Longitudinal relationship between wheelchair exercise capacity and life satisfaction in patients with spinal cord injury: A cohort study in the Netherlands

"I think it was helpful but not as helpful as it could have been" - a qualitative study of the experiences and perspectives of using fitness apps among manual wheelchair users with spinal cord injury

PURPOSE

To gain knowledge of the experiences and perceptions of using fitness apps by full-time wheelchair users with spinal cord injury (SCI) and to explore experiences and perceptions of using these apps in relation to barriers to and facilitators of physical activity (PA).

MATERIALS AND METHODS

A qualitative design was employed. Semi-structured interviews were conducted with ten manual wheelchair users with SCI. Data were analysed using reflexive thematic analysis.

RESULTS

Four themes were developed: 1) App functionality and experience, 2) Enhancing motivation, 3) Precursors to engagement and 4) Knowledge gaps. Experience and perception were strongly influenced by app design, particularly the presence or absence of features tailored for wheelchair users. Many apps incorporated the use wearable or mountable sensors. Fitness apps were perceived to increase motivation, although, this had its limitations. Conversely, apps were reported to have limited influence on commonly reported barriers to PA. Furthermore, the data highlighted gaps in knowledge which created barriers to effective app use.

CONCLUSIONS

Fitness apps were perceived to increase motivation to engage in PA in manual wheelchair users with SCI. However, more needs to be done to further develop app features for wheelchair users with SCI and to address remaining barriers to engagement.

Effect of adaptive sports on quality of life in individuals with disabilities who use wheelchairs: a mixed-methods systematic review

PURPOSE

Adaptive sports participation has been shown to improve quality of life (QoL) in individual with disabilities. However, inconsistent results in various domains of QoL exist in the literature. The objective of this mixed-methods systematic review is to identify and synthesize evidence from quantitative and qualitative studies on the effect of adaptive sports on QoL in individuals with disabilities who use wheelchairs for mobility.

METHODS

A systematic literature review of quantitative, qualitative, and mixed-methods research on the effect of adaptive sports on QoL was conducted on five databases (Scopus, Web of Science, PsycINFO, Medline, and PubMed). Quality appraisal was conducted by two authors by using the Mixed Methods Appraisal Tool.

RESULTS

This review identified 4 key findings from 41 studies, including 31 quantitative and 10 qualitative studies. First, individuals with disabilities using wheelchairs for mobility who actively engaged in adaptive sports tend to report higher QoL scores compared with those who were inactive or did not participate. Second, the relationship between the duration of regular participation in adaptive sports and QoL scores exhibited inconsistent results. Third, a multi-component adaptive sports program demonstrates the potential to further improve QoL scores. Last, qualitative investigations reveal that participation in adaptive sports positively influences various domains of well-being in wheelchair users, including encompassing physical and emotional well-being, interpersonal relationships, material well-being, personal development, self-determination, and social inclusion.

CONCLUSION

This review provides a comprehensive relationship between adaptive sports participation and QoL of wheelchair users. This study identifies the value of multi-component interventions and demonstrates the diverse positive influences of adaptive sports on well-being.

Pain and quality of life in athletes vs non-athletes with spinal cord injury: Observational study

Spinal Cord Injuries (SCI) may cause non-motor symptoms, such as chronic pain, which impair quality of life (QoL)Objective: To investigate the relationship between adapted competitive sports, pain, and QoL in people with SCI in a limited resources setting population.Methods: This prospective cross-sectional observational study involved 16 athletes and 24 non-athletes with SCI and collected data on demographic and clinical variables including scores for pain and pain interference in daily life (Brief Pain Inventory, BPI), neuropathic pain severity (Neuropathic Pain Symptoms Inventory, NPSI) and Quality of life (Word Health Organization Quality of Life Assessment, WHOQOL-BREF). Non-parametric testing was used to compare the groups, and due to athletes being younger, multiple linear regression analyses were used to adjust for the effect of sports practice on the outcome variables when adjusting for age.Results: Athletes were younger (median age 36y) than non-athletes (median age 41.5y; Mann-Whitney U test P = 0.011), and QoL was superior in athletes for the Physical, Psychological, Social Relationships, Self-Evaluation domains, and Total Score when adjusted for age (P < 0.01). Despite having no significant differences in pain intensity scores (NPSI, P = 0.742 and BPI, P = 0.261) athletes had less pain interference on "Relationship with Others", "Enjoyment of Life", and Total score (P < 0.05). Participation in competitive adapted sports (P = 0.004) and Total Pain Interference (P = 0.043) were significantly associated with QoL scores in the multiple linear regression analyses.Conclusion: Athletes with SCI have better QoL and less pain interference in some aspects of life when compared to non-athletes.

12-week concurrent brisk walking and Taijiquan (Tai Chi) improve balance, flexibility, and muscular strength of Chinese older women

Healthy aging is a global goal to enhance the quality of life for older persons. This study evaluated the benefits of 12-week concurrent brisk walking and Taijiquan. Healthy Chinese women aged 60 years and above were enrolled to the control (n = 26) and intervention (n = 25) groups. Participants in the intervention group engaged in three exercise sessions per week for 12 weeks, whereas control group engaged in free-living activities. Each exercise session consisted of 20-45 minutes of walking and 20-45 minutes of Yang style 24-form Taijiquan. 12-week exercise improved (p < 0.05) the sit and reach test (within-group mean difference: +5.6 cm; Hedges' g = 0.77), handgrip strength (mean difference: +3.1 kg; g = 0.89), arm curl (mean difference: +2.1 repetitions; g = 0.69), chair stand (mean difference: +2.6 repetitions; g = 0.63), and one-legged standing (mean difference: +2.2 seconds; g = 1.07). There was no improvement in the circulatory health, body composition, or life satisfaction. Therefore, this concurrent brisk walking and Taijiquan training, which targets major whole-body muscle groups, could improve aging-critical flexibility, muscular fitness, and balance in older women. The exercise meets the current WHO guideline, is safe to perform, and could be campaigned as a health promotion for older persons.

