Rehabilitation therapy for patients with long-term spinal cord injuries. Locomotor Training Approaches for Individuals with Spinal Cord Injury: A Preliminary Report of Walking‐related Outcomes Evidence for physiotherapy practice: a survey of the Physiotherapy Evidence Database (PEDro). Massed Practice versus Massed Practice with Stimulation: Effects on Upper Extremity Function and Cortical Plasticity in Individuals with Incomplete Cervical Spinal Cord Injury Muscle atrophy is prevented in patients with acute spinal cord injury using functional electrical stimulation Long-term exercise training in persons with spinal cord injury: effects on strength, arm ergometry performance and psychological well-being Functional electrical therapy: retraining grasping in spinal cord injury Functional electric stimulation to augment partial weight-bearing supported treadmill training for patients with acute incomplete spinal cord injury: A pilot study. The effects of an arm ergometer training programme on wheelchair subjects Acupuncture for chronic shoulder pain in persons with spinal cord injury: a small-scale clinical trial. SPINAL CORD PATIENTS BENEFIT FROM MASSAGE THERAPY Orthotic intervention for development of hand function with C-6 quadriplegia. Effect of training intensity on physical capacity, lipid profile and insulin sensitivity in early rehabilitation of spinal cord injured individuals Upper limb exercise effect on tilt tolerance during orthostatic training of patients with spinal cord injury. Efficacy of low-intensity pulsed ultrasound in the prevention of osteoporosis following spinal cord injury. Randomised trial of the effects of four weeks of daily stretch on extensibility of hamstring muscles in people with spinal cord injuries. Functional outcomes attained by T9-12 paraplegic patients with the walkabout and the isocentric reciprocal gait orthoses. Effect of a standard exercise protocol on shoulder pain in long-term wheelchair users Acupuncture and Trager psychophysical integration in the treatment of wheelchair user's shoulder pain in individuals with spinal cord injury. Improved motor function in tetraplegics following neuromuscular stimulation-assisted arm ergometry. Does three months of nightly splinting reduce the extensibility of the flexor pollicis longus muscle in people with tetraplegia? Spinal Cord Injury Rehabilitation Evidence: Methods of the SCIRE Systematic Review. Does 12 weeks of regular standing prevent loss of ankle mobility and bone mineral density in people with recent spinal cord injuries? Electrical stimulation and biofeedback effect on recovery of tenodesis grasp: a controlled study. Effect of body training position on outcomes of an aerobic training study on individuals with quadriplegia. Sufficiently Important Difference: Expanding the Framework of Clinical Significance
The functional effects of three types of therapy for subjects with long-term incomplete cervical spinal cord injuries were investigated . Men and women , aged 18 to 45 years , were assigned to one of four groups using a restricted r and omization process . The training period was divided into two consecutive eight-week time blocks where subjects received either ( 1 ) supervised physical exercise therapy ( PET ) , ( 2 ) neuromuscular stimulation ( NMS ) , or ( 3 ) electromyographic ( EMG ) biofeedback . Group 1 received EMG biofeedback followed by PET ; Group 2 received EMG biofeedback followed by NMS ; Group 3 received NMS followed by PET ; and Group 4 received 16 weeks of PET . Dependent measures ( manual muscle tests , self-care scores , mobility measures , and voluntary EMG activity ) were assessed before training , at eight weeks , and after 16 weeks of training . A significant improvement ( p less than .05 ) across time was found on all dependent measures except voluntary EMG . No difference was found on comparisons between groups Background and Purpose Body weight supported ( BWS ) locomotor training improves overground walking ability in individuals with motor-incomplete spinal cord injury ( SCI ) . While there are various approaches available for locomotor training , there is no consensus regarding which of these is optimal . The purpose of this ongoing investigation is to compare outcomes associated with these different training approaches . Subjects and Methods Twenty-seven subjects with chronic motor-incomplete SCI have completed training and initial and final testing at the time of this preliminary report . Subjects were r and omly assigned to 1 of 4 different BWS assisted-stepping groups , including : ( 1 ) treadmill training with manual assistance ( TM ) , ( 2 ) treadmill training with stimulation ( TS ) , ( 3 ) overground training with stimulation ( OG ) , or ( 4 ) treadmill training with robotic assistance ( LR ) . Prior to and following participation we assessed walking-related outcome measures including overground walking speed , training speed , step length , and step symmetry . Results Data pooled across all subject groups showed a significant effect of training on walking speed . While the differences between groups were not statistically significant , there was a trend toward greater improvement in the TS and OG groups . Post hoc subgroup analysis of outcomes from subjects with slower initial walking speed ( < 0.1 m/s ; n = 15 ) compared to those with faster initial walking speeds ( ≥ 0.1 m/s ; n = 12 ) identified meaningful differences in outcomes with walking speed increasing by 85 % in the slower group and by only 9 % in the faster group . Step length of both stronger and weaker limb increased in all groups with the exception of those in the LR group . Step symmetry was increased in the TM and LR groups . Discussion and Conclusion These results represent preliminary findings of changes in walking-related function associated with different forms of BWS locomotor training for individuals with chronic , motor-incomplete SCI . Early data indicates that locomotor outcomes in these individuals appear to be comparable across training approaches . For the individuals in this study sample , those with the greatest deficits in walking function benefitted the most from locomotor training Evidence -based practice involves the use of evidence from systematic review s and r and omised controlled trials , but the extent of this evidence in physiotherapy has not previously been surveyed . The aim of this survey is to describe the quantity and quality of r and omised controlled trials and the quantity of systematic review s relevant to physiotherapy . The Physiotherapy Evidence Data base ( PEDro ) was search ed . The quality of trials was assessed with the PEDro scale . The search identified a total of 2,376 r and omised controlled trials and 332 systematic review s. The first trial was published in 1955 and the first review was published in 1982 . Since that time , the number of trials and review s has grown exponentially . The mean PEDro quality score has increased from 2.8 in trials published between 1955 and 1959 to 5.0 for trials published between 1995 and 1999 . There is a substantial body of evidence about the effects of physiotherapy . However , there remains scope for improvements in the quality of the conduct and reporting of clinical trials To determine the effect of massed practice ( MP ) versus massed practice combined with somatosensory stimulation ( MP+SS ) on cortical plasticity and function in persons with incomplete tetraplegia . Methods . Ten subjects were assigned to either MP or MP+SS . Median nerve stimulation ( 500 ms train , 10 Hz , 1 ms pulse duration ) was delivered at the intensity eliciting a motor threshold response . Training sessions were 5 d/week for 3 weeks at 2 h/session . Outcome measures included 1 ) motor-evoked potentials ( MEPs ) elicited via transcranial magnetic stimulation ( TMS ) , motor threshold ( MT ) and MEP amplitude at 1.2 MT ; 2 ) maximal pinch grip force ; 3 ) Wolf Motor Function Test ( WMFT ) and Jebsen H and Function Test . Results . The MP+SS group demonstrated significant improvements ( P < 0.05 ) in pinch grip strength ( 190 % ) , WMFT scores ( 52 % ) , and Jebsen test scores ( 33 % ) , whereas the MP group demonstrated significant improvement ( P < 0.05 ) only in Jebsen test scores ( 11 % ) . No significant changes were detected in cortical excitability in the MP+SS or MP group . Conclusions . The findings of this preliminary study suggest that MP+SS results in greater increases in pinch strength and timed functional test scores than MP . Optimal stimulation paradigms and training methods are needed to further test this strategy Severe muscle atrophy occurs rapidly following traumatic spinal cord injury ( SCI ) . Previous research shows that neuromuscular or ‘ functional ’ electrical stimulation ( FES ) , particularly FES-cycle ergometry ( FES-CE ) can cause muscle hypertrophy in individuals with chronic SCI ( > 1 year post-injury ) . However , the modest degree of hypertrophy in these already atrophied muscles has lessened earlier hopes that FES therapy would reduce secondary impairments of SCI . It is not known whether FES treatments are effective when used to prevent , rather than reverse , muscle atrophy in individuals with acute SCI . This study explored whether unloaded isometric FES contractions ( FES-IC ) or FES-CE decreased subsequent muscle atrophy in individual with acute SCI ( <3 months post-injury ) . Twenty-six subjects , 14–15 weeks post-traumatic SCI , were assigned to control , FES-IC , or FES-CE against progessively increasing resistance . Subjects were involved in the study for 3 or 6 months . Total body lean body mass ( TB-LBM ) , lower limb lean body mass ( LL-LBM ) , and gluteal lean body mass ( G-LBM ) were determined before the study , and at 3 and 6 months using dual energy X-ray absorptiometry ( DEXA ) . Controls lost an average of 6.1 % , 10.1 % , 12.4 % , after 3 months and 9.5 % , 21.4 % , 26.8 % after 6 months in TB-LBM , LL-LBM and G-LBM respectively . Subjects in the FES-IC group consistently lost less lean body mass than controls , however , only 6 month G-LBM loss was significantly attenuated in this group relative to the controls . In the FES-CE group , LL-LBM and G-LBM loss were prevented at both 3 and 6 months , and TB-LBM loss was prevented at 6 months . In addition , FES-CE significantly increased G-LBM and LL-LBM after 6 months of training relative to pre-training levels . Within the control group , there was no significant relationship between LL-LBM loss ( 3 and 6 months ) and the number of days between injury and baseline measurement . In summary , this study shows that FES-CE , but not FES-IC , training prevents muscle atrophy in acute SCI after 3 months of training , and causes