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Klamruen P, Suttiwong J, Aneksan B, Muangngoen M, Denduang C, Klomjai W. Effects of Anodal Transcranial Direct Current Stimulation With Overground Gait Training on Lower Limb Performance in Individuals With Incomplete Spinal Cord Injury. Arch Phys Med Rehabil 2024; 105:857-867. [PMID: 37926224 DOI: 10.1016/j.apmr.2023.09.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 09/12/2023] [Accepted: 09/13/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVE To determine the effects of anodal transcranial direct current stimulation (tDCS) combined with overground gait training on gait performance, dynamic balance, sit-to-stand performance, and quality of life in individuals with incomplete spinal cord injuries (iSCI). DESIGN Double-blind sham-controlled trial with a matched-pair design. SETTING Sirindhorn National Medical Rehabilitation Institute, Thailand. PARTICIPANTS Individuals with iSCI (n=34) were allocated to the anodal or sham groups. INTERVENTION Anodal tDCS was administered over the M1 lower-limb motor area at an intensity of 2 mA for 20 min in the anodal group, while the sham group received a 30-s stimulation. Both groups received 40 min of overground gait training after tDCS for 5 consecutive daily sessions. MAIN OUTCOME MEASURES The 10-meter walk test (10MWT) was the primary outcome, while spatiotemporal gait parameters, the timed Up and Go test, Five-Time Sit-to-Stand Test, and World Health Organization Quality of Life-BREF were secondary outcomes. Outcomes were assessed at baseline, post-intervention, and at 1-month (1M) and 2-month (2M) follow-ups. RESULT Improvements in walking speed measured using the 10MWT were observed in both groups. However, the anodal group showed a greater improvement than the sham group. For fast speed, the mean between-group differences were 0.10 m/s, 95% CI (0.02 to 0.17) (post-intervention), 0.11 m/s, (0.03 to 0.19) (1M), and 0.11 m/s, (0.03 to 0.20) (2M), while for self-selected speed, the median differences were 0.10 m/s, 95% CI (0.06 to 0.14) (post-intervention) and 0.09 m/s, (0.01 to 0.19) (2M). The anodal group also had a greater stride length difference post-intervention (median difference: 0.07 m, 95% CI (0.01 to 0.14)). No significant between-group differences were found for other outcomes. CONCLUSION Five-session of anodal tDCS with gait training slightly improved walking speed, sustained for 2 months post-intervention. However, effect on spatiotemporal gait parameters was limited and dynamic balance, functional tasks (ie, sit-to-stand), and quality of life were unaffected compared with overground gait training.
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Affiliation(s)
- Pipat Klamruen
- Faculty of Physical Therapy, Mahidol University, Nakhon Pathom, Thailand; Neuro Electrical Stimulation Laboratory (NeuE), Mahidol University, Nakhon Pathom, Thailand; Physical Therapy Unit, Sirindhorn National Medical Rehabilitation Institute, Nonthaburi, Thailand
| | - Jatuporn Suttiwong
- Faculty of Physical Therapy, Mahidol University, Nakhon Pathom, Thailand
| | - Benchaporn Aneksan
- Faculty of Physical Therapy, Mahidol University, Nakhon Pathom, Thailand; Neuro Electrical Stimulation Laboratory (NeuE), Mahidol University, Nakhon Pathom, Thailand
| | - Monticha Muangngoen
- Physical Therapy Unit, Sirindhorn National Medical Rehabilitation Institute, Nonthaburi, Thailand
| | - Chanapass Denduang
- Physical Therapy Unit, Sirindhorn National Medical Rehabilitation Institute, Nonthaburi, Thailand
| | - Wanalee Klomjai
- Faculty of Physical Therapy, Mahidol University, Nakhon Pathom, Thailand; Neuro Electrical Stimulation Laboratory (NeuE), Mahidol University, Nakhon Pathom, Thailand
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Liu B, Yu J, Fan Q, Hao F, Wu J, Xiao W, Yu F, Ren Z. The effect of exercise on walking economy in patients with chronic neurological conditions: A systematic review and meta-analysis. Front Neurol 2023; 13:1074521. [PMID: 36712424 PMCID: PMC9874330 DOI: 10.3389/fneur.2022.1074521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 12/15/2022] [Indexed: 01/13/2023] Open
Abstract
