Effect of 2-speed geared manual wheelchair propulsion on shoulder pain and function

Finley MA, Rodgers MM. Effect of 2-speed geared manual wheelchair propulsion on shoulder pain and function.

Objective

To investigate the impact of a manual 2-gear drive wheelchair wheel (MAGICWheels) on shoulder pain and function in manual wheelchair users.

Design

A single-group, repeated-measures pre- and postdesign with baseline and retention.

Setting

General community.

Participants

Full-time manual wheelchair users (N=17) currently experiencing shoulder pain (mean age, 46±14y; wheelchair use, 15±10y).

Intervention

Five-month trial using a 2-gear wheelchair wheel.

Main Outcomes Measures

The Wheelchair Users Shoulder Pain Index (WUSPI), Wheelchair Users Functional Assessment (WUFA), and timed hill climb test with rating of perceived exertion (RPE).

Results

There was significant reduction in shoulder pain after the intervention at week 2 (P=.004) through week 16 (P=.015). The difference was not found at week 20; however, 1 participant reported an increase in pain from unrelated factors during week 20. Change from baseline was calculated without this subject’s data; there was a significant reduction in shoulder pain (P=.003). There was no difference in WUFA after using the 2-gear wheel (P=.06). Hill climb time was longer when using the 2-gear wheel (P=.01), but no difference in the RPE (P=.13) resulted. Shoulder pain during the 4-week retention phase showed a trend toward increasing, as indicated by increased WUSPI scores. There was not a significant percentage increase, however, in comparison with the final week of using the MAGICWheels (P<.05).

Conclusions

There were pain reductions 2 weeks after using the MAGICWheels, indicating a rapid response to the intervention. These findings indicate the potential for shoulder pain reduction with the use of a manual drive wheel during mobility, even in highly functional manual wheelchair users.     

Shoulder ultrasound abnormalities, physical examination findings, and pain in manual wheelchair users with spinal cord injury

Brose SW, Boninger ML, Fullerton B, McCann T, Collinger JL, Impink BG, Dyson-Hudson TA. Shoulder ultrasound abnormalities, physical examination findings, and pain in manual wheelchair users with spinal cord injury.

Objectives

To investigate the presence of ultrasound (US) abnormalities in manual wheelchair users with spinal cord injury (SCI) using a quantitative Ultrasound Shoulder Pathology Rating Scale (USPRS). To investigate physical examination (PE) findings using a quantitative Physical Examination of the Shoulder Scale (PESS), and to obtain data about pain and other subject characteristics such as age, years with SCI, and weight.

Design

Case series.

Setting

National Veterans' Wheelchair Games 2005 and 2006.

Participants

Volunteer sample of manual wheelchair users with SCI participating in the National Veterans' Wheelchair Games.

Interventions

Not applicable.

Main Outcome Measures

Presence of relationships between US findings, PE findings, pain, and subject characteristics.

Results

The USPRS correlated with age, duration of SCI, and weight (all P<.01), and showed a positive trend with the total Wheelchair User's Shoulder Pain Index (WUSPI) score (r=.258, P=.073). Several US findings related to presence of PE findings for specific structures. The PESS score correlated with the WUSPI (r=.679, P<.001) and duration of SCI (P<.05). The presence of untreated shoulder pain that curtailed activity was noted in 24.5% of subjects, and this was related to increased WUSPI scores (P=.002).

Conclusions

PE and US abnormalities are common in manual wheelchair users with SCI. The USPRS and PESS demonstrated evidence for external validity and hold promise as research tools. Untreated shoulder pain is common in manual wheelchair users with SCI, and further investigation of this pain is indicated.     

Effectiveness of Home Exercise on Pain,Function, and Strength of Manual Wheelchair Users With Spinal Cord Injury: A High-Dose Shoulder Program With Telerehabilitation

Objective

To test the effectiveness of a high-dose home exercise/telerehabilitation program for manual wheelchair users who have a spinal cord injury (SCI) by determining whether the intervention would reduce pain and increase function, as we hypothesized.

