Development of Cardiometabolic Health indicators to advance the quality of spinal cord injury rehabilitation: SCI-High Project

Context: Spinal cord injury or disease (SCI/D) leads to unchanged low-density lipoprotein and cholesterol, very low high-density lipoprotein a form of dyslipidemia and physical inactivity which combine to increase risk of morbidity and mortality from cardiometabolic disease. Herein, we describe the selection of structure, process and outcome indicators for adults in the first 18 months post-SCI/D rehabilitation admission. Methods: A Pan-Canadian Cardiometabolic Health Working Group was formed to develop a construct definition. Cardiometabolic risk factors were summarized in a Driver diagram. Release of the Paralyzed Veterans of America "Identification and Management of Cardiometabolic Risk after Spinal Cord Injury" and the International Scientific Exercise Guidelines: "Evidence-based scientific exercise guidelines for adults with spinal cord injury", informed the group's focus on prevention strategies to advance this Domain of rehabilitation admission. Results: The structure indicator identifies during rehabilitation the presence of appropriate time and resources for physical exercise prescription. Process indicators are lipid profile assessment at rehabilitation admission and documented exercise prescriptions prior to discharge. The outcome indicators track patient's knowledge retention regarding exercise prescription at discharge, current exercise adherence and lipid status 18 months after rehabilitation discharge. Conclusion: Routine national implementation of these indicators at the specified time points will enhance efforts to detect dyslipidemia and assure routine participation in endurance exercise. These indicators align with international initiatives to improve cardiometabolic health through interventions targeting modifiable risk factors specifically endurance exercising and optimal lipid profiles, crucial to augmenting cardiometabolic health after SCI/D.

Comparison of two TAGteach error-correction procedures to teach beginner yoga poses to adults

Teaching with acoustical guidance involves auditory feedback (e.g., a click sound when a desired behavior occurs) as part of a multicomponent intervention known as TAGteach. TAGteach has been found to improve performance in sport, dance, surgical technique, and walking. We compared the efficacy and efficiency of the standard TAGteach error-correction procedure and a modified TAGteach error-correction procedure to teach 4 novice adult yoga practitioners beginner yoga poses. Both error-correction procedures were effective for all participants; however, the relative efficiency of these error-correction procedures was unclear. Results are discussed in terms of limitations and considerations for future research.

Layer-specific systolic and diastolic strain in hypertensive patients with and without mild diastolic dysfunction

This study sought to examine layer-specific longitudinal and circumferential systolic and diastolic strain, strain rate (SR) and diastolic time intervals in hypertensive patients with and without diastolic dysfunction. Fifty-eight treated hypertensive patients were assigned to normal diastolic function (NDF, N = 39) or mild diastolic dysfunction (DD, N = 19) group. Layer-specific systolic and diastolic longitudinal and circumferential strains and SR were assessed. Results showed no between-group difference in left ventricular mass index (DD: 92.1 ± 18.1 vs NDF: 88.4 ± 16.3; P = 0.44). Patients with DD had a proportional reduction in longitudinal strain across the myocardium (endocardial for DD -13 ± 4%; vs NDF -17 ± 3, P < 0.01; epicardial for DD -10 ± 3% vs NDF -13 ± 3%, P < 0.01; global for DD: -12 ± 3% vs NDF: -15 ± 3, P = 0.01), and longitudinal mechanical diastolic impairments as evidenced by reduced longitudinal strain rate of early diastole (DD 0.7 ± 0.2 L/s vs NDF 1.0 ± 0.3 L/s, P < 0.01) and absence of a transmural gradient in the duration of diastolic strain (DD endocardial: 547 ± 105 ms vs epicardial: 542 ± 113 ms, P = 0.24; NDF endocardial: 566 ± 86 ms vs epicardial: 553 ± 77 ms, P = 0.03). Patients with DD also demonstrate a longer duration of early circumferential diastolic strain (231 ± 71 ms vs 189 ± 58 ms, P = 0.02). In conclusion, hypertensive patients with mild DD demonstrate a proportional reduction in longitudinal strain across the myocardium, as well as longitudinal mechanical diastolic impairment, and prolonging duration of circumferential mechanical relaxation.

Measuring Investment in Learning: Can Electrocardiogram Provide an Indication of Cognitive Effort During Learning?

Heart rate variability (i.e., low frequency:high frequency ratio) was measured to differentiate invested cognitive effort during the acquisition and retention of a novel task. Participants (12 male, M = 25.1 year, SD = 3.6; 12 female, M = 22.8 year, SD = 1.1) were required to produce Braille equivalents of English letter primes on a standardized keyboard in proactive or retroactive conditions (groups, each n = 12). The correct Braille response was either provided before (i.e., proactively) or after (i.e., retroactively) the participant's response. During acquisition, participants in the proactive group demonstrated shorter study time, greater recall success, and reported lower cognitive investment. Participants in the proactive and retroactive groups did not statistically differ in heart rate variability. For retention, the retroactive group showed greater recall success, lower perceived cognitive effort investment, and lower heart rate variability. The results highlight the usefulness of heart rate variability in discriminating the cognitive effort invested for a recently acquired skill.