Introduction To investigate the effect of exercise on the walking economy (WE) of patients with chronic neurological conditions (CNCs) and to determine the type of physical activity that best improves the WE of patients with CNCs. Methods Four electronic databases were searched until December 2022 (Web of Science, PubMed, Cochrane, and CINAHL). Studies were screened using the following inclusion criteria: 1. randomized controlled or non-randomized controlled trials; 2. exercise interventions >4 weeks in duration; 3. patients aged ≥18 years with a diagnosis of CNCs. 4. walking economy of patients measured before and after the intervention. The PEDro scale was used to assess the methodological quality of the included studies. Results and discussion Twenty-two studies met the inclusion criteria. Meta-analysis results showed that exercise significantly improved WE (g = -0.352, 95% CI, -0.625 to -0.078, P = 0.012). Subgroup analysis revealed that patients who received exercise showed better WE compared with those who underwent no control intervention (g = -0.474, 95% CI, -0.636 to -0.311, P < 0.001). However, exercise therapy did not show a significant improvement of WE compared with control groups (g = -0.192, 95% CI, -0.451 to 0.067, P = 0.146). In addition, we found that endurance combined with resistance, high-intensity intermittent, and other training modalities resulted in better WE compared with the pre-intervention. Of these, interval training has the greatest effect on improving WE. In conclusion, exercise can improve WE in patients with CNCs. More randomized controlled trials are necessary for the future. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022361455, identifier: CRD42022361455.
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Affiliation(s)
- Bowen Liu
- College of Physical Education, Shenzhen University, Shenzhen, China
| | - Jingxuan Yu
- College of Physical Education, Shenzhen University, Shenzhen, China
| | - Qiwei Fan
- Department of Sports Medicine and Rehabilitation, Peking University Shenzhen Hospital, Shenzhen, China
| | - Fengwei Hao
- School of Physical Education and Sports Exercise, South China Normal University, Guangzhou, China
| | - Jinlong Wu
- College of Physical Education, Southwest University, Chongqing, China
| | - Wen Xiao
- College of Physical Education, Shenzhen University, Shenzhen, China
| | - Fengyu Yu
- College of Physical Education, Shenzhen University, Shenzhen, China
| | - Zhanbing Ren
- College of Physical Education, Shenzhen University, Shenzhen, China,*Correspondence: Zhanbing Ren ✉
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Gollie JM, Guccione AA, Keyser RE, Chin LMK, Panza GS, Herrick JE. Walking endurance, muscle oxygen extraction, and perceived fatigability after overground locomotor training in incomplete spinal cord injury: A pilot study. J Spinal Cord Med 2022; 45:381-389. [PMID: 32795157 PMCID: PMC9135420 DOI: 10.1080/10790268.2020.1798137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Objective: The purpose of this study was to examine the effects of overground locomotor training (OLT) on walking endurance and gastrocnemius oxygen extraction in people with chronic cervical motor-incomplete spinal cord injury (SCI).Design: Prospective single-arm pre-post pilot study.Setting: Human Performance Research Laboratory.Participants: Adult men with traumatic chronic cervical SCI (n = 6; age = 30.8 ± 12.5).Intervention: Twenty-four sessions of structured OLT.Outcome measures: Walking endurance was determined during a constant work-rate time-to-exhaustion treadmill test. Normalized perceived fatigability was calculated by dividing subjective ratings of tiredness by walking time. Cardiorespiratory outcomes and muscle oxygen extraction were analyzed using breath-by-breath gas-exchange and near-infrared spectroscopy.Results: OLT resulted in large effects on walking endurance (1232 ± 446 s vs 1645 ± 255 s; d = 1.1; P = 0.045) and normalized perceived fatigability (5.3 ± 1.5 a.u. vs 3.6 ± 0.9 a.u.; d = 1.3; P = 0.033). Small-to-medium effects on absolute (2.8 ± 2.5 a.u. vs 4.2 ± 3.5 a.u.; d = 0.42; P = 0.035) and isotime (2.8 ± 2.5 a.u. vs 3.8 ± 3.0 a.u.; d = 0.33; P = 0.023) muscle oxygen extraction were also observed after OLT.Conclusion: These findings provide preliminary data supporting the potential for improved walking endurance, enhanced muscle O2 extraction, and reduced perceived fatigability in people with chronic cervical motor-incomplete SCI following the OLT program described in this study.
