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DeShazo JM, Kouwijzer I, de Groot S, Post MWM, Valent LJM, van Leeuwen CMC, Wen H, Cowan RE. Effect of Training for an Athletic Challenge on Illness Cognition in Individuals with Chronic Disability: A Prospective Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 21:58. [PMID: 38248523 PMCID: PMC10815898 DOI: 10.3390/ijerph21010058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 12/19/2023] [Accepted: 12/25/2023] [Indexed: 01/23/2024]
Abstract
Illness cognitions (IC) influence how a patient adapts to a chronic disease. The aim was (1) to determine if training for a handcycling mountain time trial (HandbikeBattle) improves IC and (2) to identify factors associated with IC change scores. Persons with a chronic disability (N = 220; including N = 151 with spinal cord disorder) trained 5 months and participated in the time trial. The IC Questionnaire measured helplessness, acceptance, perceived benefits and was assessed before training (T1), after training (T2), and four months after the event (T3). Age, sex, body mass index (BMI), time since injury (TSI), disability characteristics, self-efficacy, mental health (MH) and musculoskeletal pain were obtained at T1. Multilevel regression analyses showed that helplessness decreased (from 11.96 to 11.28, p < 0.01) and perceived benefits increased (from 16.91 to 17.58, p < 0.01) from T1 to T2. For helplessness this decrease persisted during follow-up (11.16 at T3). Changes in helplessness were associated with self-efficacy (p = 0.02), MH (p = 0.02) and lesion completeness (p = 0.02), and were independent of disability type (p = 0.66), lesion level (p = 0.30) and demographics such as sex (p = 0.29) and age (p = 0.67). Training with peers may improve helplessness and perceived benefits in individuals with a chronic disability. Especially individuals with MH problems might benefit from training for an athletic challenge with peers to improve illness cognitions, and ultimately, quality of life.
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Affiliation(s)
- Joy M. DeShazo
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, AL 35294, USA; (J.M.D.); (H.W.); (R.E.C.)
| | - Ingrid Kouwijzer
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, 1081 BT Amsterdam, The Netherlands;
- Amsterdam Rehabilitation Research Center|Reade, 1054 HW Amsterdam, The Netherlands
| | - Sonja de Groot
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, 1081 BT Amsterdam, The Netherlands;
- Amsterdam Rehabilitation Research Center|Reade, 1054 HW Amsterdam, The Netherlands
| | - Marcel W. M. Post
- Center of Excellence for Rehabilitation Medicine, UMCU Brain Center, University Medical Center Utrecht and De Hoogstraat Rehabilitation, 3583 TM Utrecht, The Netherlands; (M.W.M.P.); (C.M.C.v.L.)
- Center for Rehabilitation, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands
| | - Linda J. M. Valent
- Research and Development, Heliomare Rehabilitation Center, 1949 EC Wijk aan Zee, The Netherlands;
| | - Christel M. C. van Leeuwen
- Center of Excellence for Rehabilitation Medicine, UMCU Brain Center, University Medical Center Utrecht and De Hoogstraat Rehabilitation, 3583 TM Utrecht, The Netherlands; (M.W.M.P.); (C.M.C.v.L.)
| | - Huacong Wen
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, AL 35294, USA; (J.M.D.); (H.W.); (R.E.C.)
| | - Rachel E. Cowan
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, AL 35294, USA; (J.M.D.); (H.W.); (R.E.C.)
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Hodgkiss DD, Bhangu GS, Lunny C, Jutzeler CR, Chiou SY, Walter M, Lucas SJE, Krassioukov AV, Nightingale TE. Exercise and aerobic capacity in individuals with spinal cord injury: A systematic review with meta-analysis and meta-regression. PLoS Med 2023; 20:e1004082. [PMID: 38011304 PMCID: PMC10712898 DOI: 10.1371/journal.pmed.1004082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 12/11/2023] [Accepted: 10/30/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND A low level of cardiorespiratory fitness [CRF; defined as peak oxygen uptake ([Formula: see text]O2peak) or peak power output (PPO)] is a widely reported consequence of spinal cord injury (SCI) and a major risk factor associated with chronic disease. However, CRF can be modified by exercise. This systematic review with meta-analysis and meta-regression aimed to assess whether certain SCI characteristics and/or specific exercise considerations are moderators of changes in CRF. METHODS AND FINDINGS Databases (MEDLINE, EMBASE, CENTRAL, and Web of Science) were searched from inception to March 2023. A primary meta-analysis was conducted including randomised controlled trials (RCTs; exercise interventions lasting >2 weeks relative to control groups). A secondary meta-analysis pooled independent exercise interventions >2 weeks from longitudinal pre-post and RCT studies to explore whether subgroup differences in injury characteristics and/or exercise intervention parameters explained CRF changes. Further analyses included cohort, cross-sectional, and observational study designs. Outcome measures of interest were absolute (A[Formula: see text]O2peak) or relative [Formula: see text]O2peak (R[Formula: see text]O2peak), and/or PPO. Bias/quality was assessed via The Cochrane Risk of Bias 2 and the National Institute of Health Quality Assessment Tools. Certainty of the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Random effects models were used in all meta-analyses and meta-regressions. Of 21,020 identified records, 120 studies comprising 29 RCTs, 67 pre-post studies, 11 cohort, 7 cross-sectional, and 6 observational studies were included. The primary meta-analysis revealed significant improvements in A[Formula: see text]O2peak [0.16 (0.07, 0.25) L/min], R[Formula: see text]O2peak [2.9 (1.8, 3.9) mL/kg/min], and PPO [9 (5, 14) W] with exercise, relative to controls (p < 0.001). Ninety-six studies (117 independent exercise interventions comprising 1,331 adults with SCI) were included in the secondary, pooled meta-analysis which demonstrated significant increases in A[Formula: see text]O2peak [0.22 (0.17, 0.26) L/min], R[Formula: see text]O2peak [2.8 (2.2, 3.3) mL/kg/min], and PPO [11 (9, 13) W] (p < 0.001) following exercise interventions. There were subgroup differences for R[Formula: see text]O2peak based on exercise modality (p = 0.002) and intervention length (p = 0.01), but there were no differences for A[Formula: see text]O2peak. There were subgroup differences (p ≤ 0.018) for PPO based on time since injury, neurological level of injury, exercise modality, and frequency. The meta-regression found that studies with a higher mean age of participants were associated with smaller changes in A[Formula: see text]O2peak and R[Formula: see text]O2peak (p < 0.10). GRADE indicated a moderate level of certainty in the estimated effect for R[Formula: see text]O2peak, but low levels for A[Formula: see text]O2peak and PPO. This review may be limited by the small number of RCTs, which prevented a subgroup analysis within this specific study design. CONCLUSIONS Our primary meta-analysis confirms that performing exercise >2 weeks results in significant improvements to A[Formula: see text]O2peak, R[Formula: see text]O2peak, and PPO in individuals with SCI. The pooled meta-analysis subgroup comparisons identified that exercise interventions lasting up to 12 weeks yield the greatest change in R[Formula: see text]O2peak. Upper-body aerobic exercise and resistance training also appear the most effective at improving R[Formula: see text]O2peak and PPO. Furthermore, acutely injured, individuals with paraplegia, exercising for ≥3 sessions/week will likely experience the greatest change in PPO. Ageing seemingly diminishes the adaptive CRF responses to exercise training in individuals with SCI. REGISTRATION PROSPERO: CRD42018104342.
