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Morgan DW, Stevens SL. Use of water- and land-based gait training to improve walking capacity in adults with complete spinal cord injury: A pilot study. J Spinal Cord Med 2024; 47:404-411. [PMID: 35796664 PMCID: PMC11044748 DOI: 10.1080/10790268.2022.2088507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
OBJECTIVE Little is known regarding the extent to which mobility can be improved using gait-based therapies in individuals with complete spinal cord injury (cSCI). Against this backdrop, the purpose of our study was to document changes in walking capacity following an extended period of underwater treadmill training (UTT) and supplemental overground walk training (OWT) in persons with cSCI. DESIGN Longitudinal design. SETTING University research center. PARTICIPANTS Five adults (mean age = 41.2 ± 5.9 years) with motor-complete (AIS A), chronic (mean years post-injury = 3.2 ± 1.6 years) cSCI who had not received epidural spinal cord stimulation (eSCS). INTERVENTION Participants underwent one year of UTT (3 walking bouts per day; 2-3 days per week). Once independent stepping activity in the water was observed, OWT, as tolerated, was performed prior to UTT. OUTCOME MEASURE Walking capacity was evaluated using the Walking Index for Spinal Cord Injury (WISCI-II) prior to UTT (Time 1: T1), six months after the start of UTT (Time 2: T2), and following completion of UTT (Time 3: T3). RESULTS Non-parametric analyses revealed a significant time effect (P < .05) for WISCI-II. Pre-planned comparisons revealed no difference in WISCI-II levels measured at T1 (0.20 ± 0.45) and T2 (4.80 ± 4.55) and at T2 (4.80 ± 4.55) and T3 (8.40 ± 1.34). However, the WISCI-II level obtained at T3 (8.40 ± 1.34) was significantly higher compared to the T1 value. CONCLUSION Our preliminary findings demonstrate that in the absence of eSCS, combined UTT and supplemental OWT can improve functional walking capacity in adults with cSCI.
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Affiliation(s)
- Don W. Morgan
- Department of Health and Human Performance, Middle Tennessee State University, Murfreesboro, TN, USA
| | - Sandra L. Stevens
- Department of Health and Human Performance, Middle Tennessee State University, Murfreesboro, TN, USA
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Walia S, Kumar P, Kataria C. Interventions to Improve Standing Balance in Individuals With Incomplete Spinal Cord Injury: A Systematic Review and Meta-Analysis. Top Spinal Cord Inj Rehabil 2023; 29:56-83. [PMID: 37235196 PMCID: PMC10208260 DOI: 10.46292/sci21-00065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Background Incomplete spinal cord injury (iSCI) often results in impaired balance leading to functional impairments. Recovery of standing balance ability is an important aim of rehabilitative programs. However, limited information is available on effective balance training protocols for individuals with iSCI. Objectives To assess the methodological quality and effectiveness of various rehabilitation interventions for improving standing balance in individuals with iSCI. Methods A systematic search was performed in SCOPUS, PEDro, PubMed, and Web of Science from inception until March 2021. Two independent reviewers screened articles for inclusion, extracted data, and evaluated methodological quality of the trials. PEDro Scale was used to assess the quality of randomized controlled trials (RCT) and crossover studies while pre-post trials were assessed using the modified Downs and Black tool. A meta-analysis was performed to quantitatively describe the results. The random effects model was applied to present the pooled effect. Results Ten RCTs with a total of 222 participants and 15 pre-post trials with 967 participants were analyzed. The mean PEDro score and modified Downs and Black score was 7/10 and 6/9, respectively. The pooled standardized mean difference (SMD) for controlled and uncontrolled trials of body weight-supported training (BWST) interventions was -0.26 (95% CI, -0.70 to 0.18; p = .25) and 0.46 (95% CI, 0.33 to 0.59; p < .001), respectively. The pooled effect size of -0.98 (95% CI, -1.93 to -0.03; p = .04) indicated significant improvements in balance after a combination of BWST and stimulation. Pre-post studies analyzing the effect of virtual reality (VR) training interventions on Berg Balance Scale (BBS) scores in individuals with iSCI reported a mean difference (MD) of 4.22 (95% CI, 1.78 to 6.66; p = .0007). Small effect sizes were seen in pre-post studies of VR+stimulation and aerobic exercise training interventions indicating no significant improvements after training on standing balance measures. Conclusion This study demonstrated weak evidence to support the use of BWST interventions for overground training for balance rehabilitation in individuals with iSCI. A combination of BWST with stimulation however showed promising results. There is a need for further RCTs in this field to generalize findings. Virtual reality-based balance training has shown significant improvement in standing balance post iSCI. However, these results are based on single group pre-post trials and lack appropriately powered RCTs involving a larger sample size to support this intervention. Given the importance of balance control underpinning all aspects of daily activities, there is a need for further well-designed and appropriately powered RCTs to evaluate specific features of training interventions to improve standing balance function in iSCI.
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Affiliation(s)
- Shefali Walia
- Amity Institute of Physiotherapy, Amity University, Noida, Uttar Pradesh, India
- Indian Spinal Injuries Centre, New Delhi, India
| | - Pragya Kumar
- Amity Institute of Physiotherapy, Amity University, Noida, Uttar Pradesh, India
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Ma T, Zhang Q, Zhou T, Zhang Y, He Y, Li S, Liu Q. Effects of robotic-assisted gait training on motor function and walking ability in children with thoracolumbar incomplete spinal cord injury. NeuroRehabilitation 2022; 51:499-508. [DOI: 10.3233/nre-220124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: Spinal cord injury (SCI) results in neurological dysfunction of the spinal cord below the injury. OBJECTIVE: To explore the immediate and long-term effects of robotic-assisted gait training (RAGT) on the recovery of motor function and walking ability in children with thoracolumbar incomplete SCI. METHODS: Twenty-one children with thoracolumbar incomplete SCI were randomly divided into the experimental (n = 11) and control groups (n = 10). The control group received 60 min of conventional physical therapy, and the experimental group received 30 min of RAGT based on 30 minutes of conventional physical therapy. Changes in walking speed and distance, physiological cost index (PCI), lower extremity motor score (LEMS), SCI walking index and centre-of-pressure (COP) envelope area score were observed in both groups of children before and after eight weeks of training. The primary outcome measures were the 10-metre walk test (10MWT) and six-minute walk distance (6MWD) at preferred and maximal speeds. In addition, several other measures were assessed, such as postural control and balance, lower limb strength and energy expenditure. RESULTS: Compared with control group, the self-selected walk speed (SWS), maximum walking speed (MWS), 6MWD, PCI, LEMS, COP, and Walking Index for Spinal Cord injury II (WISCI II) of experimental group were improved after treatment. The 6MWD, PCI, COP, and WISCI II after eight weeks of treatment were improved in experimental group. All indicators were not identical at three different time points when compared between two groups. Pairwise comparisons in experimental group suggested that the SWS, MWS, 6MWD, PCI, LEMS, COP, and WISCI II after treatment were higher than those before treatment. The 6MWD, LEMS, COP, and WISCI II after treatment were higher than at the one-month follow-up appointment. The SWS, PCI, LEMS, COP, and WISCI II at the eight-week follow-up appointment were improved. CONCLUSION: Robotic-assisted gait training may significantly improve the immediate motor function and walking ability of children with thoracolumbar incomplete SCI.