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Affiliation(s)
- Jared M. Gollie
- Research Services, Veterans Affairs Medical Center, Washington, District of Columbi, USA
- Department of Health, Human Function, and Rehabilitation Sciences, The George Washington University, Washington, District of Columbi, USA
- Rehabilitation Science Department, George Mason University, Fairfax, Virginia, USA
| | - Andrew A. Guccione
- Rehabilitation Science Department, George Mason University, Fairfax, Virginia, USA
| | - Randall E. Keyser
- Rehabilitation Science Department, George Mason University, Fairfax, Virginia, USA
- Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Lisa M. K. Chin
- Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Gino S. Panza
- Department of Physiology, Wayne State University, Detroit, Michigan, USA
- Research Services, John D. Dingell Veterans Affairs Medical Center, Detroit, Michigan, USA
| | - Jeffrey E. Herrick
- Department of Exercise Physiology, University of Lynchburg, Lynchburg, Virginia, USA
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Panza GS, Guccione AA. Effect of repeated locomotor training on ventilatory measures, perceived exertion and walking endurance in persons with motor incomplete spinal cord injury. Spinal Cord Ser Cases 2020; 6:94. [PMID: 33046694 DOI: 10.1038/s41394-020-00346-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 09/22/2020] [Accepted: 09/23/2020] [Indexed: 11/09/2022] Open
Abstract
STUDY DESIGN Pre-Post, Repeated Measures. OBJECTIVES To determine if a warm-up bout of exercise could elicit a phasic ventilatory response to constant work rate (CWR) exercise in individuals with incomplete spinal cord injury (iSCI) during unsupported CWR treadmill walking. Describe the changes in ventilatory kinetics, ventilatory variability and ratings of perceived exertion (RPE) before and after 12 and 24 weeks of overground locomotor training (OLT). Investigate the relationship among minute ventilation (VE) variability, RPE, and walking endurance. SETTING Laboratory. METHODS A 6-min CWR was used as a warm-up preceding a CWR, at the same walking speed, until volitional fatigue or 30 min. Breath-by-breath ventilatory data were examined during the second CWR using a mono-exponential model. VE variability was calculated as the difference between the observed and predicted values. Data were time-matched before and after 12 and 24 weeks of OLT. A Pearson's correlation was used for VE variability, RPE, and walking endurance. RESULTS A warm-up CWR did elicit a phasic ventilatory response. OLT resulted in faster ventilatory kinetics. Ventilatory variability reduced after 12 weeks of OLT but returned to pre-OLT values after 24 weeks of training. The change in VE variability was correlated with the change in RPE throughout the study. 12 and 24 weeks of OLT resulted in significant improvements in treadmill walking time. CONCLUSIONS SCI patients can achieve a phasic ventilatory response to walking if the exercise bout is preceded by a warm-up. OLT normalizes the ventilatory kinetics and improves walking endurance. The change in VE variability is correlated to RPE.
