation(s)
- Michaela C Devries
- Departments of Pediatrics and Medicine, McMaster University, Neuromuscular Disease Clinic, Health Sciences Centre, Room 2H26, 1200 Main Street West, Hamilton, Ontario L8N 3Z5, Canada.
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Moriello G, Pathare N, Cirone C, Pastore D, Shears D, Sulehri S. Comparison of forward versus backward walking using body weight supported treadmill training in an individual with a spinal cord injury: A single subject design. Physiother Theory Pract 2013; 30:29-37. [DOI: 10.3109/09593985.2013.798845] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Hoekstra F, van Nunen MPM, Gerrits KHL, Stolwijk-Swüste JM, Crins MHP, Janssen TWJ. Effect of robotic gait training on cardiorespiratory system in incomplete spinal cord injury. ACTA ACUST UNITED AC 2013; 50:1411-22. [DOI: 10.1682/jrrd.2012.10.0186] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Revised: 05/30/2013] [Indexed: 11/05/2022]
Affiliation(s)
- Femke Hoekstra
- Amsterdam Rehabilitation Research Center
- Reade, Amsterdam, the Netherlands
| | | | - Karin H. L. Gerrits
- Faculty of Human Movement Sciences, MOVE Research Institute Amsterdam, VU University Amsterdam, Amsterdam, the Netherlands
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Harkema SJ, Hillyer J, Schmidt-Read M, Ardolino E, Sisto SA, Behrman AL. Locomotor training: as a treatment of spinal cord injury and in the progression of neurologic rehabilitation. Arch Phys Med Rehabil 2012; 93:1588-97. [PMID: 22920456 DOI: 10.1016/j.apmr.2012.04.032] [Citation(s) in RCA: 110] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2012] [Revised: 03/28/2012] [Accepted: 04/12/2012] [Indexed: 12/14/2022]
Abstract
Scientists, clinicians, administrators, individuals with spinal cord injury (SCI), and caregivers seek a common goal: to improve the outlook and general expectations of the adults and children living with neurologic injury. Important strides have already been accomplished; in fact, some have labeled the changes in neurologic rehabilitation a "paradigm shift." Not only do we recognize the potential of the damaged nervous system, but we also see that "recovery" can and should be valued and defined broadly. Quality-of-life measures and the individual's sense of accomplishment and well-being are now considered important factors. The ongoing challenge from research to clinical translation is the fine line between scientific uncertainty (ie, the tenet that nothing is ever proven) and the necessary burden of proof required by the clinical community. We review the current state of a specific SCI rehabilitation intervention (locomotor training), which has been shown to be efficacious although thoroughly debated, and summarize the findings from a multicenter collaboration, the Christopher and Dana Reeve Foundation's NeuroRecovery Network.
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Affiliation(s)
- Susan J Harkema
- Department of Neurological Surgery, Kentucky Spinal Cord Research Center, University of Louisville, Louisville, KY, USA.
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Dutra CMR, Pereira E, Siqueira JE, Kulczyki MM, Aguiar LR, Manffra EF. Densidade mineral óssea de pessoas com lesão medular após seis meses de treino locomotor com suporte parcial de peso. FISIOTERAPIA EM MOVIMENTO 2012. [DOI: 10.1590/s0103-51502012000300004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
INTRODUÇÃO: O treino locomotor com suporte parcial de peso (TLSP) pode ser aplicado na reabilitação de pessoas com lesão medular e proporcionar melhoras funcionais, da função cardiovascular e auxiliar na prevenção e tratamento da osteopenia e osteoporose, que são importantes complicações secundárias à LM. OBJETIVOS: Este estudo teve como objetivo determinar e comparar a densidade mineral óssea (DMO) antes e após seis meses de TLSP em sujeitos com LM incompleta. MÉTODO: A amostra foi composta por oito voluntários, com LM com classificações (ASIA) A, B e D. O grupo foi submetido a sessões de treinos, três vezes por semana, com duração de 15 minutos, a uma velocidade de 1,5 km/h. A descarga de peso sobre membros inferiores era aumentada em 5% do peso corporal a cada duas semanas, passando de 20% até 65% do peso corporal, desde o início até o fim do período. Foram realizados exames de densitometria óssea antes do início e logo após o encerramento do programa de treinamento. RESULTADOS: Houve aumento na DMO média do fêmur total que, apesar de pequeno (0,05 g/cm²), foi significativo (p = 0,034). Nas demais regiões (colo do fêmur e trocânter) não houve alteração significativa. CONCLUSÃO: O TLSP pode ter auxiliado na manutenção da DMO nas regiões do colo do fêmur e trocânter.
