Effects of a multicomponent exercise program on upper extremity strength, range of motion, cardiovascular endurance, and adherence in adults with spinal cord injury

Backgrounds: Acute Inflammatory Demyelinating Polyradiculopathy (AIDP), also known as Guillain-Barre syndrome (GBS), is a condition that can affect anyone, causing muscle weakness, discomfort, and paralysis. Occupational therapy intervention aims to enhance communication abilities and overall quality of life for GBS patients. Objective: This study aims to enhance functional communication in Guillain-Barre Syndrome patients through occupational therapy interventions Methods: The participant in the study is a 45-year-old man with GBS who struggles with functional communication activities using tablets. Instruments used to measure progress include the Canadian Occupational Performance Measure (COPM), Range of Motion (ROM), and Manual Muscle Testing (MMT), as well as analysing Occupational Performances Area (OPA) and Occupational Performances Component (OPC) abilities. Result: Occupational therapists developed interventions based on assessment results, which led to significant improvements in range of motion and muscle strength in the upper extremities. The participants' performance in using tablets also improved after the intervention, with an increase in both performance and satisfaction scores. The study showed a clear link between the importance of tablet use, patient performance, and satisfaction levels, with significant improvements seen after the occupational therapy intervention Conclusion: The biomechanical frame of reference was effective in improving range of motion and muscle strength in GBS patients. This resulted in significant increases in ROM and muscle strength in both upper extremities. Additionally, the COPM examination showed improvements in patient performance and satisfaction, indicating the potential for increased independence in daily activities with the help of the rehabilitative frame of reference.

To evaluate upper extremity (UE) function, strength, and dynamic sitting balance in individuals with spinal cord injury (SCI) who received an intensive outpatient therapy program focused on UE training augmented with wide pulse/high frequency functional electrical stimulation (WPHF-FES). This prospective case series was conducted in an outpatient (OP) clinic in an SCI-specific rehabilitation hospital. Participants were a convenience sample (N = 50) of individuals with tetraplegia receiving OP therapy focused on UE recovery. Individuals participated in 60 minutes of UE functional task-specific practice (FTP) in combination with WPHF-FES 5 times/week for an average of 72 sessions. The primary outcome for this analysis was the Capabilities of Upper Extremity Test (CUE-T). Secondary outcomes include UE motor score (UEMS) and the modified functional reach (MFR). Fifty individuals (13 motor complete; 37 motor incomplete SCI) completed an OP UE training program incorporating WPHF-FES and were included in this analysis. On average, participants demonstrated significant improvements in the total CUE-T score of 14.1 (SD = 10.0, p < .0001) points; significant changes were also noted in UEMS and MFR, improving an average of 4.6 (SD = 5.2, p < .0001) points and 13.6 (SD = 15.8, p < .0001) cm, respectively. Individuals with tetraplegia demonstrated significant improvements in UE strength, function, and dynamic sitting trunk balance after receiving UE training augmented with WPHF-FES. Future comparative effectiveness studies need to be completed to guide efficacious treatment interventions in OP therapy.

Objectives. To quantify the association between performance-based manual wheelchair propulsion tests (20 m propulsion test, slalom test, and 6 min propulsion test), trunk and upper extremity (U/E) strength, and seated reaching capability and to establish which ones of these variables best predict performance at these tests. Methods. 15 individuals with a spinal cord injury (SCI) performed the three wheelchair propulsion tests prior to discharge from inpatient SCI rehabilitation. Trunk and U/E strength and seated reaching capability with unilateral hand support were also measured. Bivariate correlation and multiple linear regression analyses allowed determining the best determinants and predictors, respectively. Results. The performance at the three tests was moderately or strongly correlated with anterior and lateral flexion trunk strength, anterior seated reaching distance, and the shoulder, elbow, and handgrip strength measures. Shoulder adductor strength-weakest side explained 53% of the variance on the 20-meter propulsion test-maximum velocity. Shoulder adductor strength-strongest side and forward seated reaching distance explained 71% of the variance on the slalom test. Handgrip strength explained 52% of the variance on the 6-minute propulsion test. Conclusion. Performance at the manual wheelchair propulsion tests is explained by a combination of factors that should be considered in rehabilitation.