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Affiliation(s)
- Tingting Ma
- China Rehabilitation Research Center, Beijing Bo’ai Hospital, Capital Medical University School of Rehabilitation Medicine, Beijing, China
| | - Qi Zhang
- China Rehabilitation Research Center, Beijing Bo’ai Hospital, Capital Medical University School of Rehabilitation Medicine, Beijing, China
| | - Tiantian Zhou
- China Rehabilitation Research Center, Beijing Bo’ai Hospital, Capital Medical University School of Rehabilitation Medicine, Beijing, China
| | - Yanqing Zhang
- China Rehabilitation Research Center, Beijing Bo’ai Hospital, Capital Medical University School of Rehabilitation Medicine, Beijing, China
| | - Yan He
- China Rehabilitation Research Center, Beijing Bo’ai Hospital, Capital Medical University School of Rehabilitation Medicine, Beijing, China
| | - Sijia Li
- China Rehabilitation Research Center, Beijing Bo’ai Hospital, Capital Medical University School of Rehabilitation Medicine, Beijing, China
| | - Qianjin Liu
- China Rehabilitation Research Center, Beijing Bo’ai Hospital, Capital Medical University School of Rehabilitation Medicine, Beijing, China
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Volmrich AM, Cuénant LM, Forghani I, Hsieh SL, Shapiro LT. ABCD1 Gene Mutations: Mechanisms and Management of Adrenomyeloneuropathy. Appl Clin Genet 2022; 15:111-123. [PMID: 35983253 PMCID: PMC9381027 DOI: 10.2147/tacg.s359479] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 08/06/2022] [Indexed: 01/05/2023] Open
Abstract
Pathogenic variants in the ABCD1 gene on the X chromosome may result in widely heterogenous phenotypes, including adrenomyeloneuropathy (AMN). Affected males typically present in their third or fourth decade of life with progressive lower limb weakness and spasticity, and may develop signs and symptoms of adrenal insufficiency and/or cerebral demyelination. Heterozygous females may be asymptomatic, but may develop a later-onset and more slowly progressive spastic paraparesis. In this review, we describe the clinical presentation of AMN, as well as its diagnosis and management. The role of rehabilitative therapies and options for management of spasticity are highlighted.
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Affiliation(s)
- Alyssa M Volmrich
- Department of Physical Medicine & Rehabilitation, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Lauren M Cuénant
- Department of Physical Medicine & Rehabilitation, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Irman Forghani
- Department of Human Genetics, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Sharon L Hsieh
- MD/MPH Program, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Lauren T Shapiro
- Department of Physical Medicine & Rehabilitation, University of Miami Miller School of Medicine, Miami, FL, USA
- Correspondence: Lauren T Shapiro, Department of Physical Medicine & Rehabilitation; University of Miami Miller School of Medicine, P.O. Box 016960 (C-206), Miami, FL, 33101, USA, Tel +1 305 243-6605, Fax +1 305 243-4650, Email
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Evans NH, Suri C, Field-Fote EC. Walking and Balance Outcomes Are Improved Following Brief Intensive Locomotor Skill Training but Are Not Augmented by Transcranial Direct Current Stimulation in Persons With Chronic Spinal Cord Injury. Front Hum Neurosci 2022; 16:849297. [PMID: 35634208 PMCID: PMC9130633 DOI: 10.3389/fnhum.2022.849297] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 03/25/2022] [Indexed: 11/30/2022] Open
Abstract
Motor training to improve walking and balance function is a common aspect of rehabilitation following motor-incomplete spinal cord injury (MISCI). Evidence suggests that moderate- to high-intensity exercise facilitates neuroplastic mechanisms that support motor skill acquisition and learning. Furthermore, enhancing corticospinal drive via transcranial direct current stimulation (tDCS) may augment the effects of motor training. In this pilot study, we investigated whether a brief moderate-intensity locomotor-related motor skill training (MST) circuit, with and without tDCS, improved walking and balance outcomes in persons with MISCI. In addition, we examined potential differences between within-day (online) and between-day (offline) effects of MST. Twenty-six adults with chronic MISCI, who had some walking ability, were enrolled in a 5-day double-blind, randomized study with a 3-day intervention period. Participants were assigned to an intensive locomotor MST circuit and concurrent application of either sham tDCS (MST+tDCSsham) or active tDCS (MST+tDCS). The primary outcome was overground walking speed measured during the 10-meter walk test. Secondary outcomes included spatiotemporal gait characteristics (cadence and stride length), peak trailing limb angle (TLA), intralimb coordination (ACC), the Berg Balance Scale (BBS), and the Falls Efficacy Scale-International (FES-I) questionnaire. Analyses revealed a significant effect of the MST circuit, with improvements in walking speed, cadence, bilateral stride length, stronger limb TLA, weaker limb ACC, BBS, and FES-I observed in both the MST+tDCSsham and MST+tDCS groups. No differences in outcomes were observed between groups. Between-day change accounted for a greater percentage of the overall change in walking outcomes. In persons with MISCI, brief intensive MST involving a circuit of ballistic, cyclic locomotor-related skill activities improved walking outcomes, and selected strength and balance outcomes; however, concurrent application of tDCS did not further enhance the effects of MST.
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Affiliation(s)
- Nicholas H. Evans
- Shepherd Center, Crawford Research Institute, Atlanta, GA, United States
- Department of Applied Physiology, Georgia Institute of Technology, Atlanta, GA, United States
| | - Cazmon Suri
- Shepherd Center, Crawford Research Institute, Atlanta, GA, United States
| | - Edelle C. Field-Fote
- Shepherd Center, Crawford Research Institute, Atlanta, GA, United States
- Department of Applied Physiology, Georgia Institute of Technology, Atlanta, GA, United States
- Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA, United States
- *Correspondence: Edelle C. Field-Fote,
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Richley Geigle P, Ogonowska-Slodownik A, Smith JE, James K, Scott WH. Metabolic and cardiopulmonary impact of aquatic exercise and nutritional guidance for four individuals with chronic motor incomplete spinal cord injury: a case series. Physiother Theory Pract 2022:1-10. [PMID: 35196186 DOI: 10.1080/09593985.2022.2042632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Persons living with chronic spinal cord injury (SCI) demonstrate an increased risk of cardiovascular diseases. Purpose The aim of this report was to assess the cardiopulmonary and metabolic impact of prescribed aquatic exercise in combination with dietary guidance for four individuals experiencing chronic SCI. CASE DESCRIPTION We measured peak oxygen consumption (peak VO2), resting energy expenditure (REE), weight, food logs, fasting glucose, insulin and glycated hemoglobin (HbA1C) in four men with incomplete SCI, aged 34 to 63 years. INTERVENTION The men received a group aquatic exercise program three times per week for 10 weeks, and a weekly individual nutritional consultation by phone. OUTCOMES Peak VO2 increased by 7.9% and 34.4% in participants #3 and #4 and decreased by 12% and 16.4% in #1 and #2. Glucose values decreased by 19.6% and 14.2% for #1 and #3, and increased by 9.3% for both #2 and #4. Body mass decreased by 9.9%, 3.0% and 5.7% for participants #1, #2 and #3, but demonstrated no change for participant #4. Dietary guidance and education produced positive changes, including reduced fat, carbohydrate, daily sugar, and average calorie intake. CONCLUSION Moderate exercise with weekly nutritional guidance appeared to positively impact body mass and dietary selections with varied metabolic and cardiopulmonary results.