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Affiliation(s)
- Daniel D. Hodgkiss
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Gurjeet S. Bhangu
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, Canada
- MD Undergraduate Program, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Carole Lunny
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, and University of British Columbia, Vancouver, Canada
| | - Catherine R. Jutzeler
- Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
- Schulthess Clinic, Zurich, Switzerland
| | - Shin-Yi Chiou
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
- Centre for Human Brain Health, University of Birmingham, Birmingham, United Kingdom
- MRC Versus Arthritis Centre for Musculoskeletal Ageing Research, University of Birmingham, Birmingham, United Kingdom
- Centre for Trauma Science Research, University of Birmingham, Birmingham, United Kingdom
| | - Matthias Walter
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, Canada
- Department of Urology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Samuel J. E. Lucas
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
- Centre for Human Brain Health, University of Birmingham, Birmingham, United Kingdom
| | - Andrei V. Krassioukov
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, Canada
- Department of Medicine, Division of Physical Medicine and Rehabilitation, University of British Columbia, Vancouver, Canada
- GF Strong Rehabilitation Centre, Vancouver Coastal Health, Vancouver, Canada
| | - Tom E. Nightingale
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, Canada
- Centre for Trauma Science Research, University of Birmingham, Birmingham, United Kingdom
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Shackleton C, Swartz L, Skowno P, Evans R, West S, Albertus Y, Derman W, Bantjes J. A qualitative study of the perceived benefits of participating in a spinal cord rehabilitation intervention in a low-middle income country. Disabil Rehabil 2023:1-7. [PMID: 37789608 DOI: 10.1080/09638288.2023.2265816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 09/15/2023] [Indexed: 10/05/2023]
Abstract
PURPOSE Improving quality of life (QoL) is a major goal of rehabilitation following spinal cord injury (SCI). However, people with disabilities in resource constrained contexts have limited access to rehabilitation and poorer health outcomes, including QoL. There is a paucity of qualitative research on the experiences of persons with SCI involved in rehabilitation programmes in low-middle income countries. This study aimed to assess participants' perceptions of the benefits of a 24-week SCI rehabilitation programme delivered as part of a pilot randomized controlled trial (RCT) in South Africa. MATERIALS AND METHODS Sixteen participants, with chronic motor-incomplete tetraplegia, were enrolled in a two-arm pilot RCT involving robotic locomotor training, a novel technology, and standard activity-based training (Pan African Clinical Trial Registry (PACTR201608001647143)). Data were collected via in-depth interviews and analysed using thematic analysis. RESULTS Participants described several improvements in QoL, including enhanced functional independence; reduced secondary complications; and improved psychosocial and emotional well-being. CONCLUSIONS The holistic approach to rehabilitation calls for the involvement of individuals' views about what matters to them to inform clinical practice and to highlight the role that physical activity and the perceived successes play in shaping the lived experiences after SCI. TRIAL REGISTRATION Pan African Clinical Trial Registry (PACTR201608001647143), registration date (21st May 2016), study start date (30th Nov 2016)https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=1647.
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Affiliation(s)
- Claire Shackleton
- Physical Activity, Lifestyle and Sport Research Centre (HPALS), Department of Human Biology, University of Cape Town, Cape Town, South Africa
| | - Leslie Swartz
- Department of Psychology, Stellenbosch University, Western Cape, South Africa
| | - Philippa Skowno
- Physical Activity, Lifestyle and Sport Research Centre (HPALS), Department of Human Biology, University of Cape Town, Cape Town, South Africa
| | - Robert Evans
- Physical Activity, Lifestyle and Sport Research Centre (HPALS), Department of Human Biology, University of Cape Town, Cape Town, South Africa
| | - Sacha West
- Department of Sport Management, Cape Peninsula University of Technology, Cape Town, Western Cape, South Africa
| | - Yumna Albertus
- Physical Activity, Lifestyle and Sport Research Centre (HPALS), Department of Human Biology, University of Cape Town, Cape Town, South Africa
| | - Wayne Derman
- Faculty of Medicine and Health Sciences, Institute of Sport and Exercise Medicine, Stellenbosch University, Cape Town, Western Cape, South Africa
- IOC Research Center, Cape Town, South Africa
| | - Jason Bantjes
- Mental Health, Alcohol, Substance Use and Tobacco (MAST) Research Unit, South African Medical Research Council, Cape Town, South Africa
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
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Willig RM, Garcia I, da Silva NSL, Corredeira R, Carvalho J. The effectiveness of community-based upper body exercise programs in persons with chronic paraplegia and manual wheelchair users: A systematic review. J Spinal Cord Med 2022; 45:24-32. [PMID: 32644024 PMCID: PMC8890546 DOI: 10.1080/10790268.2020.1782608] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Context: Physical activity has been beneficial to health, functional independence and quality of life in individuals with spinal cord injury. However, there is no consensus concerning the effects of community-based upper-body exercise for people with paraplegia who use a manual wheelchair.Objective: Conduct a systematic review of evidence of upper-body exercise effects able to be developed in a community-setting, on both functional independence and quality of life, for individuals with chronic paraplegia who use a manual wheelchair.Methods: PubMed, Scopus, Ebsco, SportDiscus and Web of Science databases were browsed, searching for studies that combined words as paraplegia, exercise, functional independence and quality of life and their synonyms, published from January/1998 to December/2018 in English. PEDro scale and the Cochrane tool analyzed methodological quality and risk of bias, respectively.Results: Four studies were selected out of 4004. Studies conducted aerobic arm-ergometer and resistance training predominantly at home. Upper-limb functionality and wheelchair propulsion assessed functional independence, but only the first presented positive effects after resistance training. Resistance and aerobic arm-ergometer training seemed to improve health-related and subjective quality of life.Conclusion: Studies have shown low methodological quality and high risk of bias. Aerobic arm-ergometer and resistance training were the most upper-body exercises used. Resistance training improved functional independence while both types of exercise induced positive effects on quality of life. Future studies with uniform and high-quality methodology should be conducted with exercise in community-dwelling people with paraplegia who use a manual wheelchair.
