Effectiveness of Activity-Based Therapy for Individuals With Spinal Cord Injury in Promoting Static and Dynamic Sitting Balance: Is Olfactory Mucosa Autograft a Factor?

Abstract

Activity-based therapy (ABT) appears to improve outcomes for individuals with spinal cord injury (SCI); however, few studies have examined sitting static and dynamic balance. It was unknown whether individuals after SCI who elected to undergo an olfactory mucosa autograft (OMA) would respond differently to ABT. The first objective was to assess changes in sitting strength (static) and dynamic balance in a group of individuals with SCI undergoing intensive ABT. The second objective was to determine whether sitting balance changes would be different for those who had participated in ABT after the OMA versus those who had ABT alone. A handheld dynamometer measured peak force (sitting strength) and the multi-directional reach test measured dynamic balance (n = 16). ABT (average dose: 7 hours per week over 4.6 months) appeared to promote improvements in sitting strength in four directions (0.6-0.8 kg per month) and dynamic balance in four of five directions (0.7-1.3 cm per month). Individuals who had undergone an OMA had similar, but not greater, improvements in static and dynamic balance when compared with those who had ABT alone. It is unknown whether balance improvements resulted from natural or other factors. ABT may have contributed to balance changes in individuals with SCI. Although small improvements in sitting static and dynamic balance did occur, future research documenting therapy intervention details and ABT dose-response in larger groups of individuals with SCI must be performed to provide guidance as to the optimal, effective ABT dose required to generate clinically meaningful functional improvements.