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Affiliation(s)
- Gino S Panza
- John D. Dingell Veterans Affairs Medical Center, Detroit, MI, USA. .,Department of Physiology, Wayne State University School of Medicine, Detroit, MI, USA.
| | - Andrew A Guccione
- Department of Rehabilitation Science, George Mason University, Fairfax, VA, USA
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Panza GS, Herrick JE, Chin LM, Gollie JM, Collins JP, O’Connell DG, Guccione AA. Effect of overground locomotor training on ventilatory kinetics and rate of perceived exertion in persons with cervical motor-incomplete spinal cord injury. Spinal Cord Ser Cases 2019; 5:80. [PMID: 31632738 PMCID: PMC6786384 DOI: 10.1038/s41394-019-0223-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 08/29/2019] [Accepted: 09/08/2019] [Indexed: 11/09/2022] Open
Abstract
Study design Pre-post, pilot study. Objectives To characterize ventilatory (VE) responses to exercise following warm-up walking in individuals with chronic incomplete spinal cord injury (iSCI) during constant work rate (CWR) exercise. Secondarily, to investigate VE and tidal volume (VT) variability, and ratings of perceived exertion (RPE) before and after overground locomotor training (OLT). Setting Research laboratory. Methods A 6-min CWR walking bout at preferred pace was used as a warm-up followed by 6 min of rest and a second 6-min CWR bout at above preferred walking pace. The second CWR bout was analyzed. Breath-by-breath ventilatory data were examined using a curvilinear least squares fitting procedure with a mono-exponential model. VE and VT variability was calculated as the difference between the observed and predicted values and RPE was taken every 2 min. Results Participants (n = 3, C4-C5) achieved a hyperpneic response to exercise in VE and VT. OLT resulted in faster ventilatory kinetics and reductions of 24 and 29% for VE and VT variability, respectively. A 30% reduction in RPE was concurrent with the reductions in ventilatory variability. Conclusions OLT may improve ventilatory control during CWR in patients with cervical motor-iSCI. These data suggest that in some participants with iSCI, ventilation may influence RPE during walking. Future research should investigate mechanisms of ventilatory variability and its implications in walking performance in patients with iSCI.
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Affiliation(s)
- Gino S. Panza
- John D. Dingell Veterans Affairs Medical Center, Detroit, MI USA
- Department of Physiology, Wayne State University School of Medicine, Detroit, MI USA
| | - Jeffrey E. Herrick
- Department of Exercise Physiology, University of Lynchburg, Lynchburg, VA USA
| | - Lisa M. Chin
- Rehabilitation Medicine Department, National Institutes of Health, Clinical Center, Bethesda, MD USA
| | | | | | | | - Andrew A. Guccione
- Department of Rehabilitation Science, George Mason University, Fairfax, VA USA
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Neville BT, Murray D, Rosen KB, Bryson CA, Collins JP, Guccione AA. Effects of Performance-Based Training on Gait and Balance in Individuals With Incomplete Spinal Cord Injury. Arch Phys Med Rehabil 2019; 100:1888-1893. [PMID: 31026461 DOI: 10.1016/j.apmr.2019.03.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 03/11/2019] [Accepted: 03/13/2019] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To determine changes in balance and gait following a task-specific, performance-based training protocol for overground locomotor training (OLT) in individuals with motor-incomplete spinal cord injury (iSCI). DESIGN Convenience sample, prepilot and postpilot study. SETTING Human performance research laboratory. PARTICIPANTS Adults (N=15; 12 men and 3 women; mean age [y] ± SD, 41.5±16.9), American Spinal Injury Association Impairment Scale C or D, >6 months post-spinal cord injury. INTERVENTIONS Two 90-minute OLT sessions per week over 12 to 15 weeks. OLT sessions were built on 3 principles of motor learning: practice variability, task specificity, and progressive overload (movement complexity, resistance, velocity, volume). Training used only voluntary movements without body-weight support, robotics, electrical stimulation, or bracing. Subjects used ambulatory assistive devices as necessary. MAIN OUTCOME MEASURES Berg Balance Scale (BBS), Spinal Cord Injury Functional Ambulation Inventory (SCI-FAI) gait parameters, spatiotemporal measures of gait (step length, step width, percent stance, stance:swing ratio) from 7 participants who walked across a pressure-sensitive walkway. RESULTS Fourteen participants completed the OLT protocol and 1 participant completed 15 sessions due to scheduled surgery. The BBS scores showed a mean improvement of 4.53±4.09 (P<.001). SCI-FAI scores showed a mean increase of 2.47±3.44 (P=.01). Spatiotemporal measures of gait showed no significant changes. CONCLUSION This pilot demonstrated improvements in balance and selected gait characteristics using a task-specific, performance-based OLT for chronic iSCI.