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Affiliation(s)
- Renata Matheus Willig
- Research Centre in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport Science, University of Porto, Porto, Portugal,Correspondence to: Renata Matheus Willig, Research Centre in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport Science, University of Porto, Rua Dr. Pláciso Costa, 91, Porto4200, Portugal; Ph: 351225074763; 351225500687.
| | - Ivo Garcia
- Faculty of Sport Science, University of Porto, Porto, Portugal
| | - Nádia Souza Lima da Silva
- Post-Graduate Program in Exercise Science and Sports, University of Rio de Janeiro State, Rio de Janeiro, Brazil
| | - Rui Corredeira
- Research Centre in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport Science, University of Porto, Porto, Portugal
| | - Joana Carvalho
- Research Centre in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport Science, University of Porto, Porto, Portugal
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Neto FR, Gomes Costa RR, Dorneles JR, Gonçalves CW, Veloso JHCL, Carregaro RL. Handgrip Strength Cutoff Points for Functional Independence and Wheelchair Ability in Men With Spinal Cord Injury. Top Spinal Cord Inj Rehabil 2021; 27:60-69. [PMID: 34456547 DOI: 10.46292/sci20-00040] [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: 11/19/2022]
Abstract
Objectives To determine optimal handgrip strength (HGS) cutoff points for greater functional independence and wheelchair skills in men with spinal cord injury (SCI), and to establish predictive equations for functional independence and wheelchair ability in men with SCI, based on demographic characteristics, HGS, and functionality. Methods In this cross-sectional study conducted at a rehabilitation hospital, 54 men with SCI were recruited and stratified into high and low paraplegia groups. All participants performed a maximum HGS test to determine cutoff points for the Spinal Cord Independence Measure (SCIM-III) and Adapted Manual Wheelchair Circuit (AMWC). The primary outcomes were the SCIM-III, AMWC, and HGS. Demographic characteristics obtained from participants' electronic medical records were the secondary outcomes, used as predictor variables of functional independence. Results The SCIM-III scale, performance score, and 3-minute overground wheeling test presented significant regression equations (R = 0.45, R = 0.69, and R = 0.72). The HGS showed a cutoff point of 102.5 kilogram force (kgf) to achieve a score of 70 on the SCIM-III and a 3-minute overground wheeling distance of 270 m. The HGS cutoff point to obtain a performance score of 23.7 seconds was 93.0 kgf. Conclusion The HGS was a significant predictor for the SCIM-III score, AMWC performance score, and 3-minute overground wheeling test. Three significant predictive equations were established based on HGS. The cutoff points could be adopted as parameters for optimal functional independence and wheelchair skills.
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Affiliation(s)
| | | | | | | | | | - Rodrigo L Carregaro
- College of Physical Education, Universidade de Brasilia (UnB), Brasilia, Brazil.,School of Physical Therapy, Universidade de Brasilia (UnB), Brasilia, Brazil
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Neto FR, Dorneles JR, Carneiro Leão Veloso JH, Gonçalves CW, Gomes Costa RR. Peak Torque Prediction Using Handgrip and Strength Predictors in Men and Women With Motor Complete Spinal Cord Injury. Top Spinal Cord Inj Rehabil 2021; 27:49-59. [PMID: 34456546 PMCID: PMC8370701 DOI: 10.46292/sci20-00027] [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: 11/19/2022]
Abstract
OBJECTIVES To establish predictive equations for peak torque of muscle groups with totally and partially preserved innervation in individuals with motor complete spinal cord injury (SCI), based on hand dynamometry and strength predictor variables. METHODS The cross-sectional study conducted at a rehabilitation hospital consecutively recruited 108 men and women with SCI. All participants performed maximum peak torque tests for shoulder abduction/adduction (isokinetic), trunk flexion/extension (isometric), and handgrip strength testing (hand dynamometer) to establish predictive peak torque equations. The primary outcomes were peak torque variables. Handgrip strength, age, injury level, time since injury, age at injury, body mass, height, body mass index, and physical activity level were the secondary outcomes used as strength predictor variables. RESULTS Handgrip strength was a predictor variable for shoulder abduction/adduction peak torque. The best predictive models for shoulder abduction/adduction peak torque exhibited R 2 = 0.57 and R 2 = 0.60, respectively (p ≤ .05). Injury level showed the highest significant predictive capacity for trunk flexion/extension peak torque models (R 2 = 0.38 and R 2 = 0.29; p ≤ .05). CONCLUSION Shoulder abduction/adduction peak torque predictive equations may be an alternative for use in an accessible strength tool (hand dynamometry) to evaluate training and rehabilitation programs. Trunk flexion/extension peak torque equations exhibited moderate correlations and high standard error of the estimates and should be used with caution.
