Exercise following spinal cord injury: physiology to therapy (original) (raw)
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Efficacy of a New Rehabilitative Device for Individuals With Spinal Cord Injury
The journal of spinal …, 2008
Background/Objective:Regular exercise is required in persons with spinal cord injury (SCI) to reduce the deleterious effects of chronic paralysis. The primary aims of the study were to examine responses to passive and active exercise on a new rehabilitative device for persons with SCI and to examine reliability of these responses over 2 days of testing.Methods:Nine men and women with chronic SCI completed the study, 2 with a complete injury and 7 with an incomplete injury. The level of injury ranged from thoracic (T4-T6 and T10) to cervical (4 with C5-C6 and 3 with C6-C7 injuries). They completed 2 30-minute sessions of active lower-body and passive upper-body exercise, during which heart rate (HR), blood pressure (BP), gas exchange data, rating of perceived exertion (RPE), and oxygen-hemoglobin saturation were continuously assessed.Data Analysis:One-way ANOVA with repeated measures was used to examine differences in all variables over time.Results:Results demonstrated significant increases (P < 0.05) in HR, systolic BP, RPE, and oxygen uptake (Vo2) from rest to exercise. No change (P > 0.05) in diastolic BP or oxygen-hemoglobin saturation was evident. Cronbach's alpha values for HR, systolic BP, and Vo2 recorded over both days of testing ranged from 0.79 to 0.97, indicating adequate consistency.Conclusions:Data demonstrated that exercise on this device significantly increases HR, Vo2, and systolic BP compared to rest. However, its efficacy for long-term rehabilitation, especially in regular exercisers with SCI, is unknown.
Effects of an exercise program on the rehabilitation of patients with spinal cord injury
Archives of Physical Medicine and Rehabilitation, 2001
Objectives: To evaluate the impact of directed physical exercise in patients with spinal cord injury (SCI) and to measure functional independence before and after an exercise program. Design: Case series. Setting: Tertiary care center. Participants: Thirteen volunteers with thoracic SCI. Intervention: Patients participated in a 16-week exercise program, consisting of 3 weekly 120-minute sessions. They performed mobility, strength, coordination, aerobic resistance, and relaxation activities. Main Outcome Measures: The FIM™ instrument, arm crank exercise test, wheelchair skills, maximum strength, anthropometry (body composition measurements), and lipid levels. The results were processed by using nonparametric statistical tests. Results: After comparing the values at the beginning and end of the program, patients showed a significant increase in the following parameters: average FIM score (p Ͻ .001) 113 Ϯ 7.1; weight lifted in the bench press exercise (46%, p Ͻ .0001), military press (14%, p Ͻ .0002), and butterfly press exercise (23%, p Ͻ .0001), and number of repetitions for biceps (10%, p Ͻ .0001), triceps (18%, p Ͻ .0001), shoulder abductors (61%, p Ͻ .0001), abdominals (33%, p Ͻ .009), and curl back neck exercise (19%, p Ͻ .0001). The maximum resistance achieved during the arm crank exercise test increased (p Ͻ .001), and heart rate 6 minutes after the exercise test decreased (p Ͻ .05). The time required for the wheelchair skill tests significantly decreased in all the tasks. No statistically significant changes occurred in body weight (p Ͻ .154), percentage of body fat (p Ͻ .156), lean body weight (p Ͻ .158), cholesterol/high-density lipoprotein cholesterol ratio (p Ͻ .076), or maximum heart rate (p Ͻ .20). The only complication arose in a patient who developed transient sinus bradycardia and hypotension after the arm crank exercise test. Conclusion: The directed exercise program had a positive impact for most of the variables of the study.
Reconditioning programs for spinal cord-injured persons: a brief review and recommendations
Science & Sports, 2003
Aim.-The interest or relevance of exercise for the general population is emphasized widely; therefore, it must be even more important for paraplegics. Actualities.-Various training programs have already been proposed for people with spinal cord injuries (SCI), however, no consensus about a specific training program has been reached for such a population. Projects.-This review attempts to summarize the available literature on the effects of exercise on paraplegics and will hopefully provide some directions not only for further research but will also provide recommendations for practitioners working in the field.
Trials, 2013
Background: Rehabilitation after spinal cord injury (SCI) has traditionally involved teaching compensatory strategies for identified impairments and deficits in order to improve functional independence. There is some evidence that regular and intensive activity-based therapies, directed at activation of the paralyzed extremities, promotes neurological improvement. The aim of this study is to compare the effects of a 12-week intensive activity-based therapy program for the whole body with a program of upper body exercise.