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Affiliation(s)
| | - Anna Ogonowska-Slodownik
- Faculty of Rehabilitation, Jozef Pilsudski University of Physical Education in Warsaw, Warsaw, Poland
| | | | | | - William H Scott
- Baltimore Veterans Administration Medical Center, Baltimore, MD, USA
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Marinho-Buzelli AR, Gauthier C, Chan K, Bonnyman AM, Mansfield A, Musselman KE. The state of aquatic therapy use for clients with spinal cord injury or disorder: Knowledge and current practice. J Spinal Cord Med 2022; 45:82-90. [PMID: 33830895 PMCID: PMC8890513 DOI: 10.1080/10790268.2021.1896274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
CONTEXT/OBJECTIVES Aquatic therapy (AT) has been reported to be beneficial for individuals with spinal cord injury or disorder (SCI/D); however, AT has also been reported to be underutilized in SCI/D rehabilitation. We aimed to understand the knowledge and current practice of AT for clients with SCI/D by physiotherapists, physiotherapy assistants and kinesiologists across Canada. DESIGN/METHOD A survey with closed- and open-ended questions was distributed (July-October 2019) to professionals through letters sent by professional associations. Non-parametric analyses were used to compare AT knowledge and practice between AT and non-AT users; content analysis was used to identify the themes from open-ended questions. RESULTS Seventy-eight respondents from 10 provinces were included in the analysis: 33 physiotherapists, 5 physiotherapy assistants and 40 kinesiologists. Respondents using AT (73%) reported greater knowledge of AT benefits and confidence to apply AT than respondents not using AT (p<0.01). Four themes were identified: 1-Variety of physical and psychosocial benefits of AT for people with SCI/D; 2-Attainment of movement and independence not possible on land; 3-Issues around pool accessibility; and 4-Constraints on AT implementation. CONCLUSIONS Respondents implemented AT to improve health outcomes for patients with SCI/D, despite facing challenges with pool accessibility and numerous constraints. Respondents who provided AT reported having better knowledge of AT and a supported AT practice in the work environment than respondents not providing AT. This study will inform AT stakeholders and institutions when considering strategies to increase the access to AT after SCI/D.
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Affiliation(s)
| | - Cindy Gauthier
- KITE-Toronto Rehabilitation Institute-University Health Network, Toronto, Canada
| | - Katherine Chan
- KITE-Toronto Rehabilitation Institute-University Health Network, Toronto, Canada
| | | | - Avril Mansfield
- KITE-Toronto Rehabilitation Institute-University Health Network, Toronto, Canada,Department of Physical Therapy, University of Toronto, Toronto, Canada,Evaluative Clinical Sciences, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Kristin E. Musselman
- KITE-Toronto Rehabilitation Institute-University Health Network, Toronto, Canada,Department of Physical Therapy, University of Toronto, Toronto, Canada,Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Canada,Correspondence to: Kristin E. Musselman, Lyndhurst Center, KITE-Toronto Rehabilitation Institute-UHN, 520 Sutherland Dr, Toronto, CanadaM4G 3V9.
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The effect of exercise on balance in patients with stroke, Parkinson, and multiple sclerosis: a systematic review and meta-analysis of clinical trials. Neurol Sci 2021; 43:167-185. [PMID: 34709478 DOI: 10.1007/s10072-021-05689-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 10/19/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Stroke, Parkinson, and multiple sclerosis are a range of diseases affecting the nervous system and show balance impairments due to damage of the balance control system. Many early articles have been published on the effect of exercise on balance in patients suffering from neuromuscular diseases. However, a comprehensive study showing a clear result of these three diseases was not found. Hence, the purpose of the present meta-analysis and systematic review is to determine the effect of exercise on balance in people with stroke, Parkinson, and multiple sclerosis. METHODS According to the PRISMA 2009 multi-step instructions, keywords related to the purpose of the research were browsed in the MeSH browser databases; IranDoc, MagIran, IranMedex, SID, ScienceDirect, Web of Science (WoS), ProQuest, Medline (PubMed), Scopus, and Google Scholar were searched to extract articles published in Persian and English language. The search process for retrieving the articles in the sources mentioned from January 01, 2000, to December 30, 2020, was done. The heterogeneity index of the studies was determined using the I2 test. Given the heterogeneity, the random-effects model was used to combine the articles and the results. RESULTS Initially, 7067 articles were found, but after removing duplicate and irrelevant articles, 96 clinical trials with a sample size of the intervention group of 1760 people were included in the study. As a result of the articles' composition, the mean balance score index after exercise in the intervention group showed a significant increase of 0.67 ± 0.12 of the unit (P˂0.01). The highest rate of increase in the balance score after the intervention was reported in patients with myelomeningocele with 1.66 ± 0.3 unit (P˂0.01). CONCLUSION Considering the positive effect of using exercise on increasing the balance in patients with stroke, Parkinson, and multiple sclerosis, it is recommended that health care providers implement a regular exercise program to improve the condition of these patients.
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Evans JD, Panebianco GP, Psycharakis S. Effect of water depth on muscle activity and stride duration when walking in the water at different speeds. J Sports Sci 2021; 39:1944-1951. [DOI: 10.1080/02640414.2021.1909810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- James David Evans
- Institute for Sport, Physical Education and Health Sciences, the University of Edinburgh, Edinburgh, UK
| | - Giulia P Panebianco
- Department of Electrical, Electronic and Information Engineering “Guglielmo Marconi”, University of Bologna, Bologna, Italy
| | - Stelios Psycharakis
- Institute for Sport, Physical Education and Health Sciences, the University of Edinburgh, Edinburgh, UK
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Vivodtzev I, Taylor JA. Cardiac, Autonomic, and Cardiometabolic Impact of Exercise Training in Spinal Cord Injury: A QUALITATIVE REVIEW. J Cardiopulm Rehabil Prev 2021; 41:6-12. [PMID: 33351539 PMCID: PMC7768813 DOI: 10.1097/hcr.0000000000000564] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Direct and indirect effects of spinal cord injury lead to important cardiovascular (CV) complications that are further increased by years of injury and the process of "accelerated aging." The present review examines the current evidence in the literature for the potential cardioprotective effect of exercise training in spinal cord injury. REVIEW METHODS PubMed and Web of Science databases were screened for original studies investigating the effect of exercise-based interventions on aerobic capacity, cardiac structure/function, autonomic function, CV function, and/or cardiometabolic markers. We compared the effects in individuals <40 yr with time since injury <10 yr with those in older individuals (≥40 yr) with longer time since injury (≥10 yr), reasoning that the two can be considered individuals with low versus high CV risk factors. SUMMARY Studies showed similar exercise effects in both groups (n = 31 in low CV risk factors vs n = 15 in high CV risk factors). The evidence does not support any effect of exercise training on autonomic function but does support an increased peripheral blood flow, improved left ventricular mass, higher peak cardiac output, greater lean body mass, better antioxidant capacity, and improved endothelial function. In addition, some evidence suggests that it can result in lower blood lipids, systemic inflammation (interleukin-6, tumor necrosis factor α, and C-reactive protein), and arterial stiffness. Training intensity, volume, and frequency were key factors determining CV gains. Future studies with larger sample sizes, well-matched groups of subjects, and randomized controlled designs will be needed to determine whether high-intensity hybrid forms of training result in greater CV gains.
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Affiliation(s)
- Isabelle Vivodtzev
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts (Drs Vivodtzev and Taylor); Cardiovascular Research Laboratory, Spaulding Rehabilitation Hospital, Cambridge, Massachusetts (Drs Vivodtzev and Taylor); and Sorbonne Université, INSERM, UMRS1158, Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France (Dr Vivodtzev)
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Marinho-Buzelli AR, Barela AMF, Craven BC, Masani K, Rouhani H, Popovic MR, Verrier MC. Effects of water immersion on gait initiation: part II of a case series after incomplete spinal cord injury. Spinal Cord Ser Cases 2019; 5:84. [PMID: 31700682 PMCID: PMC6821750 DOI: 10.1038/s41394-019-0231-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 09/24/2019] [Accepted: 09/28/2019] [Indexed: 11/09/2022] Open
Abstract
Study design Case series. Objectives This case series describes how the aquatic environment influences gait initiation in terms of the center of pressure (COP) excursion, impulses, trunk acceleration, and perceptions of participants with incomplete spinal cord injury (iSCI). Setting Tertiary Rehabilitation Hospital, Ontario, Canada. Methods Five individuals with iSCI (four cervical injuries/one thoracic injury, AIS D) participated in the study. Baseline clinical balance was evaluated by Berg Balance Scale and Mini-Balance Evaluation System Test. Participants initiated gait on a waterproof force plate and walked ~4 steps, in water and on land. COP trajectories during anticipatory and execution phases, impulses, and trunk acceleration parameters were investigated. Perceptions of walking in both environments were obtained using an interview. Results COP trajectory was prominently longer when individuals stepped forward. A decrease in velocity of COP was observed predominantly in the AP direction during stepping. Non-normalized vertical impulses decreased as the AP impulses increased, in water compared to land. Upper to lower trunk acceleration ratios showed how water resistance influenced the lower trunk acceleration. Most of participants reported that walking in water was challenging, but safer than on land. Conclusions Participants with higher balance function seemed to have more pronounced changes in anticipatory and execution phases' duration, length and velocity of COP. A faster anticipatory phase and a slower execution phase were observed in water than on land. Participants walked in water using a different trunk control strategy than on land and reported no fear of falling when walking in water versus land.