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Harman KA, DeVeau KM, Squair JW, West CR, Krassioukov AV, Magnuson DSK. Effects of early exercise training on the severity of autonomic dysreflexia following incomplete spinal cord injury in rodents. Physiol Rep 2021; 9:e14969. [PMID: 34337884 PMCID: PMC8327165 DOI: 10.14814/phy2.14969] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 06/16/2021] [Accepted: 06/17/2021] [Indexed: 12/04/2022] Open
Abstract
Hemodynamic instability and cardiovascular (CV) dysfunction are hallmarks of patients living with cervical and high thoracic spinal cord injuries (SCI). Individuals experience bouts of autonomic dysreflexia (AD) and persistent hypotension which hamper the activities of daily living. Despite the widespread use of exercise training to improve health and CV function after SCI, little is known about how different training modalities impact hemodynamic stability and severity of AD in a model of incomplete SCI. In this study, we used implantable telemetry devices to assess animals with T2 contusions following 3.5 weeks of exercise training initiated 8 days post-injury: passive hindlimb cycling (T2-CYC, n = 5) or active forelimb swimming (T2-SW, n = 6). Uninjured and non-exercised SCI control groups were also included (CON, n = 6; T2-CON, n = 7; T10-CON, n = 6). Five weeks post-injury, both T2-CON and T2-CYC presented with resting hypotension compared to uninjured CON and T10-CON groups; no differences were noted in resting blood pressure in T2-SW versus CON and T10-CON. Furthermore, pressor responses to colorectal distention (AD) were larger in all T2-injured groups compared to T10-CON, and were not attenuated by either form of exercise training. Interestingly, when T2-injured animals were re-stratified based on terminal BBB scores (regardless of training group), animals with limited hindlimb recovery (T2-LOW, n = 7) had more severe AD responses. Our results suggest that the spontaneous recovery of locomotor and autonomic function after severe but incomplete T2 SCI also influences the severity of AD, and that short periods (3.5 weeks) of passive hindlimb cycling or active forelimb swimming are ineffective in this model.
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Affiliation(s)
- Kathryn A. Harman
- Department of Health & Sport SciencesUniversity of LouisvilleLouisvilleKYUSA
- Kentucky Spinal Cord Injury Research CenterUniversity of LouisvilleLouisvilleKYUSA
| | - Kathryn M. DeVeau
- Department of Anatomy and Cell BiologyGeorge Washington UniversityWashingtonD.C.USA
| | - Jordan W. Squair
- International Collaboration on Repair DiscoveriesUniversity of British ColumbiaVancouverBCCanada
| | - Christopher R. West
- International Collaboration on Repair DiscoveriesUniversity of British ColumbiaVancouverBCCanada
| | - Andrei V. Krassioukov
- International Collaboration on Repair DiscoveriesUniversity of British ColumbiaVancouverBCCanada
- GF Strong Rehabilitation CentreVancouver Health AuthorityVancouverCanada
| | - David S. K. Magnuson
- Kentucky Spinal Cord Injury Research CenterUniversity of LouisvilleLouisvilleKYUSA
- Department of Neurological SurgeryUniversity of LouisvilleLouisvilleKYUSA
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Farahani MF, Khankeh HR, Hosseini M, Dalvandi A, NorouziTabrizi K. Exploring Facilitators of Regaining Autonomy in People with Spinal Cord Injury: A Qualitative Study. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2021; 26:154-161. [PMID: 34036064 PMCID: PMC8132859 DOI: 10.4103/ijnmr.ijnmr_25_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 05/30/2020] [Accepted: 10/20/2020] [Indexed: 11/04/2022]
Abstract
Background One of the most important aims of rehabilitation in Spinal Cord Injuries (SCI) is regaining autonomy, which can affect individuals' Quality of Life (QOL). This study was conducted to understand the experiences of individuals with SCI in terms of regaining autonomy during transition from hospital to community. Materials and Methods The present study was conducted using a qualitative research design. In this study, 15 semi-structured, in-depth interviews were conducted with individuals with SCI in Spinal Cord Injury (SCI) Association of Arak, Iran, from June 2018 to May 2019. The interviews were analyzed using the conventional content analysis method. Results Data analysis emerged four core categories of "self-management" (adaptation to a new life, self-care, responsibility, and seeking information), "social support" (family and friends' support, health care providers' support, and peer support), "access to facilities and resources" (home modification, use of various rehabilitation techniques, and use of mobility equipment), and "spiritual and religious beliefs" (believing in divine destiny and performance of religious rites). Conclusions The present study showed that several factors influenced the regaining of autonomy in individuals with SCI. It is important to consider the impact of these factors during transition from hospital to community. Health service providers can use the findings of this research to help these individuals regain their autonomy.