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Cragg JJ, Stone JA, Krassioukov AV. Management of Cardiovascular Disease Risk Factors in Individuals with Chronic Spinal Cord Injury: An Evidence-Based Review. J Neurotrauma 2012; 29:1999-2012. [DOI: 10.1089/neu.2012.2313] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Jacquelyn J. Cragg
- International Collaboration on Repair Discoveries (ICORD), Division of Physical Medicine and Rehabilitation University of British Columbia, Vancouver, British Columbia, Canada
- School of Population and Public Health, Division of Physical Medicine and Rehabilitation University of British Columbia, Vancouver, British Columbia, Canada
| | - James A. Stone
- University of Calgary, the Libin Cardiovascular Institute, and the Cardiac Wellness Institute of Calgary, Calgary, Alberta, Canada
| | - Andrei V. Krassioukov
- International Collaboration on Repair Discoveries (ICORD), Division of Physical Medicine and Rehabilitation University of British Columbia, Vancouver, British Columbia, Canada
- Department of Medicine, Division of Physical Medicine and Rehabilitation University of British Columbia, Vancouver, British Columbia, Canada
- G.F. Strong Rehabilitation Centre, Vancouver Health Authority, Vancouver, British Columbia, Canada
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Systematic review of the methodological quality and outcome measures utilized in exercise interventions for adults with spinal cord injury. Spinal Cord 2012; 50:718-27. [DOI: 10.1038/sc.2012.78] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Richard-Greenblatt M, Martin Ginis KA, Leber B, Ditor D. Knowledge mobilization regarding activity and exercise after spinal cord injury: a Canadian undergraduate curriculum scan. Disabil Rehabil 2011; 34:1456-60. [PMID: 22206494 DOI: 10.3109/09638288.2011.644025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE The purpose of this study was to conduct a curriculum scan of Canadian undergraduate university programs to determine the relative emphasis placed on the activity and exercise after spinal cord injury (SCI), in the context of physical disability studies. METHOD Eighty-three Canadian Universities were evaluated for courses discussing: (i) general information about SCI, (ii) physical activity and exercise after SCI, (iii) general information about other physical disabilities and (iv) physical activity and exercise for such disabilities. Online course calendars (2009) were scanned, and their accuracy was verified by instructors or administrative assistants. RESULTS The curriculum scan revealed 113 courses that discuss physical disability. Seventy-four of these courses cover information regarding SCI, 47 of which include content relating to activity and exercise. In comparison, 104 courses discuss other physical disabilities, 76 of which cover material related to activity and exercise. Further, the 47 courses that cover activity and exercise after SCI are only offered in 22 Canadian Universities, and only 31 are mandatory for a degree. CONCLUSIONS A substantial number of future healthcare professionals lack exposure to material regarding activity and exercise after SCI during their undergraduate education. This curricular oversight likely contributes to ineffective exercise strategies and the relative inactivity of the SCI population. [ IMPLICATIONS FOR REHABILITATION • Individuals with spinal cord injury are relatively inactive due to the many physical, psychological and social barriers they face regarding activity and exercise participation.• Effective knowledge mobilization regarding activity and exercise after SCI to future healthcare providers is an essential step in promoting participation.• This undergraduate curriculum scan showed that students lack exposure to issues regarding the activity and exercise after SCI in Canadian Universities.• The lack of effective knowledge mobilization in this area likely contributes to the low levels of activity and exercise participation in the SCI population.]
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Forrest GP, Smith TC, Triolo RJ, Gagnon J, DiRisio D, Miller ME, Rhodi L. Use of the Case Western Reserve/Veterans Administration neuroprosthesis for exercise, standing and transfers by a paraplegic subject. Disabil Rehabil Assist Technol 2011; 7:340-4. [PMID: 22053832 DOI: 10.3109/17483107.2011.629328] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Functional electric stimulation (FES) is a technology that may allow patients with spinal cord injury (SCI) to transfer stand and walk. This paper reports upon the use of the Case Western Reserve Neuroprosthesis by a T6 ASIA B paraplegic subject. The subject was able to stand for two minutes and 50 seconds. He could walk 35 feet with a swing to gait. Measurement of energy consumption showed that metabolic demand was only 2.1 metabolic equivalent units. The factors that limited the use of the device that need to be improved to make the technology practical for household or community ambulation are speed (5.8 m/min) of ambulation and fatigue of the stimulated muscles.
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Affiliation(s)
- George P Forrest
- Department of Physical Medicine and Rehabilitation, MetroHealth Medical Center, Cleveland, OH, USA.