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Affiliation(s)
| | - Ana Maria Forti Barela
- Institute of Physical Activity and Sport Sciences, Cruzeiro do Sul University, Sao Paulo, Brazil
| | - B. Catharine Craven
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, ON Canada
- Department of Medicine & Rehabilitation Sciences Institute, University of Toronto, Toronto, ON Canada
| | - Kei Masani
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, ON Canada
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON Canada
| | - Hossein Rouhani
- Department of Mechanical Engineering, University of Alberta, Edmonton, AB Canada
| | - Milos R. Popovic
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, ON Canada
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON Canada
| | - Mary C. Verrier
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, ON Canada
- Department of Physical Therapy & Rehabilitation Sciences Institute, University of Toronto, Toronto, ON Canada
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Marinho-Buzelli AR, Zaluski AJ, Mansfield A, Bonnyman AM, Musselman KE. The use of aquatic therapy among rehabilitation professionals for individuals with spinal cord injury or disorder. J Spinal Cord Med 2019; 42:158-165. [PMID: 31573458 PMCID: PMC6783731 DOI: 10.1080/10790268.2019.1647935] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Context/Objective: Aquatic therapy (AT) has been used to enhance balance and mobility in people with disabilities; however, AT is reported to be underused among people with spinal cord injury or disorder (SCI/D). We aimed to understand the perceptions of AT use by physical therapists (PT), PT assistants (PTA) and kinesiologists (KIN) across Canada for clients with SCI/D. Design/Methods: Individual semi-structured interviews were completed with PT, PTA and KIN (phone or in-person). PT, PTA and KIN who had used AT with at least one client with SCI/D in the past year were eligible. Interview questions queried each participant's AT setting, AT approaches, and perceived facilitators and barriers to AT implementation for clients with SCI/D. Interviews were audio recorded and transcribed verbatim. Thematic analysis was used to identify themes and subthemes. Results: Six PT (2 male, 4 female), three PTA (female) and 1 KIN (female) participated. The following four themes were identified: (1) multi-system benefits from AT (e.g. from impairment to function, confidence and enjoyment); (2) application of AT (e.g. based on principles of the water); (3) perceived barriers to implementing AT (e.g. pool accessibility, client comorbidities); and (4) water as an enabler to function on land. Conclusions: The participants reported AT was a unique and versatile approach that benefits the multi-dimensional aspects of the health of individuals with SCI/D. They successfully integrated AT into their clinical practice despite the barriers faced by professionals and clients.
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Affiliation(s)
- Andresa R. Marinho-Buzelli
- KITE, Toronto Rehab-University Health Network, Toronto, Canada,Correspondence to: Andresa R. Marinho-Buzelli, KITE-Toronto Rehab-University Health Network, 520 Sutherland Drive, Toronto, ON, Canada, M4G 3V9.
| | | | - Avril Mansfield
- KITE, Toronto Rehab-University Health Network, Toronto, Canada,Department of Physical Therapy, University of Toronto, Toronto, Canada,Evaluative Clinical Sciences, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Canada
| | | | - Kristin E. Musselman
- KITE, Toronto Rehab-University Health Network, Toronto, Canada,School of Rehabilitation Science, University of Saskatchewan, Saskatoon, Canada,Department of Physical Therapy, University of Toronto, Toronto, Canada,Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
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Ogonowska-Slodownik A, Geigle PR, Gorman PH, Slodownik R, Scott WH. Aquatic, deep water peak VO 2 testing for individuals with spinal cord injury. J Spinal Cord Med 2019; 42:631-638. [PMID: 30632946 PMCID: PMC6758719 DOI: 10.1080/10790268.2018.1559494] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Objective: To determine the reliability of peak VO2 testing for individuals with spinal cord injury (SCI) in deep water and on land; and to examine the relationship between these two testing conditions. Design: Reliability study. Setting: Comprehensive rehabilitation center in Baltimore, MD, USA. Participants: 17 participants (13 men, 4 women) with motor complete and incomplete SCI. Participants were randomized into either aquatic or arm cycle ergometer first measurements. Intervention: Pilot study to assess peak VO2. Outcome measures: Peak VO2 measured with metabolic cart in supported deep water with the addition of Aquatrainer® connection, and on land with arm cycle ergometer. Two trials were conducted for each condition with 48 h separating each test. Results: Peak oxygen consumption reliability was statistically significant for both conditions, aquatic (r = 0.93, P < 0.001) and arm cycle ergometry (r = 0.96, P < 0.001). Additionally, aquatic and arm cycle peak VO2 correlation existed (r = 0.72, P < 0.001). For these 17 participants, lower extremity motor score influenced supported, deep water peak VO2, B = 0.57, P < 0.02, whereas age, sex, and weight did not impact deep water or ergometer values. Conclusion: Determining peak VO2 for individuals with SCI is highly reproducible for arm cycle ergometry and in deep water assessment. Additionally, aquatic, deep water peak VO2 testing is valid when compared to arm cycle ergometry. Although the peak VO2 relationship between deep water and arm cycle ergometry is high, variance in the two conditions does exist. Therefore, it is important to assess peak VO2 via the same exercise modality utilized in the treatment intervention.
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Affiliation(s)
| | - Paula R. Geigle
- Department of Research, University of Maryland Rehabilitation and Orthopaedic Institute, Baltimore, Maryland, USA,Correspondence to: Paula R. Geigle, Department of Research, University of Maryland Rehabilitation and Orthopaedic Institute, Baltimore, Maryland.
| | - Peter H. Gorman
- Department of Neurology, VA Maryland Healthcare System, Baltimore, Maryland, USA,Department of Neurology, University of Maryland Rehabilitation and Orthopaedic Institute, Baltimore, Maryland, USA,Department of Neurology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | | | - William H. Scott
- Department of Neurology, University of Maryland School of Medicine, Baltimore, Maryland, USA
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14
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Stone WJ, Stevens SL, Fuller DK, Caputo JL. Ambulation and physical function after eccentric resistance training in adults with incomplete spinal cord injury: A feasibility study. J Spinal Cord Med 2019; 42:526-533. [PMID: 29360000 PMCID: PMC6718937 DOI: 10.1080/10790268.2017.1417804] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Background: Strengthening the lower extremities has shown to positively influence walking mechanics in those with neurological deficiencies. Eccentric resistance training (ERT) is a potent stimulus for the development of muscular strength with low metabolic demand. Thereby, ERT may benefit those with incomplete spinal cord injuries (iSCI) seeking to improve ambulatory capacity. Design: This study was aimed to determine the effect of ERT on walking speed, mobility, independence, and at home function following iSCI. Methods: Individuals with longstanding iSCI trained twice a week for 12 weeks on an eccentrically biased recumbent stepper. Outcome measures: Walking speed (10 meter walk test; 10MWT), mobility (timed up and go), independence (Walking Index for Spinal Cord Injury; WISCI), and at home function (Spinal Cord Independence Measure; SCIM) were assessed at baseline, after 6 weeks, and after 12 weeks of ERT. Results: There were improvements in walking mobility (158.36 + 165.84 seconds to 56.31 + 42.42 seconds, P = .034, d = 0.62), speed (0.34 + 0.42 m/s to 0.43 + 0.50 m/s, P = .005, d = .23), and independence (8 + 7 to 13 + 7, P = .004, d = .73) after 12 weeks of ERT. At home function remained unchanged (22 + 10 to 24 + 10, P = .10, d = .12). Conclusions: Improving lower extremity strength translated to walking performance and independence in those with iSCI. Additionally, ERT may diminish therapist burden in programs designed to improve ambulatory capacity or strength in those with iSCI.