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Affiliation(s)
| | - Hamid Reza Khankeh
- Department of Nursing, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.,Research Center in Emergency and Health, University of Social Welfare and Rehabilitation, Tehran, Iran
| | - Mohammadali Hosseini
- Department of Nursing, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Asghar Dalvandi
- Department of Nursing, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Kian NorouziTabrizi
- Department of Nursing, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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Muscle Strength Cutoff Points for Functional Independence and Wheelchair Ability in Men With Spinal Cord Injury. Arch Phys Med Rehabil 2020; 101:985-993. [DOI: 10.1016/j.apmr.2020.01.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 11/18/2019] [Accepted: 01/08/2020] [Indexed: 11/20/2022]
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Changes in Quality of Life During Training for the HandbikeBattle and Associations With Cardiorespiratory Fitness. Arch Phys Med Rehabil 2020; 101:1017-1024. [DOI: 10.1016/j.apmr.2019.12.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 11/18/2019] [Accepted: 12/24/2019] [Indexed: 11/23/2022]
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Holm NJ, Møller T, Adamsen L, Dalsgaard LT, Biering-Sorensen F, Schou LH. Health promotion and cardiovascular risk reduction in people with spinal cord injury: physical activity, healthy diet and maintenance after discharge- protocol for a prospective national cohort study and a preintervention- postintervention study. BMJ Open 2019; 9:e030310. [PMID: 31892644 PMCID: PMC6955524 DOI: 10.1136/bmjopen-2019-030310] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 10/24/2019] [Accepted: 11/05/2019] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Spinal cord injury (SCI) predisposes those who suffer from it to physical inactivity and weight gain; consequently, death due to cardiovascular diseases is more frequent among people with SCI than in the general population. The literature documents a consensus about an interdisciplinary multimodal approach for the prevention and treatment of cardiovascular risk factors including overweight and obesity in people with SCI, focusing on diet, physical activity (PA) and behavioural interventions. This study will investigate implementation of recommendations from a recent clinical practice guideline for identification and management of cardiometabolic risk after SCI through multimodal patient education in a subacute clinical setting. METHODS AND ANALYSIS All patients who are aged 18 years or older with an SCI within the previous 12 months and admitted to highly specialised rehabilitation are included, regardless of SCI aetiology or neurological level. A primary study designed as a controlled, pragmatic, preintervention- postintervention study with 6-month follow-up evaluates the effect of the clinical intervention; a prospective national cohort study on body mass index (BMI) serves as a historical control. The intervention consists of a standardised approach to patient education about cardiovascular risk factors, PA and a healthy diet that begins at the outset of primary SCI rehabilitation and is integrated into existing settings and workflows. Outcome measures are collected at admission, discharge and 6 months after discharge and include peak oxygen uptake (VO2peak) (primary outcome), BMI, body composition, metabolic profile, neurological status, level of functioning, depression, quality of life, objective PA (accelerometry), self-reported PA, self-assessed PA ability, shared decision making, and dietary habits. Test-retest reliability of four VO2peak test protocols are investigated, as is test-retest reliability of a multisensor accelerometer in a rehabilitation setting. ETHICS AND DISSEMINATION The project is approved by the Committees on Health Research Ethics in the Capital Region of Denmark on 10 July 2018 (Journal-nr.: H-18018325). The principal investigator obtains informed consent from all participants. The interventions in the project are closely related to existing rehabilitation care, and the risk of pain and discomfort is considered modest. Any unintended events related to the elements of the intervention are reported, according to existing regional procedures. Data are stored in a secure web-based database (Redcap). The primary study and prospective cohort study are registered at Clinicaltrials.gov. Positive and negative results will be submitted to relevant scientific journals related to SCI for publication. Important protocol modifications are reported to the Committees on Health Research Ethics in the Capital Region of Denmark. TRIAL REGISTRATION NUMBERS NCT03689023 and NCT03369080.
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Affiliation(s)
- Nicolaj Jersild Holm
- Neuroscience Center, Clinic for Spinal Cord Injuries, Rigshospitalet, Hornbæk, Denmark
| | - Tom Møller
- Department 9701, The University Hospitals Centre for Health Research, UCSF Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Lis Adamsen
- Department 9701, The University Hospitals Centre for Health Research, UCSF Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Line Trine Dalsgaard
- Neuroscience Center, Clinic for Spinal Cord Injuries, Rigshospitalet, Hornbæk, Denmark
| | - Fin Biering-Sorensen
- Neuroscience Center, Clinic for Spinal Cord Injuries, Rigshospitalet, Hornbæk, Denmark
| | - Lone Helle Schou
- Department of Nursing and Nutrition, University College Copenhagen, Copenhagen, Denmark
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12
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Differences of Relative and Absolute Strength of Individuals With Spinal Cord Injury From Able-Bodied Subjects: A Discriminant Analysis. J Sport Rehabil 2019; 28:699-705. [PMID: 30040012 DOI: 10.1123/jsr.2018-0104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 05/21/2018] [Accepted: 05/28/2018] [Indexed: 11/18/2022]
Abstract
CONTEXT Strength training is one of the most common interventions employed to increase functional independence during rehabilitation of individuals with spinal cord injury (SCI). However, in the literature, different results have been reported in terms of strength modifications after a SCI compared with a control group (CG). OBJECTIVE This study aimed to verify whether discriminant analysis using relative and absolute strength is able to discriminate individuals with different levels of SCI from a CG and to compare strength values of men with different levels of SCI with a CG. DESIGN Cross-sectional study. SETTING Rehabilitation hospital setting. PARTICIPANTS A total of 36 individuals with SCI stratified in tetraplegia (TP; C6-C8), high paraplegia (HP; T1-T6), and low paraplegia (LP; T7-L2), and 12 matched control subjects were enrolled in the study. MAIN OUTCOME MEASURES The subjects performed a maximum strength test of elbow extension/flexion and also shoulder abduction/adduction and flexion/extension in an isokinetic dynamometer. Discriminant analysis was carried out to identify which strength variables would be able to discriminate the TP, HP, or LP groups from the CG. A 1-way analysis of variance was performed to compare peak torque and agonist/antagonist ratio means. RESULTS Shoulder adduction, followed by elbow extension peak torque, was the best variable for discriminating the TP group from the CG (function coefficients: -0.056 and 0.051, respectively, Wilks Λ = 0.41, P ≤ .05). There were no significant differences between the HP group, LP group, and CG. CONCLUSIONS The strength similarity of the paraplegic groups and the CG should not be extrapolated for activities of daily living or sports. The TP group demonstrated lower peak torque for all movements than the CG.
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13
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Ribeiro Neto F, Costa RRG, Carregaro RL. The addition of three new items in the Adapted Manual Wheelchair Circuit improves the discrimination between different levels of spinal cord injury. Physiother Theory Pract 2019; 36:1329-1339. [PMID: 30686099 DOI: 10.1080/09593985.2019.1571139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Purpose: To determine whether the inclusion of three additional items improved the discriminative capacity of the Adapted Manual Wheelchair Circuit (AMWC). Design: Cross-sectional study. Methods: A total of 126 men (median age 28.9 years [percentiles 25 and 75: 23.7; 38.5 years]) with spinal cord injury were consecutively enrolled and divided into three subgroups: high paraplegia (HP), medium paraplegia (MP), and low paraplegia (LP). The participants performed the AMWC with three additional items. Ability score and total time of AMWC (AMWCAS and AMWCTT) and AMWC plus the three additional items (AMWC+3AS and AMWC+3TT), 3 min of overground wheeling test and performance score were evaluated. Results: AMWC was not able to discriminate HP from MP and LP (Wilks' lambda = 0.93; P= 0.07). In contrast, AMWC+3 was able to discriminate between the three subgroups (Wilks' lambda = 0.86; P≤ 0.05). AMWC+3AS presented a better sensitivity compared to AMWCAS (lower success rate for all subgroups, 38.5% vs. 82.1% for HP; 49.0% vs. 75.5% for MP; 78.9% vs. 94.7% for LP). The LP group presented a significant higher AMWC+3AS compared to MP and HP (17.0 vs. 16.5 and 16.5, respectively, P≤ 0.05). AMWC+3TT was significantly lower in LP compared to MP and HP (139.85 s vs. 242.52 s and 326.21 s, respectively, P≤ 0.05). Conclusion: The AMWC+3 outcomes were able to discriminate between HP, MP, and LP subgroups, and the addition of the three items enhanced the sensitivity of the wheelchair circuit. The performance of LP was more evident with significant differences compared to HP and MP for all AMWC+3 outcomes.