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Robotic treadmill training improves cardiovascular function in spinal cord injury patients. Int J Cardiol 2011; 149:323-9. [DOI: 10.1016/j.ijcard.2010.02.010] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2009] [Revised: 01/05/2010] [Accepted: 02/06/2010] [Indexed: 11/18/2022]
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Tremblay MS, Colley RC, Saunders TJ, Healy GN, Owen N. Physiological and health implications of a sedentary lifestyle. Appl Physiol Nutr Metab 2011; 35:725-40. [PMID: 21164543 DOI: 10.1139/h10-079] [Citation(s) in RCA: 764] [Impact Index Per Article: 58.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Sedentary behaviour is associated with deleterious health outcomes, which differ from those that can be attributed to a lack of moderate to vigorous physical activity. This has led to the field of "sedentary physiology", which may be considered as separate and distinct from exercise physiology. This paper gives an overview of this emerging area of research and highlights the ways that it differs from traditional exercise physiology. Definitions of key terms associated with the field of sedentary physiology and a review of the self-report and objective methods for assessing sedentary behaviour are provided. Proposed mechanisms of sedentary physiology are examined, and how they differ from those linking physical activity and health are highlighted. Evidence relating to associations of sedentary behaviours with major health outcomes and the population prevalence and correlates of sedentary behaviours are reviewed. Recommendations for future research are proposed.
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Affiliation(s)
- Mark Stephen Tremblay
- Healthy Active Living and Obesity Research Group, Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Road, Ottawa, ON K1H 8L1 Canada.
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Kostovski E, Iversen PO, Hjeltnes N. [Complications of chronic spinal cord injury]. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2010; 130:1242-5. [PMID: 20567276 DOI: 10.4045/tidsskr.09.0055] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND A spinal cord injury changes body composition and metabolism over time. The main purpose of this article is to provide an overview of what is known about these changes and the consequences of those in the chronic phase, long after the acute injury. MATERIAL AND METHODS The article is based on own research and clinical experience, as well as a non-systematic search in the PubMed database. RESULTS The following has been documented for people with spinal cord injury: reduced bone and muscle mass, altered composition of muscle fibre, marked increase of body fat, decreased sensitivity to insulin and leptin and an increased activity in inflammatory signalling pathways. Changes are also demonstrated in hemostatic mechanisms and immune system. INTERPRETATION Changes in metabolism and hormonal regulation in people with spinal cord injury, may increase the risk of osteoporosis, obesity, cardiovascular disease and type 2 diabetes. Changed body composition and inflammatory activity may contribute to the higher incidence of cardiovascular disease and diabetes/metabolic syndrome, although other important risk factors (such as obesity and high blood pressure) may be absent. It has not been documented that changes in haemostatic mechanisms and the immune system are associated with the increased incidence of thromboembolic complications, severe infections or certain types of cancer.
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Affiliation(s)
- Emil Kostovski
- Forskningsavdelingen, Sunnaas sykehus, 1450 Nesoddtangen, Norway.
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Carlson KF, Wilt TJ, Taylor BC, Goldish GD, Niewoehner CB, Shamliyan TA, Kane RL. Effect of exercise on disorders of carbohydrate and lipid metabolism in adults with traumatic spinal cord injury: systematic review of the evidence. J Spinal Cord Med 2009; 32:361-78. [PMID: 19777857 PMCID: PMC2830675 DOI: 10.1080/10790268.2009.11754465] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND/OBJECTIVE Carbohydrate and lipid metabolism disorders may affect adults with spinal cord injuries (SCIs) differently than able-bodied individuals because of reduced physical activity in the SCI population. The objective of this study was to conduct a systematic review to determine the effectiveness of exercise to improve carbohydrate and lipid metabolism disorders in adults with chronic SCI. METHODS Studies were identified in MEDLINE (1996-2008), Cochrane Library, bibliographies of identified articles, and expert recommendations. English language articles were included if they evaluated adults with chronic SCI; evaluated exercise; and reported carbohydrate-, lipid-, and/or cardiovascular disease-related outcomes. RESULTS Twenty-two studies met inclusion criteria, including 15 intervention case-series and 7 cross-sectional surveys using self-reported physical activity measures. Intervention protocols involved active (n=7) or electrically stimulated (n=7) exercise or an educational program (n ) from 8 to 52 weeks in duration. Frequency of exercise was typically 2 to 3 sessions/week, lasting 30 to 60 minutes/session. Totals of 150 and 369 subjects participated in studies with carbohydrate (n=12) or lipid and cardiovascular (n=16) outcomes, respectively; 78% were men. Level of SCI ranged from C4 to L5 and included both incomplete and complete lesions. Outcomes measures included fasting and postload blood glucose and insulin concentrations and serum cholesterol levels. Small sample sizes and variations in study design, intervention, SCI characteristics, and reported outcomes precluded quantitative pooling of results or reliable assessment of metabolic efficacy. No intervention studies assessed cardiovascular outcomes. CONCLUSIONS Evidence is insufficient to determine whether exercise improves carbohydrate and lipid metabolism disorders among adults with SCI. Expert consensus, based on the preliminary evidence, is needed to inform future studies.