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Affiliation(s)
- Brian T Neville
- Department of Rehabilitation Science, George Mason University, Fairfax, Virginia
| | - Donal Murray
- Department of Rehabilitation Science, George Mason University, Fairfax, Virginia
| | - Kerry B Rosen
- Department of Rehabilitation Science, George Mason University, Fairfax, Virginia
| | - Caitlin A Bryson
- Department of Rehabilitation Science, George Mason University, Fairfax, Virginia
| | | | - Andrew A Guccione
- Department of Rehabilitation Science, George Mason University, Fairfax, Virginia.
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Gollie JM. Fatigability during volitional walking in incomplete spinal cord injury: cardiorespiratory and motor performance considerations. Neural Regen Res 2018; 13:786-790. [PMID: 29862998 PMCID: PMC5998625 DOI: 10.4103/1673-5374.232461] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2018] [Indexed: 02/06/2023] Open
Abstract
Fatigability describes the decline in force production (i.e., performance fatigability) and/or changes in sensations regulating performance (i.e., perceived fatigability) during whole-body activity and poses a major challenge to those living with spinal cord injuries (SCI). After SCI, the inability to overcome disruptions to metabolic homeostasis due to cardiorespiratory limitations and physical deconditioning may contribute to increased fatigability severity. The increased susceptibility to fatigability may have implications for motor control strategies and motor learning. Locomotor training approaches designed to reduce fatigability and enhance aerobic capacity in combination with motor learning may be advantageous for promoting functional recovery after SCI. Future research is required to advance the understanding of the relationship between fatigability, cardiorespiratory function and motor performance following SCI.
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Affiliation(s)
- Jared M. Gollie
- Muscle Morphology, Mechanics and Performance Laboratory, Clinical Research Center-Human Performance Research Unit, Veteran Affairs Medical Center Washington, DC, USA
- Department of Health, Human Function, and Rehabilitation Sciences, School of Medicine and Health Sciences, The George Washington University, Washington, DC, USA
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Badran A, Davies BM, Bailey HM, Kalsi-Ryan S, Kotter MRN. Is there a role for postoperative physiotherapy in degenerative cervical myelopathy? A systematic review. Clin Rehabil 2018; 32:1169-1174. [DOI: 10.1177/0269215518766229] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: To review peer-reviewed literature relating to postoperative physiotherapy for degenerative cervical myelopathy (DCM), to determine efficacy in improving clinical outcome and recovery. Data sources: MEDLINE, EMBASE, CENTRAL, PEDro, ISRCTN registry, WHO ICTRP and Clinicaltrials.gov . References and citations of relevant articles were searched. Methods: A systematic search was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (PROSPERO CRD42016039511) from the origins of the databases till 15 February 2018. Included were all studies investigating physiotherapy as an intervention after surgical treatment of DCM to determine effect on clinical outcome and recovery. Study quality was determined using the Grades of Recommendation, Assessment, Development and Evaluation guidelines. Results: In all, 300 records were identified through tailored systematic searches, after removing duplicates. After screening, only one investigated postoperative rehabilitation using physiotherapy for DCM; however, this was retrospective with no controls. This study suggested that rehabilitation including physiotherapy improved postoperative recovery. There are currently two registered trials investigating the use of postoperative physiotherapy for DCM. Conclusions: The literature provides insufficient evidence to make any evidence-based recommendations regarding postoperative physiotherapy use in DCM.