Response of Bone Turnover Markers and Cytokines to High-Intensity Low-Impact Exercise

INTRODUCTION

Low-impact, high-intensity interval exercise (HIE) was used to investigate the postexercise response in bone turnover markers and cytokines.

METHODS

Twenty-three recreationally active males (21.8 ± 2.4 yr) performed one HIE bout on a cycle ergometer at 90% maximum workload. The total duration of the exercise was 12 min and included six 1-min high-intensity exercise intervals separated by 1-min rest intervals. Blood samples were collected before exercise, 5 min, 1 h, and 24 h after exercise and were analyzed for serum levels of anti- and pro-inflammatory cytokines (interleukin 10 [IL-10], interleukin 6 [IL-6], interleukin 1-alpha [IL-1α], interleukin 1-beta [IL-1β], and tumor necrosis factor alpha [TNF-α]) and markers of bone formation (bone alkaline phosphatase [BAP], osteoprotegerin [OPG]) and resorption (amino-terminal cross-linking propeptide [NTX], receptor activator of NF-κB ligand [RANKL]).

RESULTS

There was a significant (P < 0.05) time effect for all bone turnover markers. Post hoc analysis showed that BAP, OPG, and RANKL significantly increased from baseline to 5 min after exercise (10.9%, 13.5%, and 34.2%, P < 0.05). At 1 h after exercise, only BAP was significantly higher than baseline (9.5%, P = 0.010) and remained higher than baseline at 24 h (10.9%, P = 0.001). NTX was significantly lower than baseline 24 h after exercise (-14.6%, P = 0.046). Significant (P < 0.05) time effects were also observed for IL-1α, IL-1β, IL-6, and TNF-α, with all four significantly increasing 5 min after exercise and returning to baseline levels 1 h after exercise. The postexercise changes in bone formation markers correlated positively with the anti-inflammatory cytokine (IL-10) and negatively with the pro-inflammatory cytokines while NTX correlated positively with a pro-inflammatory cytokine, TNF-α (P < 0.05).

CONCLUSIONS

These results suggest that HIE stimulates a response in bone turnover markers and cytokines and that a correlation exists between immune and skeletal responses to this form of exercise. This type of exercise may benefit individuals for whom high-impact exercise might be contraindicated.

Effects of FES-Ambulation Training on Locomotor Function and Health-Related Quality of Life in Individuals With Spinal Cord Injury

BACKGROUND

The combination of body weight-supported gait training with functional electrical stimulation (FES) may provide the optimal stimulus for improving overground walking after spinal cord injury (SCI). This potential benefit is likely due to the combination of specificity with the maximization of muscle contractions.

OBJECTIVES

To investigate the effects of 12 weeks of FES-ambulation on overground walking and health-related quality of life (HRQOL) in individuals with SCI.

METHODS

Six individuals (60.5 ± 13.2 years) with SCI (C4-L3; AIS D; 9.3 ± 12.0 years post injury), completed a thrice-weekly, 12-week FES-ambulation training program. Locomotor function was assessed via the Walking Index for Spinal Cord Injury II (WISCI II), the 6-minute walk test (6MWT), the 10-meter walk test (10MWT), and the body-weight support required during training. HRQOL was assessed via the Short Form-36, the Perceived Stress Scale, and the Center of Epidemiological Studies for Depression scale.

RESULTS

Participants showed significant improvements in the 6MWT (223.6 ± 141.5 m to 297.3 ± 164.5 m; P = .03), the required body weight support (55.3% ± 12.6% to 14.7% ± 23.2%; P = .03), and a nonsignificant trend toward an increase in walking speed during the 10MWT (0.69 ± 0.4 m/s to 0.9 ± 0.5 m/s; P = .08) following the training program. Four participants showed improvements on the WISCI II (1-4 points). Participants also showed a decrease in the Short Form-36 pain score (6.5 ± 1.2 to 5.0 ± 1.7; P = .04) and an increase in the overall mental health score (47.8 ± 12.6 to 54.2 ± 6.7; P = .04).

CONCLUSION

FES-ambulation was associated with enhanced overground walking in individuals with AIS D SCI, reduced pain, and improved mental health.

Knowledge mobilization regarding activity and exercise after spinal cord injury: a Canadian undergraduate curriculum scan

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.]

The optimal joint angle for adductor pollicis force production in men and women

The purpose of this study was to determine the joint angle that allows for the greatest MVC and evoked twitch forces from the adductor pollicis (AP), and also whether there is a gender difference in either the above forces or the optimum thumb angle. Ten men (25.2 yrs) and 10 women (27.6 yrs) participated. The nondominant hand was placed palm-down with the thumb fixed at four angles of abduction (55, 70, 85, 100 degrees). Male MVC forces were significantly greater than female, and there was no significant effect of joint angle on MVC force in either gender. For the evoked twitch, men were significantly stronger than women when tested at the 100 and 85 degrees angles, and a significant effect was found for joint angle such that the lowest twitch force occurred at 55 degrees. Men also tended to have a greater rate of force development than women (p = 0.07). These data suggest that studies using the AP muscle in stimulated and voluntary paradigms should use a thumb angle between 70 and 100 degrees of abduction, or approximately 85 degrees, and that the same angle can be used for both men and women.