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Affiliation(s)
- Kathleen F Carlson
- Center for Chronic Disease Outcomes Research, VA Medical Center, Minneapolis, Minnesota 55417, USA.
| | - Timothy J Wilt
- Center for Chronic Disease Outcomes Research, VA Medical Center, Minneapolis, Minnesota
,Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Brent C Taylor
- Center for Chronic Disease Outcomes Research, VA Medical Center, Minneapolis, Minnesota
,Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Gary D Goldish
- Center for Chronic Disease Outcomes Research, VA Medical Center, Minneapolis, Minnesota
| | | | | | - Robert L Kane
- School of Public Health, University of Minnesota, Minneapolis, Minnesota
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Groah S, Spungen M, Bauman W. Cardiovascular Disease in Individuals with Spinal Cord Injury: Toward Best Practice. Top Spinal Cord Inj Rehabil 2009. [DOI: 10.1310/sci1403-84] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Forrest, Sisto, Asselin, Mores, Bond, LaFountaine, Harkema. Locomotor Training with Incremental Changes in Velocity: Muscle and Metabolic Responses. Top Spinal Cord Inj Rehabil 2008. [DOI: 10.1310/sci1401-16] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Quintana R, Neiva CM. Fatores de risco para síndrome metabólica em cadeirantes: jogadores de basquetebol e não praticantes. REV BRAS MED ESPORTE 2008. [DOI: 10.1590/s1517-86922008000300005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
A atividade física tem sido sistematicamente estudada como fator preventivo no acometimento de enfermidades crônico-degenerativas, especialmente a síndrome metabólica e doenças cardiovasculares. Sedentarismo está relacionado à diminuição ou ausência de parâmetros mínimos de exigência física diária além do estado de repouso, sendo este fortemente associado à redução na condição de saúde dos indivíduos portadores de deficiência física. As respostas metabólicas do organismo mediante a ausência de determinada musculatura, ou sua inatividade pela falta de estímulos, conduzem a diferenças significativas na estruturação da composição corporal. Esta pesquisa teve como objeto o exercício físico regular e a condição de saúde de indivíduos portadores de deficiência física, através da determinação do perfil antropométrico e bioquímico sangüíneo, e ainda pela determinação da prevalência de fatores de risco para síndrome metabólica. Foram estudados 27 homens com paraplegia (T2-L1), portadores de seqüelas de poliomielite ou amputados, divididos em jogadores de basquetebol cadeirantes (JBC) e não jogadores de basquetebol cadeirantes (NJBC). Os JBC apresentaram circunferência de cintura menor comparada aos NJBC, 76,40±8,44 e 89,25±9,73 cm respectivamente (p<0,05). A pressão arterial sistólica foi significativamente maior nos NJBC 123,33±13,70 e 114,00±9,85 mmHg para JBC (p<0,05), não sendo verificada diferença para PAD. Os NJBC apresentaram valores superiores aos JBC para a bioquímica sangüínea de glicemia, TG, CT e frações, exceto para HDL-C (p<0,05). Os indivíduos NJBC apresentaram alta prevalência para fatores de risco da SM, sendo hipertensão arterial prevalente em 58,33% dos indivíduos, dislipidemia de HDL-C presente em 50% e circunferência de cintura acima da normalidade em 41,66%. Os achados do presente estudo sugerem um papel importante do exercício físico na prevenção da síndrome metabólica, embora estudos adicionais devam ser realizados para a melhor compreensão dos mecanismos que promovem a saúde dos deficientes físicos ativos.