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Affiliation(s)
- Abdul Badran
- Churchill College and University of Cambridge, Cambridge, UK
- Academic Neurosurgery Unit, Department of Clinical Neurosurgery, University of Cambridge, Cambridge, UK
| | - Benjamin M Davies
- Academic Neurosurgery Unit, Department of Clinical Neurosurgery, University of Cambridge, Cambridge, UK
| | - Heidi-Marie Bailey
- Academic Neurosurgery Unit, Department of Clinical Neurosurgery, University of Cambridge, Cambridge, UK
| | - Sukhvinder Kalsi-Ryan
- Toronto Western Hospital, University Health Network and University of Toronto, Toronto, ON, Canada
| | - Mark RN Kotter
- Academic Neurosurgery Unit, Department of Clinical Neurosurgery, University of Cambridge, Cambridge, UK
- Toronto Western Hospital, University Health Network and University of Toronto, Toronto, ON, Canada
- WT MRC Cambridge Stem Cell Institute, Anne McLaren Laboratory, University of Cambridge, Cambridge, UK
- John van Geest Centre for Brain Repair, University of Cambridge, Cambridge, UK
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Gollie JM, Herrick JE, Keyser RE, Chin LMK, Collins JP, Shields RK, Panza GS, Guccione AA. Fatigability, oxygen uptake kinetics and muscle deoxygenation in incomplete spinal cord injury during treadmill walking. Eur J Appl Physiol 2017; 117:1989-2000. [PMID: 28744558 DOI: 10.1007/s00421-017-3685-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 07/20/2017] [Indexed: 01/17/2023]
Abstract
PURPOSE The purpose of the present study was to characterize hypothesized relationships among fatigability and cardiorespiratory fitness in individuals with chronic motor-incomplete SCI (iSCI) during treadmill walking. The theoretical framework was that exacerbated fatigability would occur concomitantly with diminished cardiorespiratory fitness in people with iSCI. METHODS Subjects with iSCI (n = 8) and an able-bodied reference group (REF) (n = 8) completed a 6-min walking bout followed by a walking bout of 30-min or until volitional exhaustion, both at a self-selected walking speed. Fatigability was assessed using both perceived fatigability and performance fatigability measures. Pulmonary oxygen uptake kinetics (VO2 on-kinetics) was measured breath-by-breath and changes in deoxygenated hemoglobin/myoglobin concentration (∆[HHb]) of the lateral gastrocnemius was measured by near-infrared spectroscopy. Adjustment of VO2 and ∆[HHb] on-kinetics were modeled using a mono-exponential equation. RESULTS Perceived fatigability and performance fatigability were 52% and 44% greater in the iSCI group compared to the REF group (p = 0.003 and p = 0.004). Phase II time constant (τp) of VO2 on-kinetics and ∆[HHb] ½ time during resting arterial occlusion were 55.4% and 16.3% slower in iSCI vs REF (p < 0.01 and p = 0.047, respectively). CONCLUSIONS The results of the present study may suggest that compromised O2 delivery and/or utilization may have contributed to the severity of fatigability in these individuals with iSCI. The understanding of the extent to which fatigability and VO2 and Δ[HHb] on-kinetics impacts locomotion after iSCI will assist in the future development of targeted interventions to enhance function.
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Affiliation(s)
- Jared M Gollie
- Department of Rehabilitation Science, George Mason University, 4400 University Drive MS2G7, Fairfax, VA, 22030, USA.