Design

A pre-post trial with outcomes measured at 3 time points: baseline, postintervention (12wk), and follow-up (>24 wk).

Setting

Subjects performed an exercise program at their homes using telerehabilitation for therapist monitoring of technique and exercise advancement. Baseline and postintervention data were collected at a motion analysis laboratory in a tertiary medical center.

Participants

A convenience sample of manual wheelchair users (N=16, 3 women; average age, 41y; average time in a wheelchair, 16y) with shoulder pain (average pain duration, 9y) and mechanical impingement signs on physical examination.

Interventions

A 12-week home exercise program of rotator cuff and scapular stabilization exercises was given to each participant. The program included a high dose of 3 sets of 30 repetitions, 3 times weekly, and regular physical therapist supervision via videoconferencing.

Main Outcome Measures

Primary outcomes of pain and function were measured with the Wheelchair User's Shoulder Pain Index (WUSPI), Disabilities of Arm, Shoulder, and Hand (DASH) Index, and Shoulder Rating Questionnaire (SRQ). Secondary outcomes of strength were measured with isometric strength tests of scapulothoracic and glenohumeral muscles, and a static fatigue test of the lower trapezius.

Results

Pain was reduced and function improved after the intervention. There was a significant main effect for pain and function between the 3 time points based on the Friedman signed-ranked test, WUSPI (χ²₂=5.10, P=.014), DASH Index (χ²₂=5.41, P=.012), and SRQ (χ²₂=23.71, P≤.001). Wilcoxon signed-rank tests demonstrated that isometric strength measurements of the serratus anterior and scapular retractors increased after the exercise intervention ([t=2.42, P=.04] and [t=4.67, P=.003], respectively). Muscle impulse produced by the lower trapezius during a fatigue task also improved (t=2.2, P=.02). No differences were measured in isometric strength for the lower trapezius, glenohumeral rotators, and abductors between the baseline and 12-week time points.

Conclusions

A high-dose scapular stabilizer and rotator cuff strengthening program using telerehabilitation for supervision holds promise for shoulder pain treatment in manual wheelchair users with SCI. Additional work is needed to determine the effectiveness compared with other interventions, as well as the potential for earlier intervention to prevent development of shoulder pain.     

A Randomized Controlled Trial on the Effects of Cycling With and Without Electrical Stimulation on Cardiorespiratory and Vascular Health in Children With Spinal Cord Injury

Johnston TE, Smith BT, Mulcahey MJ, Betz RR, Lauer RT. A randomized controlled trial on the effects of cycling with and without electrical stimulation on cardiorespiratory and vascular health in children with spinal cord injury.

Objective

To examine the cardiorespiratory/vascular effects of cycling with and without functional electrical stimulation (FES) in children with spinal cord injury (SCI).

Design

Randomized controlled trial.

Setting

Pediatric referral hospital.

Participants

Children with SCI (N=30), ages 5 to 13 years, with injury levels from C4 to T11, and American Spinal Injury Association grades A, B, or C.

Interventions

Children were randomly assigned to 1 of 3 groups: FES leg cycling exercise, passive leg cycling, or noncycling control group receiving electrical stimulation therapy. After receiving instruction on the use of the equipment, children exercised for 1 hour 3 times per week for 6 months at home with parental supervision.

Main Outcome Measures

Oxygen uptake (V̇o₂) during an incremental arm ergometry test, resting heart rate, forced vital capacity, and a fasting lipid profile.

Results

There were no differences (P>.05) between groups after 6 months of exercise when comparing pre- and postvalues. However, there were differences between groups for some variables when examining percent change. The FES cycling group showed an improvement (P=.035) in V̇o₂ (16.2%±25.0%) as compared with the passive cycling group (–28.7%±29.1%). For lipid levels, the electrical stimulation–only group showed declines (P=.032) in cholesterol levels (–17.1%±8.5%) as compared with the FES cycling group (4.4%±20.4%).

Conclusions

Cycling with FES led to gains in V̇o₂, whereas electrical stimulation alone led to improvements in cholesterol.     