significant hypertrophy after 6 months . The magnitude of differences in regionalized LBM between controls and FES-CE subject raises hopes that such treatment may indeed be beneficial in preventing secondary impairments of SCI if employed before extensive post-injury atrophy occurs Study design : R and omized controlled trial of exercise training in persons with spinal cord injury . Objective : The purpose of this study was to examine the effects of 9 months of twice-weekly exercise training on strength , arm ergometry performance , and indices of psychological well-being and quality of life . Setting : Centre for Health Promotion and Rehabilitation , McMaster University , Hamilton , Ontario , Canada . Methods : Thirty-four men and women ( aged 19–65 years ) with traumatic spinal cord injury ( C4–L1 ; ASIA A – D ) of 1–24 years duration volunteered to participate , and were r and omized into exercise ( EX ; n=21 ) and control ( CON ; n=13 ) groups . Twenty-three subjects ( 11 EX ; 12 CON ) successfully completed the 9-month study . Subjects were assessed for one repetition maximum ( 1RM ) strength , arm ergometry performance , and several indices of quality of life and psychological well-being at baseline , 3 , 6 , and 9 months . Results : At baseline , there were no significant differences between groups in age , submaximal arm ergometry performance , muscle strength , or psychological well-being . Following training , the EX group had significant increases in submaximal arm ergometry power output ( 81 % ; P<0.05 ) , and significant increases in upper body muscle strength ( 19–34 % ; P<0.05 ) ; no significant changes occurred in CON . Participants in EX reported significantly less pain , stress and depression after training , and scored higher than CON in indices of satisfaction with physical function , level of perceived health and overall quality of life ( P<0.05 ) . Exercise adherence ( per cent of prescribed sessions attended ) in those subjects who completed the 9 months of training was 82.5 % . Conclusions : These results demonstrate that long-term twice-weekly exercise training in this population is feasible , and results in significant gains in both physical and psychological well-being Objective : To determine the clinical efficacy of functional electrical therapy in the rehabilitation of grasping function for quadriplegics . Study design : R and omized intervention-versus-control trial . Setting : Rehabilitation hospital for spinal cord injury in Toronto , Canada . Methods : A total of 21 people with new spinal cord injuries ranging from C3 to C7 were r and omly assigned to two groups : Control ( N=9 ) and Intervention ( N=12 ) . The intervention was functional electrical therapy , which consisted of repetitive grasping exercises using a neuroprosthesis that applied surface electrical stimulation to the arm to generate and /or assist grasping movements . It was applied by registered Occupational Therapists in a clinical setting . Main outcome measures were : Functional Independence Measure ( FIM ) , Spinal Cord Independence Measure ( SCIM ) , and the Rehabilitation Engineering Laboratory H and Function Test . Consumer perceptions of functional electrical therapy  were assessed via qualitative interviews . Results : Differences between the Control and Intervention groups could be observed although they are not significant due to an insufficient number of participants . Consumer perceptions were positive , including improved Activities of Daily Living and self-satisfaction . Conclusion : Functional electrical therapy has the potential to be an effective treatment modality to restore grasping function in quadriplegia . It can be implemented by occupational therapists in a clinical setting . Further research is required to establish suitable indications for participant selection . In addition , a larger number of participants is needed to demonstrate statistical significance of the Functional Electrical Therapy OBJECTIVE To study the application of partial weight-bearing ( PWB ) supported treadmill gait training augmented by functional electric stimulation ( FES ) in subjects with acute incomplete spinal cord injury ( SCI ) . DESIGN Before-after crossover trial with control ( A ) and intervention ( B ) periods . SETTING Physiotherapy ( PT ) department of a spinal injuries unit in Scotl and . PARTICIPANTS Fourteen in patients with acute incomplete SCI with American Spinal Injury Association class C or D injury . INTERVENTION Training consisted of treadmill walking with PWB support augmented by FES . Subjects walked on the treadmill for up to 25 minutes a day , 5 days a week for 4 weeks . The intervention was compared with a 4-week control period in which st and ard PT was given . MAIN OUTCOME MEASURES Overground walking endurance and speed , cadence , stride length , and observational gait analysis and walking speed , distance , and percentage PWB support on the treadmill . RESULTS A greater increase in overground walking endurance was achieved after the intervention ( AB group mean , 72.2 m ; confidence interval [ CI ] , 39.8 - 104.6 m ; BA group mean , 63.8 m ; CI , -10.2 to 137.9 m ) , as compared with after st and ard PT ( AB group mean , 38.4 m ; CI , 1.8 - 75.0 m ; BA group mean , 60.1 m ; CI , 9.2 - 110.9 m ) . A similar pattern was observed for overground walking speed . CONCLUSIONS