| | - Jeffrey E Herrick
- Department of Rehabilitation Science, George Mason University, 4400 University Drive MS2G7, Fairfax, VA, 22030, USA
| | - Randall E Keyser
- Department of Rehabilitation Science, George Mason University, 4400 University Drive MS2G7, Fairfax, VA, 22030, USA
| | - Lisa M K Chin
- Department of Rehabilitation Science, George Mason University, 4400 University Drive MS2G7, Fairfax, VA, 22030, USA
| | - John P Collins
- Department of Rehabilitation Science, George Mason University, 4400 University Drive MS2G7, Fairfax, VA, 22030, USA
| | - Richard K Shields
- Department of Physical Therapy and Rehabilitation Sciences, University of Iowa, Iowa, USA
| | - Gino S Panza
- Department of Rehabilitation Science, George Mason University, 4400 University Drive MS2G7, Fairfax, VA, 22030, USA
| | - Andrew A Guccione
- Department of Rehabilitation Science, George Mason University, 4400 University Drive MS2G7, Fairfax, VA, 22030, USA
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Effects of overground locomotor training on the ventilatory response to volitional treadmill walking in individuals with incomplete spinal cord injury: a pilot study. Spinal Cord Ser Cases 2017; 3:17011. [PMID: 28435743 DOI: 10.1038/scsandc.2017.11] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 02/22/2017] [Accepted: 03/02/2017] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION Although there has been substantial emphasis on the neuromuscular and cardiovascular adaptations following rehabilitation, pulmonary adaptations in individuals with incomplete SCI (iSCI) in response to locomotor training have been less frequently studied. In healthy individuals, effective transition from rest to work is accomplished by a hyperpneic response, which exhibits an exponential curve with three phases. However, the degree to which our current understanding of exercise hyperpnea can be applied to individuals with iSCI is unknown. The purpose of this case series was to characterize exercise hyperpnea during a rest to constant work rate (CWR) transition before and after 12-15 weeks of overground locomotor training (OLT). CASE PRESENTATION Six subjects with cervical motor incomplete spinal cord injury participated in 12-15 weeks of OLT. Subjects were trained in 90-min sessions twice a week. All training activities were weight-bearing and under volitional control without the assistance of body-weight support harnesses, robotic devices or electrical stimulation. Six minutes of CWR treadmill walking was performed at self-selected pace with cardiorespiratory analysis throughout the tests before and after OLT. Averaged group data for tidal volume, breathing frequency or VE showed no difference before and after training. VE variability was decreased by 46.7% after OLT. DISCUSSION CWR VE from rest to work was linear throughout the transition. Following OLT, there was a substantial reduction in VE variability. Future research should investigate the lack of a phasic ventilatory response to exercise, as well as potential mechanisms of ventilatory variability and its implications for functional performance.
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Gollie JM, Guccione AA. Overground Locomotor Training in Spinal Cord Injury: A Performance-Based Framework. Top Spinal Cord Inj Rehabil 2017; 23:226-233. [PMID: 29339898 PMCID: PMC5562030 DOI: 10.1310/sci2303-226] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Background: Locomotor training (LT) is the most commonly used treatment to improve walking performance following spinal cord injury (SCI). The advancement of LT treatments requires the addition of integrative models accounting for the numerous systems responsible for the recovery of walking function following SCI. Objective: This perspective monograph aims to (a) describe a performance-based framework for overground LT (OLT), (b) describe principles of adaptation and motor learning used to inform OLT program design, and (c) present an example OLT program based on the proposed framework. Methods: Individuals with chronic motor-incomplete SCI (7 male, 1 female) classified according to the American Spinal Injury Association Impairment Scale (AIS) as C and D were included. OLT included two 90-minute sessions performed over 12 weeks for a total of 24 sessions. Outcomes measures included overground walking speed, walking economy, pulmonary oxygen uptake, and muscle oxygen extraction measured via near-infrared spectroscopy. Results: Preliminary findings demonstrate the potential of OLT, as describe here, to increase overground walking speed, improve walking economy, accelerate processes associated with oxygen delivery and utilization at the rest-to-work transition, and lower oxygen extraction requirements of skeletal muscle during walking in individuals with chronic motor-incomplete SCI. Conclusion: The proposed framework offers a valuable template for LT program design in both clinical and research settings. Further research is necessary to better understand the effects of OLT and how principles of specificity, progressive overload, and variation within the performance-based framework can be manipulated to maximize function, health, and quality of life in SCI.
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Affiliation(s)
- Jared M. Gollie
- Department of Rehabilitation Science, George Mason University College of Health and Human Services, Fairfax, Virginia
| | - Andrew A. Guccione
- Department of Rehabilitation Science, George Mason University College of Health and Human Services, Fairfax, Virginia
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