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Forrest GF, Sisto SA, Barbeau H, Kirshblum SC, Wilen J, Bond Q, Bentson S, Asselin P, Cirnigliaro CM, Harkema S. Neuromotor and musculoskeletal responses to locomotor training for an individual with chronic motor complete AIS-B spinal cord injury. J Spinal Cord Med 2008; 31:509-21. [PMID: 19086708 PMCID: PMC2607123 DOI: 10.1080/10790268.2008.11753646] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND/OBJECTIVE To determine the effects of locomotor training (LT) using body weight support (BWS), treadmill, and manual assistance on muscle activation, bone mineral density (BMD), and body composition changes for an individual with motor complete spinal cord injury (AIS B), 1 year after injury. METHODS A man with chronic C6 AIS B (motor complete and sensory incomplete) spinal cord injury (SCI), 1 year after injury, completed 2 blocks of LT over a 9-month training period (35-session block followed by 8.6 weeks of no training and then a 62-session block). RESULTS Before training, muscle activation was minimal for any muscle examined, whereas after the 2 blocks of LT (97 sessions), hip and knee muscle activation patterns for the bilateral rectus femoris, biceps femoris, and gastrocnemius were in phase with the kinematics. Mean EMG amplitude increased for all bilateral muscles and burst duration increased for rectus femoris and gastrocnemius muscles, whereas burst duration decreased for the biceps femoris after 62 LT sessions. Before LT, left biceps femoris had a pattern that reflected muscle stretch, whereas after training, muscle stretch of the left biceps femoris could not totally account for mean EMG amplitude or burst duration. After the 62 training sessions, total BMD decreased (1.54%), and regional BMD decreased (legs: 6.72%). Total weight increased, lean mass decreased (6.6%), and fat mass increased (7.4%) in the arms, whereas fat mass decreased (3.5%) and lean mass increased (4%) in the legs. CONCLUSIONS LT can induce positive neural and body composition changes in a nonambulatory person with chronic SCI, indicating that neuromuscular plasticity can be induced by repetitive locomotor training after a motor complete SCI.
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Affiliation(s)
- Gail F Forrest
- Kessler Medical Research and Education Center, West Orange, NJ 07052, USA.
| | - Sue Ann Sisto
- 1Kessler Medical Rehabilitation Research and Education Corporation, West Orange, New Jersey; 2Department of Physical Medicine and Rehabilitation, University of Medicine and Dentistry of New Jersey–New Jersey Medical School, Newark, New Jersey; 3Stony Brook University, Stony Brook, New York; 4McGill University, Faculty of Medicine, Montreal, Canada; 5Kessler Institute for Rehabilitation, West Orange, New Jersey; 6Biokinetics, LLC of New Jersey, Middletown, New Jersey; 7Veterans Affairs Research and Development Center of Excellence in Spinal Cord Injury, Bronx, New York; 8Department of Neurological Surgery, University of Louisville, Louisville, Kentucky
| | - Hugues Barbeau
- 1Kessler Medical Rehabilitation Research and Education Corporation, West Orange, New Jersey; 2Department of Physical Medicine and Rehabilitation, University of Medicine and Dentistry of New Jersey–New Jersey Medical School, Newark, New Jersey; 3Stony Brook University, Stony Brook, New York; 4McGill University, Faculty of Medicine, Montreal, Canada; 5Kessler Institute for Rehabilitation, West Orange, New Jersey; 6Biokinetics, LLC of New Jersey, Middletown, New Jersey; 7Veterans Affairs Research and Development Center of Excellence in Spinal Cord Injury, Bronx, New York; 8Department of Neurological Surgery, University of Louisville, Louisville, Kentucky
| | - Steven C Kirshblum
- 1Kessler Medical Rehabilitation Research and Education Corporation, West Orange, New Jersey; 2Department of Physical Medicine and Rehabilitation, University of Medicine and Dentistry of New Jersey–New Jersey Medical School, Newark, New Jersey; 3Stony Brook University, Stony Brook, New York; 4McGill University, Faculty of Medicine, Montreal, Canada; 5Kessler Institute for Rehabilitation, West Orange, New Jersey; 6Biokinetics, LLC of New Jersey, Middletown, New Jersey; 7Veterans Affairs Research and Development Center of Excellence in Spinal Cord Injury, Bronx, New York; 8Department of Neurological Surgery, University of Louisville, Louisville, Kentucky
| | - Janina Wilen
