Does Rehabilitation Matter in Patients With Femoral Neck Fracture and Cognitive Impairment? A Prospective Study of 246 Patients

Al-Ani AN, Flodin L, Söderqvist A, Ackermann P, Samnegård E, Dalén N, Sääf M, Cederholm T, Hedström M. Does rehabilitation matter in patients with femoral neck fracture and cognitive impairment? A prospective study of 246 patients.

Objective

To identify factors associated with preserved walking ability and Katz activities of daily living (ADLs) index at 4-month and 12-month follow-up in cognitively impaired patients with femoral neck fracture.

Design

Population-based cohort study.

Setting

A multicenter study of the Stockholm Hip Fracture Group including 4 university hospitals.

Participants

Consecutive patients (N=246) with femoral neck fracture, older than 65 years (mean, 84y; 72% women) with cognitive impairment (known dementia or low [0-2 points] score) in Short Portable Mental Status Questionnaire [0-10 points]) and able to walk before the fracture.

Interventions

Not applicable.

Main Outcome Measure

Walking ability and ADLs index at 4-month and 12-month follow-up.

Results

Significant predictors of preserved walking ability at 12-month follow-up were discharge to rehabilitation unit (odds ratio [OR]=2.83; confidence interval [CI], 1.1-7.26; P=.03) and walking ability before the fracture (OR=8.98; CI, 3.52-22.93; P<.001), while type of surgery was not (P=.197). Analyses were adjusted for age, sex, American Society of Anesthesiologists score, fracture type, and surgical method. Corresponding predictors of preserved Katz ADLs index at 12-month follow-up, after adjustment for age and sex, were discharge to rehabilitation unit (OR=5.33; CI, 1.44-19.65; P=.012) and ADLs index before fracture (OR=2.51; CI, 1.8-3.5; P<.001), while type of surgery was not (P=.376).

Conclusions

Discharge to rehabilitation unit, a factor we can influence, was associated with preserved walking ability and ADLs index in cognitively impaired patients with hip fracture.     

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.     

Balance-Based Torso-Weighting May Enhance Balance in Persons With Multiple Sclerosis: Preliminary Evidence

Widener GL, Allen DD, Gibson-Horn C. Balance-based torso-weighting may enhance balance in persons with multiple sclerosis: preliminary evidence.

Objective

To determine whether weight placed on the trunk in response to directional balance loss would enhance function and stability in people with multiple sclerosis (MS).

Design

Quasi-experimental study in which subjects served as their own controls.

Setting

Research laboratory.

Participants

Subjects (N=16) age 20 to 65 years with MS recruited through the Northern California Chapter of the National Multiple Sclerosis Society.

Interventions

Balance-based torso-weighting where up to 1.5% body weight was placed in a garment on the trunk. Subjects were tested at baseline and then in randomly ordered balance-based torso-weighting and nonweighted garment conditions.

Main Outcome Measures

Sharpened Romberg, eyes open (SREO) and Sharpened Romberg, eyes closed, computerized dynamic platform posturography (CDPP), Timed Up & Go (TUG), and 25-foot timed walk.

Results

Significant improvement (P<.014) was found with SREO in the balance-based torso-weighting compared with nonweighted conditions. CDPP eyes open and TUG showed improvements (P<.03) from baseline to balance-based torso-weighting and nonweighted conditions.

Conclusions

Improved performance in a group of adults with MS was seen when light weights were placed on the torso to counteract balance loss. Placement of weights may have the potential to produce immediate improvements in balance in this population.     

Changes and determinants of life satisfaction after spinal cord injury: a cohort study in the Netherlands

van Koppenhagen CF, Post MW, van der Woude LH, de Witte LP, van Asbeck FW, de Groot S, van den Heuvel W, Lindeman E. Changes and determinants of life satisfaction after spinal cord injury: a cohort study in The Netherlands.

Objective

To determine the impact of spinal cord injury (SCI) on life satisfaction of persons with SCI 1 year after discharge of inpatient rehabilitation.

Design

A cohort study. Life satisfaction before SCI was retrospectively measured at the start of active rehabilitation. One year after discharge from inpatient rehabilitation, current life satisfaction was measured.

Setting

Eight rehabilitation centers in The Netherlands.

Participants

Persons (N=147) aged 18 to 65 and wheelchair-dependent at least for long distances.