This pilot study indicated that PWB supported treadmill training with FES had a positive effect on overground gait parameters and could potentially accelerate gait training in subjects with incomplete SCI . A larger r and omized trial is required to substantiate these findings The purpose of the present investigation was to study the effects of an arm ergometer training programme on several physiological variables of recreational wheelchair subjects . Ten paraplegics ( 5 experimental , 5 control ) were tested prior to and immediately after a 2 month exercise regimen at 80 % of peak heart rate ( 30 min per day , 5 days per week , for 8 consecutive weeks at 50 rev/min ) . The results demonstrated significant increases ( P<0.05 ) in VO2max ( 1 min-1 & ml kg-1 min-1 ) and workload but only mild improvements in maximal heart rate and post exercise blood lactates . Body fat , vital capacity and forced expiratory volume did not change with training . Triceps lateralis fibre distribution and fast twitch ( FT ) fibre area were unaffected by the endurance training programme . However , slow twitch ( ST ) fibre area increased ( P < 0·05 ) with training . The results indicate that physiological variables of paraplegic subjects  following an arm ergometer endurance training programme react similarly to changes previously observed in non-h and icapped subjects . The values when compared with normals are low as a result of the relative inactivity of the subjects due to the lack of available exercise programmes for wheelchair people OBJECTIVE To determine the efficacy of acupuncture in the treatment of chronic musculoskeletal shoulder pain in subjects with spinal cord injury ( SCI ) . DESIGN R and omized , double blind ( participants , evaluator ) , placebo ( invasive sham ) controlled trial . SETTING Clinical research center . PARTICIPANTS Seventeen manual wheelchair-using subjects with chronic SCI and chronic musculoskeletal shoulder pain . INTERVENTIONS Participants were r and omly assigned to receive 10 treatments of either acupuncture or invasive sham acupuncture ( light needling of nonacupuncture points ) . MAIN OUTCOME MEASURE Changes in shoulder pain intensity were measured using the Wheelchair User 's Shoulder Pain Index . RESULTS Shoulder pain decreased significantly over time in both the acupuncture and the sham acupuncture groups ( P=.005 ) , with decreases of 66 % and 43 % , respectively . There was no significant difference between the 2 groups ( P=.364 ) . There was , however , a medium effect size associated with the acupuncture treatment . CONCLUSIONS There appears to be an analgesic effect or a powerful placebo effect associated with both acupuncture and sham acupuncture . There was a medium treatment effect associated with the acupuncture , which suggests that it may be superior to sham acupuncture . This observation , along with the limited power , indicates that a larger , more definitive r and omized controlled trial using a similar design is warranted The present study assessed the effects of massage therapy on depression , functionality , upper body muscle strength and range of motion on spinal cord injury patients . Twenty C5 through C7 spinal cord injury individuals recruited from a University outpatient clinic were r and omly assigned to a massage therapy group or an exercise group . Patients in the massage therapy group received two 40-min massage therapy sessions per week for 5 weeks . Patients in the control group practice d a range of motion exercise routine targeting the arms , neck , shoulders , and back 2 times per week for 5 weeks . Although both the massage and exercise group appeared to benefit from treatment , only the massage group showed lower anxiety and depression scores and significantly increased their muscle strength and wrist range of motion OBJECTIVES Much has been written about the use of static orthoses to maintain proper position and prevent deformity , but there are few empirical data to determine whether static orthoses improve function , maintain range of motion , or prevent deformity in the h and . METHOD This study measured gains in h and function during a 3-month rehabilitation period in 13 persons with sixth cervical ( C-6 ) level complete quadriplegia , 7 of whom wore a static orthosis at night ( experimental group ) and 6 who did not wear the orthosis ( control group ) .  H and function , range of motion and strength were measured in all subjects 4 weeks and 8 weeks after the study commenced , and again after 12 weeks in only 69 % of the subjects . RESULTS No significant differences were found in h and function between control and experimental groups ; h and function had improved significantly in all 13 subjects . CONCLUSION As the effects of deformity have been clinical ly observed , future studies should examine the effects of static orthoses with increased daily wear or wear over a longer period of time Study design : Pre – post training intervention . Objectives : To evaluate the effect of training intensity on physical capacity , lipid profile and insulin sensitivity in early rehabilitation of spinal cord injured ( SCI ) patients , and to assess the correlation between peak aerobic capacity ( VO2Peak ) and insulin sensitivity . Setting : Spinal Cord Rehabilitation Unit , Sunnaas Hospital , Nesoddtangen , Norway . Method : Six recently injured SCI