Spinal Cord Injury - Interventions Flashcards
What does strength training above the lesion for neurally intact muscles involve?
- PRT principles
- Target muscles required for function
- Task-specfic (training in the specific position/with the specific loads)
- Consider power & endurance
- Greater than 5/5 strength required for function esp in UL
What does strength training below the lesion for partially paralysed muscles involve?
- Partially paralysed muscles may not respond the same way
- Principles of PRT but modified for weakness with neurological strengthening principles (e.g. reducing lever arm, using EMG/mental practice, gravity eliminated etc.)
What did Lu et al 2015 find regarding strength training in quadriplegia?
- Systematic review of exercise therapy, e-stim & FES
- 3-5 days/week, 6-8 weeks
- Exercise therapies have benefits on UL strength & ADLs in people with quadriplegia
- FES + exercise therapy may improve arm/hand muscle strength & ADL performance
- E-stim alone can increase wrist extensor strength, but may not increase function
What did Hicks et al find regarding strength training in SCI?
- Systematic review of acute & chronic SCI (mix of lesion levels)
- Only included high quality papers
- Evidence that 2-3 times at mod-vig intensity increases muscular strength in chronic SCI
- Insufficient high quality evidence of the effect of exercise on functional activity performance
What did Kloosterman et al 2009 find regarding strength training for partially paralysed muscles in SCI?
- Systematic review of strength training for partially paralysed muscles
- 3-5 times/week, 20-45 mins, 16 weeks-6 months
- Exercise therapy provides benefits for UL following modified principles of PRT in patients with SCI
- Increases strength & function
What are some of the other strength training interventions that can be used for SCI?
- Electrical stimulation: Limited evidence for UL, may not be useful in LMN lesions
- Mental practice
- Tendon transfers
- Tenodesis
What does tendon transfers involve?
- Surgical repositioning of a tendon from its normal insertion & reattachment to a bone, tendon or insertion of another muscle
- Includes deltoid-triceps, biceps-triceps, brachioradialis-ECRB
What is tenodesis surgery?
- Division/attachment of a tendon alone to a bone or ligament
- Includes tendonesis FPL, FPL split tenodesis
What are the principles of training new motor skills?
- Task specific practice (whole, modified, part)
- Intensity of practice
- Preparatory & task specific strengthening
What activities are trained in SCI?
- Bed mobility
- Balance in sitting & standing
- Transfers
- Wheelchair mobility
- UL & hand function
- Walking
What did van Langevelde et al 2011 find is the current amount and content of practice used at the Australian specialised SCI unit?
- 8.9 sessions/week
- 43 mins/session
- Most therapy directed at strength training & modified activity practice
What evidence is there for task specific training?
- Limited research in training new activities in complete lesions
- Training function is based on theory of the pathology & evidence from other populations
What did Boswell-Ruys et al 2010 find regarding sitting training in chronic thoracic paraplegia?
- 1 hour task specific training 3 times weekly for 6 weeks
- No treatment control
- Improvements in max reach distance
- No differences in perceived functional performance, fear of falling or inobjective measures of sway & time t-shirt test
What did Harvey et al 2011 find regarding sitting training in subacute thoracic paraplegia?
- Usual therapy + additional 30 mins task specific training 3 times weekly for 6 weeks
- Usual therapy control
- All subjects improved
- No clinically significant differences between groups in subjective & objective outcomes
What did Harvey et al 2009 find regarding gait training in incomplete lesions?
- Systematic review of exercise training in acute & chronic SCI
- Evidence for gait training to improve walking function & independence
What did Merholtz et al 2012 find regarding gait training in incomplete lesions?
Insufficient evidence for BWS TT or robotics alone on walking speed & capacity in SCI
What did Spooren et al 2009 find regarding UL hand function in incomplete lesions?
- Systematic review of repetitive motor task training in acute & chronic SCI
- Evidence suggests improved UL & hand function
What did Kloosterman et al 2009 find regarding exercise therapy in chronic SCI?
- Systematic review
- Evidence suggests increases strength & functional task practice
What are the ACSM CV fitness training guidelines for wheelchair dependent people with SCI?
- At least 20 mins mod-vig aerobic activity 3-5 times per week
- Intensity 50-80% peak exercise capacity or 70-85% max HR
- Mode similar to the task in which fitness is required
- Exercise intensity progressed as fitness improves (e.g. BORG)
What are the ACSM CV fitness training guidelines for able-bodied people with SCI?
Usual fitness training principles
What are the precautions/considerations for CV fitness training in SCI?
- Adequate hydration
- Cool environment
- Monitor hypotension, hypertension & autonomic dysreflexia (sudden increase in BP & HR, can cause organ failure)
- Be aware of CIs related to recent surgery
- Technique (e.g. wheelchair, ergometer)
What does optimal outcomes relation to activity performance depend on?
- Neurological injury
- Age
- Body morphology
- Pre-injury function & health
What outcome measures are used for activity & performance in SCI?
- FIM (generic)
- Spinal cord independence measure (very specific)
- Walking index for SCI
- Clinical outcomes variable scale (COVS)
- Usual outcome measures (6MWT, 10MWT etc)
What are the impairments that physio can address in SCI?
- Strength
- Muscle length/joint ROM
- CV fitness
- Pain
- Respiratory function
What is often the primary goal for people with SCI?
Independence
What are the differences between training activities in people with SCI & training activities in stroke?
- Stroke is recoverable, SCI is not (esp complete)
- In SCI, focus is on training modified/adaptive skills or new motor skills