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Affiliation(s)
- Whitley J. Stone
- Nutrition and Kinesiology, University of Central Missouri, Warrensburg, Missouri, USA
| | - Sandra L. Stevens
- Health and Human Performance, Middle Tennessee State University, Murfreesboro, Tennessee, USA
| | - Dana K. Fuller
- Psychology, Middle Tennessee State University, Murfreesboro, Tennessee, USA
| | - Jennifer L. Caputo
- Health and Human Performance, Middle Tennessee State University, Murfreesboro, Tennessee, USA
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15
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Effects of water immersion on quasi-static standing exploring center of pressure sway and trunk acceleration: a case series after incomplete spinal cord injury. Spinal Cord Ser Cases 2019; 5:5. [PMID: 30675389 DOI: 10.1038/s41394-019-0147-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 11/24/2018] [Accepted: 01/02/2019] [Indexed: 11/08/2022] Open
Abstract
Study design This work is a case series. Objectives We assessed the influence of the aquatic environment on quasi-static posture by measuring center of pressure (COP) sway and trunk acceleration parameters after incomplete spinal cord injury (iSCI) in water and on land. Setting Tertiary Rehabilitation Hospital, Ontario, Canada. Methods Six adult participants with iSCI (4 cervical/2 thoracic injuries, AIS D) were enrolled. Baseline balance was assessed by the Berg Balance Scale and Mini-Balance Evaluation System Test. Participants stood on a waterproof force plate for one minute per trial on land and in water; participants completed testing with their eyes open or closed in random order over 10 trials. Individuals' perceptions of their standing balance were obtained. COP and trunk acceleration parameters were analyzed in the time-domain. Results COP sway and upper to lower trunk acceleration ratios in the AP direction increased in water, which was in contrast to standing on land in both visual conditions for 5/6 participants. Three participants (P1, P3 & P4) with greater sensorimotor deficits had larger COP sway in water with the eyes closed. Two (P1 & P4) of six participants reported more discomfort standing in water than standing on land. Conclusions Increased COP sway seemed to reflect the balance and sensorimotor impairments of the participants, especially when standing with eyes closed in water. Although most participants (4/6) perceived that they swayed more in water in contrast to on land, 5 out of 6 participants reported that water felt like a safer environment in which to stand.
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16
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Gorman PH, Scott W, VanHiel L, Tansey KE, Sweatman WM, Geigle PR. Comparison of peak oxygen consumption response to aquatic and robotic therapy in individuals with chronic motor incomplete spinal cord injury: a randomized controlled trial. Spinal Cord 2019; 57:471-481. [DOI: 10.1038/s41393-019-0239-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 12/14/2018] [Accepted: 01/02/2019] [Indexed: 01/17/2023]
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17
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Tranquille CA, Tacey JB, Walker VA, Nankervis KJ, Murray RC. International Survey of Equine Water Treadmills—Why, When, and How? J Equine Vet Sci 2018. [DOI: 10.1016/j.jevs.2018.05.220] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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18
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Stone WJ, Stevens SL, Fuller DK, Caputo JL. Strength and Step Activity After Eccentric Resistance Training in Those With Incomplete Spinal Cord Injuries. Top Spinal Cord Inj Rehabil 2018; 24:343-352. [PMID: 30459497 PMCID: PMC6241222 DOI: 10.1310/sci17-00052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background: Individuals with spinal cord injuries (SCIs) often experience general weakness in the lower extremities that undermines daily step activity. Objective: To investigate the efficacy of eccentrically biased resistance training on lower extremity strength and physical activity of individuals with spinal injuries. Methods: Individuals with long-standing incomplete SCIs (N = 11) capable of completing a 10-meter walk assessment were included. All participants who completed the familiarization period finished the training. Individuals trained two times per week for 12 weeks on a lower body eccentric resistance training machine. It was hypothesized that the outcome variables (eccentric strength, isometric strength, and daily step physical activity) would improve as a result of the training intervention. Results: Eccentric strength [F(1.27, 12.71) = 8.42, MSE = 1738.35, H-F p = .009] and isometric strength [F(1.97, 19.77) = 7.10, MSE = 11.29, H-F p = .005] improved as a result of the training while daily step activity remained unchanged [F(2.00, 18.00) = 2.73, MSE = 216,836.78, H-F p = .092]. Conclusions: Eccentric resistance training improves eccentric and isometric strength. These physiological adaptations may translate to improved gait mechanics, but further study is required to identify this potential crossover effect.
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Affiliation(s)
- Whitley J. Stone
- School of Nutrition, Kinesiology, and Psychological Science, University of Central Missouri, Warrensburg, Missouri
| | - Sandra L. Stevens
- Department of Health and Human Performance, Middle Tennessee State University, Murfreesboro, Tennessee
| | - Dana K. Fuller
- Department of Psychology, Middle Tennessee State University, Murfreesboro, Tennessee
| | - Jennifer L. Caputo
- Department of Health and Human Performance, Middle Tennessee State University, Murfreesboro, Tennessee
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19
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Arora T, Oates A, Lynd K, Musselman KE. Current state of balance assessment during transferring, sitting, standing and walking activities for the spinal cord injured population: A systematic review. J Spinal Cord Med 2018; 43:10-23. [PMID: 29869951 PMCID: PMC7006707 DOI: 10.1080/10790268.2018.1481692] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
CONTEXT Comprehensive balance measures with high clinical utility and sound psychometric properties are needed to inform the rehabilitation of individuals with spinal cord injury (SCI). OBJECTIVE To identify the balance measures used in the SCI population, and to evaluate their clinical utility, psychometric properties and comprehensiveness. METHODS Medline, PubMed, Embase, Scopus, Web of Science, and the Allied and Complementary Medicine Database were searched from the earliest record to October 19/16. Two researchers independently screened abstracts for articles including a balance measure and adults with SCI. Extracted data included participant characteristics and descriptions of balance measures. Quality was evaluated by considering study design, sampling method and adequacy of description of research participants. Clinical utility of all balance measures was evaluated. Comprehensiveness was evaluated using the modified Systems Framework for Postural Control. RESULTS 2820 abstracts were returned and 127 articles included. Thirty-one balance measures were identified; 11 evaluated a biomechanical construct and 20 were balance scales. All balance scales had high clinical utility. The Berg Balance Scale and Functional Reach Test were valid and reliable, while the mini-BESTest was the most comprehensive. CONCLUSION No single measure had high clinical utility, strong psychometric properties and comprehensiveness. The mini-BESTest and/or Activity-based Balance Level Evaluation may fill this gap with further testing of their psychometric properties.
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Affiliation(s)
- Tarun Arora
- Health Sciences, College of Medicine, University of Saskatchewan, Saskatoon, Canada,School of Rehabilitation Science, College of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Alison Oates
- College of Kinesiology, University of Saskatchewan, Saskatoon, Canada
| | - Kaylea Lynd
- School of Rehabilitation Science, College of Medicine, University of Saskatchewan, Saskatoon, Canada,Toronto Rehabilitation Institute-University Health Network, Toronto, Canada
| | - Kristin E. Musselman
- Health Sciences, College of Medicine, University of Saskatchewan, Saskatoon, Canada,School of Rehabilitation Science, College of Medicine, University of Saskatchewan, Saskatoon, Canada,Toronto Rehabilitation Institute-University Health Network, Toronto, Canada,Department of Physical Therapy, Faculty of Medicine, University of Toronto, Canada,Correspondence to: Kristin E. Musselman PT, PhD, SCI Mobility Lab, Lyndhurst Centre, Toronto Rehabilitation Institute-University Health Network, 520 Sutherland Drive, Toronto, ON, Canada, M4G 3V9; Ph: (416) 597-3422 x6190.