Perception of autonomy among people who use wheeled mobility assistive devices: Dependence on the type of wheeled assistive technology

We evaluated perceived autonomy among users of different types of wheeled mobility assistive devices (WMADs) across five environments and identified the effect on user autonomy due to specific device characteristics. A study-specific questionnaire was used to assess satisfaction with autonomy of WMAD users in the Home, Buildings Outside of the Home, Outdoor Built, Outdoor Natural Environment, and Transportation. For each environment, 15 contextual factors were rated for their impact on participants' autonomy. Our results revealed that manual wheelchair with add-on (MWC+AO) users had higher overall satisfaction with their autonomy compared to other WMAD users. MWC+AO users reported higher satisfaction with autonomy due to their health conditions compared to other WMAD users across all environments. In Outdoor Natural Environments, MWC+AO users had the highest satisfaction with autonomy across all factors except for negotiating hills. When performing activities in Buildings, MWC users with and without add-ons reported higher satisfaction for all factors compared to power wheelchair users, except for maneuverability on different surfaces. Satisfaction with autonomy regarding contextual factors varied among WMAD users, however, MWC+AO(s) appeared to provide a more balanced sense of autonomy across most factors and environments. More in-depth investigations are required to evaluate impacts of add-on use on autonomy.

Peak oxygen uptake in sportsmen with spinal cord injury: importance of body composition

BACKGROUND

Although peak oxygen uptake (VO<inf>2peak</inf>) is considered the most useful index of functional capacity, it's difficult to interpret the results of cardiopulmonary exercise testing (CPET) in individuals with spinal cord injury (SCI). In fact, VO<inf>2peak</inf> is usually normalized for total body weight, but body composition in persons with SCI largely varies depending on physical activity and time since injury, with a progressive loss of fat-free mass (FFM). This can lead to a misinterpretation of the cardiopulmonary fitness in this population.

AIM

Our study proposes a methodology of evaluation, based on bioelectrical impedance analysis (BIA), which could provide more individualized and accurate data in sportsmen with SCI.

DESIGN

Case-control study.

POPULATION

Ambulatory patients at the Sports Medicine Unit of the IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy.

METHODS

Comparison of data derived from BIA, echocardiography and CPET between 10 male sportsmen with complete, high SCI (group T) and 10 able-bodied controls (group C).

RESULTS

Mean VO<inf>2peak</inf>, weight-normalized VO<inf>2peak</inf>, fat-free mass (FFM)-normalized VO<inf>2peak</inf> and body cellular mass (BCM)-normalized values were significantly lower in group T. At the same heart rate (on average the 55% of the maximal theoretical for age), mean of absolute VO<inf>2</inf>, weight-normalized VO<inf>2</inf> and FFM-normalized VO<inf>2</inf> were still significantly lower in group T. Considering the BCM-normalized VO<inf>2</inf>, the group T showed greater values than controls, 39.4±7.8 vs. 31.1±8.5 mL/kg/min.

CONCLUSIONS

Body composition is a crucial factor for properly interpreting a CPET in individuals with SCI. In particular, normalization of VO<inf>2peak</inf> values for the BCM seems the most reliable tool to assess the real functional capacity in this population.

CLINICAL REHABILITATION IMPACT

A more accurate definition of the aerobic power and functional capacity of people with SCI can improve the monitoring of rehabilitations protocols and physical exercise in this population.

Effects of Resistance Training on Oxidative Stress Markers and Muscle Damage in Spinal Cord Injured Rats

Simple Summary

Spinal Cord Injury is a devastating condition that compromises the individual’s health, quality of life and functional independence. Rats submitted to Spinal Cord Injury were evaluated after four weeks of resistance training. Analyses of levels of muscle damage and oxidative stress surgery were performed. Resistance training demonstrated increase antioxidative activity while decreased oxidative damage in injured rats, in addition to having presented changes in the levels of muscle damage in that same group. The results highlight that resistance training promoted a decrease in oxidative stress and a significant response in muscle damage markers.

Abstract

Background: Spinal cord injury (SCI) is a condition that affects the central nervous system, is characterized by motor and sensory impairments, and impacts individuals’ lives. The objective of this study was to evaluate the effects of resistance training on oxidative stress and muscle damage in spinal cord injured rats. Methodology: Forty Wistar rats were selected and divided equally into five groups: Healthy Control (CON), Sham (SHAM) SCI Untrained group (SCI-U), SCI Trained group (SCI- T), SCI Active Trained group (SCI- AT). Animals in the trained groups were submitted to an incomplete SCI at T9. Thereafter, they performed a protocol of resistance training for four weeks. Results: Significant differences in muscle damage markers and oxidative stress in the trained groups, mainly in SCI- AT, were found. On the other hand, SCI- U group presented higher levels of oxidative stress and biomarkers of LDH and AST. Conclusion: The results highlight that resistance training promoted a decrease in oxidative stress and a significative response in muscle damage markers.

Cultural adaptation and Turkish version of Physical Activity Scale for Individuals with Physical Disabilities in individuals with spinal cord injury: a reliability and validity study

PURPOSE

To translate the "Physical Activity Scale for Individuals with Physical Disabilities (PASIPD)" into Turkish, to make a cultural adaptation, and to examine the psychometric properties including validity and reliability.

METHODS

During the translation period cross-cultural adaptation design proposed by guideline was used. Patients completed the Turkish version of the PASIPD and it was applied again a week later. To determine the reliability and internal consistency, Cronbach's alpha coefficient was calculated. Test-retest reliability was determined by using intraclass correlation coefficient (ICC) and Pearson's correlation analysis. Construct validity was examined with factor analysis. Convergent validity was examined by comparing PASIPD with Functional Independent Measurement (FIM), Nottingham Health Profile (NHP), and Craig Handicap Assessment and Reporting Technique Short (CHART-SF), and criterion validity was examined by comparing PASIPD with Manual wheelchair propulsion tests scores.