Assessing physical function in adult acquired major upper-limb amputees by combining the Disabilities of the Arm, Shoulder and Hand (DASH) Outcome Questionnaire and clinical examination

Østlie K, Franklin RJ, Skjeldal OH, Skrondal A, Magnus P. Assessing physical function in adult acquired major upper-limb amputees by combining the Disabilities of the Arm, Shoulder and Hand (DASH) Outcome Questionnaire and clinical examination.

Objectives

To describe physical function in adult acquired major upper-limb amputees (ULAs) by combining self-assessed arm function and physical measures obtained by clinical examinations; to estimate associations between background factors and self-assessed arm function in ULAs; and to assess whether clinical examination findings may be used to detect reduced arm function in unilateral ULAs.

Design

Survey: postal questionnaires and clinical examinations.

Setting

Norwegian ULA population. Clinical examinations performed at 3 clinics.

Participants

Questionnaires: population-based sample (n=224; 57.4% response rate). Clinical examinations: combined referred sample and convenience sample of questionnaire responders (n=70; 83.3% of those invited). Survey inclusion criteria: adult acquired major upper-limb amputation, resident in Norway, mastering of spoken and written Norwegian.

Interventions

Not applicable.

Main Outcome Measures

The Disabilities of the Arm, Shoulder and Hand (DASH) Outcome Questionnaire, and clinical examination of joint motion and muscle strength with and without prostheses.

Results

Mean DASH score was 22.7 (95% confidence interval [CI], 20.3–25.0); in bilateral amputees, 35.7 (95% CI, 23.0–48.4); and in unilateral amputees, 22.1 (95% CI, 19.8–24.5). A lower unilateral DASH score (better function) was associated with paid employment (vs not in paid employment: adjusted regression coefficient [aB]=−5.40, P=.033; vs students: aB=−13.88, P=.022), increasing postamputation time (aB=−.27, P=.001), and Norwegian ethnicity (aB=−14.45, P<.001). At clinical examination, we found a high frequency of impaired neck mobility and varying frequencies of impaired joint motion and strength at the shoulder, elbow, and forearm level. Prosthesis wear was associated with impaired joint motion in all upper-limb joints (P<.006) and with reduced shoulder abduction strength (P=.002). Impaired without-prosthesis joint motion in shoulder flexion (ipsilateral: aB=12.19, P=.001) and shoulder abduction (ipsilateral: aB=12.01, P=.005; contralateral: aB=28.82, P=.004) was associated with increased DASH scores.

Conclusions

Upper-limb loss clearly affects physical function. DASH score limitation profiles may be useful in individual clinical assessments. Targeted clinical examination may indicate patients with extra rehabilitational needs. Such examinations may be of special importance in relation to prosthesis function.     

Effects of a physical therapy program combined with manual lymphatic drainage on shoulder function,quality of life,lymphedema incidence,and pain in breast cancer patients with axillary web syndrome following axillary dissection

Purpose

The aim of this study was to evaluate the effects of physical therapy (PT) combined with manual lymphatic drainage (MLD) on shoulder function, pain, lymphedema, visible cords, and quality of life (QOL) in breast cancer patients with axillary web syndrome (AWS).

Methods

In this prospective, randomized trial, 41 breast cancer patients with visible and palpable cords on the arm and axilla and a numeric rating scale (NRS) pain score of >3 were randomly assigned to PT (3 times/week for 4 weeks; n?=?20) and PT combined with MLD (5 times/week for 4 weeks; PTMLD; n?=?21) groups. MLD was performed by a physical therapist and the patients themselves during week 1 and weeks 2–4, respectively. Arm volume, shoulder function (muscular strength; active range of motion; and disabilities of the arm, shoulder, and hand [DASH]); QOL (European Organization for Research and Treatment of Cancer Core and Breast Cancer‐Specific QOL questionnaires), and pain (NRS) were assessed at baseline and after 4 weeks of treatment.

