Part 1: rationale, evidence and key principles supporting Motor Training in the SCI-MT Trial
neurological loss, paraplegia
PARTIAL PARALYSIS, AIDS, PARAPLEGIA
The Motor Training provided during the SCI-MT Trial is directed at increasing motor function at and below the level of injury. This will be measured using the Total Motor Score of the International Standards for the Neurological Classification of SCI. For example, in a person with partial paralysis of the lower limbs, the Motor Training (i.e., task-specific training and strength training) will be used to improve the ability to stand or walk as well as to increase lower limb muscle strength. Of course, Motor Training as typically provided in rehabilitation can also be targeted above the level of injury. For example, it can be used to improve the ability of a person with paraplegia to transfer through their neurologically intact upper limbs. However, this is not the focus of the SCI-MT Trial. Rather, the focus is on improving motor function at and below the level of injury with the primary aim of increasing total motor scores.The Motor Training provided during the SCI-MT Trial is also directed at helping people regain the ability to move in a way that is as close as possible to that of a non-disabled person. For example, gait training will be directed at walking without aids and orthoses if possible. Similarly, upper limb training will focus on regaining the ability to reach and grasp with the kinematics and kinetics of a non-disabled person where possible. Needless to say, even small amounts of residual weakness may ultimately require some type of adaptation or compensation that alters the kinematics and kinetics of movement from that of a non-disabled person. The extent of adaptation or compensation will depend on the extent of neurological loss and may range from a slight variation to the need for extensive orthoses, aids, manual guidance, or assistance.The SCI-MT Trial intervention will be provided in a high dosage. Dosage is determined by a combination of exercise intensity, duration, and frequency. Participants in the SCI-MT Trial will be required to exercise as hard as possible (i.e., at high intensities and with a high number of movement repetitions) for 12 h per week over 10 weeks (i.e., for a long duration and at a high frequency). There are no stipulations about the number of sessions per week but typically the 12 h are provided over 5 to 10 sessions of 1 to 2 h duration each.The two components of Motor Training are described below