RESULTS

Cronbach's alpha coefficient was 0.725. The ICC coefficient for the test-retest reliability was 0.851. PASIPD was explained by three factors. The ratio of explaining the total variance of these 3 factors was determined as 51.66%. FIM (r = 0.307, p = 0.040) and CHART-SF were moderately positively correlated with PASIPD total score. The correlation between the total score of PASIPD and NHP was r = -0.443 (p = 0.002). 20 Meters Propulsion (r = -0.404, p = 0.005) and Slalom Tests (r = -0.305, p = 0.037) were highly negative and 6 min Push Propulsion (r = 0.456, p = 0.001) were moderately positive with PASIPD total score.

CONCLUSION

The Turkish version of the PASIPD is a valid and reliable scale in patients with spinal cord injury. IMPLICATIONS FOR REHABILITATIONThe Turkish and cross-culturally adapted version of PASIPD is a useful physical activity scale to evaluate the physical activity level of SCI.The Turkish version of the PASIPD is a valid and reliable scale and can be used in Turkish patients with SCI.PASIPD can be used to compare physical activity levels between disability types and groups with and without disabilities.PASIPD can be used to evaluate the effectiveness of attempts to increase physical activity in patients with SCI.

Quality of Life and Associated Factors Among Male Wheelchair Handball Athletes

Although scarce, some recent studies have observed good self-reported quality of life (QOL) among wheelchair users who are involved in adapted sports. These findings have encouraged further investigations, particularly investigations of combined sociodemographic and sport factors in the study of QOL. In this study we analyzed the association between sociodemographic and sport factors with QOL in a cross-sectional study of 105 male wheelchair handball (WH) athletes with higher and lower QOL. We used the World Health Organization Quality of Life - BREF (WHOQOL-BREF) scale to evaluate the respondents QOL; and we used a sociodemographic questionnaire to evaluate associated sociodemographic and sport factors. A logistic regression analysis found these athletes' good QOL to be generally characterized by stable marital status, disability due to cerebral palsy, the use of locomotion/mobility resources, full independence, bi-weekly training, and the use of a custom-made wheelchair for around 70% of their daily living activities. These findings support the role of such sociodemographic and sport factors in determining QOL among these WH respondents. These findings reveal the important issues to be considered in the sport modality when attempting to improve the QOL and functionality of these participants and perhaps WH athletes worldwide.

The test-retest reliability of individualized VO2peak test modalities in people with spinal cord injury undergoing rehabilitation

STUDY DESIGN

Test-retest study.

OBJECTIVE

To describe the test-retest reliability of an individualized approach for peak oxygen uptake (VO₂peak) testing in a clinical context, accommodating inpatients with heterogeneous levels of physical functioning.

SETTING

Inpatient rehabilitation.

METHOD

Test-retest on two types of devices (recumbent stepper and arm-crank ergometer) with two predefined protocols of varying load increments on each device. No participants performed all four test modalities. VO₂peak, respiratory exchange ratio (RER), peak workload, and the reason for termination were reported. Of 23 participants included, 21 completed the test-retest procedure. Participants were inpatients, ≥18 years, who sustained a spinal cord injury (SCI) within the last 12 months at the time of admission. The median age was 52 years and 74% were male. Median time since injury at the time of the first test (T1) was 5.5 months. Seventeen were classified as American Spinal Injury Association Impairment Scale D. Intraclass correlation coefficients (ICC) and Bland-Altman plots for VO₂peak was calculated to determine intra- and intertester reliability of VO₂peak.

RESULTS

Mean VO₂peak obtained at T1 was 1.91 L/min (95%CI: 1.31-2.51); 1.26 L/min and 2.69 L/min for the recumbent stepper protocols; 0.61 L/min and 1.39 L/min for the arm-crank ergometer protocols. ICC for intra- and intertester reliability was 0.997 (95%CI: 0.986-0.999) and 0.994 (95%CI: 0.978-0.998) respectively. Bland-Altman plots showed a mean difference of -0.005 (SD 0,12) for overall test-retest.

CONCLUSION

Test-retest reliability was high. Mean VO₂peak at discharge from rehabilitation was higher than previously reported and individualized test modalities seemed to yield more optimal results in a heterogenous and representative sample during rehabilitation.

Sport participation after the HandbikeBattle: benefits, barriers, facilitators from the event-a follow-up survey

OBJECTIVES

To investigate sports participation among individuals in the HandbikeBattle project 1.5-5.5 years after the event, the barriers and facilitators to sport participation and benefits of participating in the event.

SETTING

Former participants of the HandbikeBattle, a handcycling race on an Austrian mountain.

METHODS

Handcyclists who took part in one or more HandbikeBattle events in 2013-2017 were invited to complete a survey in December 2018. Questions were asked on benefits of participating in this event, current sport participation, and experienced barriers and facilitators regarding current sport participation.

RESULTS

Respondents (N = 96 (N = 59 with spinal cord injury (SCI) or Spina Bifida (SB)), response rate = 47%) reported benefits from this event regarding their fitness level (90%), personal development (81%), daily life activities (66%), and health (64%). Median current sport participation was 5 h/week (IQR: 3-8). Most frequently indicated personal barriers for sports participation were: lack of time (31%), disability (17%), and pain (15%). Most frequently mentioned environmental barriers were: transportation time to sport accommodation (19%), and lack of peers to do sports with (16%). Most important facilitators were motivation to improve health and/or fitness (92%), fun and/or relaxation (85%). The results for the subgroup with SCI were comparable with the results of the total group.

CONCLUSIONS

Results highlight the role sports challenges can have in establishing a sustainable active life lifestyle among people with disabilities.

The brief window of time comprising a wheelchair transfer confers a significant fracture risk on elderly Americans

OBJECTIVES

Wheelchairs grant increased mobility to their users but can result in injuries of varying severities, including fractures which are often associated with wheelchair transfers. However, this fracture burden remains poorly characterized in elderly Americans. The purpose of this study was to report demographic and environmental risk factors for these injuries.

STUDY DESIGN

We used data from the National Electronic Injury Surveillance System (NEISS) for the years 2007-2017 to perform a retrospective, cross-sectional analysis of wheelchair transfer fractures in patients aged 65 years and older.