Results

QOL including functional and symptom aspects, shoulder flexor strength, DASH, and NRS scores were significantly improved in both groups after the 4-week intervention (P?<?0.05). NRS score and arm volume were significantly lower in the PTMLD group than in the PT group (P?<?0.05). Lymphedema was observed in the PT (n?=?6), but not PTMLD, group (P?<?0.05).

Conclusions

PT improves shoulder function, pain, and QOL in breast cancer patients with AWS and combined with MLD decreases arm lymphedema.

     

Efficacy of intra-articular injection of botulinum toxin type A in refractory hemiplegic shoulder pain

Castiglione A, Bagnato S, Boccagni C, Romano MC, Galardi G. Efficacy of intra-articular injection of botulinum toxin type A in refractory hemiplegic shoulder pain.

Objective

To evaluate the efficacy of intra-articular injection of botulinum toxin type A (BTX-A) in relieving hemiplegic shoulder pain (HSP).

Design

Pilot study with assessments before and after BTX-A intra-articular injection.

Setting

Hospital rehabilitation department.

Participants

Patients (N=5) with HSP refractory to standard treatments and pain score at rest greater than 7 on a pain visual analog scale (VAS) of 0 to 10cm.

Intervention

Intra-articular BTX-A injection.

Main Outcome Measure

Variation in VAS score at rest and during 90° passive arm abduction 2 and 8 weeks after BTX-A intra-articular injection.

Results

Baseline VAS score was 8.7±1 at rest and 9.8±0.4 during passive arm abduction. It clearly decreased at 2 (1.5±1.1 at rest, P=.001; 3±1.2 during arm abduction, P<.001) and 8 weeks (1.5±1.2 at rest, P=.001; 2.3±1.1 during arm abduction, P<.001) after BTX-A intra-articular injection.

Conclusions

We found a strong correlation between intra-articular BTX-A injection and pain relief in patients with HSP. This result could provide the rationale for blind randomized controlled trials designed to better evaluate the safety and efficacy of intra-articular BTX-A injection in patients with refractory HSP.     

Prognostic models for physical capacity at discharge and 1 year postdischarge from rehabilitation in persons with spinal cord injury

Haisma JA, van der Woude LH, Stam HJ, Bergen MP, Sluis TA, de Groot S, Dallmeijer AJ, Bussmann JB. Prognostic models for physical capacity at discharge and 1 year postdischarge from rehabilitation in persons with spinal cord injury.

Objective

To develop prognostic models for physical capacity at discharge and 1 year after discharge from inpatient rehabilitation in persons with spinal cord injury (SCI).

Design

Inception cohort; data collected at start of rehabilitation (n=104), at discharge (n=81), and 1 year later (n=74).

Setting

Eight Dutch rehabilitation centers.

Participants

Patients with SCI at initial rehabilitation.

Interventions

Not applicable.

Main Outcome Measures

Physical capacity determined by endurance capacity (peak oxygen uptake [Vo₂peak, in L/min] and power output [POpeak, in watts]) during a maximal exercise test, arm muscle strength, and respiratory function. Multiple regression models, either with or without prior outcome, evaluated subject, lifestyle, and lesion-related predictors.

Results

Only start Vo₂peak contributed to the prediction of discharge Vo₂peak (R²=.51). Discharge Vo₂peak contributed to its prediction 1 year later (R²=.75). Start POpeak, sex, age, and level of lesion contributed to discharge POpeak (R²=.73). Discharge POpeak, hours of employment before injury, and level of lesion contributed to POpeak 1 year later (R²=.81). Models without prior outcome explained less variance. Education, employment, body mass index, not smoking, and conservative stabilization of the spine positively contributed to endurance capacity. Muscle strength was well predicted (R² range, .68−.84). Without prior outcome, respiratory function was poorly predicted.

Conclusions

Because prior outcome contributed to an accurate prediction, the early assessment of physical capacity is important in establishing prognoses. Although their accuracy warrants caution in their application, models could complement clinical expertise when informing patients about expected physical outcome and identifying those at risk of low physical capacity.     