individuals participated in the arm training intervention and were r and omly admitted to a high-intensity ( HI ; 70–80 % heart rate reserve ( HRR ) ) and low-intensity ( LI ; 40–50 % HRR ) group . The 1 h interval training consisted of 3 min exercise bouts interspersed with 2 min of rest , three times a week for 8 weeks . In addition , a correlation coefficient was obtained between VO2Peak and insulin sensitivity in 11 SCI patients . Results : The 8-week training program result ed in a significant increase in VO2Peak and maximal power output ( POMax ) for the group as a whole ( P<0.05 ) . VO2Peak increased significantly more and total cholesterol/high-density lipoprotein cholesterol ( TC/HDL-C ) ratio and triglycerids decreased significantly more in the HI group than in the LI group ( P=0.05 ) . Training-induced changes in insulin sensitivity were significantly different between the groups ( P=0.05 ) , which was due to a nonsignificant decline in insulin sensitivity in the HI group and a nonsignificant improvement in the LI group . A significant positive correlation was found between VO2peak and insulin sensitivity ( r=0.68 , P=0.02 ) . Conclusion : The interval arm training protocol as used in the present study enables recently injured SCI patients to do substantial work at a relatively high intensity . Results indicate that improvements in physical capacity and lipid profile were more pronounced in response to high-intensity training . The significant correlation between maximal oxygen consumption and insulin sensitivity indicates that , as in the able-bodied population , peak aerobic capacity is a predictive value with regard to insulin sensitivity in SCI . Future studies with larger groups assessing the role of exercise intensity on insulin sensitivity in SCI are suggested Twelve male patients with traumatic spinal cord injury were r and omly divided into a group of six experimental and six control subjects . All subjects were tilted from 0 degree to 70 degrees by 10 degrees increments at five-minute intervals until blood pressure dropped below 70/40 , hypotensive symptoms appeared , or 70 degrees of tilt was achieved . The experimental subjects performed 60 active bilateral full-range forearm flexion and extension movements per minute during the first and third minute of each tilt angle . The control patients did not perform upper limb exercises during the same orthostatic training procedure . Blood pressure and pulse rate of all subjects were recorded prior to orthostatic training , during the training at specified intervals and posttraining on each day of testing and training . Total group response was quantitated by indicating the tilting protocol step at which subjects experienced orthostatic hypotension requiring termination of the test . All subjects significantly increased their tolerance of higher tilt angles by using this protocol , but there was no significant difference between the exercise group and nonexercise group with reference to tolerance to progressive vertical tilt ( Mann-Whitney U test ) Ultrasound ( US ) , a high-frequency acoustic energy traveling in the form of a mechanical wave , represents a potential site-specific intervention for osteoporosis . Bone is a dynamic tissue that remodels in response to applied mechanical stimuli . As a form of mechanical stimulation , US is anticipated to produce a similar remodeling response . This theory is supported by growing in vitro and in vivo evidence demonstrating an osteogenic effect of pulsed-wave US at low spatial-averaged temporal-averaged intensities . The aim of this study was to investigate whether low-intensity pulsed US could prevent calcaneal osteoporosis in individuals following spinal cord injury ( SCI ) . Fifteen patients with a 1 - 6 month history of SCI were recruited .  Active US was introduced to one heel for 20 min/day , 5 days/week , over 6 weeks . The contralateral heel was simultaneously treated with inactive US . Patients were blind to which heel was being actively treated . Active US pulsed with a 10 microsec burst of 1.0 MHz sine waves repeating at 3.3 kHz . The spatial-averaged temporal-averaged intensity was set at 30 mW/cm(2 ) . Bone status was assessed at baseline and following the intervention period by dual-energy X-ray absorptiometry and quantitative US . SCI result ed in significant bone loss . Bone mineral content decreased by 7.5 + /- 3.0 % in inactive US-treated calcanei ( p < 0.001 ) . Broadb and US attenuation and speed of sound decreased by 8.5 + /- 6.9 % ( p < 0.001 ) and 1.5 + /- 1.3 % ( p < 0.001 ) , respectively . There were no differences between active and inactive US-treated calcanei for any skeletal measure ( p > 0.05 ) . These findings confirm the negative skeletal impact of SCI , and demonstrate that US at the dose and mode administered was not a beneficial intervention for SCI-induced osteoporosis . This latter finding may primarily relate to the inability of US to effectively penetrate the outer cortex of bone due to its acoustic properties The aim of this assessor-blind r and omised controlled trial was to determine the effect of four weeks of 30 minute stretches each weekday on extensibility of the hamstring muscles in people with recent spinal cord injuries . A consecutive sample of 16 spinal cord-injured patients with no or minimal voluntary motor power in the lower limbs and insufficient hamstring muscle extensibility to enable optimal long sitting were recruited . Subjects ' legs were r and omly allocated to experimental and control conditions . The hamstring muscles of the experimental leg of each subject were stretched with a 30 Nm torque at the hip for 30 minutes each weekday for four weeks . The hamstring muscles of the contralateral leg were not stretched during this period .  