Interventions

Not applicable.

Main Outcome Measure

The Life Satisfaction Questionnaire.

Results

Mean satisfaction with life ± SD as a whole was 5.3±0 before SCI and 4.3±1.3 one year after inpatient rehabilitation. Sexual life, self-care, and vocational situation showed the largest impact of SCI (P<.05), whereas the social relationships domains appeared to be the least affected. Decrease of life satisfaction after SCI was larger when using the retrospective ratings than when using general population scores. Significant determinants of life satisfaction after SCI were high lesion level (β=.31, P<.05), pain (β=.19, P<.05), and secondary impairments (β=.22, P<.05).

Conclusions

Life satisfaction decreased in persons with SCI. Level of lesion and suffering secondary impairments or pain were associated with low life satisfaction 1 year after discharge from inpatient rehabilitation.     

Higher Muscle Passive Stiffness in Parkinson's Disease Patients Than in Controls Measured by Myotonometry

Marusiak J, Kisiel-Sajewicz K, Jaskólska A, Jaskólski A. Higher muscle passive stiffness in Parkinson's disease patients than in controls measured by myotonometry.

Objective

To assess muscle passive stiffness in medicated Parkinson's disease patients using myotonometry.

Design

Case-control study.

Setting

Kinesiology laboratory.

Participants

Women with Parkinson's disease (PD) (n=8) and healthy matched elderly women (controls) (n=10) (mean age: PD, 77±3y; controls, 77±4y).

Interventions

Not applicable.

Main Outcome Measures

Passive stiffness of relaxed biceps brachii (BB) muscle was measured using myotonometry. Additionally, surface electromyographic and mechanomyographic signals were recorded from the muscle at rest, and amplitude of those signals was analyzed offline.

Results

The values of BB muscle passive stiffness were significantly (P=.004) higher in PD than in the controls, with a statistically significant influence of parkinsonian rigidity score (Unified Parkinson's Disease Rating Scale) on intergroup differences (P<.001). The Spearman correlation coefficient ρ value showed a significant (P=.005) positive relationship (ρ=.866) between the parkinsonian rigidity score and passive stiffness values of BB in PD. The groups did not differ significantly in the electromyogram amplitude (P=.631) and mechanomyogram amplitude (P=.593) of the BB muscle, and values of these parameters did not correlate significantly with rigidity score (P=.555, P=.745, respectively) in the patients.

Conclusions

Myotonometer is a sensitive enough tool to show that PD patients have higher muscle passive stiffness than healthy controls.     

A Randomized, Double-Blinded, Crossover Pilot Study Assessing the Effect of Nabilone on Spasticity in Persons With Spinal Cord Injury

Pooyania S, Ethans K, Szturm T, Casey A, Perry D. A randomized, double-blinded, crossover pilot study assessing the effect of nabilone on spasticity in persons with spinal cord injury.

Objectives

To determine whether nabilone, a synthetic cannabinoid, alleviates spasticity in people with spinal cord injury (SCI).

Design

A double-blind, placebo-controlled crossover study.

Setting

Outpatient rehabilitation clinics.

Participants

We recruited volunteers (N=12) with SCI and spasticity. One subject, a paraplegic man, dropped out of the study because of an unrelated cause. Eleven subjects completed the study; all subjects were men with an average age of 42.36 years; 6 of them were persons with tetraplegia, and 5 were persons with paraplegia.

Interventions

The subjects received either nabilone or placebo during the first 4-week period (0.5mg once a day with option to increase to 0.5mg twice a day), and then outcome measures were assessed. After a 2-week washout, subjects were crossed over to the opposite arm.

Main Outcome Measures

The primary outcome was the Ashworth Scale for spasticity in the most involved muscle group, in either the upper or lower extremities, chosen by the subject and clinician. The secondary outcomes included the sum of the Ashworth Scale in 8 muscle groups of each side of the body measured by the clinician; Spasm Frequency Scale and visual analog scale, reported by the subject; Wartenberg Pendulum Test, in order to quantify severity of spasticity; and the Clinician's and Subject's Global Impression of Change.

Results

One subject dropped out during the placebo arm because of an unrelated urinary stricture, and 11 subjects completed the study. There was a significant decrease on active treatment for the Ashworth in the most involved muscle (mean difference ± SD, .909±.85; P=.003), as well as the total Ashworth score (P=.001). There was no significant difference in other measures. Side effects were mild and tolerable.