Home-Based Exercise Enhances Health-Related Quality of Life in Persons With Spinal Cord Injury: A Randomized Controlled Trial

Objective

To assess the influence of a home-based exercise intervention on indices of health-related quality of life (HRQOL) in persons with spinal cord injury (SCI).

The effect of clinically relevant pressure duration on sacral skin blood flow and temperature in patients after acute spinal cord injury

Sae-Sia W, Wipke-Tevis DD, Williams DA. The effect of clinically relevant pressure duration on sacral skin blood flow and temperature in patients after acute spinal cord injury.

Objective

To test the effect of clinically relevant duration of pressure loading (2h) on sacral skin blood flow (SBF) and skin temperature in subjects with spinal cord injury (SCI) within 24 to 96 hours after injury compared with subjects with acute orthopedic trauma and healthy subjects.

Design

Three-group, repeated-measures, inception cohort.

Setting

Three acute care hospitals in southern Thailand.

Participants

Convenience sample of 20 subjects with acute SCI within 24 to 96 hours after injury. Age- and sex-matched subjects with acute orthopedic trauma (n=35) and healthy subjects (n=47) served as comparison groups.

Interventions

Not applicable.

Main Outcome Measures

Sacral SBF and skin temperature were measured simultaneously by using a laser Doppler sensor and thermocouple sensor, respectively, with subjects lying in the lateral (baseline, no pressure, 30min), supine (pressure loading, 2h), and lateral position (recovery, no pressure, 90min).

Results

Baseline skin temperature was higher in subjects with acute SCI (P<.05) compared with subjects with orthopedic trauma and healthy subjects. A relative decrease in sacral SBF occurred in subjects with acute SCI (P<.01) over 2 hours of pressure loading compared with subjects with orthopedic trauma and healthy subjects. During the same time course, subjects with acute SCI had a smaller increase in sacral skin temperature compared with subjects with orthopedic trauma and healthy subjects (P<.001). During recovery, the time to the initial sacral SBF-reactive hyperemia response was shorter in subjects with acute SCI compared with subjects with orthopedic trauma (P<.001) and healthy subjects (P=.003). Additionally, the initial positive slope of the SBF reactive hyperemia response was higher in subjects with acute SCI than subjects with orthopedic trauma (P=.005) and healthy (P=.004) subjects.

Conclusions

Collectively, a negative change in SBF during pressure loading plus a shorter time to increase and greater slope for SBF after pressure release reveal microvascular dysfunction in acute SCI subjects. The clinical relevance of the protocol suggests that turning interval guidelines may require reevaluation for patients with acute SCI.     

Classifying subgroups of chronic low back pain patients based on lifting patterns

Slaboda JC, Boston JR, Rudy TE, Lieber SJ. Classifying subgroups of chronic low back pain patients based on lifting patterns.

Objective

To compare self-reported measures of chronic lower back pain (CLBP) patients who were assigned to 2 subgroups based on their lifting patterns performed during a repetitive lifting task.

Design

Cross-sectional study.

Setting

Research laboratory

Participants

CLBP subjects (n=81) and pain-free controls (n=53).

Interventions

Not applicable.

Main Outcome Measures

Measures of lifting patterns and self-reported disability, pain, and psychosocial aspects.

Results

Two CLBP subgroups were found: 1 group that lifts similarly to control subjects (n=35) and 1 group that lifts very differently from controls (n=46). The CLBP group that lifted differently than controls reported higher pain intensity (P=.005), higher pain severity (P=.025), and lower self-efficacy (P=.013) than the CLBP group that lifted similarly to controls.

Conclusions

A classification system based on lifting patterns identified 2 CLBP subgroups that were significantly different on lifting and self-reported measures, indicating the importance of physical functioning measures in classification systems.     

Predictors and Outcomes of Antibiotic Adequacy for Bloodstream Infections in Veterans With Spinal Cord Injury

Evans CT, Burns SP, Chin A, Weaver FM, Hershow RC. Predictors and outcomes of antibiotic adequacy for bloodstream infections in veterans with spinal cord injury.