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20
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Ellapen TJ, Hammill HV, Swanepoel M, Strydom GL. The benefits of hydrotherapy to patients with spinal cord injuries. Afr J Disabil 2018; 7:450. [PMID: 29850439 PMCID: PMC5968875 DOI: 10.4102/ajod.v7i0.450] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 04/04/2018] [Indexed: 11/30/2022] Open
Abstract
Background Many patients with spinal cord injury (PWSCI) lead sedentary lifestyles, experiencing poor quality of life and medical challenges. PWSCI don’t like to participate in land-based-exercises because it’s tedious to perform the same exercises, decreasing their rehabilitative compliance and negatively impacting their well-being. An alternative exercise environment and exercises may alleviate boredom, enhancing compliance. Objectives Discuss the benefits of hydrotherapy to PWSCI concerning underwater gait-kinematics, thermoregulatory and cardiovascular responses and spasticity. Methodology A literature surveillance was conducted between 1998 and 2017, through the Crossref meta-database and Google Scholar, according to the PRISMA procedures. Key search words were water-therapy, aquatic-therapy, hydrotherapy, spinal cord injury, rehabilitation, human, kinematics, underwater gait, cardiorespiratory, thermoregulation and spasticity. The quality of each paper was evaluated using a modified Downs and Black Appraisal Scale. The participants were records pertaining to PWSCI and hydrotherapy. The outcomes of interest were: hydrotherapy interventions, the impact of hydrotherapy on gait-kinematics, thermoregulation during water submersion and cardiorespiratory function of PWSCI. Omitted records included: non-English publications from before 1998 or unrelated to hydrotherapy and PWSCI. The record screening admissibility was performed as follows: the title screen, the abstract screen and the full text screen. Results Literature search identified 1080 records. Upon application of the exclusion criteria, 92 titles, 29 abstracts and 17 full text records were eligible. Only 15 records were selected to be included in this clinical commentary. Evidence shows a paucity of randomised control trials (RCT) conducted in this field. Conclusion Hydrotherapy improves PWSCI underwater gait-kinematics, cardiorespiratory and thermoregulatory responses and reduces spasticity.
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Affiliation(s)
- Terry J Ellapen
- School of Biokinetics Recreation and Sport, Physical Activity Sport and Recreation (PhASRec), North-West University, South Africa
| | - Henriëtte V Hammill
- School of Biokinetics Recreation and Sport, Physical Activity Sport and Recreation (PhASRec), North-West University, South Africa
| | - Mariëtte Swanepoel
- School of Biokinetics Recreation and Sport, Physical Activity Sport and Recreation (PhASRec), North-West University, South Africa
| | - Gert L Strydom
- School of Biokinetics Recreation and Sport, Physical Activity Sport and Recreation (PhASRec), North-West University, South Africa
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21
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Tse CM, Chisholm AE, Lam T, Eng JJ. A systematic review of the effectiveness of task-specific rehabilitation interventions for improving independent sitting and standing function in spinal cord injury. J Spinal Cord Med 2018; 41:254-266. [PMID: 28738740 PMCID: PMC6055957 DOI: 10.1080/10790268.2017.1350340] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
CONTEXT Impaired balance function after a spinal cord injury (SCI) hinders performance of daily activities. OBJECTIVE To assess the evidence on the effectiveness of task-specific training on sitting and standing function in individuals with SCI across the continuum of care. METHODS A systematic search was conducted on literature published to June 2016 using people (acute or chronic SCI), task-specific interventions compared to conventional physical therapy, and outcome (sitting or standing balance function). The PEDro scale was used to investigate the susceptibility to bias and trial quality of the randomized controlled trials (RCTs). A standardized mean difference (SMD) was conducted to investigate the effect size for interventions with sitting or standing balance outcomes. RESULTS Nineteen articles were identified; three RCTs, two prospective controlled trials, one cross-over study, nine pre-post studies and four prospective cohort studies. RCT and cross-over studies were rated from 6 to 8 indicating good quality on the PEDro scale. The SMD of task-specific interventions in sitting compared to active and inactive (no training) control groups was -0.09 (95% CI: -0.663 to 0.488) and 0.39 (95% CI: -0.165 to 0.937) respectively, indicating that the addition of task-specific exercises did not affect sit and reach test performance significantly. Similarly, the addition of BWS training did not significantly affect BBS compared to conventional physical therapy -0.36 (95% CI: -0.840 to 0.113). Task-specific interventions reported in uncontrolled trials revealed positive effects on sitting and standing balance function. CONCLUSION Few RCT studies provided balance outcomes, and those that were evaluated indicate negligible effect sizes. Given the importance of balance control underpinning all aspects of daily activities, there is a need for further research to evaluate specific features of training interventions to improve both sitting and standing balance function in SCI.
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Affiliation(s)
- Cynthia M. Tse
- School of Kinesiology, University of British Columbia, Vancouver, BC, Canada,International Collaboration On Repair Discoveries, Vancouver Costal Health Research Institute, Vancouver, BC, Canada
| | - Amanda E. Chisholm
- School of Kinesiology, University of British Columbia, Vancouver, BC, Canada,International Collaboration On Repair Discoveries, Vancouver Costal Health Research Institute, Vancouver, BC, Canada
| | - Tania Lam
- School of Kinesiology, University of British Columbia, Vancouver, BC, Canada,International Collaboration On Repair Discoveries, Vancouver Costal Health Research Institute, Vancouver, BC, Canada,Correspondence to: Tania Lam, School of Kinesiology, University of British Columbia, 210–6081 University Blvd, Vancouver, BC, Canada, V6T 1Z1.
| | - Janice J. Eng
- International Collaboration On Repair Discoveries, Vancouver Costal Health Research Institute, Vancouver, BC, Canada,Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada,GF Strong Rehabilitation Center, Vancouver, BC, Canada
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22
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de Oliveira LAS, Martins CP, Horsczaruk CHR, da Silva DCL, Vasconcellos LF, Lopes AJ, Meira Mainenti MR, Rodrigues EDC. Partial Body Weight-Supported Treadmill Training in Spinocerebellar Ataxia. Rehabil Res Pract 2018; 2018:7172686. [PMID: 29535874 PMCID: PMC5817333 DOI: 10.1155/2018/7172686] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 11/17/2017] [Accepted: 12/12/2017] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND AND PURPOSE The motor impairments related to gait and balance have a huge impact on the life of individuals with spinocerebellar ataxia (SCA). Here, the aim was to assess the possibility of retraining gait, improving cardiopulmonary capacity, and challenging balance during gait in SCA using a partial body weight support (BWS) and a treadmill. Also, the effects of this training over functionality and quality of life were investigated. METHODS Eight SCA patients were engaged in the first stage of the study that focused on gait training and cardiovascular conditioning. From those, five took part in a second stage of the study centered on dynamic balance training during gait. The first and second stages lasted 8 and 10 weeks, respectively, both comprising sessions of 50 min (2 times per week). RESULTS The results showed that gait training using partial BWS significantly increased gait performance, treadmill inclination, duration of exercise, and cardiopulmonary capacity in individuals with SCA. After the second stage, balance improvements were also found. CONCLUSION Combining gait training and challenging tasks to the postural control system in SCA individuals is viable, well tolerated by patients with SCA, and resulted in changes in capacity for walking and balance.