METHODS

Each yearly sample in the NEISS database was queried between 2007 and 2017 for fractures associated with wheelchair transfers in patients aged 65 years or older. The narrative sections of the database were individually read and reviewed to identify cases in which a patient explicitly transferred into or out of a wheelchair while sustaining said fracture.

RESULTS

Between 2007 and 2017, the average number of patients aged 65 years and older presenting to US emergency departments was 3924 (95% confidence interval [CI] = 2792-5055). A significantly higher percentage of fractures (61.8%; 95% CI = 56.7%-66.8%) is associated with transferring out of wheelchairs. Moreover, such fractures were often associated with transferring to and from beds (29.9%; 95% CI = 25.4%-34.3%), with the hip (37.5%; 95% CI = 33.3%-41.6%) being the most commonly fractured anatomical region overall. A majority of patients required admission to the hospital (60.2%; 95%CI = 52.4%-68.0%) and most wheelchair transfer fractures occurred at home (44.1%; 95% CI = 36.7%-51.5%), with women (71.9%; 95% CI = 68.3%-75.6%) comprising the majority of these patients.

CONCLUSIONS

Our findings show that wheelchair transfers are associated with significant risk of severe fracture in elderly Americans. As such, wheelchair transfer events merit extra attention from healthcare providers because they comprise a brief window of time relative to the number of occupancy hours in full-time wheelchair users yet can result in significant morbidity and mortality. Preventative measures and patient education should be encouraged to preserve patient mobility and reduce injury.

Grafting Embryonic Raphe Neurons Reestablishes Serotonergic Regulation of Sympathetic Activity to Improve Cardiovascular Function after Spinal Cord Injury

Cardiovascular dysfunction often occurs after high-level spinal cord injury. Disrupting supraspinal vasomotor pathways affects basal hemodynamics and contributes to the development of autonomic dysreflexia (AD). Transplantation of early-stage neurons to the injured cord may reconstruct the descending projections to enhance cardiovascular performance. To determine the specific role of reestablishing serotonergic regulation of hemodynamics, we implanted serotonergic (5-HT⁺) neuron-enriched embryonic raphe nucleus-derived neural stem cells/progenitors (RN-NSCs) into a complete spinal cord transection lesion site in adult female rats. Grafting embryonic spinal cord-derived NSCs or injury alone served as 2 controls. Ten weeks after injury/grafting, histological analysis revealed well-survived grafts and partial integration with host tissues in the lesion site. Numerous graft-derived serotonergic axons topographically projected to the caudal autonomic regions. Neuronal tracing showed that host supraspinal vasomotor pathways regenerated into the graft, and 5-HT⁺ neurons within graft and host brainstem neurons were transsynaptically labeled by injecting pseudorabies virus (PRV-614) into the kidney, indicating reconnected serotonergic circuits regulating autonomic activity. Using an implanted telemeter to record cardiovascular parameters, grafting RN-NSCs restored resting mean arterial pressure to normal levels and remarkably alleviated naturally occurring and colorectal distension-induced AD. Subsequent pharmacological blockade of 5-HT_2A receptors with ketanserin in RN-NSC-grafted rats reduced resting mean arterial pressure and increased heart rate in all but 2 controls. Furthermore, spinal cord retransection below RN-NSC grafts partially eliminated the recovery in AD. Collectively, these data indicate that RN-NSCs grafted into a spinal cord injury site relay supraspinal control of serotonergic regulation for sympathetic activity to improve cardiovascular function.SIGNIFICANCE STATEMENT Disruption of supraspinal vasomotor pathways results in cardiovascular dysfunction following high-level spinal cord injury. To reestablish the descending regulation of autonomic function, we transplanted serotonergic neuron enriched embryonic raphe nucleus-derived neural stem cells/progenitors into the lesion site of completely transected rat spinal cord. Consequently, grafted raphe nucleus-derived neural stem cells/progenitors acted as a neuronal relay to reconnect supraspinal center and spinal sympathetic neurons below the injury. The reconstituted serotonergic regulation of sympathetic activity led to the improvement of hemodynamic parameters and mitigated autonomic dysreflexia. Based on morphological and physiological results, this study validates the effectiveness of transplanting early-stage serotonergic neurons into the spinal cord for cardiovascular functional recovery after spinal cord injury.

Health promotion and cardiovascular risk reduction in people with spinal cord injury: physical activity, healthy diet and maintenance after discharge- protocol for a prospective national cohort study and a preintervention- postintervention study

INTRODUCTION

Spinal cord injury (SCI) predisposes those who suffer from it to physical inactivity and weight gain; consequently, death due to cardiovascular diseases is more frequent among people with SCI than in the general population. The literature documents a consensus about an interdisciplinary multimodal approach for the prevention and treatment of cardiovascular risk factors including overweight and obesity in people with SCI, focusing on diet, physical activity (PA) and behavioural interventions. This study will investigate implementation of recommendations from a recent clinical practice guideline for identification and management of cardiometabolic risk after SCI through multimodal patient education in a subacute clinical setting.

METHODS AND ANALYSIS

All patients who are aged 18 years or older with an SCI within the previous 12 months and admitted to highly specialised rehabilitation are included, regardless of SCI aetiology or neurological level. A primary study designed as a controlled, pragmatic, preintervention- postintervention study with 6-month follow-up evaluates the effect of the clinical intervention; a prospective national cohort study on body mass index (BMI) serves as a historical control. The intervention consists of a standardised approach to patient education about cardiovascular risk factors, PA and a healthy diet that begins at the outset of primary SCI rehabilitation and is integrated into existing settings and workflows. Outcome measures are collected at admission, discharge and 6 months after discharge and include peak oxygen uptake (VO2peak) (primary outcome), BMI, body composition, metabolic profile, neurological status, level of functioning, depression, quality of life, objective PA (accelerometry), self-reported PA, self-assessed PA ability, shared decision making, and dietary habits. Test-retest reliability of four VO2peak test protocols are investigated, as is test-retest reliability of a multisensor accelerometer in a rehabilitation setting.