Objective

To identify predictors and outcomes associated with receiving inadequate empirical antimicrobial treatment for bloodstream infections (BSIs) in persons with spinal cord injury (SCI).

Design

Retrospective cohort study from October 1, 1997, through September 30, 2004.

Setting

A Department of Veterans Affairs SCI center that serves approximately 700 patients a year.

Participants

Hospitalized patients with SCI (N=123) who had 1 or more BSIs during the study period.

Interventions

Not applicable.

Main Outcome Measures

Adequacy of antimicrobial treatment (inadequate treatment was defined as the absence of antimicrobial agents for a particular organism within 2 days after the collection of blood cultures and/or the microorganism's resistance to the antimicrobial administered), hospital length of stay (LOS) post-BSI infection, and in-hospital and 30-day mortality. Cluster-adjusted multivariable models were assessed.

Results

Over one third (88; 37.4%) of the 235 episodes of BSI identified received inadequate empirical antibiotic treatment. Having a polymicrobial BSI was associated with inadequate treatment (odds ratio [OR]=3.28; 95% confidence interval [CI]=1.62–6.65; P=.001). Factors protective against inadequate therapy included having a comorbid pressure ulcer (OR=0.37; 95% CI=0.21–0.68; P=.001) or a BSI that was not primary (OR=0.30; 95% CI=0.15–0.58; P<.0001). Mortality did not differ between the inadequate and adequate treatment groups (11.4% vs 10.9%; P=.92). Similarly LOS postinfection was not affected by treatment status (inadequate treatment median=22d vs adequate treatment median=27d; P=.98).

Conclusions

Over one third of patients received inadequate empirical treatment, which was associated with having a polymicrobial BSI. However, inadequate treatment was not associated with increased mortality or LOS postinfection.     

Assessment of arm activity using triaxial accelerometry in patients with a stroke

van der Pas SC, Verbunt JA, Breukelaar DE, van Woerden R, Seelen HA. Assessment of arm activity using triaxial accelerometry in patients with a stroke.

Objective

To study the validity of accelerometry in the assessment of arm activity of patients with impaired arm function after stroke.

Design

Cross-sectional concurrent validity study.

Setting

Rehabilitation center.

Participants

Patients (N=45) at different stages after stroke.

Interventions

Not applicable.

Main Outcome Measures

All patients wore 2 triaxial accelerometers around their wrists during 3 consecutive days. Arm activity was assessed, based on unilateral (activity of the affected arm) and bilateral accelerometry (ratio between the activity of the affected and nonaffected arm). The Motor Activity Log-26 (MAL-26) Amount of Use (AOU) scale was used as the main external criterion to test the concurrent validity of arm accelerometry. In addition, the MAL-26 Quality of Movement (QOM) scale and the Stroke Impact Scale (SIS) subscale Hand Function were used. To test the divergent validity, the SIS subscale Mobility was used. Spearman correlation coefficients were calculated. In an additional regression analysis, the hypothesized confounding influence of spasm, therapy intensity, and interobserver differences was studied.

Results

Both unilateral (ρ=.58, P<.001) and bilateral (ρ=.60, P<.001) accelerometry were significantly related to the MAL-AOU scale. Associations of both unilateral and bilateral accelerometry with the MAL-QOM and SIS subscale Hand Function corroborated these findings. The SIS subscale Mobility was not significantly associated with unilateral accelerometry (ρ=.41, P=.01) or bilateral accelerometry (ρ=.23, P=.11). None of the hypothesized confounders influenced these associations significantly.

Conclusions

Based on the results, both the concurrent and divergent validity of unilateral and bilateral arm accelerometry for measuring arm activity after stroke are good.     

Self-Perceived Utilization of the Paretic Arm in Chronic Stroke Requires High Upper Limb Functional Ability

Objective

To explore potential predictors of self-reported paretic arm use at baseline and after task-specific training (TST) in survivors of stroke.