Conclusions

Nabilone may be beneficial to reduce spasticity in people with SCI. We recommend a larger trial with a more prolonged treatment period and an option to slowly increase the dosage further.     

Predictors of Cardiopulmonary Hospitalization in Chronic Spinal Cord Injury

Waddimba AC, Jain NB, Stolzmann K, Gagnon DR, Burgess JF, Kazis LE, Garshick E. Predictors of cardiopulmonary hospitalization in chronic spinal cord injury.

Objective

To investigate longitudinal risk factors of hospitalization for circulatory and pulmonary diseases among veterans with chronic spinal cord injury (SCI). Circulatory and respiratory system illnesses are leading causes of death in patients with chronic SCI, yet risk factors for related hospitalizations have not been characterized.

Design

Prospective cohort study.

Setting

Veterans Affairs (VA) Boston Healthcare System, Boston, Massachusetts.

Participants/Data Sources

Veterans (N=309) greater than or equal to 1 year post-SCI from the VA Boston Chronic SCI cohort who completed a health questionnaire and underwent spirometry at study entry. Baseline data were linked to 1996 through 2003 hospitalization records from the VA National Patient Care Database.

Interventions

Not applicable.

Main Outcome Measures

Cardiopulmonary hospital admissions, the predictors of which were assessed by multivariate Cox regression.

Results

Of 1478 admissions observed, 143 were a result of cardiopulmonary (77 circulatory and 66 respiratory) illnesses. Independent predictors were greater age (3% increase/y), hypertension, and the lowest body mass index quintile (<22.4kg/m²). A greater percentage-predicted forced expiratory volume in 1 second was associated with reduced risk. SCI level and completeness of injury were not statistically significant after adjusting for these risk factors.

Conclusions

Cardiopulmonary hospitalization risk in persons with chronic SCI is related to greater age and medical factors that, if recognized, may result in strategies for reducing future hospitalizations.     

Differential Performance of SF-36 Items in Healthy Adults With and Without Functional Limitations

Horner-Johnson W, Krahn GL, Suzuki R, Peterson JJ, Roid G, Hall T, the RRTC Expert Panel on Health Measurement. Differential performance of SF-36 items in healthy adults with and without functional limitations.

Objective

To determine whether Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) items show differential item functioning among healthy adults with various types of functional limitations as compared with a healthy sample with no identified limitations.

Design

Survey responses were analyzed by using partial correlations.

Setting

General community.

Participants

Participants (N=206) included (1) adults with spinal cord injury (SCI), (2) adults who were deaf or hard of hearing, (3) adults who were legally blind, (4) adults with psychiatric or emotional conditions, and (5) adults with no reported functional limitations. Participants were screened to ensure the absence of substantial health problems.

Interventions

Not applicable.

Main Outcome Measure

SF-36.

Results

Partial correlations showed a significant negative correlation, indicating differential item functioning (ie, apparent bias) for people with SCI on all 10 SF-36 Physical Functioning items. For people who were blind, 5 items showed a significant negative correlation. Two items had significant negative correlations for the deaf/hard-of-hearing group. One item showed significant negative performance for people with mental health conditions.

Conclusions

Our data indicated a possibility for measurement bias caused by the blending of health and function concepts in the SF-36.     

Effects of resistance training on lower-extremity impairments in older people with hip fracture

Portegijs E, Kallinen M, Rantanen T, Heinonen A, Sihvonen S, Alen M, Kiviranta I, Sipilä S. Effects of resistance training on lower-extremity impairments in older people with hip fracture.

Objective

To study the effects of resistance training on muscle strength parameters, mobility, and balance.

Design

Randomized controlled trial.

Setting

Research laboratory and senior gym.

Participants

Population-based sample of eligible 60- to 85-year-old community-dwelling men and women 0.5 to 7.0 years after hip fracture. Forty-six people had no contraindications and were willing to participate in the exercise trial.

Intervention

Twelve-week intensive progressive strength-power training (n=24), aiming to reduce asymmetric deficit in leg muscle strength and power, or no intervention (n=22).

