The effect of early mobilisation (< 14 days) on pathophysiological and functional outcomes in animals with induced spinal cord injury: a systematic review with meta-analysis

INTRODUCTION

The optimum time to mobilise (standing, walking) following spinal cord injury (SCI) is unknown but may have implications for patient outcomes. There are no high-quality experimental studies that examine this issue, with a paucity of guidance for clinicians. Pre-clinical studies lead research in this field and can contribute to knowledge and support future clinical practice.

OBJECTIVE

to evaluate the effect of early compared to no mobilisation on pathophysiological and functional outcomes in animals with induced SCI.

METHODS

A systematic review with meta-analysis was conducted by searching pre-clinical literature in MEDLINE (PubMed), Embase (Ovid), Web of Science, OpenGrey, and EThOS (June 2023). Studies were included of any research method giving numerical results comparing pathophysiological and functional outcomes in rats and mice mobilised within 14-days of induced SCI to those that did not mobilise. Data were synthesised using random-effects meta-analyses. The quality of the evidence was assessed using the CAMARADES checklist. The certainty of findings was reported using the GRADE approach. This study is registered on PROSPERO (CRD42023437494).

RESULTS

Seventeen studies met the inclusion criteria. Outcomes found that Brain Derived Neurotrophic Factor levels were greater in those that initiated mobilisation within 14-days of SCI compared to the groups that did not. Mobilisation initiated within 14-days of SCI was also associated with statistically significant functional gains: (Basso, Beattie and Bresnahan locomotor rating score (BBB) = 2.13(0-21), CI 1.43, 2.84, Ladder Rung Walking Task = - 12.38(0-100), CI 20.01, - 4.76). Meta-analysis identified the greatest functional gains when mobilisation was initiated within 3 days of SCI (BBB = 3.00, CI 2.31-3.69, p < 0.001), or when delivered at low intensity (BBB = 2.88, CI 2.03-3.70, p < 0.001). Confidence in the findings from this review was low to moderate due to the risk of bias and mixed methodological quality.

CONCLUSION

Mobilisation instigated within 14-days of injury, may be an effective way of improving functional outcomes in animal models following SCI, with delays potentially detrimental to recovery. Outcomes from this study support further research in this field to guide future clinical practice.

A Comparison of Methods for the Estimation of Body Composition in Highly Trained Wheelchair Games Players

The purpose of this study was to assess the agreement in body composition measurements of wheelchair athletes using skinfolds, bio-impedance analysis (BIA) and air displacement plethysmography (ADP) relative to dual-energy X-ray absorptiometry (DXA). A secondary objective was to develop new skinfold prediction equations to estimate %fat for this sample. 30 wheelchair games players were recruited and the body composition outcomes of BIA, ADP, and skinfolds were compared to the DXA outcomes by a paired-samples t-test (systematic bias), intraclass correlation (ICC, relative agreement) and Bland-Altman plots (absolute agreement). Regression models to predict the %fat as measured by DXA by the sum of skinfolds or BIA were calculated. Results showed that the predictions of %fat when using BIA, ADP or skinfolds systematically underestimated the %fat mass as measured by the DXA. All ICC values, except for the measurement of fat (kg) by ADP (ICC=0.702), were below 0.7. New prediction models found the ∑7 skinfolds and calf circumference as the best model to predict %fat (R(2)=0.84). In conclusion, BIA, ADP and existing skinfolds equations should be used with caution when estimating %fat of wheelchair athletes with substantial body asymmetry, lower body muscular atrophy and upper body muscular development.