ETHICS AND DISSEMINATION

The project is approved by the Committees on Health Research Ethics in the Capital Region of Denmark on 10 July 2018 (Journal-nr.: H-18018325). The principal investigator obtains informed consent from all participants. The interventions in the project are closely related to existing rehabilitation care, and the risk of pain and discomfort is considered modest. Any unintended events related to the elements of the intervention are reported, according to existing regional procedures. Data are stored in a secure web-based database (Redcap). The primary study and prospective cohort study are registered at Clinicaltrials.gov. Positive and negative results will be submitted to relevant scientific journals related to SCI for publication. Important protocol modifications are reported to the Committees on Health Research Ethics in the Capital Region of Denmark.

TRIAL REGISTRATION NUMBERS

NCT03689023 and NCT03369080.

Motor learning outcomes of handrim wheelchair propulsion during active spinal cord injury rehabilitation in comparison with experienced wheelchair users

PURPOSE

To investigate changes in wheelchair propulsion technique and mechanical efficiency across first five weeks of active inpatient spinal cord injury rehabilitation and to compare the outcomes at discharge with experienced wheelchair users with spinal cord injury.

METHODS

Eight individuals with recent spinal cord injury performed six weekly submaximal exercise tests. The first and last measurement additionally contained a wheelchair circuit and peak graded exercise test. Fifteen experienced individuals performed all above-mentioned tests on one occasion.

RESULTS

Mechanical efficiency and propulsion technique did not change during the five weeks of inpatient rehabilitation. Peak power output during peak graded test and performance time on the wheelchair circuit improved between the first and the last week. No difference in propulsion technique, peak power output, and performance time was found between the persons with a recent injury and the experienced group. Mechanical efficiency was higher after the correction for the difference in relative power output in the experienced group.

CONCLUSION

The group with a recent injury did not improve mechanical efficiency and propulsion technique over the period of active rehabilitation, despite significant improvements on the wheelchair circuit and in work capacity. The only significant difference between the groups was found in mechanical efficiency.Implications for rehabilitationThe lack of time-dependent changes in mechanical efficiency and propulsion technique in the group with a recent spinal cord injury, combined with the lack of differences in technique, work capacity and on the wheelchair circuit between the groups, suggest that important adaptations of motor learning may happen even earlier in rehabilitation and emphasize that the group in active rehabilitation was relatively skilled.Standardized observational analyses of handrim wheelchair propulsion abilities during early spinal cord injury rehabilitation provide detailed understanding of wheelchair technique, skill as well as wheelchair propulsion capacity.Measurement of external power output is critical to interpretation of gross efficiency, propulsion technique, and capacity.Wheelchair quality and body weight - next to wheelchair fitness and skill - require careful consideration both in early rehabilitation as well as in the chronic phase of spinal cord injury.

Peak oxygen uptake measured during a perceptually-regulated exercise test is reliable in community-based manual wheelchair users

This study compares test-retest reliability and peak exercise responses from ramp-incremented (RAMP) and maximal perceptually-regulated (PRET_max) exercise tests during arm crank exercise in individuals reliant on manual wheelchair propulsion (MWP). Ten untrained participants completed four trials over 2-weeks (two RAMP (0-40 W + 5-10 W · min^-1) trials and two PRET_max. PRET_max consisted of five, 2-min stages performed at Ratings of Perceived Exertion (RPE) 11, 13, 15, 17 and 20). Participants freely changed the power output to match the required RPE. Gas exchange variables, heart rate, power output, RPE and affect were determined throughout trials. The V̇O_2peak from RAMP (14.8 ± 5.5 ml · kg^-1 · min^-1) and PRET_max (13.9 ± 5.2 ml · kg^-1 · min^-1) trials were not different (P = 0.08). Measurement error was 1.7 and 2.2 ml · kg^-1 · min^-1 and coefficient of variation 5.9% and 8.1% for measuring V̇O_2peak from RAMP and PRET_max, respectively. Affect was more positive at RPE 13 (P = 0.02), 15 (P = 0.01) and 17 (P = 0.01) during PRET_max. Findings suggest that PRET_max can be used to measure V̇O_2peak in participants reliant on MWP and leads to a more positive affective response compared to RAMP.

Peak power output in handcycling of individuals with a chronic spinal cord injury: predictive modeling, validation and reference values

Purpose: To develop and validate predictive models for peak power output to provide guidelines for individualized handcycling graded exercise test protocols for people with spinal cord injury (SCI); and to define reference values.Materials and methods: Power output was measured in 128 handcyclists with SCI during a synchronous handcycling exercise test. Eighty percent of the data was used to develop four linear regression models: two theoretical and two statistical models with peak power output (in W and W/kg) as dependent variable. The other 20% of the data was used to determine agreement between predicted versus measured power output. Reference values were based on percentiles for the whole group.Results: Lesion level, handcycling training hours and sex or body mass index were significant determinants of peak power output. Theoretical models (R² = 42%) were superior to statistical models (R²=39% for power output in W, R² = 30% for power output in W/kg). The intraclass correlation coefficients varied between 0.35 and 0.60, depending on the model. Absolute agreement was low.Conclusions: Both models and reference values provide insight in physical capacity of people with SCI in handcycling. However, due to the large part of unexplained variance and low absolute agreement, they should be used with caution. Implications for rehabilitationIndividualization of the graded exercise test protocol is very important to attain the true peak physical capacity in individuals with spinal cord injury.The main determinants to predict peak power output during a handcycling graded exercise test for individuals with a spinal cord injury are lesion level, handcycling training hours and sex or body mass index.The predictive models for peak power output should be used with caution and should not replace a graded exercise test.

Is Fitbit Charge 2 a feasible instrument to monitor daily physical activity and handbike training in persons with spinal cord injury? A pilot study

Study design

It is a longitudinal pilot study.

Objectives

To investigate the feasibility of a low-cost and widely used fitness tracker with step count and heart rate data to monitor daily physical activity in wheelchair users with spinal cord injury (SCI).

Setting

Dutch community.

