Bilateral muscle strength symmetry and performance are improved following walk training with restricted blood flow in an elite paralympic sprint runner: Case study

Upper extremity blood-flow restriction training applied during walking in an adult with a rare form of spina bifida: a case report

INTRODUCTION

Adults with spina bifida have impaired mobility and often rely on assistive devices like crutches for walking, which exert high torque demands on the upper extremities. Blood flow restriction training (BFRT) may improve strength and gait measures by increasing intensity of training when applied during walking for individuals with limited walking tolerance. However, no studies have investigated the application of BFRT to the upper extremities for individuals who rely on crutches for walking.

CASE DESCRIPTION

This case describes a 29-year-old female with diastematomyelia, a rare form of spina bifida, who had lower extremity weakness and reduced gait capacity requiring crutches. The patient underwent 8 weeks of bilateral upper extremity BFRT during walking. The BFRT program consisted of 4 bouts of walking per session, each lasting 3 minutes with 35-50% limb occlusion pressure. Outcomes measured at baseline and 8 weeks included the 10 Meter Walk Test (10MWT), Timed Up and Go (TUG), 5 Times Sit-Stand Test (5×STS), hand-held dynamometry of 8 upper extremity muscles, and a BFRT satisfaction questionnaire.

OUTCOMES

After 8 weeks, she demonstrated improvements on the 10MWT (0.15 m/s, 23%), TUG (-3.4s, 20%), 5×STS (-3.4 s, -22%), and upper extremity strength improvements ranged from 8-79% (2.8-6.7 kg). There were no adverse events related to the intervention and satisfaction was high.

DISCUSSION

Bilateral upper extremity BFRT was safely applied during walking in an adult with spina bifida. The improvements in strength and functional mobility warrant future study among individuals who rely on upper extremity strength for ambulation.

Clinical use of blood flow restriction in people with neurologic conditions: a cross-sectional survey

[Purpose] There is little evidence for blood flow restriction (BFR), or Kaatsu, training in people with neurologic conditions. This study's purpose was to survey clinicians on BFR use in people with neurologic conditions. [Participants and Methods] One-hundred twelve physical therapists and other healthcare professionals who reported using BFR in the past 5 years completed an anonymous, online survey. [Results] Eighty-nine percent of respondents thought BFR was safe in people with neurologic conditions. Meanwhile, 38% reported BFR use in people with neurologic conditions. The most common intervention used with BFR was resistance training (n=33) and the most commonly reported benefit was improved strength (n=27). The most common side-effect causing treatment to stop was intolerance to pressure (n=6). No side-effects requiring medical attention were reported. In order to support future BFR use in neurologic populations, the most common response was the need for more research (n=63). [Conclusion] Despite the lack of evidence, clinical use of BFR in people with neurologic conditions may be somewhat common. Although this study had a relatively small sample size and collected data retrospectively, the results support the potential clinical feasibility and safety of BFR use in patients with neurologic conditions and suggest that more research is needed.

Feasibility and safety of 4 weeks of blood flow-restricted exercise in an individual with tetraplegia and known autonomic dysreflexia: a case report

INTRODUCTION

Blood flow-restricted exercise (BFRE) appears to hold considerable potential in spinal cord injury (SCI) rehabilitation, due to its ability to induce beneficial functional changes and morphological alterations from low-intensity, low-load exercise. However, it remains unclear if this training approach is feasible and safe in individuals with autonomic dysreflexia (AD).

CASE PRESENTATION

A 23-year-old male with traumatic, cervical (C6), motor-complete (AIS: B) SCI and diagnosed AD completed eight sessions of BFRE for the upper extremities over 4 weeks. Blood pressure and heart rate recordings and perceptual pain responses were collected repeatedly during exercise. Blood samples were drawn pre- and post-training. Training was carried out in a neurorehabilitation hospital setting with appertaining medical staff readiness, and was supervised by a physiotherapist with expertise in AD in general as well as prior knowledge of the present patient's triggers and symptoms. Four incidences of AD (defined as systolic blood pressure increase >20 mmHg) were recorded across all training sessions, of which one was symptomatic. The patient's blood profile did not change considerably from pre- to post-training sessions. Self-reported average pain during training corresponded from "mild" to "moderate".

DISCUSSION

The patient was able to perform 4 weeks of BFRE, but encountered episodes of AD. Similarly, two AD episodes were registered during a single conventional, free-flow resistance training session. Evidence from clinically controlled safety studies is needed in order to establish if and how BFRE can be applied in a rehabilitation strategy in SCI individuals with neurological level of injury at or above T6 level.

Neuromuscular and postural control in visually and nonvisually impaired judo athletes: case study

This study aimed to analyze neuromuscular and postural control in visually and nonvisually impaired judo athletes. Two judo athletes, one visually impaired and the other nonvisually impaired, participated in the study. The athletes presented similar demographic, anthropometric, and judo-technical characteristics. They performed maximal isometric handgrip strength (dominant and nondominant hand), vertical jumps (countermovement jump [CMJ] and squat jump [SJ]), and center of pressure assessment in three positions: neutral, anteroposterior, and judo combat base (Migi-shizentai). The main findings showed that the visually impaired athlete presented higher standing balance in the neutral and anteroposterior positions than non-visually impaired athlete (effect size [ES]>2.0). In the Migi-shizentai position, the disparity between both athletes was reduced, particularly in the displacement area (ES=0.52). The visually impaired athlete showed higher performance in the SJ but lesser performance in CMJ and handgrip strength tests than nonimpaired athlete (ES>2.0). We concluded that the postural stability was higher in the visually impaired athlete in the neutral and anteroposterior position, but similar to the nonvisually impaired athlete in Migi-shizentai position, possible due to the influence of judo practice. Moreover, the visually impaired athlete showed higher performance in the SJ than nonvisually impaired.

Systematic review of high-level mobility training in people with a neurological impairment

AIM

The objective of this paper was to systematically review the efficacy of interventions targeting high-level mobility skills in people with a neurological impairment.

METHODS

A comprehensive electronic database search was conducted. Study designs were graded using the American Academy of Cerebral Palsy and Developmental Medicine (AACPDM) system and methodological quality was described using the Physiotherapy Evidence Database (PEDro) scale.

RESULTS

Twelve exploratory studies (AACPDM levels IV/V), of limited methodological quality (PEDro scores of 2-3 out of 10), were included. Interventions included treadmill training, a three-phase programme, a high-level mobility group, plyometric training, running technique coaching and walk training with blood flow restriction. Diagnoses included acquired brain injury, cerebral palsy, incomplete spinal cord injury and neurofibromatosis type 1. There were difficulties generalizing results from exploratory designs with a broad range of participants, interventions and outcome measures. However, it seems that people with a neurological impairment have the capacity to improve high-level mobility skills, running speed and distance with intervention. There were no adverse events that limited participation.

CONCLUSION

There is preliminary evidence to support the efficacy of interventions to improve high-level mobility skills in people with neurological impairments. Well-controlled research with a larger sample is required to provide sufficient evidence to change clinical practice.