Main Outcome Measures

Isometric knee extension torque (KET) and leg extension power (LEP) measured in the weaker and stronger leg and the asymmetric deficit ([weak/sum both legs] × 100%), 10-m walking speed, dynamic balance test, and self-reported outdoor mobility.

Results

KET increased in both legs (P<.021), LEP tended to increase in the weaker leg (P=.071), and asymmetric LEP deficit decreased (P=.010) after training compared with the control group. LEP of the stronger leg, asymmetric KET deficit, walking speed, and balance performance were not significantly affected by training. Self-reported ability to walk outdoors improved after training. The compliance to the training was over 90%, and few adverse events (n=4; mainly musculoskeletal) were likely to be caused by the training.

Conclusions

Intensive resistance training is feasible for people with a hip fracture and improved muscle strength and power. More intensive training especially for the weaker leg may be needed to obtain more marked effects on asymmetric deficit, mobility, and balance. Also, the timing and duration of training program should be considered. (ISRCTN identifier ISRCTN34271567.)     

The Ability of Ultrasonography, Magnetic Resonance Imaging and Bone Mineral Densitometry to Predict the Strength of Human Achilles' Tendons

Devitt D, Koike Y, Doherty GP, Ramachandran N, Dinh L, Uhthoff HK, Lecompte M, Trudel G. The ability of ultrasonography, magnetic resonance imaging and bone mineral densitometry to predict the strength of human Achilles' tendons.

Objective

To assess the value of ultrasonography (US), magnetic resonance imaging (MRI), and bone mineral densitometry (BMD) in evaluating human Achilles' tendon strength.

Design

Cross-sectional observational study.

Setting

Tertiary care hospital.

Participants

Ninety-eight Achilles' tendons from 49 consecutive cadavers (26 men and 23 women with a mean age of 66.6 years) undergoing hospital autopsy were assessed.

Interventions

Not applicable.

Main Outcome Measures

Tendon dimensions on US and MRI, and T1-weighted optical density were measured. Areas of hypodensity, hyperdensity, calcification, and heterogeneity were identified on US. The BMD of each calcaneus was recorded. The tendons were mechanically tested to determine peak load at failure.

Results

Sixteen patients (32.7%, 27 tendons) had abnormalities in 1 or both tendons on US and/or MRI (17 on US, 17 on MRI). Fifty-seven tendons (58%) ruptured in their midsubstance, at an average peak load of 4722±990N. Tendons with and without abnormalities on imaging had similar strengths (P>.05). Calcaneal BMD correlated weakly with peak load at failure (r=.21, P<.05).

Conclusions

The prevalence of Achilles' tendons abnormalities on US or MRI was 32.7% in our study group. Abnormalities on clinical imaging (US or MRI) were not predictive of the load at failure. Therefore, tendons with imaging abnormalities are not necessarily weaker, and one cannot predict the likelihood of rupture based on imaging results. Further, higher-powered studies could explore the ability of BMD to detect minimal clinically important differences and to predict Achilles' tendon weakness.     

Implanted Electrical Stimulation of the Trunk for Seated Postural Stability and Function After Cervical Spinal Cord Injury: A Single Case Study

Triolo RJ, Boggs L, Miller ME, Nemunaitis G, Nagy J, Bailey SN. Implanted electrical stimulation of the trunk for seated postural stability and function after cervical spinal cord injury: a single case study.

Objectives

To explore and quantify the physical and functional effects of stabilizing the torso with electrical stimulation of the paralyzed hip and trunk musculature after motor complete tetraplegia.

Design

Single-subject case study with repeated measures and concurrent controls.

Setting

Academic outpatient rehabilitation center.

Participants

Forty-four-year-old man with C4 American Spinal Injury Association grade A tetraplegia 20 years postspinal cord injury.

Intervention

A surgically implanted multichannel pulse generator and intramuscular stimulating electrodes to activate lumbar erector spinae, quadratus lumborum, and gluteus maximus muscles bilaterally.

Main Outcome Measures

Outcomes assessed with and without stimulation included (1) spinal alignment and pelvic orientation, (2) pulmonary function and ventilatory volumes, (3) forward bimanual reaching distance, (4) seated stability and resistance to externally applied disturbances, (5) maximal force and speed of rowing-like movements, and the ability to (6) independently return to an erect seated position from full forward or lateral flexion and (7) roll in bed without assistance.