Data logger device applicability for wheelchair tennis court movement

Assessment of movement logging devices is required to ensure suitability for the determination of court-movement variables during competitive sports performance and allow for practical recommendations to be made. Hence, the purpose was to examine wheelchair tennis speed profiles to assess data logger device applicability for court-movement quantification, with match play stratified by rank (HIGH, LOW), sex (male, female) and format (singles, doubles). Thirty-one wheelchair tennis players were monitored during competitive match play. Mixed sampling was employed (male = 23, female = 8). Friedman's test with Wilcoxon signed-rank post hoc testing revealed a higher percentage of time below 2.5 m · s(-1) [<2.5 vs. ≥2.5 m · s(-1): 89.4 (5.0) vs. 1.2 (3.5)%, Z = -4.860, P < 0.0005, r = 0.87] with the remaining time [9.0 (4.9%)] spent stationary. LOW-ranked players were stationary for longer than HIGH-ranked counterparts [12.6 (8.7) vs. 8.2 (5.1)%, U = 30.000, P = 0.011, r = 0.46] with more time at low propulsion speeds (<1.0 m · s(-1)). HIGH-ranked and doubles players spent more time in higher speed zones than respective counterparts. Females spent more time in the 1.0-1.49 m · s(-1) zone (U = 48.000, P = 0.047, r = 0.36). Regardless of rank, sex or format, propulsion speeds during wheelchair tennis match play are consistent with data logger accuracy. Hence, data logging is appropriate for court-movement quantification.

The effects of experience on the energy cost of wheelchair propulsion

BACKGROUND

Gross mechanical efficiency (GE) of experienced wheelchair users is significantly higher than novice able-bodied individuals suggesting energy expenditure (EE) may be reduced in experienced individuals. With knowledge of the energy expended during wheelchair propulsion, nutritional recommendations can be provided for individuals in their early stages of rehabilitation and for habituated wheelchair users.

AIM

To investigate the effects of experience on EE during wheelchair propulsion at fixed power outputs (PO's).

DESIGN

This was an experimental study.

SETTING

The experiment was conducted in a controlled University laboratory.

POPULATION

Thirty-one individuals took part in this study.

METHODS

Participants were assigned to a group in accordance to their wheelchair propulsion experience: 1) novice able-bodied individuals (NOV; N.=11), 2) able-bodied individuals habituated to three weeks practice (PRAC; N.=11) and 3) experienced paraplegic daily-wheelchair users (EXP; N.=9). Oxygen uptake, EE, GE% and HR were measured during wheelchair propulsion on a motorised treadmill at 10, 18 and 26 W.

RESULTS

Energy expenditure analysis revealed a significant main effect of PO and group (P<0.01) and a significant group by PO interaction (P<0.01). Follow-up pair-wise comparisons revealed significantly lower EE in EXP compared to both other groups (P<0.01), but no difference was shown between NOV and PRAC (P=0.15). A lower relative EE of 20, 22 and 32% was reported in the EXP group compared to the NOV group at 10, 18 and 26 W respectively. In comparison to the PRAC group, the EE of the EXP group was 10, 16 and 26% lower in relative terms at the same PO's respectively.

CONCLUSION

The EXP expended less EE compared to both NOV and PRAC.

CLINICAL REHABILITATION IMPACT

This finding has great implications for nutritionists and health care professionals working in the field of physical activity and weight management since the EE is influenced by experience.

Effect of low-compression balls on wheelchair tennis match-play

The purpose of this study was to compare court-movement variables and physiological responses to wheelchair tennis match-play when using low vs. standard compression tennis balls. Eleven wheelchair basketball players were monitored during repeated bouts of tennis (20 min) using both ball types. Graded and peak exercise tests were completed. For match-play, a data logger was used to record distance and speed. Individual linear heart rate oxygen consumption relationships were used to estimate match-play oxygen uptake. Significant main effects for ball type revealed that total distance (P<0.05), forward distance (P<0.05), and average speed (P<0.05) were higher for play using a low-compression ball. A lower percentage of total time was spent stationary (P<0.001), with significantly more time spent at speeds of 1-1.49 (P<0.05), 1.5-1.99 (P<0.05) and 2.0-2.49 (P<0.05) m ∙ sec(-1) when using the low-compression ball. Main effects for physiological variables were not significant. Greater total and forward distance, and higher average speeds are achieved using a low-compression ball. The absence of any difference in measured HR and estimated physiological responses would indicate that players move further and faster at no additional mean physiological cost. This type of ball will be useful for novice players in the early phases of skill development.