Journal of sport rehabilitation, 2018
Considering the reduction of physical activity performed daily in people with spinal cord injury, it is necessary to analyze the interventions based on physical exercises in order to provide recommendations based on evidence. To review and evaluate the literature on physical exercise interventions for individuals with SCI, based on the ICF, as well as physiological parameters for exercise prescription. A systematic review of the literature produced from August 2016 to February 2017 within the PubMed, EMBASE, Cochrane Library, and MEDLINE databases. Results: Two independent examiners conducted a search in which 223 articles were initially found. A third evaluator verified possible divergences and generated a final list of 25 articles that strictly met the inclusion criteria, 5 of which investigated the effects of aerobic exercise, 2 of resistance training, 2 of balance training, 12 of gait training, and 4 evaluating the combined effect of two or more forms of training. Considering st...
Exercise awareness and barriers after spinal cord injury
World Journal of Orthopedics, 2014
Exercise is an essential element in managing several of the non-communicable diseases after spinal cord injury (SCI). Awareness of the importance of prescribing a customized exercise program that meets the goals of persons with SCI should be highly considered in the rehabilitation community. The barriers of implementing specific exercise program as well as the factors that may mask the outcomes of regular exercise regimen need to be continuously addressed as a part of patients' rehabilitation care. The focus of this editorial is to encourage the medical community to consider routine physical activity as one of the necessary vital signs that needs to be routinely checked in patients with SCI. Providing education tips, nutritional counseling and engaging in recreational programs may provide motivational route to the community of SCI. This may result in reinforcing active lifestyle in survivors with SCI as well as to reduce the impact of chronic life threatening medical disorders.
Physical activity outside of structured therapy during inpatient spinal cord injury rehabilitation
Journal of NeuroEngineering and Rehabilitation, 2016
Background: Little information exists on the content of inpatient rehabilitation stay when individuals with spinal cord injury (SCI) are not engaged in structured rehabilitation therapy sessions. Investigation of inpatient therapy content is incomplete without the context of activities outside of this time. We sought to quantify physical activity occurring outside of physical therapy (PT) and occupational therapy (OT) sessions during inpatient SCI rehabilitation and examine how this activity changes over time from admission to discharge. Methods: In this longitudinal observational study at two inpatient SCI rehabilitation centres, 95 participants were recruited through consecutive admissions. Physical activity at admission and discharge was recorded by 1) selfreport (PARA-SCI questionnaire) and 2) real-time accelerometers worn on the dominant wrist, and hip if ambulatory. For analyses, we separated participants into those with paraplegia or tetraplegia, and a subgroup of those ambulatory at discharge. Wilcoxon signed rank tests (admission vs. discharge) were used for PARA-SCI minutes and accelerometry activity kilocounts. Results: There was no change in self-report physical activity, where the majority of time was spent in leisure time sedentary activity (~4 h) and leisure time physical activity at a higher intensity had a median value of 0 min. In contrast, significant increases in physical activity outside PT and OT sessions from admission to discharge were found for wrist accelerometers for individuals with tetraplegia (i.e., upper limb activity) and hip accelerometers for ambulatory individuals (i.e., walking activity). Conclusion: Physical activity is low in the inpatient SCI rehabilitation setting outside of structured therapy with a substantial amount of time spent in leisure time sedentary activity. Individuals appear to have the capacity to increase their levels of physical activity over the inpatient stay.
Neurorehabilitation and Neural Repair
Background. While upper body training has been effective for improving aerobic fitness and muscle strength after spinal cord injury (SCI), activity-based therapies intended to activate the paralyzed extremities have been reported to promote neurological improvement. Objective. To compare the effectiveness of intensive whole-body exercise compared with upper body exercise for people with chronic SCI. Methods. A parallel-group randomized controlled trial was conducted. Participants with a range of SCI levels and severity were randomized to either full-body exercise (FBE) or upper body exercise (UBE) groups (3 sessions per week over 12 weeks). FBE participants underwent locomotor training, functional electrical stimulation-assisted leg cycling, and trunk and lower extremity exercises, while UBE participants undertook upper body strength and aerobic fitness training only. The primary outcome measure was the American Spinal Injury Association (ASIA) motor score for upper and lower extrem...
Improving physical activity levels of individuals with spinal cord injury in the community
2017
Lack of regular physical activity (PA) is a major concern among the approximately 300,000 individuals with spinal cord injury (SCI) who are at an elevated risk of mortality due to cardiovascular diseases, diabetes, and lung disease [1]. Low levels of PA and high levels of sedentary behavior (SB) in individuals with SCI have also been associated with secondary conditions such as pain, fatigue, weight gain, and deconditioning [1, 2]. Regular PA and exercise interventions have been linked with improved outcomes and healthier lifestyles among those with SCI [2]. To assess regular PA and exercise interventions, researchers have evaluated sensor-based activity monitors that quantify movement of the individual, wheelchair movement, and physiological changes [3-5] .