Results

Stimulation improved spinal convexity and kyphosis by 26° and 21°, reduced posterior pelvic tilt by 11°, increased forced expiratory volume and vital capacity by 10% and 22%, and improved forward reach by more than 7cm. Average resistance to sagittal disturbances increased by more than 40% (P<.002), and mean force exerted during underhanded pulling more than doubled (P=.014) with stimulation. Restoration of upright sitting in both sagittal and coronal planes and bed turning was made possible through appropriately timed activation of the hip and trunk muscles.

Conclusions

A neuroprosthesis for controlling the paralyzed torso can positively impact spinal alignment, seated posture, pulmonary function, trunk stability, and reach. Stimulation of hip and trunk muscles can improve performance of activities of daily living as well as enable independent wheelchair and bed mobility.     

The Effect of Stretching on Muscle Responses and Postural Sway Responses During Computerized Dynamic Posturography in Women and Men

Lewis NL, Brismée JM, James CR, Sizer PS, Sawyer SF. The effect of stretching on muscle responses and postural sway responses during computerized dynamic posturography in women and men.

Objective

To evaluate the effect of stretching on the parameters of postural sway and on the kinematic variables associated with balance control in women and men.

Design

Mixed repeated measures design with 2 levels.

Setting

Research laboratory.

Participants

Fifteen women and fifteen men (mean age 23.4±2.2).

Intervention

Two separate sessions of (1) lower extremity stretching and (2) no-stretching, immediately prior to balance testing with simultaneous surface electromyographic (EMG) recordings of muscle responses.

Main Outcome Measures

EMG latencies and average amplitudes for 4 lower extremity muscles for the preferred stance limb during computerized dynamic posturography (CDP) tests, specifically the Postural Evoked Response Test, Adaptation Test, Motor Control Test, Sensory Organization Test, and Unilateral Stance Test.

Results

Analyses of variance indicated no significant main effect for stretching and 2 significant main effects for gender for the Motor Control Test (P=.021) and latency of tibialis anterior (P=.009). Analyses of covariance with covariants of height and active knee extension revealed no significant main effect of stretching or of gender on muscles responses or CDP performance.

Conclusions

In both women and men, lower extremity stretching did not significantly affect muscle responses or performance during CDP.     

Test position and hip strength in healthy adults and people with chronic stroke

Barbic S, Brouwer B. Test position and hip strength in healthy adults and people with chronic stroke.

Objective

To determine if peak torques generated by the hip flexors and extensors are dependent on test position in healthy adults and in people with chronic stroke.

Design

Cross-sectional study.

Setting

Motor performance laboratory.

Participants

Volunteers were 10 young (20.7±1.5y), 10 older adults (62.1±7y), and 10 stroke survivors (60.6±10y) who were an average of 5 years poststroke.

Interventions

Not applicable.

Main Outcome Measures

Isokinetic (60°/s) peak concentric hip flexor and extensor torques (in Nm/kg) generated in supine and standing positions.

Results

Peak flexor torques measured in standing were generally higher than in supine (P=.018); a pattern evident in all groups, but significant only in stroke. An interaction between test position and group for hip extensor strength (P=.016) reflected 2 distinct patterns in which torques were highest in standing among the young subjects and highest in supine after stroke.

Conclusions

Isokinetic hip flexor and extensor strength measured in standing and supine are comparable in young and older healthy people. In chronic stroke, the test position may over or underestimate maximum peak torque depending on the muscle group tested, particularly on the side ipsilateral to the lesion. These findings may have implications for predicting functional ability from strength measurements.     

Cervical erector spinae and upper trapezius muscle activity in children using different information technologies

Objectives

Researchers investigating the effects of computer use and the development of musculoskeletal disorders have mainly focused on the effects of prolonged muscle loading associated with postures assumed during computer use in the adult population. The objective of this study was to investigate the effects of different forms of old and new information technology (IT) on muscle activity levels in a paediatric population.

Design

A 3 × 3 × 2 mixed model design was used for this study.

Participants

Thirty-two schoolchildren aged 4-17 years participated in this study.

Outcome measures

Surface electromyography (EMG) data were collected from the left and right cervical erector spinae and upper trapezius muscles. Participants performed a 5-minutes reading task using the three IT types (book, laptop and desktop computer).