Design

Data were obtained from a randomized controlled trial of somatosensory stimulation and upper limb TST in chronic stroke.

Setting

University laboratory.

Participants

Chronic (≥3mo) survivors of stroke (N=33; mean age, 62y; mean stroke duration, 38mo).

Interventions

Participants received 12 sessions of TST preceded by either active (n=16) or sham (n=17) somatosensory stimulation to all 3 peripheral nerves.

Main Outcome Measures

Demographic and clinical characteristics were entered stepwise into multiple linear regression analyses to determine the factors that best predict baseline Motor Activity Log (MAL) amount of use rating and change 3 months after TST.

Results

The Action Research Arm Test (ARAT) score predicted the amount of use at baseline (R²=.47, P<.001); in using this model, an ARAT score of 54 (maximum of 57) is required to score 2.5 on the MAL (use described as between rarely and sometimes). After TST the change in the ARAT score predicted the change in the amount of use (R²=.31, P=.001). The predictive power of the model for change at 3 months increased if the Fugl-Meyer Assessment wrist component score was added (R²=.41, P=.001).

Conclusions

Utilization of the paretic upper limb in activities of daily living requires high functional ability. The increase in self-reported arm use after TST is dependent on the change in functional ability. These results provide further guidance for rehabilitation decisions.     

Comparison of soleus H-reflex modulation after incomplete spinal cord injury in 2 walking environments: treadmill with body weight support and overground

Phadke CP, Wu SS, Thompson FJ, Behrman AL. Comparison of soleus H-reflex modulation after incomplete spinal cord injury in 2 walking environments: treadmill with body weight support and overground.

Objective

To investigate a walking environment effect on soleus H-reflex modulation during walking in persons with motor incomplete spinal cord injury (SCI) and noninjured controls.

Design

Pretest and posttest repeated-measures quasi-experimental controlled design.

Setting

Locomotor training laboratory.

Participants

Eight adults with incomplete SCI and 8 noninjured age- and speed-matched controls.

Intervention

Walking overground with a customary assistive device and brace at a self-selected, comfortable walking speed was compared with walking on treadmill with 40% body weight support (BWS) and manual trainers for leg and trunk movement guidance.

Main Outcome Measure

Mean soleus H-reflex amplitude (H/M ratio) was recorded during midstance and midswing phases of walking.

Results

The H/M ratio was 33% smaller in stance phase (P=.078) and 56% smaller in the swing phase (P=.008) of walking on the treadmill with BWS and manual assistance compared with overground in the incomplete SCI group. The H/M ratio in the incomplete SCI group was significantly greater compared with noninjured controls in the stance and swing phases of overground walking (P=.001, P=.007, respectively). Soleus H-reflex modulation in the 2 walking environments did not differ significantly in the noninjured population.

Conclusions

Training walking on a treadmill with BWS and manual assistance to approximate the kinematics and spatiotemporal pattern of walking may be a more optimal environment to aid in normalizing reflex modulation after incomplete SCI when compared with conventional gait training overground.     

Article 11: Aerobic exercise improves work capacity and functional mobility in spinal cord injury above T6

Objective: To determine if adults with low-cervical and high-thoracic spinal cord injury (SCI) significantly improve work capacity and functional mobility after a structured aerobic exercise. Design: Pre- and posttest interventional trial. Setting: Exercise laboratory. Participants: 6 subjects (4 men, 2 women; mean age ± SD, 37.7±12.1y; mean weight, 74.1±21.2kg; mean time since injury, 5.9±5.6y) with motor complete SCI between C7 and T5 completed the intervention. Interventions: Subjects performed arm crank ergometry at 70% of peak power output for 30min/d, 3d/wk for 10 weeks. Main Outcome Measures: Peak oxygen consumption (Vo₂peak), peak power output, and 12-minute wheelchair propulsion (12WCP). Results: Vo₂peak significantly increased, from 10.8±3.6mL·kg⁻¹·min⁻¹ to 12.6±4.2mL·kg⁻¹·min⁻¹ (P<.05) after the intervention, while peak power output and 12WPC increased from 40.8±15.3W to 54.2±18.9W and 1260±344ft to 1358±312ft, respectively (P<.005). Conclusions: Structured aerobic exercise can significantly improve work capacity and functional mobility in persons with motor complete SCI between C7 and T5.     