Methods

Six participants with SCI who were in training for a handbike event were recruited. They were asked to wear a Fitbit Charge 2^® 24 h a day for at least 2 weeks and were questioned about the utility and user-friendliness of this device.

Results

Five out of six participants managed to wear the device nonstop for 2 weeks, and continued to wear the device after this initial period. Most participants were enthusiastic about the direct feedback provided by the tracker and reported the data to be accurate. Data collected during more than 2 months of three participants and during 8 months on one of them showed the possibility of detecting training days and observing interpersonal and intrapersonal variation in daily physical activity level.

Conclusions

A commercially available, low-cost, self-monitoring multi-sensor wrist device or a fitness tracker like the Fitbit Charge 2^® can be a promising instrument to monitor daily activity levels among wheelchair users with SCI. The free commercial dashboard and log data clearly show trends of variations in physical activity and increases in heart rate, which are of value to both researchers and clinicians interested in identifying training schedules of wheelchair athletes.

A Descriptive Study of Self-Reported Injury in Non-elite Adaptive Athletes

BACKGROUND

Adaptive sports programs are increasing across the country and there is a paucity of research investigating the epidemiology and sports injury risk factors in non-elite athletes.

OBJECTIVE

To assess the demographics, training regime, and injuries incurred by adaptive athletes participating in local adaptive sports clubs and to assess the athletes' type of medical care and prevalence of those with spasticity.

DESIGN

Descriptive cross-sectional study.

SETTING

Local area adaptive sports teams and programs.

PARTICIPANTS

Sixty-one athletes participating in wheelchair basketball, wheelchair rugby, sled hockey, and adaptive rowing were surveyed, with a response rate of 70.5%.

INTERVENTIONS

Completion of self-report survey.

OUTCOME

Report of injury prevalence, injury characteristics, type of medical care, and assessment of frequency and severity of spasticity using the Penn Spasm Frequency Scale.

RESULTS

Most athletes (86%) trained or competed in their main sport 9-12 months per year. Most athletes (79.1%) trained at least 4 hours per week. In the past 12 months, 39.5% of athletes surveyed sustained an injury that required them to miss practice or a competition, with 58.8% of these athletes having sustained a significant injury. Many of those injured (64.7%) had never participated in an injury prevention or conditioning program. Injury prevalence by sport was 42.9% in wheelchair rugby, 60% in sled hockey, 44% wheelchair basketball, and 0% in adaptive rowing. The most commonly injured body parts were the shoulder (52.9%) and wrist (52.9%).

CONCLUSIONS

This study shows that non-elite adaptive sports athletes sustain similar types of injuries as noted in published reports of elite athletes but could be provided with less injury prevention education and access to medical care. This area will require future study, especially investigating injury risk factors within specific sports and diagnoses.

LEVEL OF EVIDENCE

III.

Relationship between wheelchair skills scores and peak aerobic exercise capacity of manual wheelchair users with spinal cord injury: a cross-sectional study

Purpose: Although both wheelchair skills and fitness are important and probably inter-related, the extent and nature of the relationship between them are not well understood. The objective of this study was to test the hypothesis that there are significant relationships between wheelchair skills scores and the peak exercise capacity of community-dwelling manual wheelchair users with spinal cord injury.Materials and methods: We studied 26 participants, recording Wheelchair Skills Test Questionnaire scores and peak power output from graded aerobic wheelchair exercise testing on a motorized treadmill.Results: The median Wheelchair Skills Test Questionnaire capacity, confidence, and performance scores were 83.3%, 81.5%, and 76.7% and the median peak power output was 58.2 W. On regression analysis, there were significant relationships between the total Wheelchair Skills Test Questionnaire capacity, confidence, and performance scores and peak power output (R² 0.270-0.709, odds ratios 1.043-1.150, p < 0.05).Conclusions: Significant relationships exist between the wheelchair skills capacity, confidence, and performance scores and the peak exercise capacity of community-dwelling manual wheelchair users with spinal cord injury. These findings suggest that both wheelchair skills training and exercise training may be useful during the rehabilitation of people with spinal cord injury.Implications for rehabilitationModerate positive relationships exist between wheelchair skills capacity and the peak exercise capacity of community-dwelling manual wheelchair users with spinal cord injury.Moderate positive relationships exist between wheelchair skills confidence and the peak exercise capacity of community-dwelling manual wheelchair users with spinal cord injury.Although further research is needed, these findings suggest that clinicians should address both wheelchair skills training and exercise training during the rehabilitation of people with spinal cord injury and not assume that either alone is sufficient.

Validity of consumer-grade activity monitor to identify manual wheelchair propulsion in standardized activities of daily living

Background

Hypoactive lifestyle contributes to the development of secondary complications and lower quality of life in wheelchair users. There is a need for objective and user-friendly physical activity monitors for wheelchair-dependent individuals in order to increase physical activity through self-monitoring, goal setting, and feedback provision.

Objective

To determine the validity of Activ8 Activity Monitors to 1) distinguish two classes of activities: independent wheelchair propulsion from other non-propulsive wheelchair-related activities 2) distinguish five wheelchair-related classes of activities differing by the movement intensity level: sitting in a wheelchair (hands may be moving but wheelchair remains stationary), maneuvering, and normal, high speed or assisted wheelchair propulsion.

Methods

Sixteen able-bodied individuals performed sixteen various standardized 60s-activities of daily living. Each participant was equipped with a set of two Activ8 Professional Activity Monitors, one at the right forearm and one at the right wheel. Task classification by the Active8 Monitors was validated using video recordings. For the overall agreement, sensitivity and positive predictive value, outcomes above 90% are considered excellent, between 70 and 90% good, and below 70% unsatisfactory.

Results

Division in two classes resulted in overall agreement of 82.1%, sensitivity of 77.7% and positive predictive value of 78.2%. 84.5% of total duration of all tasks was classified identically by Activ8 and based on the video material. Division in five classes resulted in overall agreement of 56.6%, sensitivity of 52.8% and positive predictive value of 51.9%. 59.8% of total duration of all tasks was classified identically by Activ8 and based on the video material.