Extensibility of the hamstring muscles ( hip flexion range of motion with knee extended , measured with a 48 Nm torque at the hip ) of both legs was measured by a blinded assessor at the commencement of the study and one day after the completion of the four-week stretch period . Changes in hamstring muscle extensibility from initial to final measurements were calculated . The effect of stretching was expressed as the mean difference in these changes between stretched and non-stretched legs . The mean effect of stretching was 1 degree ( 95 % CI -2 to 5 degrees ) . Four weeks of 30 minute stretches each weekday does not affect the extensibility of the hamstring muscle in people with spinal cord injuries OBJECTIVE To compare the functional outcomes attained by persons with paraplegia using the  Walkabout Orthosis ( WO ) and the Isocentric Reciprocal Gait Orthosis ( IRGO ) . DESIGN A r and omized crossover design . PATIENTS Ten subjects with complete lesions between T9-T12 . INTERVENTIONS Over two 8-week periods , subjects were taught to use each orthosis in conjunction with elbow crutches . MAIN OUTCOME MEASURES After each 8-week training period , subjects were assessed on their ability to perform five different sets of key skills associated with functional ambulation . RESULTS There were no differences between orthoses in the ability of subjects to don and doff the orthoses , get up and down stairs and curbs , or walk on a flat surface . Subjects required significantly more assistance when using the WO to walk over inclined surfaces ( median IRGO = " independent , " median WO = " minimal assistance " ; p = .03 ) but less assistance when using the WO to get from sitting to st and ing and st and ing to sitting ( median IRGO = " moderate assistance , " median WO = " minimal assistance " ; p = .03 ) . In addition , subjects walked significantly faster with the IRGO both on the flat ( mean IRGO = .34 m/sec + /- .18 , mean WO = .14 m/sec + /- .12 ; p = .002 ) and on inclined surfaces . CONCLUSIONS Although it is easier to st and up and sit down with the WO , the IRGO facilitated a faster and more independent gait . Neither orthosis enabled subjects to be fully independent in the key skills necessary for functional ambulation after 8 weeks of training Purpose : To analyze the effectiveness of a 6-month exercise protocol on shoulder pain experienced by wheelchair users during functional activities . Subjects : Forty-two wheelchair users , 35 males and seven females : average age of 35 years and an average duration of wheelchair use of 14 years . Methods : Subjects were r and omly assigned to treatment ( n=21 ) and control ( n=21 ) groups . The treatment group received instruction in five shoulder exercises which they performed daily for 6 months . The exercise protocol included two exercises for stretching anterior shoulder musculature and three exercises for strengthening posterior shoulder musculature . Outcome measures : All subjects completed a self-report question naire and the Wheelchair Users Shoulder Pain Index ( WUSPI ) initially and at bimonthly intervals during the 6-month intervention . Results : Seventy-five per cent of the subjects reported a history of shoulder pain since beginning wheelchair use . The average initial performance-corrected ( PC-WUSPI ) score of the 42 subjects was 17.7 ( ±21.3 ) with a range of 0–103.2 points . Over 83 % of the subjects ( 35 of 42 ) completed the 6-month study . Subjects in the treatment group decreased their PC-WUSPI score by an average of 39.9 % , compared to decreases of only 2.5 % in the control group . Conclusions : These findings supported the effectiveness of this exercise protocol in decreasing the intensity of shoulder pain which interferes with functional activity in wheelchair users OBJECTIVE To determine the effectiveness of acupuncture and Trager Psychophysical Integration ( a form of manual therapy ) in decreasing chronic shoulder pain in wheelchair users with spinal cord injury ( SCI ) . DESIGN A prospect i ve clinical trial , with subjects r and omized to acupuncture or Trager treatment condition . Subjects served as their own controls by including a 5-week pretreatment baseline period and a 5-week posttreatment follow-up period . SETTING Rehabilitation hospital research department . PARTICIPANTS Eighteen subjects with chronic SCI and chronic shoulder pain who used manual wheelchairs as their primary means of mobility . INTERVENTION Ten acupuncture or 10 Trager treatments over a 5-week period . MAIN OUTCOME MEASURES Changes in performance-corrected Wheelchair User 's Shoulder Pain Index ( PC-WUSPI ) scores during baseline , treatment , and follow-up periods were assessed by using analysis of variance . RESULTS The mean PC-WUSPI score + /- st and ard deviation of the 18 subjects at entry was 48.9 + /- 24.6 ( range , 8.0 - 94 ) . No significant change in mean PC-WUSPI scores occurred during the pretreatment baseline period . Mean