Feasibility of a Smartphone-Based Exercise Program for Office Workers With Neck Pain: An Individualized Approach Using a Self-Classification Algorithm

Objective

To explore the feasibility of a newly developed smartphone-based exercise program with an embedded self-classification algorithm for office workers with neck pain, by examining its effect on the pain intensity, functional disability, quality of life, fear avoidance, and cervical range of motion (ROM).

The effect of a series of repetitive transcranial magnetic stimulations of the motor cortex on central pain after spinal cord injury

Defrin R, Grunhaus L, Zamir D, Zeilig G. The effect of a series of repetitive transcranial magnetic stimulations of the motor cortex on central pain after spinal cord injury.

Objective

To study the analgesic effect of repetitive transcranial magnetic stimulation (rTMS) of the motor cortex on central pain in patients with chronic spinal cord injury (SCI).

Design

Double-blind randomized controlled trial. Mean follow-up period was 4.5 weeks.

Setting

General hospital.

Participants

Twelve paraplegic patients due to thoracic SCI suffering chronic central pain (11 completed the study) who were randomly selected from a list of eligible patients.

Intervention

Real or sham 10 daily motor rTMS treatments (500 trains at 5Hz for 10s; total of 500 pulses at intensity of 115% of motor threshold) using figure-of-8 coil over the vertex.

Main Outcome Measures

Chronic pain intensity (visual analog scale [VAS], McGill Pain Questionnaire [MPQ]), pain threshold, and level of depression (Beck Depression Inventory).

Results

Both real and sham TMS induced a similar, significant reduction in VAS scores (P<.001) immediately after each of the 10 treatment sessions and in VAS and MPQ scores after the end of the treatment series. However, only real rTMS conferred a significant increase in heat-pain threshold (4°C, P<.05) by the end of the series. Most important, the reduction in MPQ scores in the real rTMS group continued during the follow-up period. Depression scores were equally reduced in both groups but similar to pain relief, depression continued to improve at follow-up in the real rTMS group.

Conclusions

Whereas the pain alleviation induced by a single rTMS treatment is probably due to placebo, patients with SCI may benefit from a series of rTMS treatments.     

EFFECTS OF A DRY‐LAND STRENGTHENING PROGRAM IN COMPETITIVE ADOLESCENT SWIMMERS

Background

Shoulder pain is common in competitive young swimmers. A relationship between shoulder strength and shoulder soreness in competitive young swimmers may indicate need for strengthening.

Purpose

To determine if a shoulder exercise program will improve shoulder strength and decrease pain in competitive young swimmers.

Study Design

Randomized control

Methods

Participants (10 control, 11 experimental), randomly assigned to a control or experiment group, completed the 12 week program. Strength was measured prior to the study for shoulder flexion, abduction, external rotation, internal rotation, and extension on the dominant arm using handheld dynamometry. The experimental group was then assigned exercises to be performed three times per week. The control group was instructed not to perform the exercises. All participants were re‐tested at six and twelve weeks following initiation of the study.

Results

The changes in strength for each muscle group and pain were compared between groups using a mixed design two‐way ANOVA. The experimental group significantly increased external rotation strength compared to the control group. Shoulder soreness was not significantly different between groups.

Conclusion

Adolescents who perform shoulder strengthening significantly increased their external rotation strength compared to adolescents who only participated in a regular swimming regimen.     

Comparison of Peritendinous Hyaluronan Injections Versus Extracorporeal Shock Wave Therapy in the Treatment of Painful Achilles' Tendinopathy: A Randomized Clinical Efficacy and Safety Study

Objective

To compare the safety and efficacy of hyaluronan (HA) injections with standard extracorporeal shock wave therapy (ESWT) in the treatment of painful midportion Achilles' tendinopathy.