POSTURAL CONTROL ASSESSMENT IN PHYSICALLY ACTIVE AND SEDENTARY INDIVIDUALS WITH PARAPLEGIA

Prognostic validity of trunk control scales for mobility in individuals with motor complete thoracic SCI: a prospective cohort study

STUDY DESIGN

Prospective cohort study.

OBJECTIVES

To investigate the sensitivity to change and prognostic validity of Trunk Control Test (TCT) and Thoracic-Lumbar Control Scale (TLC) in terms of mobility in persons with motor complete thoracic spinal cord injury (SCI).

SETTING

Participants were recruited at an Italian SCI rehabilitation facility from October 2015 to January 2020.

METHODS

Inclusion criteria were acute traumatic or non-traumatic event and T1-L1 neurological level. Trunk control and mobility were assessed at baseline, discharge, and at 6 and 18-month follow-ups. Mobility was measured using Spinal Cord Independence Measure III mobility subscale. Linear regression models were used to analyze changes in trunk control and mobility over time, and the relationship between these measures.

RESULTS

The 39 participants were predominantly male, with a mean age of 38 years. Trunk control improved during rehabilitation, at 6-month follow-up, and remained stable thereafter, according to TCT and TLC scales. A higher baseline TCT score was associated with improvements in mobility at discharge and at follow-ups. Baseline TLC score and its change during rehabilitation were unrelated with changes in mobility.

CONCLUSIONS

Results suggest that the TCT and TLC scales are useful to capture changes in trunk control during the acute and subacute phases. Improvements in functional mobility are however associated with TCT score only, suggesting the potential of this test as a useful prognostic indicator. Further research with larger sample sizes is warranted to determine whether these findings are consistent across neurological level strata.

Italian translation and reliability of Fist-Sci Scale for chronic paraplegic patients: an observational study

BACKGROUND AND AIM

Lack of trunk control following spinal cord injury implicates a worse quality of life and a higher dependence on caregivers; literature proposes several evaluation scales, but studies show poor methodological quality. This study aimed to translate and explore the significance of the Italian version of the FIST-SCI scale for chronic spinal cord injury patients.

METHODS

A longitudinal cohort study was conducted at Fiorenzuola D'Arda Hospital. After a forward/backward translation of the FIST-SCI scale in Italian content and face translational validity, intervalutator reliability was assessed. Patients were recruited by historical tracking of patients who received acute rehabilitation care at the Villanova D'Arda Spinal Unit. Two researchers administered the FIST-SCI scale to the same patients at the follow-up.

RESULTS

Ten patients took part in the study; results showed that higher inter-rater correlation coefficient (Pearson's R= 0.89, p= 0.01 Intra-class correlation coefficient= 0.94, p=0.000). Content validity was also excellent (Scale Content Validity Index = 0.91); some experts suggested future scale developments.

DISCUSSION

Italian FIST-SCI scale for assessing trunk control in chronic spinal patients appears to be an excellent assessment tool concerning intervalutator reliability. Content validity further confirms the validity of the instrument.

Comparison of cardiac autonomic modulation of athletes and non-athletes individuals with spinal cord injury at rest and during a non-immersive virtual reality task

STUDY DESIGN

Cross-sectional study.

OBJECTIVES

To compare cardiac autonomic modulation of individuals with spinal cord injury (SCI) that practice different amounts of moderate to vigorous physical activity (PA) and able-bodied controls at rest and during a non-immersive Virtual Reality task.

SETTING

Athletes with SCI of wheelchair basketball, wheelchair tennis, wheelchair handball, WCMX (wheelchair motocross), and para-swimming were assessed at the Faca na Cadeira Institute, ICEL and Clube Espéria in São Paulo, Brazil; non-athletes with SCI and able-bodied controls were assessed at the Acreditando Centro de Recuperação Neuromotora, São Paulo, Brazil.

METHODS

One-hundred forty-five individuals were assessed: 36 athletes with traumatic SCI (41.1 ± 16.8 years old), 52 non-athletes with traumatic SCI (40.2 ± 14.1 years old), and 57 able-bodied individuals (39.4 ± 12.5 years old). Cardiac autonomic modulation was assessed through heart rate variability (HRV) measured in the sitting position at rest and during a VR game activity.

RESULTS

We found significantly more favourable HRV for athletes with SCI when compared to non-athletes with SCI, but no differences between athletes with SCI and able-bodied controls. In addition, athletes and able-bodied controls showed adequate autonomic nervous system (ANS) adaptation (rest versus physical activity in VR), i.e., they experienced parasympathetic withdrawal during VR physical activity, which was not found in non-athletes with SCI.

CONCLUSION

The practice of moderate to vigorous physical activity is associated with healthier cardiac autonomic modulation in adults with SCI, which may lead to more favourable health outcomes.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT04618003, retrospectively registered.

Community exercise programing and its potential influence on quality of life and functional reach for individuals with spinal cord injury

Context/Objective: After an individual with a Spinal Cord Injury (SCI) participates in the initial rehabilitation process, they often experience limited access to physical therapy services and other fitness activities. The purpose of this study was to examine previously collected data for changes in quality of life (QoL) and functional reach in individuals with SCI following an 8-week community exercise program.Design: Secondary analysis of previously collected data.Setting: Community-based exercise program.Participants: Twenty-two participants with an average of 9 years post-SCI, both complete and incomplete injuries, and injury levels ranging from C2 to L5.Interventions: Participants completed an 8-week program, once per week for 4 hours that included a four-station circuit of resistance training, aerobic exercise, trunk stability, and education.Outcome Measures: Physical function was measured using the modified Functional Reach Test (mFRT). QoL was measured with the Life Satisfaction Questionnaire-9 (LiSAT-9).Results: The mFRT improved by 2 inches (±7.04) P < 0.001 and QoL improved as well, P < 0.001.Conclusion: The findings of this study are consistent with the hypothesis that a supervised post-rehabilitation community exercise program, like Spinal Mobility, may positively impact the QoL and functional reach in individuals with SCI.