The effects of rear-wheel camber on maximal effort mobility performance in wheelchair athletes

This study examined the effect of rear-wheel camber on maximal effort wheelchair mobility performance. 14 highly trained wheelchair court sport athletes performed a battery of field tests in 4 standardised camber settings (15°, 18°, 20°, 24°) with performance analysed using a velocometer. 20 m sprint times reduced in 18° (5.89±0.47 s, P=0.011) and 20° camber (5.93±0.47 s, P=0.030) compared with 24° (6.05±0.45 s). Large effect sizes revealed that 18° camber enabled greater acceleration over the first 2 (r=0.53, 95% CI=0.004 to 0.239) and 3 (r=0.59, 95% CI=0.017 to 0.170) pushes compared with 24°. Linear mobility times significantly improved (P≤0.05) in 15° (16.08±0.84 s), 18° (16.06±0.97 s) and 20° (16.22±0.84 s) camber compared with 24° (16.62±1.10 s). Although no statistically significant main effect of camber was revealed, large effect sizes (r=0.72, 95% CI=0.066 to 0.250) demonstrated that 18° camber reduced times taken to perform the manoeuvrability drill compared with 15°. It was concluded that 18° camber was the best performing setting investigated given its superior performance for both linear and non-linear aspects of mobility, whereas 24° camber impaired linear performance. This was likely to be due to the greater drag forces experienced. Subsequently, athletes would be recommended to avoid 24° camber and young or inexperienced athletes in particular may benefit from selecting 18° as a starting point due to its favourable performance for all aspects of mobility performance in the current study.

Body composition of female wheelchair athletes

Wheelchair users undergo changes in body composition as a result of disability. In this study the distribution of bone mineral, lean and fat mass was assessed in highly-trained female wheelchair athletes and a reference group by dual-energy X-ray absorptiometry (DXA). The transferability of anthropometric equations commonly used in female groups was examined in order to establish a suitable field method of body composition assessment. The DXA total-body results indicated no difference between groups, but segmental analyses uncovered regional differences. The wheelchair athletes had greater BMD (p=0.088), more lean mass (p<0.001) and a lower percent fat (p=0.050) in their arms. The reverse was true of the legs (p< or =0.001). The trunk as a whole did not differ between groups. In general, the anthropometric equations showed a lack of transferability to the wheelchair group and tended to underestimate total percent body fat. Anthropometric measures such as body mass index (BMI) and waist girth showed strong correlations with body fat in the wheelchair group (BMI: r=0.90, p=0.001; waist: r=0.83, p=0.001), but weaker results in the reference group. It is recommended that specific anthropometric equations be developed for use in the absence of a 'gold standard' measure of body composition such as DXA.

Aerobic capacity and peak power output of elite quadriplegic games players

BACKGROUND

Participation in wheelchair sports such as tennis and rugby enables people with quadriplegia to compete both individually and as a team at the highest level. Both sports are dominated by frequent, intermittent, short term power demands superimposed on a background of aerobic activity.

OBJECTIVE

To gain physiological profiles of highly trained British quadriplegic athletes, and to examine the relation between aerobic and sprint capacity.

METHODS

Eight male quadriplegic athletes performed an arm crank exercise using an ergometer fitted with a Schoberer Rad Messtechnik (SRM) powermeter. The sprint test consisted of three maximum-effort sprints of five seconds duration against a resistance of 2%, 3%, and 4% of body mass. The highest power output obtained was recorded (PPO). Peak oxygen consumption (V(O2peak)), peak heart rate (HR(peak)), and maximal power output (PO(aer)) were determined.

RESULTS

Mean PO(aer) was 67.7 (16.2) W, mean V(O2peak) was 0.96 (0.17) litres/min, and HR(peak) was 134 (19) beats/min for the group. There was high variability among subjects. Peak power over the five second sprint for the group was 220 (62) W. There was a significant correlation between V(O2peak) (litres/min) and PO(aer) (W) (r = 0.74, p<0.05).

CONCLUSIONS

These British quadriplegic athletes have relatively high aerobic fitness when compared with the available literature. Moreover, the anaerobic capacity of these athletes appeared to be relatively high compared with paraplegic participants.