Conclusions

Activ8 system proved to be suitable for distinguishing between active wheelchair propulsion and other non-propulsive wheelchair-related activities. The ability of the current system and algorithms to distinguish five various wheelchair-related activities is unsatisfactory.

Health status of regularly physically active persons with spinal cord injury

Study design

A non-controlled cross-sectional study.

Objectives

To make a descriptive examination of health status in persons with paraplegia and tetraplegia who exercise regularly according to Canadian guidelines.

Settings

Sunnaas Rehabilitation Hospital and the Norwegian School of Sport Sciences.

Methods

Eighteen persons (men/women = 9/9), aged 41‒72 years with spinal cord injury (SCI), who exercise regularly were included. Post-injury years ranged from 4 to 48 years. Clinical examination of body composition, bone mineral density (BMD), forced vital capacity (FVC), forced expiratory volume in one second (FEV₁), diffusion capacity (DL_CO), cardiorespiratory fitness (VO_2max), and self-reported quality of life (QOL) obtained by questionnaire was performed. Lung function results are presented as % predicted and VO_2max as absolute values relative to body weight. All results are given as median and range.

Results

Persons with paraplegia (n = 13) were defined as overweight with fat mass 42% (25‒51). BMD 1.047 g cm⁻² (0.885‒1.312) was within normal range. FVC 95% predicted (60‒131), FEV₁ 90% predicted (61‒119), DL_CO 77% predicted (56‒103), and VO_2max 16.66 ml kg⁻¹ min⁻¹ (12.15‒25.28) defined good aerobic capacity according to age controlled reference values (18). Persons with tetraplegia (n = 5) were slightly overweight with fat mass 35% (26‒47). BMD 1.122 g cm⁻² (1.095‒1.299) was within normal range. FVC 72% predicted (46‒91), FEV₁ 75% predicted (43‒83), DL_CO 67% predicted (56‒84), and VO_2max 16.70 ml kg⁻¹ min⁻¹ (9.91‒21.01) defined excellent aerobic capacity according to reference values (18). QOL was ranked as median 7.5 (0‒10 scale).

Conclusions

Persons with SCI who exercise regularly following the Canadian guidelines responded with rather positive associations for health outcomes. Additional research is needed to strengthen our findings.

Baroreflex autonomic control in human spinal cord injury: Physiology, measurement, and potential alterations

The arterial baroreflex is a primary regulator of autonomic outflow to effectively regulate acute changes in blood pressure. After a spinal cord injury (SCI), regulation of autonomic function is disrupted, although the damage of the autonomic pathways may not necessarily be related to the severity of injury (i.e. level and completeness). Nonetheless, it can be assumed that there would be greater loss of sympathetic innervation with higher level of injury and that cardiac parasympathetic control would remain intact regardless of injury level. In those with SCI, impaired baroreflex regulation has implications not only for adequate pressure regulation, but also for long term cardiovascular health. In this review, we discuss the expected impact ofan SCI on baroreflex control and the studies that have investigated baroreflex sensitivity in this population. The data generally indicates that baroreflex sensitivity is lesser in those with chronic injuries. However, these findings are counter to the expected effect of an SCI and hence may indicate that the effect of an SCI on baroreflex control might be secondary to long term deconditioning and/or vascular stiffening of baroreceptive arteries. Furthermore, the alterations in the ability to regulate pressure do not impact the relationship between spontaneous heart rate and blood pressure variabilities. In addition, those with SCI are not adequately able to control blood pressure changes in response to orthostasis, resulting in frank hypotension in a significant proportion of those with high level injuries.

Exercise Intensity During Power Wheelchair Soccer

OBJECTIVE

To determine exercise intensity during power wheelchair soccer among a sample of persons with mobility impairments.

DESIGN

Cross-sectional descriptive.

SETTING

On-site training facilities of multiple power wheelchair soccer teams.

PARTICIPANTS

Participants with severe mobility impairments (N=30) (mean ± SD, age: 29.40±15.51y, body mass index: 24.11±6.47kg/m², power soccer experience: 7.91±3.93y, disability sport experience: 12.44±9.73y) were recruited from multiple power wheelchair soccer teams.

INTERVENTIONS

Portable metabolic carts were used to collect oxygen consumption (V˙o₂) data during resting and game play conditions.

MAIN OUTCOME MEASURES

Average V˙o₂ (expressed in metabolic equivalent tasks [METs]) during resting and game play conditions and rating of perceived exertion for game play.

RESULTS

V˙o₂ increased from 1.35±0.47 METs at rest to 1.81±0.65 METs during game play. This 34% increase in exercise intensity was significant (P<.01) and supported by a mean perceived exertion score of approximately 13 (somewhat hard).

CONCLUSIONS

Although not able to sustain an intensity associated with reduced secondary disease risk (ie, 3 METs), the documented light-intensity exercise in the current study surpassed an intensity threshold associated with improved functional capacity and performance of daily living activities (ie, 1.5 METs).

Active Lifestyle Is Associated With Reduced Dyspnea and Greater Life Satisfaction in Spinal Cord Injury

OBJECTIVE

To assess the relations between measures of activity with dyspnea and satisfaction with life in chronic spinal cord injury (SCI).

DESIGN

Cross-sectional survey.

SETTING

Five SCI centers.

PARTICIPANTS

Between July 2012 and March 2015, subjects (N=347) with traumatic SCI ≥1 year after injury who used a manual wheelchair or walked with or without an assistive device reported hours spent away from home or yard on the previous 3 days, sports participation, and planned exercise.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Satisfaction with Life Scale (SWLS) and dyspnea. Dyspnea was defined as shortness of breath when hurrying on the level or going up a slight hill, going slower than people the same age on the level because of breathlessness, or stopping for breath when going at your own pace, or after about 100yd (or after a few minutes) on the level.