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Affiliation(s)
- Frederico Ribeiro Neto
- College of Physical Education, Universidade de Brasilia (UnB) , Brasília/DF, Brazil.,Spinal Cord Injury Department , SARAH Rehabilitation Hospital Network/SARAH Brasilia , Brasilia/DF, Brazil
| | | | - Rodrigo Luiz Carregaro
- College of Physical Education, Universidade de Brasilia (UnB) , Brasília/DF, Brazil.,School of Physical Therapy, Universidade de Brasilia (UnB) , Brasília/DF, Brazil
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14
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Maher JL, McMillan DW, Nash MS. Exercise and Health-Related Risks of Physical Deconditioning After Spinal Cord Injury. Top Spinal Cord Inj Rehabil 2018; 23:175-187. [PMID: 29339894 DOI: 10.1310/sci2303-175] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
A sedentary lifestyle occurring soon after spinal cord injury (SCI) may be in contrast to a preinjury history of active physical engagement and is thereafter associated with profound physical deconditioning sustained throughout the lifespan. This physical deconditioning contributes in varying degrees to lifelong medical complications, including accelerated cardiovascular disease, insulin resistance, osteopenia, and visceral obesity. Unlike persons without disability for whom exercise is readily available and easily accomplished, exercise options for persons with SCI are more limited. Depending on the level of injury, the metabolic responses to acute exercise may also be less robust than those accompanying exercise in persons without disability, the training benefits more difficult to achieve, and the risks of ill-considered exercise both greater and potentially irreversible. For exercise to ultimately promote benefit and not impose additional impairment, an understanding of exercise opportunities and risks if exercise is undertaken by those with SCI is important. The following monograph will thus address common medical challenges experienced by persons with SCI and typical modes and benefits of voluntary exercise conditioning.
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Affiliation(s)
- Jennifer L Maher
- The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, Florida
| | - David W McMillan
- The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, Florida.,Department of Kinesiology and Sports Sciences, University of Miami, Coral Gables, Florida
| | - Mark S Nash
- The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, Florida.,Departments of Neurological Surgery and Physical Medicine & Rehabilitation, University of Miami Miller School of Medicine, Miami, Florida
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15
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Ribeiro Neto F, Costa RRG, Lopes ACG, Carregaro RL. Cross-cultural validation of a Brazilian version of the adapted manual wheelchair circuit (AMWC-Brazil). Physiother Theory Pract 2018; 35:860-872. [PMID: 29659301 DOI: 10.1080/09593985.2018.1458356] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Purpose: To translate, culturally adapt and validate the Adapted Manual Wheelchair Circuit (AMWC) into Brazilian-Portuguese. Design: Cross-sectional study. Methods: Sixty-six men (median age of 30.5 years [percentiles 25 and 75: 24.0; 38.3 years]) with traumatic spinal cord injury were consecutively enrolled and divided into two groups: tetraplegia (TP) and paraplegia (PP). The participants performed the AMWC-Brazil and were evaluated by the Spinal Cord Injury Measure version III (SCIM-III). Translation, translation synthesis, back-translation, committee review and construct validity were adopted for the cross-cultural adaptation. Construct validity was performed by testing whether the test scores were significantly correlated (Spearman's correlation coefficient) to the subjects' injury level, age, time since injury, body mass index (BMI) and SCIM-III scale. Results: All the AMWC-Brazil's outcomes were significantly correlated with SCIM-III total score and subscales (P ≤ 0.01). However, when the analyses were stratified over injury level, only the TP showed a high correlation between the AMWC-Brazil's outcomes and the SCIM-III. For construct validity, 4 of 5 hypotheses were confirmed. Only BMI was not a significant predictor of the AMWC-Brazil outcomes. Conclusion: The AMWC was successfully translated to the Brazilian-Portuguese (AMWC-Brazil) and presented high and satisfactory construct validity.
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Affiliation(s)
- Frederico Ribeiro Neto
- a College of Physical Education , Universidade de Brasilia (UnB) , Brasília , DF , Brazil.,b Spinal Cord Injury Department, SARAH Rehabilitation Hospital Network/SARAH , Brasilia , DF , Brazil
| | | | - Ana Cláudia Garcia Lopes
- b Spinal Cord Injury Department, SARAH Rehabilitation Hospital Network/SARAH , Brasilia , DF , Brazil
| | - Rodrigo Luiz Carregaro
- a College of Physical Education , Universidade de Brasilia (UnB) , Brasília , DF , Brazil.,c School of Physical Therapy , Universidade de Brasilia (UnB), Campus UnB Ceilândia, Centro Metropolitano, Ceilândia Sul , Brasília , DF , Brazil
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16
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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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17
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Ribeiro Neto F, Guanais P, Lopes GH, Dornelas E, de Campos Barbetta D, Coutinho AC, Gonçalves CW, Gomes Costa RR. Influence of Relative Strength on Functional Independence of Patients With Spinal Cord Injury. Arch Phys Med Rehabil 2016; 98:1104-1112. [PMID: 27717738 DOI: 10.1016/j.apmr.2016.08.483] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 07/29/2016] [Accepted: 08/25/2016] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To investigate the influence of strength values and fat mass on functional independence of men with different spinal cord injury (SCI) levels. DESIGN Cross-sectional study. SETTING Hospital network. PARTICIPANTS Men with SCI (N=45). INTERVENTIONS Subjects were assessed in functional independence scales, a 1 repetition maximum (1RM) test, and body composition to detect absolute and relative strength: 1RM divided by body mass (BM) and lean body mass (LBM), respectively. MAIN OUTCOME MEASURES Stepwise multiple regression analysis was used to verify the influence of predictors on functional independence (FIM and Spinal Cord Independence Measure [SCIM] scale and subscales). Receiver operating characteristic curves were created to identify cutoff points of strength for functional independence. RESULTS The best models for FIM total, FIM mobility, and SCIM total used 1RM as the best predictor (adjusted R2=.75, .67, and .65, respectively; P<.05). Relative strength (1RM/LBM) was the best predictor for SCIM mobility (adjusted R2=.62, P<.05). A FIM score of 69 has a 1RM cutoff point of 50.1kg, and a FIM score of 76 has cutoff points of .73 for 1RM/BM and .91 for 1RM/LBM. A SCIM score of 68 has cutoff points for 1RM, 1RM/BM, and 1RM/LBM of 50.1kg, .77, and .92, respectively. CONCLUSIONS Cutoff points of relative strength should be used as determinant variables for independence, health, or sports performance. This study may contribute to more adequate guidance of physical activity during a rehabilitation program and after discharge.