- 1Kessler Medical Rehabilitation Research and Education Corporation, West Orange, New Jersey; 2Department of Physical Medicine and Rehabilitation, University of Medicine and Dentistry of New Jersey–New Jersey Medical School, Newark, New Jersey; 3Stony Brook University, Stony Brook, New York; 4McGill University, Faculty of Medicine, Montreal, Canada; 5Kessler Institute for Rehabilitation, West Orange, New Jersey; 6Biokinetics, LLC of New Jersey, Middletown, New Jersey; 7Veterans Affairs Research and Development Center of Excellence in Spinal Cord Injury, Bronx, New York; 8Department of Neurological Surgery, University of Louisville, Louisville, Kentucky
| | - Quin Bond
- 1Kessler Medical Rehabilitation Research and Education Corporation, West Orange, New Jersey; 2Department of Physical Medicine and Rehabilitation, University of Medicine and Dentistry of New Jersey–New Jersey Medical School, Newark, New Jersey; 3Stony Brook University, Stony Brook, New York; 4McGill University, Faculty of Medicine, Montreal, Canada; 5Kessler Institute for Rehabilitation, West Orange, New Jersey; 6Biokinetics, LLC of New Jersey, Middletown, New Jersey; 7Veterans Affairs Research and Development Center of Excellence in Spinal Cord Injury, Bronx, New York; 8Department of Neurological Surgery, University of Louisville, Louisville, Kentucky
| | - Scott Bentson
- 1Kessler Medical Rehabilitation Research and Education Corporation, West Orange, New Jersey; 2Department of Physical Medicine and Rehabilitation, University of Medicine and Dentistry of New Jersey–New Jersey Medical School, Newark, New Jersey; 3Stony Brook University, Stony Brook, New York; 4McGill University, Faculty of Medicine, Montreal, Canada; 5Kessler Institute for Rehabilitation, West Orange, New Jersey; 6Biokinetics, LLC of New Jersey, Middletown, New Jersey; 7Veterans Affairs Research and Development Center of Excellence in Spinal Cord Injury, Bronx, New York; 8Department of Neurological Surgery, University of Louisville, Louisville, Kentucky
| | - Pierre Asselin
- 1Kessler Medical Rehabilitation Research and Education Corporation, West Orange, New Jersey; 2Department of Physical Medicine and Rehabilitation, University of Medicine and Dentistry of New Jersey–New Jersey Medical School, Newark, New Jersey; 3Stony Brook University, Stony Brook, New York; 4McGill University, Faculty of Medicine, Montreal, Canada; 5Kessler Institute for Rehabilitation, West Orange, New Jersey; 6Biokinetics, LLC of New Jersey, Middletown, New Jersey; 7Veterans Affairs Research and Development Center of Excellence in Spinal Cord Injury, Bronx, New York; 8Department of Neurological Surgery, University of Louisville, Louisville, Kentucky
| | - Christopher M Cirnigliaro
- 1Kessler Medical Rehabilitation Research and Education Corporation, West Orange, New Jersey; 2Department of Physical Medicine and Rehabilitation, University of Medicine and Dentistry of New Jersey–New Jersey Medical School, Newark, New Jersey; 3Stony Brook University, Stony Brook, New York; 4McGill University, Faculty of Medicine, Montreal, Canada; 5Kessler Institute for Rehabilitation, West Orange, New Jersey; 6Biokinetics, LLC of New Jersey, Middletown, New Jersey; 7Veterans Affairs Research and Development Center of Excellence in Spinal Cord Injury, Bronx, New York; 8Department of Neurological Surgery, University of Louisville, Louisville, Kentucky
| | - Susan Harkema
- 1Kessler Medical Rehabilitation Research and Education Corporation, West Orange, New Jersey; 2Department of Physical Medicine and Rehabilitation, University of Medicine and Dentistry of New Jersey–New Jersey Medical School, Newark, New Jersey; 3Stony Brook University, Stony Brook, New York; 4McGill University, Faculty of Medicine, Montreal, Canada; 5Kessler Institute for Rehabilitation, West Orange, New Jersey; 6Biokinetics, LLC of New Jersey, Middletown, New Jersey; 7Veterans Affairs Research and Development Center of Excellence in Spinal Cord Injury, Bronx, New York; 8Department of Neurological Surgery, University of Louisville, Louisville, Kentucky
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Warburton DER, Eng JJ, Krassioukov A, Sproule S. Cardiovascular Health and Exercise Rehabilitation in Spinal Cord Injury. Top Spinal Cord Inj Rehabil 2007; 13:98-122. [PMID: 22719205 DOI: 10.1310/sci1301-98] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
There appears to be an increased prevalence and earlier onset of cardiovascular disease (CVD) in persons with SCI. Physical inactivity is thought to be a key factor in the increased risk for CVD. Physical inactivity is highly prevalent in persons with SCI and it appears that activities of daily living are not sufficient to maintain cardiovascular fitness and health. This systematic review examines the current literature regarding the risk for CVD and the effectiveness of varied exercise rehabilitation programs in attenuating the risk for CVD in SCI.