PC-WUSPI scores decreased significantly during the treatment period in both the acupuncture ( 53.4 % ; 23.3 points ) and Trager ( 53.8 % ; 21.7 points ) treatment groups . The reduced PC-WUSPI scores were maintained in both groups throughout the 5-week posttreatment follow-up period . CONCLUSION Acupuncture and Trager are both effective treatments for reducing chronic shoulder pain associated with functional activities in persons with SCI The effectiveness of neuromuscular stimulation (NMS)-assisted arm ergometry for strengthening triceps brachii was evaluated in 34 cervical spinal cord injured persons . Group I ( n = 12 ) received eight weeks of NMS-assisted ergometry . Group II ( n = 11 ) received four weeks of NMS-assisted ergometry followed by four weeks of arm ergometry alone . Group III ( N = 11 ) received only arm ergometry ( control group ) . Seventeen of 24 muscles in Group I subjects had improved manual muscle test scores after eight weeks , compared with 10 of 22 Group II muscles and five of 22 Group III muscles . Including only muscles with initial scores < or = 3 , Group I demonstrated significant improvements versus Group III after four weeks ( p < .003 ) and after eight weeks ( p < .0005 ) of exercise . A difference was also found between Groups II and III ( p < .03 ) after eight weeks . These results suggest that NMS-assisted ergometry is effective for strengthening voluntary triceps muscle contractions in tetraplegics BACKGROUND AND PURPOSE The extensibility of the paralysed flexor pollicis longus ( FPL ) muscle is an important determinant of an effective tenodesis grip in people with C6 and C7 tetraplegia . Therapists believe that splinting can reduce the extensibility of the FPL muscle and thus improve h and function . However , there remains much controversy around the optimal position of splinting and its effectiveness is yet to be verified . The aim of the present study was to determine whether a three-month thumb splinting protocol reduces extensibility of the FPL muscle in people with tetraplegia . METHOD An assessor-blinded , within-subject , r and omized controlled trial was undertaken . Twenty people with tetraplegia and bilateral paralysis of all thumb muscles were recruited from a sample of convenience . One r and omly selected h and of each subject was splinted each night for three months . The splint immobilized the FPL muscle in a relatively shortened position by positioning the carpometacarpal and metacarpophalangeal joint of the thumb in flexion . The other h and remained unsplinted for the duration of the study . Carpometacarpal angle was measured with the application of a st and ardized torque by a blinded assessor at the beginning and end of the three-month study period . A device specifically design ed for this purpose that stabilized the wrist and other joints of the thumb in full extension was used . RESULTS No subject withdrew from the study . The three-month splinting protocol had a mean treatment effect on carpometacarpal joint angle of 0 * ( 95 % CI , -6 degrees to 6 degrees ) . CONCLUSION Splinting the FPL muscle in a relatively shortened position each night for three months does not reduce its extensibility The Spinal Cord Injury Rehabilitation Evidence ( SCIRE ) is a synthesis of the research evidence underlying rehabilitation interventions to improve the health of people living with SCI . SCIRE covers a comprehensive set of topics and in this issue we present six papers relevant to SCI rehabilitation clinicians ( SCI inpatient rehabilitation practice s , gait strategies , upper extremity reconstructive surgery , spasticity treatments , cardiovascular health and bone health ) . The SCIRE used a systematic and well-defined protocol to assess and synthesize the evidence . Each article was scored for its method ological quality using either the Physiotherapy Evidence Data base ( PEDro ) Score for r and omized controlled trials or the Downs and Black Tool for other types of studies . Following the individual study assessment , conclusions were drawn about the accumulated studies for each topic of interest based on the levels of evidence , quality of studies and concurring evidence . The SCIRE project was design ed for health professionals to inform them of best practice The purpose of this study was to determine the effects of a 12-week st and ing program on ankle mobility and femur bone mineral density in patients with lower limb paralysis following recent spinal cord injury . An assessor-blinded within-subject r and omised controlled trial was undertaken . Twenty patients with lower limb paralysis following a recent spinal cord injury were recruited . Subjects stood weight-bearing through one leg on a tilt-table for 30 minutes , three times each week for 12 weeks . By st and ing on one leg a large dorsiflexion stretch was applied to the ankle and an axial load was applied to the bones of the weight-bearing leg . Ankle mobility and femur bone mineral density of both legs were measured at the beginning and end of the study . Ankle mobility ( range of motion ) was measured with the application of a 17 Nm dorsiflexion torque .  