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Affiliation(s)
- Laura Alice Santos de Oliveira
- Post-Graduation Program in Rehabilitation Sciences, Augusto Motta University Center (UNISUAM), Rio de Janeiro, RJ, Brazil
- School of Physiotherapy, Federal Institute of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Camilla Polonini Martins
- Post-Graduation Program in Rehabilitation Sciences, Augusto Motta University Center (UNISUAM), Rio de Janeiro, RJ, Brazil
| | | | - Débora Cristina Lima da Silva
- Post-Graduation Program in Rehabilitation Sciences, Augusto Motta University Center (UNISUAM), Rio de Janeiro, RJ, Brazil
| | - Luiz Felipe Vasconcellos
- Institute of Neurology Deolindo Couto, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Agnaldo José Lopes
- Post-Graduation Program in Rehabilitation Sciences, Augusto Motta University Center (UNISUAM), Rio de Janeiro, RJ, Brazil
| | | | - Erika de Carvalho Rodrigues
- Post-Graduation Program in Rehabilitation Sciences, Augusto Motta University Center (UNISUAM), Rio de Janeiro, RJ, Brazil
- D'Or Institute for Research and Education (IDOR), Rio de Janeiro, RJ, Brazil
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23
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Zamani H, Dadgoo M, Ebrahimi Takamjani I, Hajouj E, Jamshidi Khorneh AA. The Effects of Two Months Body Weight Supported Treadmill Training on Balance and Quality of Life of Patients With Incomplete Spinal Cord Injury. JOURNAL OF REHABILITATION 2018. [DOI: 10.21859/jrehab.18.4.7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Capelari TV, Borin JS, Grigol M, Saccani R, Zardo F, Cechetti F. EVALUATION OF MUSCLE STRENGTH IN MEDULLAR INJURY: A LITERATURE REVIEW. COLUNA/COLUMNA 2017. [DOI: 10.1590/s1808-185120171604179802] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective: To identify the tools used to evaluate muscle strength in subjects with spinal cord injury in both clinical practice and scientific research. Methods: Initially, the literature review was carried out to identify the tools used in scientific research. The search was conducted in the following databases: Virtual Health Library (VHL), Pedro, and PubMed. Studies published between 1990 and 2016 were considered and selected, depicting an evaluation of muscle strength as an endpoint or for characterization of the sample. Next, a survey was carried out with physiotherapists to identify the instruments used for evaluation in clinical practice, and the degree of satisfaction of professionals with respect to them. Results: 495 studies were found; 93 were included for qualitative evaluation. In the studies, we verified the use of manual muscle test with different graduation systems, isokinetic dynamometer, hand-held dynamometer, and manual dynamometer. In clinical practice, the manual muscle test using the motor score recommended by the American Spinal Cord Injury Association was the most used method, despite the limitations highlighted by the physiotherapists interviewed. Conclusion: In scientific research, there is great variation in the methods and tools used to evaluate muscle strength in individuals with spinal cord injury, differently from clinical practice. The tools available and currently used have important limitations, which were highlighted by the professionals interviewed. No instrument depicts direct relationship of muscle strength and functionality of the subject. There is no consensus as to the best method for assessing muscle strength in spinal cord injury, and new instruments are needed that are specific for use in this population.
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Affiliation(s)
| | | | - Melissa Grigol
- Pontifícia Universidade Católica do Rio Grande do Sul, Brazil
| | | | - Franciele Zardo
- Universidade Federal de Ciências da Saúde de Porto Alegre, Brazil
| | - Fernanda Cechetti
- Universidade Federal de Ciências da Saúde de Porto Alegre, Brazil; Universidade Federal de Ciências da Saúde de Porto Alegre, Brazil
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25
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van der Scheer JW, Hutchinson MJ, Paulson T, Martin Ginis KA, Goosey-Tolfrey VL. Reliability and Validity of Subjective Measures of Aerobic Intensity in Adults With Spinal Cord Injury: A Systematic Review. PM R 2017; 10:194-207. [DOI: 10.1016/j.pmrj.2017.08.440] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 08/03/2017] [Accepted: 08/14/2017] [Indexed: 01/23/2023]
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26
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Recio AC, Stiens SA, Kubrova E. Aquatic-Based Therapy in Spinal Cord Injury Rehabilitation: Effective Yet Underutilized. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2017. [DOI: 10.1007/s40141-017-0158-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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27
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Lee ME, Jo GY, Do HK, Choi HE, Kim WJ. Efficacy of Aquatic Treadmill Training on Gait Symmetry and Balance in Subacute Stroke Patients. Ann Rehabil Med 2017; 41:376-386. [PMID: 28758074 PMCID: PMC5532342 DOI: 10.5535/arm.2017.41.3.376] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 09/09/2016] [Indexed: 11/24/2022] Open
Abstract
Objective To determine the efficacy of aquatic treadmill training (ATT) as a new modality for stroke rehabilitation, by assessing changes in gait symmetry, balance function, and subjective balance confidence for the paretic and non-paretic leg in stroke patients. Methods Twenty-one subacute stroke patients participated in 15 intervention sessions of aquatic treadmill training. The Comfortable 10-Meter Walk Test (CWT), spatiotemporal gait parameters, Berg Balance Scale (BBS), and Activities-specific Balance Confidence scale (ABC) were assessed pre- and post-interventions. Results From pre- to post-intervention, statistically significant improvements were observed in the CWT (0.471±0.21 to 0.558±0.23, p<0.001), BBS (39.66±8.63 to 43.80±5.21, p<0.001), and ABC (38.39±13.46 to 46.93±12.32, p<0.001). The step-length symmetry (1.017±0.25 to 0.990±0.19, p=0.720) and overall temporal symmetry (1.404±0.36 to 1.314±0.34, p=0.218) showed improvement without statistical significance. Conclusion ATT improves the functional aspects of gait, including CWT, BBS and ABC, and spatiotemporal gait symmetry, though without statistical significance. Further studies are required to examine and compare the potential benefits of ATT as a new modality for stroke therapy, with other modalities.
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Affiliation(s)
- Mi Eun Lee
- Department of Physical Medicine and Rehabilitation, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Geun Yeol Jo
- Department of Physical Medicine and Rehabilitation, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Hwan Kwon Do
- Department of Physical Medicine and Rehabilitation, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Hee Eun Choi
- Department of Physical Medicine and Rehabilitation, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Woo Jin Kim
- Department of Physical Medicine and Rehabilitation, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
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28
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Lee SA, Kim MK. Comparison therapeutic efficacy of underwater and overground walking training on the healthy subjects balancing ability. J Phys Ther Sci 2017; 29:924-926. [PMID: 28603373 PMCID: PMC5462700 DOI: 10.1589/jpts.29.924] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 02/20/2017] [Indexed: 11/24/2022] Open
Abstract
[Purpose] This study's working hypothesis is that underwater walking training is beneficial for healthy subjects balance. [Subjects and Methods] Forty eight subjects (Underwater walking group=25, Overground walking group=23) completed the experiment. Healthy subjects with no orthopedic history of lower extremity injuries were recruited. Gait training is performed using the underwater treadmill consisted of 30-minute walking sessions, five times per week for four weeks. [Results] After the intervention, the medial-lateral and anterior-posterior balance indices increased significantly. [Conclusion] This study conducted underwater walking training on the healthy subjects, with positive effects on balancing ability.