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Affiliation(s)
- Darren E R Warburton
- Cardiovascular Physiology and Rehabilitation Laboratory, Experimental Medicine, Faculty of Medicine, University of British Columbia
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38
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Wilkinson SB, Tarnopolsky MA, Macdonald MJ, Macdonald JR, Armstrong D, Phillips SM. Consumption of fluid skim milk promotes greater muscle protein accretion after resistance exercise than does consumption of an isonitrogenous and isoenergetic soy-protein beverage. Am J Clin Nutr 2007; 85:1031-40. [PMID: 17413102 DOI: 10.1093/ajcn/85.4.1031] [Citation(s) in RCA: 319] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Resistance exercise leads to net muscle protein accretion through a synergistic interaction of exercise and feeding. Proteins from different sources may differ in their ability to support muscle protein accretion because of different patterns of postprandial hyperaminoacidemia. OBJECTIVE We examined the effect of consuming isonitrogenous, isoenergetic, and macronutrient-matched soy or milk beverages (18 g protein, 750 kJ) on protein kinetics and net muscle protein balance after resistance exercise in healthy young men. Our hypothesis was that soy ingestion would result in larger but transient hyperaminoacidemia compared with milk and that milk would promote a greater net balance because of lower but prolonged hyperaminoacidemia. DESIGN Arterial-venous amino acid balance and muscle fractional synthesis rates were measured in young men who consumed fluid milk or a soy-protein beverage in a crossover design after a bout of resistance exercise. RESULTS Ingestion of both soy and milk resulted in a positive net protein balance. Analysis of area under the net balance curves indicated an overall greater net balance after milk ingestion (P < 0.05). The fractional synthesis rate in muscle was also greater after milk consumption (0.10 +/- 0.01%/h) than after soy consumption (0.07 +/- 0.01%/h; P = 0.05). CONCLUSIONS Milk-based proteins promote muscle protein accretion to a greater extent than do soy-based proteins when consumed after resistance exercise. The consumption of either milk or soy protein with resistance training promotes muscle mass maintenance and gains, but chronic consumption of milk proteins after resistance exercise likely supports a more rapid lean mass accrual.
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Affiliation(s)
- Sarah B Wilkinson
- Exercise Metabolism Research Group, Department of Kinesiology, McMaster University, Hamilton, Canada
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Hicks AL, Adams MM. In reply to Dr Anton Wernig. Spinal Cord 2006. [DOI: 10.1038/sj.sc.3101828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Giangregorio LM, Hicks AL, Webber CE, Phillips SM, Craven BC, Bugaresti JM, McCartney N. Body weight supported treadmill training in acute spinal cord injury: impact on muscle and bone. Spinal Cord 2006; 43:649-57. [PMID: 15968302 DOI: 10.1038/sj.sc.3101774] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
DESIGN Longitudinal prospective case series. OBJECTIVE To evaluate the impact of early introduction post-spinal cord injury (SCI) of twice-weekly body-weight supported treadmill training (BWSTT) on muscle and bone. SETTING Centre for Health Promotion and Rehabilitation, McMaster University, Canada. METHODS Five individuals who had sustained traumatic SCI within 2-6 months participated in the study. Bone mineral densities (BMD) of proximal femur, distal femur, proximal tibia and lumbar spine were measured before and after training, as well as muscle cross-sectional area (CSA), BMD and bone geometry at mid-femur and proximal tibia. Serum osteocalcin and urinary deoxypyridinoline were measured at baseline, and after 24 and 48 sessions of training. RESULTS All participants experienced increased muscle CSAs, ranging from 3.8 to 56.9%. Reductions in BMD were evident in all participants at almost all lower limb sites after training, ranging in magnitude from -1.2 to -26.7%. Lumbar spine BMD changes ranged from 0.2 to -7.4%. No consistent changes were observed in bone geometry. BWSTT did not alter the expected pattern of change in bone biochemical markers over time. The individual with the greatest improvement in ambulatory ability demonstrated the smallest reduction in lower limb BMD. Conversely, the individual who completed the fewest BWSTT sessions demonstrated the greatest reductions in BMD. CONCLUSIONS Twice-weekly BWSTT appeared to partially reverse muscle atrophy after SCI, but did not prevent bone loss. Larger, controlled trials should evaluate whether relative preservation of bone loss occurs with regular BWSTT following acute SCI. SPONSORSHIP Ontario Neurotrauma Foundation.