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Affiliation(s)
| | | | - Guilherme H Lopes
- College of Physical Education, University of Brasília, Brasília/DF, Brazil
| | - Elisa Dornelas
- SARAH Rehabilitation Hospital Network, Brasília/DF, Brazil
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18
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Tørhaug T, Brurok B, Hoff J, Helgerud J, Leivseth G. The effect from maximal bench press strength training on work economy during wheelchair propulsion in men with spinal cord injury. Spinal Cord 2016; 54:838-842. [PMID: 26976530 DOI: 10.1038/sc.2016.27] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 01/24/2016] [Accepted: 02/02/2016] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To assess the effect from maximal bench press strength training (MST) on wheelchair propulsion work economy (WE). STUDY DESIGN Pretest-posttest case-control group design. SETTING St Olavs Hospital, Trondheim, Norway. METHODS Seventeen male individuals with spinal cord injury (SCI) paraplegia were allocated to either MST bench press (n=11) or the control group (CG) (n=7). The MST group trained bench press three times per week, for 6 weeks, starting at 85-95% of their pretest bench press one-repetition maximum (1RM). For calculation of WE during wheelchair propulsion, oxygen uptake (VO2) measurements were collected during wheelchair ergometry (WCE) at submaximal workload of 50 W. Similarly, peak oxygen uptake (VO2peak) and peak power output (W) were measured during WCE. RESULTS Individuals in the MST regimen significantly improved WE compared with the CG by 17.3 % (mean between-group differences: 95% confidence interval) of 2.63 ml kg-1 min-1: (-4.34, -0.91) (P=0.007). Between pretest and posttest, the increase in bench press 1RM was by 17% higher in the MST group compared with the CG. At peak testing, the MST group generated significantly higher peak power compared with the CG. All other physiological variables were comparable within and between groups. CONCLUSIONS A 6-week MST bench press regimen significantly improved WE during wheelchair propulsion at 50 W workload. These preliminary data support a possible beneficial role for MST to reduce the energy cost of wheelchair propulsion for SCI individuals.
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Affiliation(s)
- T Tørhaug
- Clinic of Physical Medicine and Rehabilitation, Spinal Cord Injury Department, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.,Department of Neuroscience, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - B Brurok
- Clinic of Physical Medicine and Rehabilitation, Spinal Cord Injury Department, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - J Hoff
- Clinic of Physical Medicine and Rehabilitation, Spinal Cord Injury Department, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.,Department of Circulation and Imaging, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - J Helgerud
- Department of Circulation and Imaging, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway.,Hokksund Medical Rehabilitation Centre, Hokksund, Norway.,Department of Sports and Outdoor Life Studies, Telemark University College, Bø, Norwayn
| | - G Leivseth
- Department of Neuroscience, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway.,Hokksund Medical Rehabilitation Centre, Hokksund, Norway.,Department of Clinical Medicine, Neuromuscular Disorders Research Group, UiT The Arctic University of Norway, Tromsø, Norway
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19
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Nooijen CFJ, Post MWM, Spooren AL, Valent LJ, Broeksteeg R, Sluis TA, Stam HJ, van den Berg-Emons RJG. Exercise self-efficacy and the relation with physical behavior and physical capacity in wheelchair-dependent persons with subacute spinal cord injury. J Neuroeng Rehabil 2015; 12:103. [PMID: 26586130 PMCID: PMC4653935 DOI: 10.1186/s12984-015-0099-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Accepted: 11/16/2015] [Indexed: 11/30/2022] Open
Abstract
Background Since physical activity and exercise levels are known to be generally low in persons with spinal cord injury (SCI), there seems to be a need for intervention. Exercise self-efficacy (ESE), the confidence persons have in their ability to be physically active and exercise, is an important and modifiable predictor of physical behavior. The goal of this study was to 1) describe ESE in persons with subacute SCI, 2) to assess ESE in subgroups based on demographic and lesion characteristics, and 3) to explore the relation between ESE and physical behavior and physical capacity. Methods Thirthy-seven persons with subacute SCI who are wheelchair dependent participated. Participants completed the Exercise Self-Efficacy Scale. We recorded age and lesion characteristics, measured physical behavior (physical activity, motility and sedentary day time, n = 35) with an accelerometer-based activity monitor and measured physical capacity (peak power output, n = 28 and peak oxygen uptake, n = 24) during a maximal hand-cycling test. Measurements were performed 2 months prior to discharge from inpatient rehabilitation. Mann-Whitney tests were used to test for differences between subgroups based on age and lesion characteristics and spearman correlations were used to assess the relation between ESE and physical activity and physical capacity. Results Persons with tetraplegia had lower ESE compared to persons with paraplegia (Z = −1.93, p = 0.05). No differences in ESE were found between subgroups based on age and motor completeness of the lesion. In persons with paraplegia, ESE was positively related to peak power output (ρ = 0.58, p = 0.02). The relation of ESE with wheeled physical activity was ρ = 0.36, p = 0.09. Conclusions In persons with SCI who are dependent on a manual wheelchair, lesion level when categorized as paraplegic and tetraplegic affected ESE whereas age categories and completeness categories did not. Persons with tetraplegia were found to have lower confidence with regard to physical activity and exercise indicating that this subgroup can benefit from extra attention in the promotion of physical activity and exercise. In persons with paraplegia, ESE seemed to be lower in persons with less peak power output and less daily physical activity.