Femur bone mineral density was measured using dual energy X-ray absorptiometry ( DEXA ) . The effect of st and ing was estimated from the difference between legs in mean change of ankle mobility and femur bone mineral density . The results indicated a mean treatment effect on ankle mobility of 4 degrees ( 95 % CI 2 to 6 degrees ) and on femur bone mineral density of 0.005 g/cm(2 ) ( 95 % CI -0.015 to 0.025 g/cm(2 ) ) . Tilt-table st and ing for 30 minutes , three times per week for 12 weeks has a small effect on ankle mobility , and little or no effect on femur bone mineral density . It is unclear whether clinicians and patients would consider such effects to be clinical ly worthwhile OBJECTIVE Evaluate the effectiveness of electrical stimulation and biofeedback on the recovery of tenodesis grasp in tetraplegic individuals during the initial phase of acute rehabilitation . DESIGN A 2 x 2 block design was used with subjects r and omized to treatment groups . Forty-five subjects completed the study . SETTING Inpatient occupational therapy department . SUBJECTS In patients with tetraplegia , first admission for rehabilitation after an acute spinal cord injury . INTERVENTIONS The four treatment groups were : conventional treatment , electrical stimulation , biofeedback , and combined electrical stimulation and biofeedback . The treatment period was between 5 and 6 weeks . MAIN OUTCOME MEASURES Manual muscle testing and scoring of activities of daily living performance by a blinded evaluator . RESULTS All four treatment groups showed improvements . No treatment group was superior to the others . CONCLUSIONS Biofeedback and electrical stimulation alone or in combination offer no advantages over conventional rehabilitation treatment of wrist extensors in tetraplegic patients after spinal cord injury The use of the supine training position to enhance aerobic training was evaluated in a 10-week upper-body exercise study . Fourteen subjects with quadriplegia ( QD ) were matched on initial peak power output ( PO ) values and then r and omly assigned to either a supine ( SUP , n = 7 ) or sitting ( SIT , n = 7 ) training group .  Peak VO2 and PO were measured pretraining and posttraining in both the supine and sitting positions . There were significant ( p < .01 ) increases in peak VO2 ( 720 to 780 mL.min-1 ) and PO ( 29.3 to 33.3W ) with training . Although the SIT group exhibited a small training effect size ( 0.1 ) , while the SUP group exhibited a moderate effect size ( 0.6 ) , the interaction between time and training group failed to reach significance ( p = .07 ) because of a large injury level-related variation in VO2 . The training effect achieved by the SUP group generalized to the sitting position , as their peak VO2 increased 80mL.min-1 in the sitting position . Endurance improved ( p < .0001 ) in all subjects , with time to exhaustion increasing from 52min to 135min over the 10 weeks of training . The sum of 4 skinfolds decreased ( p < .05 ) from 67.5 to 61.0 mm . The lack of change in stroke volume at rest and at 50 % of peak PO suggests that an inotropic adaptation of the heart , commonly observed in subjects without SCI , did not occur in this population . However , a 4.7bpm increase ( p < .01 ) in resting heart rate ( HR ) and a near significant increase ( p = .07 ) in peak HR from pretraining to posttraining suggests a training-induced chronotropic adaptation of the heart . Although improvements in aerobic capacity can be achieved by training in either supine or sitting positions , the training effect size was larger in the supine position . Improvements in SV were not observed in either training position ; this may be because of low absolute workloads were used . Central cardiovascular adaptation may occur in subjects with QD but changes are reflected as chronotropic and not inotropic adaptations Background . It is generally agreed that r and omized controlled trials should be powered to detect small but clinical ly significant treatment effects . Toward these ends , minimal important difference ( MID ) was proposed as a benchmark for design ing trials and for interpreting health-related quality -of-life instrument scores . MID was defined in 1989 as “ the smallest difference in score in the domain of interest which patients perceive as beneficial and which would m and ate , in the absence of troubling side effects and excessive cost , a change in the patient ’s management . ” Objective . 1 ) To exp and the idea of minimal clinical ly important difference so as to take into account harms as well as benefits . 2 ) To propose concepts and methods with which to do so . Summary . The authors define sufficiently important difference ( SID ) as the smallest amount of patient-valued benefit that an intervention would require to justify associated costs , risks , and other harms . As a means toward estimation of SID , the authors propose benefit-harm tradeoff methods , in which domains of benefit and harm are systematic ally traded off against each other and assessed in relation to the global decision of whether a treatment choice is worthwhile . Specific SID estimates can be used to power and interpret clinical trials or to inform health services research and /or public health policy . This article briefly describes the evolution of the important difference concept and outlines similarities and differences between MID and SID
Objectives : To provide a quantitative analysis of all r and omized controlled trials design ed to determine the effectiveness of physical interventions for people with spinal cord injury ( SCI ) .