RESULTS

Dyspnea prevalence was 30%. Adjusting for asthma or chronic obstructive pulmonary disease, mobility mode, race, and season, there was a significant linear trend between greater SWLS scores and quartiles of time spent away from the home or yard (P=.0002). SWLS score was greater if participating in organized sports (P=.01), although was not significantly greater with planned exercise (P=.093). Planned exercise was associated with a reduced odds ratio (OR) of dyspnea (.57; 95% confidence interval [CI], .34-.95; P=.032), but organized sports was not (P=.265). Dyspnea was not significantly increased in persons who spent the fewest hours outside their home or yard (≤7h) compared with people who spent the most hours outside their home or yard (>23h) (OR=1.69; 95% CI, 0.83-3.44; P=.145).

CONCLUSIONS

In SCI, a planned exercise program is associated with less dyspnea. An active lifestyle characterized by greater time spent away from home or yard and sports participation is associated with greater SWLS scores.

Teleexercise for Persons With Spinal Cord Injury: A Mixed-Methods Feasibility Case Series

Background

Spinal cord injury (SCI) results in significant loss of function below the level of injury, often leading to restricted participation in community exercise programs. To overcome commonly experienced barriers to these programs, innovations in technology hold promise for remotely delivering safe and effective bouts of exercise in the home.

Objective

To test the feasibility of a remotely delivered home exercise program for individuals with SCI as determined by (1) implementation of the intervention in the home; (2) exploration of the potential intervention effects on aerobic fitness, physical activity behavior, and subjective well-being; and (3) acceptability of the program through participant self-report.

Methods

Four adults with SCI (mean age 43.5 [SD 5.3] years; 3 males, 1 female; postinjury 25.8 [SD 4.3] years) completed a mixed-methods sequential design with two phases: an 8-week intervention followed by a 3-week nonintervention period. The intervention was a remotely delivered aerobic exercise training program (30-45 minutes, 3 times per week). Instrumentation included an upper body ergometer, tablet, physiological monitor, and custom application that delivered video feed to a remote trainer and monitored and recorded exercise data in real time. Implementation outcomes included adherence, rescheduled sessions, minutes of moderate exercise, and successful recording of exercise data. Pre/post-outcomes included aerobic capacity (VO₂ peak), the Physical Activity Scale for Individuals with Physical Disabilities (PASIPD), the Satisfaction with Life Scale (SWLS), and the Quality of Life Index modified for spinal cord injury (QLI-SCI). Acceptability was determined by participant perceptions of the program features and impact, assessed via qualitative interview at the end of the nonintervention phase.

Results

Participants completed all 24 intervention sessions with 100% adherence. Out of 96 scheduled training sessions for the four participants, only 8 (8%) were makeup sessions. The teleexercise system successfully recorded 85% of all exercise data. The exercise program was well tolerated by all participants. All participants described positive outcomes as a result of the intervention and stated that teleexercise circumvented commonly reported barriers to exercise participation. There were no reported adverse events and no dropouts.

Conclusion

A teleexercise system can be a safe and feasible option to deliver home-based exercise for persons with SCI. Participants responded favorably to the intervention and valued teleexercise for its ability to overcome common barriers to exercise. Study results are promising but warrant further investigation in a larger sample.

Predicting peak oxygen uptake from submaximal exercise after spinal cord injury

The purpose of this study was to determine the validity of the 6-min arm ergometry test (6MAT) in predicting peak oxygen consumption (V̇O2peak) in individuals with chronic spinal cord injury (SCI). Fifty-two individuals with chronic SCI (age, 38 ± 10 years; American Spinal Injury Association Impairment Scale (AIS), A-D; neurological level of injury (NLI), C1-L2; years post-injury (YPI), 13 ± 10 years) completed an incremental arm ergometry V̇O2peak test and a submaximal 6MAT. Oxygen consumption (V̇O2) data from both tests were used to create a predictive equation with regression analysis. Subsequently, a cross-validation group comprising an additional 10 individuals with SCI (age, 39 ± 13 years; AIS, A-D; NLI, C3-L3; YPI, 9 ± 9 years) were used to determine the predictive power of the equation. All participants were able to complete both the V̇O2peak and 6MAT assessments. Regression analysis yielded the following equation to predict V̇O2peak from end-stage 6MAT V̇O2: V̇O2peak (mL·kg(-1)·min(-1)) = 1.501(6MAT V̇O2) - 0.940. Correlation between measured and predicted V̇O2peak was excellent (r = 0.89). No significant difference was found between measured (17.41 ± 7.44 mL·kg(-1)·min(-1)) and predicted (17.42 ± 6.61 mL·kg(-1)·min(-1)) V̇O2peak (p = 0.97). When cross-validated with a sample of 10 individuals with SCI, correlation between measured and predicted V̇O2peak remained high (r = 0.89), with no differences between measured (18.81 ± 8.35 mL·kg(-1)·min(-1)) and predicted (18.73 ± 7.27 mL·kg(-1)·min(-1)) V̇O2peak (p = 0.75). Results suggest that 6MAT V̇O2 can be used to predict V̇O2peak among individuals with chronic SCI. The 6MAT should be used as a clinical tool for assessing aerobic capacity when peak exercise testing is not feasible.

The effect of adaptive sports on employment among people with disabilities

PURPOSE

The purpose of this study is to analyse the role of adaptive sport in predicting employment for individuals with physical disabilities.

METHOD

This study is cross-sectional. We collected survey data on employment and other covariates including education, age, age at disability onset, veteran status and athletic classification from 140 mobility impaired athletes who play either wheelchair rugby or wheelchair basketball.

RESULTS

One hundred and thirty-one participants were studied. Our analysis shows that playing an additional year of adaptive sport is associated with an approximately 4% increase in likelihood of employment. Education and duration of disability are found to be positive predictors of employment, while veteran status and severity of injury are negative predictors of employment. Age of disability onset is not found to be a predictor of employment when other controls are included.

CONCLUSIONS

This result indicates that a substantial economic benefit would result from increased participation in adaptive sport, and therefore may justify additional funding to expand adaptive sport programs. Implications for Rehabilitation Employment rates are very low among individuals with physical disabilities, despite research indicating extensive benefits from employment. Participation in adaptive sport is associated with a higher likelihood of employment. Efforts to increase participation in adaptive sport could have a large economic benefit.