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Affiliation(s)
- Carla F J Nooijen
- Department of Rehabilitation Medicine, Erasmus MC University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.
| | - Marcel W M Post
- Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands. .,Department of Rehabilitation Medicine, Center for Rehabilitation, University of Groningen, Groningen, The Netherlands. .,University Medical Center Groningen, Groningen, The Netherlands.
| | - Annemie L Spooren
- Adelante Center of Expertise in Rehabilitation and Audiology, Hoensbroek, The Netherlands. .,CAPHRI School for Public Health and Primary Care, Department of Rehabilitation Medicine, Maastricht University, Maastricht, Netherlands.
| | - Linda J Valent
- Heliomare Rehabilitation Center, Wijk aan Zee, The Netherlands.
| | | | - Tebbe A Sluis
- Rijndam Rehabilitation Institute, Rotterdam, The Netherlands.
| | - Henk J Stam
- Department of Rehabilitation Medicine, Erasmus MC University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.
| | | | - Rita J G van den Berg-Emons
- Department of Rehabilitation Medicine, Erasmus MC University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.
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20
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de Groot S, van der Scheer JW, Bakkum AJT, Adriaansen JJE, Smit CA, Dijkstra C, Post MWM, van der Woude LHV. Wheelchair-specific fitness of persons with a long-term spinal cord injury: cross-sectional study on effects of time since injury and physical activity level. Disabil Rehabil 2015; 38:1180-6. [DOI: 10.3109/09638288.2015.1076072] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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21
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Simmons OL, Kressler J, Nash MS. Reference fitness values in the untrained spinal cord injury population. Arch Phys Med Rehabil 2014; 95:2272-8. [PMID: 25007709 DOI: 10.1016/j.apmr.2014.06.015] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Revised: 06/02/2014] [Accepted: 06/23/2014] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Establish reference values of cardiorespiratory fitness applicable to the general, untrained spinal cord injury (SCI) population. DESIGN Data were retroactively obtained from 12 studies (May 2004 to May 2012). SETTING An institution-affiliated applied physiology research laboratory. PARTICIPANTS A total of 153 men and 26 women (age, 18-55y) with chronic SCI (N=179) were included. Participants were not involved in training activities for 1 or more months before testing and were able to complete a progressive resistance exercise test to determine peak oxygen consumption (Vo2peak). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE Percentile ranking (poor<20%; fair; 20%-40%; average, 40%-60%; good, 60%-80%; excellent, 80%-100%) used to establish reference values. RESULTS Reference cardiorespiratory fitness values based on functional classification as paraplegic or tetraplegic were established (paraplegic: median, 16.0mL·kg(-1)·min(-1); range, 1.4-35.2mL·kg(-1)·min(-1); tetraplegic: median, 8.8mL·kg(-1)·min(-1); range, 1.5-21.5mL·kg(-1)·min(-1)) for untrained men and women. For the primary outcome measure (Vo2peak), persons with paraplegia had significantly higher values than did persons with tetraplegia (P<.001). Although men had higher values than did women, these differences did not reach significance (P=.256). Regression analysis revealed that motor level of injury was associated with 22.3% of the variability in Vo2peak (P<.001), and an additional 8.7% was associated with body mass index (P<.001). No other measure accounted for additional significant variability. CONCLUSIONS Established reference fitness values will allow investigators/clinicians to stratify the relative fitness of subjects/patients from the general SCI population. Key determinants are motor level of injury and body habitus, yet most variability in aerobic capacity is not associated with standard measures of SCI status or demographic characteristics.
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Affiliation(s)
| | | | - Mark S Nash
- University of Miami Miller School of Medicine, Miami, FL
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22
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Ovechkin AV, Vitaz TW, Terson de Paleville DGL, McKay WB. Quality of residual neuromuscular control and functional deficits in patients with spinal cord injury. Front Neurol 2013; 4:174. [PMID: 24223568 PMCID: PMC3819596 DOI: 10.3389/fneur.2013.00174] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Accepted: 10/22/2013] [Indexed: 12/02/2022] Open
Abstract
Study Design: Prospective cohort study. Objective: This study examined the relationship between motor control and clinical function outcomes after spinal cord injury (SCI). Setting: University of Louisville, Louisville, KY, USA. Materials: Eleven persons with SCI and 5 non-injured subjects were included in this study. Methods: The ASIA Impairment Scale (AIS) was used to categorize injury level and severity. Multi-muscle, surface EMG (sEMG) recording, was carried out using a protocol of reflex and volitional motor tasks and was analyzed using a vector-based tool that calculates index values that relate a distribution of multi-muscle activation pattern of each SCI subject to the prototype obtained from non-injured subject group and presents overall magnitude as a separate value. Functional Independence Measure motor sub-scale, Spinal Cord Injury Independence Measure (SCIM-III), and Walking Index for Spinal Cord Injury (WISCI) scale scores were compared to neurophysiological parameters. Results: AIS category and injury level correlated significantly with the WISCI and SCIM mobility sub-scales. sEMG-derived parameters were significantly correlated with SCIM and WISCI scores but only for examinations carried out 48 or more days post-injury. Conclusion: These results supported the hypothesis that clinically relevant function after SCI is related to the degree to which functional organization within the central nervous system is disrupted. Further, due likely to the constraints placed on the expression of functional ability by early post-injury immobilization and hospitalization, neurophysiological assessment of motor function may provide better sensitivity and reliability than can be obtained using the clinical function scales examined here within the early period after injury.
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Affiliation(s)
- Alexander V Ovechkin
- Department of Neurological Surgery, University of Louisville , Louisville, KY , USA
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