Results

Cervical erector spinae and upper trapezius muscle activity levels were significantly higher when children used the laptop set-up (P < 0.001). The lowest muscle activity levels were found when children used the desktop set-up. Cervical erector spinae and upper trapezius muscle activities were found to be higher on the left side in the book set-up compared with higher right muscle activity levels in the computer set-ups (P = 0.047 and <0.001, respectively).

Conclusions

The three IT types had different effects on cervical erector spinae and upper trapezius muscle activity, suggesting varying risks associated with different IT types. Activity levels were often above 5% maximum EMG (MEMG). As adult studies have linked activity levels greater than 5%MEMG with the development of musculoskeletal disorders, it seems that children are potentially at risk of replicating these adverse health reactions associated with adult IT use.     

Effect of a gravity-compensating orthosis on reaching after stroke: evaluation of the Therapy Assistant WREX

Iwamuro BT, Cruz EG, Connelly LL, Fischer HC, Kamper DG. Effect of a gravity-compensating orthosis on reaching after stroke: evaluation of the Therapy Assistant WREX.

Objective

To evaluate the effectiveness of an upper-extremity orthosis to improve the reaching workspace of stroke survivors.

Design

Within-subjects repeated-measures design evaluating reaching with and without the Therapy Assistant Wilmington Robotic Exoskeleton (WREX).

Setting

Laboratory.

Participants

Stroke survivors (N=10) with chronic upper-extremity hemiparesis.

Interventions

Not applicable.

Main Outcome Measures

Arm movement kinematics (Optotrak Certus motion detection system), muscle activity for biceps, triceps, anterior deltoid, and brachioradialis muscles (bipolar surface electromyography).

Results

Significant improvements of reaching distance occurred for all subjects across all targets (P<.001) when using the Therapy Assistant WREX. While the self-selected peak speed of hand movement during the reach decreased significantly with the Therapy Assistant WREX (P<.001), use of the Therapy Assistant WREX led to improved quality of movement as signified by a decrease in jerk (P<.001) and a shift in the timing of the peak speed to an earlier point in the movement (P<.001). Electromyographic muscle activity analysis showed that use of the Therapy Assistant WREX led to a reduction in biceps activity across all targets during the reach (P<.05), in conjunction with a marginally significant reduction in activity of the anterior deltoid (P<.055). No changes were observed in triceps (P=.47) or brachioradialis activity (P=.28).

Conclusions

By reducing requirements for shoulder activation, the Therapy Assistant WREX improved reaching performance among stroke survivors compared with free reaching, thereby potentially facilitating practice of functional tasks.     

A Multivariate Examination of Temporal Changes in Berg Balance Scale Items for Patients With ASIA Impairment Scale C and D Spinal Cord Injuries

Datta S, Lorenz DJ, Morrison S, Ardolino E, Harkema SJ. A multivariate examination of temporal changes in Berg Balance Scale items for patients with ASIA Impairment Scale C and D spinal cord injuries.

Objective

To provide a multivariate examination of the Berg Balance Scale (BBS) in patients with spinal cord injury (SCI) as a first step in developing a balance tool for the SCI population.

Design

Observational cohort.

Setting

The NeuroRecovery Network (NRN), a specialized network of treatment centers providing standardized, activity-based therapy for patients with SCI.

Participants

Patients (N=97) with American Spinal Injury Association Impairment Scale C or D SCI who were enrolled in the NRN between March 1, 2005, and June 12, 2007.

Interventions

All enrolled patients received 3 to 5 locomotor training sessions a week, according to NRN protocol, and were periodically evaluated for progress on functional outcome measurements.

Main Outcome Measures

Scores on the items of the BBS, six-minute walk test distances, ten-meter walk test speeds, and scores on the SCI Functional Ambulation Index. Temporal rates of change of the BBS items were examined with a principal components and correlation analysis.

Results

The first principal component accounted for nearly half of the overall variability in the BBS, correlated well with rates of change in functional mobility measures, and had good stability in its composition as verified by a resampling analysis. Further analysis showed that the composition of the first principal component varied with the patient's level of recovery.

Conclusions

The BBS captures a significant amount of information about balance recovery in persons with SCI and may be a good foundation for a balance tool. However, the utility of BBS items may be dependent on a patient's level of recovery. A dynamic balance instrument for the SCI population may be needed.     