The purpose of this study was to verify the difference in physical fitness according to the experience of falling and intensity of fear of falling in elderly females. The subjects were comprised of 164 elderly women (aged 65-88). Subjects were divided into four groups: 1) have fallen-high K-SAFE group, 2) have fallen -low K-SAFE group, 3) have not fallen-high K-SAFE, 4) have not fallen-low K-SAFE group. Fear of falling was measured with Korean survey of activities and fear of falling (K-SAFE) questionnaire. Physical fitness was assessed by measuring upper and lower extremity strength, aerobic endurance, upper and lower extremity flexibility, agility, and dynamic and static balance. In order to analyze collected data, 2×2 ANCOVA was utilized. The statistical significance was accepted at .05 levels. The results were as follows: Age affect upper and lower extremity strength, aerobic endurance, upper extremity flexibility, agility, and dynamic and static balance(p.05). Upper and lower extremity strength, aerobic endurance, lower extremity flexibility, agility, and dynamic and the static balance of the low K-SAFE groups were significantly higher than the high K-SAFE groups(p.05). Upper extremity strength and upper extremity flexibility of the have not fallen groups were significantly higher than the have fallen groups(p.05). In conclusion, high intensity of fear of falling was associated with a reduction in Upper and lower extremity strength, aerobic endurance, lower extremity flexibility, agility, and dynamic and the static balance. Therefore, if elderly women have an intense fear of falling, even though they did not actually fall, they need countermeasures, education in fall prevention and specific exercises to help strength a balance, which will help ease fears and prevent falls.

Yoga leads to multiple physical improvements after stroke, a pilot study

Objective: To determine whether the aerobic fitness, upper extremity strength, and body composition in groups of adolescents with mobility impairment due to thoracic and upper lumbar spinal cord injury (SCI) or spina bifida (SB) are significantly different from those in groups of adolescents without mobility impairment who are of normal weight (CTRL) or overweight (OW). Subjects: One hundred fifteen total subjects were evaluated including 59 female (19 SB, 9 SCI, 17 OW, and 14 CTRL) and 56 male (18 SB, 1 0 SCI, 8 OW, and 20 CTRL) participants aged 11 to 21 years.Methods: Aerobic fitness was assessed using a ramp protocol with a magnetically braked arm ergometer. Heart rate and oxygen uptake (V02) were recorded. Peak isokinetic upper arm and shoulder strength values were determined with a dynamometer. Body composition was estimated using dual energy x–ray absorptiometry (DEXA). Male and female subjects were categorized as overweight if their percent body fat by DEXA exceeded 25% and 30%, respectively. Results were analyzed with an ANOVA using the Bonferroni correction. Significance was accepted at P<0.05.Results: The percent body fat of both the male and female SB and SCI subjects was significantly higher than CTRL but was not different than OW. In general, the shoulder extension and flexion strength in both the SB and SCI males and females was significantly lower than that of the CTRL and OW. The SCI and SB subjects had significantly reduced aerobic capacity (VO2 /kg) compared to the CTRL subjects but were not different than the OW subjects. During the maximal exercise test, the SB and SCI subjects reached exhaustion at significantly lower workloads than the CTRL and OW subjects.Conclusions: Patients age 11 to 21 years with SB and SCI had reduced aerobic capacity that was associated with being overweight and having reduced upper extremity strength. These data suggest that interventions to increase strength and fitness and to manage weight should be recommended in this population.

Introduction: Cancer is the second most cause of mortality among which oral cancer is the most prevalent form. In temporomandibular joint dysfunction (TMJD), patients present with pain, restricted mouth opening, poor posture, facial asymmetry, diminished strength, altered breathing patterns, decreased deglutition, and poor eating habits The objective of this research was to determine and compare the effect of a multicomponent exercise program with conventional physiotherapy program for TMJD in oral cancer survivors. Materials and Methods: This study included 100 participants with TMJD based on inclusion and exclusion criteria. Then, the subjects were randomly allocated into Group A and Group B by a simple random sampling method. Group A was given a conventional physiotherapy exercise program and for Group B multicomponent exercise program was given. Outcome measures used were a Visual Analog Scale, assessment of range of motion (ROM) and manual muscle testing (MMT) and the American Academy of Orofacial Pain questionnaire. Pre- and post-assessment of the above measures was taken to confirm the results. Results: The results showed a statistically significant effect of the multicomponent exercise program as compared to a conventional exercise program for TMJD in oral cancer survivors. There was a significant reduction in pain (&lt;0.0001) in individuals in Group B than in Group A. Restriction in the ROM and improvement in MMT were also significantly (P &lt; 0.0001) resolved and the facial symmetry, breathing patterns as well as swallowing difficulty were also improved. Conclusion: On the basis of the results, it can be concluded that the Group B who followed the multicomponent exercise program showed better improvement in pain intensity, ROM, facial symmetry, muscle strength, breathing pattern and in swallowing as compared to Group A. Similarly utilizing a multifaceted patient-centered approach has been proven to be effective and lead to successful recovery of the temporomandibular joint function in oral cancer survivors.