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Affiliation(s)
- L M Giangregorio
- Spinal Cord Rehabilitation Program, Toronto Rehabilitation Institute, Ontario, Canada
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Adams MM, Ditor DS, Tarnopolsky MA, Phillips SM, McCartney N, Hicks AL. The effect of body weight-supported treadmill training on muscle morphology in an individual with chronic, motor-complete spinal cord injury: A case study. J Spinal Cord Med 2006; 29:167-71. [PMID: 16739562 PMCID: PMC1864805 DOI: 10.1080/10790268.2006.11753860] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVE The purpose of this pilot study was to examine the effects of 4 months of thrice-weekly body weight-supported treadmill training (BWSTT) on skeletal muscle morphology in a woman (age 27 y) with chronic, motor-complete (ASIA B) spinal cord injury (SCI). METHODS The participant performed passive thrice-weekly BWSTT for 4 months (48 total sessions) with manual assistance from therapists. Muscle biopsies of the vastus lateralis were taken prior to the beginning of the training program as well as following the completion of 4 months of training. Histochemical analysis was utilized to evaluate changes in muscle fiber size and type following training. RESULTS At baseline, vastus lateralis muscle biopsies showed evidence of fiber atrophy and fiber type redistribution typical of persons with SCI, with mean fiber areas (and % distributions) of type I, type IIa and type IIx fibers being 3474 microm2 (1.3%), 3146 microm2 (30.8%) and 1284 microm2 (68.0%), respectively. Following training, there were increases in treadmill walking speed (pre: 1.0km/h; post: 2.5km/h) and distance walked/session (pre: 500m; post: 1875m). Vastus lateralis mean fiber area increased by 27.1% and type I fiber % distribution increased to 24.6%, whereas type IIa and type IIx fiber % distributions both decreased following training. CONCLUSION These data indicate that 4 months of thrice-weekly BWSTT improved muscle morphology in an individual with chronic, motor-complete SCI.
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Affiliation(s)
- Melanie M Adams
- Department of Kinesiology, McMaster University, Hamilton, Ontario, Canada.
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Bouyer LJ. Animal Models for Studying Potential Training Strategies in Persons with Spinal Cord Injury. J Neurol Phys Ther 2005; 29:117-25. [PMID: 16398944 DOI: 10.1097/01.npt.0000282244.31158.40] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
In the late 1980s, it was clearly demonstrated that adult spinal cats can be re-trained to walk after a complete spinal cord transection, using treadmill training. This has led to profound changes in the rehabilitation of persons with spinal cord injury. The use of animal models to study training-induced locomotor plasticity after spinal cord injury has expanded since this original demonstration. The goal of the present review is to summarize findings obtained with these animal models that may be of relevance to the re-training of humans with spinal cord injury. From the complete spinal cord transection models, adaptive capacity, retention of training, task-specificity, role of cutaneous inputs, effect of training with robotic devices, and spinal cord stimulation will be discussed. From the partial spinal lesion models, the effect of ventral or dorsal lesions of the cord will be presented. Finally, the effects of drugs on training will be compared between the complete and partial spinal lesions models.
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Affiliation(s)
- Laurent J Bouyer
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Departement de Readaptation, Universite Laval, Canada G7K 1P4.
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Hicks AL, Adams MM, Martin Ginis K, Giangregorio L, Latimer A, Phillips SM, McCartney N. Long-term body-weight-supported treadmill training and subsequent follow-up in persons with chronic SCI: effects on functional walking ability and measures of subjective well-being. Spinal Cord 2005; 43:291-8. [PMID: 15685260 DOI: 10.1038/sj.sc.3101710] [Citation(s) in RCA: 152] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Longitudinal, prospective within-subject design. OBJECTIVES (1) To determine the effects of long-term body-weight-supported treadmill training (BWSTT) on functional walking ability and perceived quality of life in persons with chronic incomplete spinal cord injury (SCI), and (2) to investigate whether training adaptations are maintained following cessation of the BWSTT programme. SETTING Hamilton, Ontario, Canada. METHODS A group of 14 individuals with chronic (mean 7.4 years postinjury) incomplete SCI (ASIA B & C) participated in thrice-weekly sessions of BWSTT for a period of approximately 12 months (144 sessions). Functional walking ability and indices of subjective well-being were evaluated during the training programme and over an 8-month follow-up. RESULTS In total, 13 subjects successfully completed the 144 training sessions in the required study period (max. 15 months). Adherence to the thrice-weekly training frequency was 78.8%. All subjects improved in treadmill walking ability (54% reduction in required external body-weight support (BWS), 180% increase in treadmill walking speed, 335% increase in distance walked/session), and six subjects improved their capacity to walk over ground. There were accompanying increases in satisfaction with life and satisfaction with physical function, both of which were significantly correlated with improvements in treadmill walking ability. All but one subject returned for follow-up assessment 8 months post-training; while there was a slight decline in treadmill walking performance, over ground walking scores remained relatively stable. The only change in subjective well-being in the follow-up was a slight decrease in satisfaction with physical function. CONCLUSION Thrice-weekly BWSTT for 12 months was an effective stimulus to improve treadmill walking ability and indices of subjective well-being in persons with chronic incomplete SCI, and most of these improvements were maintained for up to 8 months following the cessation of training.
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Affiliation(s)
- A L Hicks
- Department of Kinesiology, McMaster University, Hamilton, Ontario, Canada
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