Evaluation of an innovative methodology to recruit research participants with spinal cord injury through durable medical equipment suppliers

Krahn G, McCarthy M, Westwood D, Powers L. Evaluation of an innovative methodology to recruit research participants with spinal cord injury through durable medical equipment suppliers.

Objective

To evaluate the effectiveness, strengths, and limitations of an innovative research method to recruit persons with spinal cord injury (SCI).

Design

A pilot study for feasibility.

Setting

Community-based durable medical equipment suppliers (DMESs) in the states of Oregon, Washington, and New York.

Participants

Three DMESs participated and successfully distributed surveys to 591 customers with International Classification of Disease, 9th Revision, codes reflecting SCI. Of these, 316 people completed surveys, with 270 identifying SCI among their disabling conditions.

Interventions

Not applicable.

Main Outcome Measures

The effort required to solicit recruitment assistance from DMESs, survey response rate, verification of SCI by self-report, and comparability of sample demographics to those of other SCI research samples from both the United States and other countries.

Results

A moderate level of effort was required to solicit recruitment assistance from DMESs. The survey had a 53% response rate, and 85% of respondents verified that they had an SCI by self-report. Sample demographics were generally similar to those of comparable research samples but with more single and unemployed persons responding and with longer duration of SCI.

Conclusions

This method of recruitment has the potential to address limitations of other recruitment methods but presents its own challenges with implementation. Potential sampling bias is discussed.     

Dual Energy X-Ray Absorptiometry of the Distal Femur May Be More Reliable than the Proximal Tibia in Spinal Cord Injury

Morse LR, Lazzari AA, Battaglino R, Stolzmann KL, Matthess KR, Gagnon DR, Davis SA, Garshick E. Dual energy x-ray absorptiometry of the distal femur may be more reliable than the proximal tibia in spinal cord injury.

Objective

To evaluate the precision of dual energy x-ray absorptiometry scanning at 2 skeletal sites at the knee (proximal femur and distal tibia) in people with SCI.

Design

Cross-sectional.

Setting

Veterans Affairs Medical Center.

Participants

Subjects (N=20) with chronic SCI.

Interventions

Not applicable.

Main Outcome Measures

Precision as determined by root mean square coefficient of variation (RMS-CV) and root mean square standard deviation (RMS-SD).

Results

At the distal femur the root RMS-CV was 3.01% and the RMS-SD was 0.025g/cm². At the proximal tibia the RMS-CV was 5.91% and the RMS-SD was 0.030g/cm².

Conclusions

Precision at the distal femur is greater than at the proximal tibia and we recommend it as the preferred site for the longitudinal assessment of bone mineral density at the knee in chronic SCI.     

A Comparison of Functional Electrical and Magnetic Stimulation for Propelled Cycling of Paretic Patients

Szecsi J, Schiller M, Straube A, Gerling D. A comparison of functional electrical and magnetic stimulation for propelled cycling of paretic patients.

Objective

To compare isometric torque and cycling power, smoothness and symmetry using repetitive functional magnetic stimulation (FMS) and functional electrical stimulation (FES) in patients with paretic legs with preserved sensibility and in patients without sensibility.

Design

Repeated-measures design.

Setting

Laboratory setting.

Participants

Eleven subjects with complete spinal cord injury (SCI) and 29 subjects with chronic hemiparesis (16.6±5.5mo poststroke) volunteered.

Interventions

Using a tricycle testbed, participants were exposed to isometric measurements and ergometric cycling experiments, performed during both 20Hz FMS and FES stimulation. Subjects with hemiparesis and with complete SCI were stimulated at maximally tolerable level and maximal intensity, respectively.

Main Outcome Measures

Maximal isometric pedaling torque and mean ergometric power, smoothness, and symmetry were recorded for voluntary, FES, and FMS conditions.

Results

Two different patterns of the efficacy of FMS were identified. (1) Patients with complete SCI did not benefit (less torque and power was evoked with FMS than with FES, P<.003 and 10⁻⁴ respectively). (2) Patients with hemiplegia and preserved sensibility could improve their torque output (P<.05), smoothness, and symmetry of pedaling (P<.05) with FMS more than with FES.

Conclusions

FMS is a potential alternative to surface FES of the large thigh musculature in stimulation-supported cycling of patients with partially or completely preserved sensibility.