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Affiliation(s)
- Si-A Lee
- Department of Physical Therapy, College of Rehabilitation Sciences, Daegu University, Republic of Korea
| | - Myoung-Kwon Kim
- Department of Physical Therapy, College of Rehabilitation Sciences, Daegu University, Republic of Korea
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Gandhi P, Chan K, Verrier MC, Pakosh M, Musselman KE. Training to Improve Walking after Pediatric Spinal Cord Injury: A Systematic Review of Parameters and Walking Outcomes. J Neurotrauma 2017; 34:1713-1725. [PMID: 27869534 DOI: 10.1089/neu.2016.4501] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Walking or locomotor training is often initiated following pediatric spinal cord injury (SCI). There is no synthesis of the literature on interventions targeting walking for pediatric SCI, although this would assist future clinical trials and interventions. To address this need, we completed a systematic review to summarize the who, what, when, and how of walking interventions in children with SCI. Participant characteristics, training parameters, and walking outcomes with training in pediatric SCI were identified and compared with training parameters and outcomes in adults with SCI. The PubMed, Medline, AMED, Embase, PsycInfo, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and CINAHL databases were searched for studies that included participants aged 1-17 years with a SCI acquired post-birth, physical interventions, and pre- and post-training walking measures. Two researchers evaluated each study's risk of bias using a domain-based approach. Training parameters and walking outcomes were extracted. Total training duration (duration × frequency × number of weeks) was calculated. Thirteen pediatric studies (n = 43 children) were included; all but one were case series/reports. Risk of bias was high in the pediatric studies. A 2012 adult review was updated (11 studies added). As with adults, the training durations, frequencies, and modes used with the children varied; however, overground walking practice was included in 10/13 pediatric studies. Improvements in walking capacity, speed, and distance were comparable between children and adults. There was a trend for greater gains with greater total training durations. There is a paucity of high-quality research examining interventions targeting walking after pediatric SCI; however, intensive training, including practice overground, results in notable improvements.
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Affiliation(s)
- Payal Gandhi
- 1 Toronto Rehabilitation Institute-University Health Network , Toronto, Ontario, Canada
| | - Katherine Chan
- 1 Toronto Rehabilitation Institute-University Health Network , Toronto, Ontario, Canada
| | - Mary C Verrier
- 1 Toronto Rehabilitation Institute-University Health Network , Toronto, Ontario, Canada
- 2 Department of Physical Therapy, Rehabilitation Sciences Institute, University of Toronto , Toronto, Ontario, Canada
| | - Maureen Pakosh
- 1 Toronto Rehabilitation Institute-University Health Network , Toronto, Ontario, Canada
| | - Kristin E Musselman
- 1 Toronto Rehabilitation Institute-University Health Network , Toronto, Ontario, Canada
- 2 Department of Physical Therapy, Rehabilitation Sciences Institute, University of Toronto , Toronto, Ontario, Canada
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Li C, Khoo S, Adnan A. Effects of aquatic exercise on physical function and fitness among people with spinal cord injury: A systematic review. Medicine (Baltimore) 2017; 96:e6328. [PMID: 28296754 PMCID: PMC5369909 DOI: 10.1097/md.0000000000006328] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE The aim of this review is to synthesize the evidence on the effects of aquatic exercise interventions on physical function and fitness among people with spinal cord injury. DATA SOURCE Six major databases were searched from inception till June 2015: MEDLINE, CINAHL, EMBASE, PsychInfo, SPORTDiscus, and Cochrane Center Register of Controlled Trials. STUDY APPRAISAL AND SYNTHESIS METHODS Two reviewers independently rated methodological quality using the modified Downs and Black Scale and extracted and synthesized key findings (i.e., participant characteristics, study design, physical function and fitness outcomes, and adverse events). RESULTS Eight of 276 studies met the inclusion criteria, of which none showed high research quality. Four studies assessed physical function outcomes and 4 studies evaluated aerobic fitness as outcome measures. Significant improvements on these 2 outcomes were generally found. Other physical or fitness outcomes including body composition, muscular strength, and balance were rarely reported. CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS There is weak evidence supporting aquatic exercise training to improve physical function and aerobic fitness among adults with spinal cord injury. Suggestions for future research include reporting details of exercise interventions, evaluating other physical or fitness outcomes, and improving methodological quality.
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Affiliation(s)
- Chunxiao Li
- Department of Health and Physical Education, The Education University of Hong Kong, Hong Kong, China
| | - Selina Khoo
- Sports Centre, University of Malaya, Kuala Lumpur, Malaysia
| | - Athirah Adnan
- Sports Centre, University of Malaya, Kuala Lumpur, Malaysia
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Kim MK, Lee SA. Underwater treadmill training and gait ability in the normal adult. J Phys Ther Sci 2017; 29:67-69. [PMID: 28210041 PMCID: PMC5300807 DOI: 10.1589/jpts.29.67] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 09/26/2016] [Indexed: 11/28/2022] Open
Abstract
[Purpose] Our working hypothesis is that underwater treadmill training improves normal
people’s gait ability. [Subjects and Methods] Twenty-five healthy subjects with no
orthopedic history of lower extremity were recruited. Gait training is performed using an
underwater treadmill (HydroTrack® Underwater Treadmill System, Conray, Inc.,
Phoenix, AZ, USA), for twenty minutes per session, five sessions a week for four weeks.
The water temperature was set at about 33 °C and the depth was fixed to reach between the
subjects’ xiphoid process and the navel. [Results] After the intervention, step length,
velocity, and cadence increased significantly. [Conclusion] This study conducted
underwater treadmill training with normal people, with positive effects on gait
ability.
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Affiliation(s)
- Myoung-Kwon Kim
- Department of Physical Therapy, College of Rehabilitation Sciences, Daegu University, Republic of Korea
| | - Si-A Lee
- Department of Physical Therapy, College of Rehabilitation Sciences, Daegu University, Republic of Korea
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Petrosyan HA, Alessi V, Hunanyan AS, Sisto SA, Arvanian VL. Spinal electro-magnetic stimulation combined with transgene delivery of neurotrophin NT-3 and exercise: novel combination therapy for spinal contusion injury. J Neurophysiol 2015; 114:2923-40. [PMID: 26424579 DOI: 10.1152/jn.00480.2015] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Accepted: 09/29/2015] [Indexed: 12/12/2022] Open
Abstract
Our recent terminal experiments revealed that administration of a single train of repetitive spinal electromagnetic stimulation (sEMS; 35 min) enhanced synaptic plasticity in spinal circuitry following lateral hemisection spinal cord injury. In the current study, we have examined effects of repetitive sEMS applied as a single train and chronically (5 wk, every other day) following thoracic T10 contusion. Chronic studies involved examination of systematic sEMS administration alone and combined with exercise training and transgene delivery of neurotrophin [adeno-associated virus 10-neurotrophin 3 (AAV10-NT3)]. Electrophysiological intracellular/extracellular recordings, immunohistochemistry, behavioral testing, and anatomical tracing were performed to assess effects of treatments. We found that administration of a single sEMS train induced transient facilitation of transmission through preserved lateral white matter to motoneurons and hindlimb muscles in chronically contused rats with effects lasting for at least 2 h. These physiological changes associated with increased immunoreactivity of GluR1 and GluR2/3 glutamate receptors in lumbar neurons. Systematic administration of sEMS alone for 5 wk, however, was unable to induce cumulative improvements of transmission in spinomuscular circuitry or improve impaired motor function following thoracic contusion. Encouragingly, chronic administration of sEMS, followed by exercise training (running in an exercise ball and swimming), induced the following: 1) sustained strengthening of transmission to lumbar motoneurons and hindlimb muscles, 2) better retrograde transport of anatomical tracer, and 3) improved locomotor function. Greatest improvements were seen in the group that received exercise combined with sEMS and AAV-NT3.
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Affiliation(s)
- Hayk A Petrosyan
- Northport Veterans Affairs Medical Center, Northport, New York; Department of Neurobiology and Behavior, Stony Brook University, Stony Brook, New York; and
| | - Valentina Alessi
- Northport Veterans Affairs Medical Center, Northport, New York; Department of Neurobiology and Behavior, Stony Brook University, Stony Brook, New York; and
| | | | - Sue A Sisto
- Department of Physical Therapy, Division of Rehabilitation Sciences, Stony Brook University, Stony Brook, New York
| | - Victor L Arvanian
- Northport Veterans Affairs Medical Center, Northport, New York; Department of Neurobiology and Behavior, Stony Brook University, Stony Brook, New York; and
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