Sarcoidosis is a multisystem granulomatous disorder that rarely involves the spinal cord. This report describes the presentation and rehabilitative course of a 31-yr-old man with quadriparesis secondary to spinal cord sarcoidosis. The patient had insidious, progressive weakness in his arms and legs for six weeks before evaluation. Examination revealed a C4 incomplete spinal cord injury. Computed tomography demonstrated an intrinsic cord lesion from the brainstem to approximately T8. Magnetic resonance imaging (MRI) suggested the lesion was granulomatous and cervical laminectomy confirmed noncaseating granulomas. The patient was started on high dose steroids, subsequently gained strength in the distal upper extremities, and was sent for spinal cord rehabilitation. Examination revealed 3 to 4+/5 strength in the upper extremities, 2- to 3-/5 in the lower extremities. The right side was slightly stronger than the left, with proximal musculature stronger than distal. Sensory examination was intact except in the C-8 to T-2 dermatomes. The patient was dependent in self-care and mobility except for feeding. Initial progress was inhibited by severe spasticity requiring medication, but by discharge he was independent at the wheelchair level with 4/5 strength in all four extremities except for his hands, which had 3/5 strength. Sensory exam did not change. Follow-up MRI studies revealed reduction of the lesion. Review of previous cases revealed that myelopathy is the most common presenting complaint and cervical segments are most commonly involved. Survival averaged almost three years and significant gains were made in functional status. Rehabilitative course and special considerations, treatment and follow-up recommendations are discussed.

Our aim was to analyze the effects of a multicomponent exercise program (MEP) on frailty and physical performance in older adults with HIV (OAWH) since exercise can reverse frailty in the older population overall, but there is no data for OAWH. A prospective longitudinal study with intervention and control group was designed. Sedentary adults 50 or over with and without HIV were included. The intervention was a 12-week home-based MEP. Dependent variables were frailty (frailty phenotype), physical performance (Senior Fitness Test), muscle mass (ASMI) by bioimpedance. Pre- and postintervention measurements were analyzed using McNemar's test for categorical variables and the Wilcoxon signed-rank test for quantitative variables. 40 OAWH and 20 OA without HIV. The median age was 56.5 years. 23.3% were women. The prevalence of frailty was 6.6% with no frail HIV-negative participants. Three of the four frail HIV-participants transitioned two (50%) from frail to prefrail and one (25%) to robust after the MEP. In participants with an adherence ≥50%, physical performance was significantly improved [basal vs. 12 week]: upper extremity strength [13 (13-15) vs. 16 (15-19), p = 0.0001], lower extremity strength [13 (11-16) vs. 15 (13-16), p = 0.004], aerobic endurance [62 (55-71) vs. 66 (58-80), p = 0.005]. Participants with low adherence experienced a significant worsening in ASMI [8.35 (7.44-9.26) vs. 7.09 (6.08-8.62), p = 0.03]. A 12-week MEP enhances frailty by increasing robustness in OAWH, and improves physical performance, and preserves muscle mass in older adults with good adherence to the MEP independently of HIV status.

Context Transcutaneous spinal stimulation (TSS), applied to the cervical spine, is able to improve voluntary upper extremity strength and function in individuals with cervical spinal cord injury (SCI). While most respond and improve in the presence of TSS, others do not respond as favorably. Midsagittal tissue bridges, adjacent to the lesion, can be observed and measured using T2-weighted magnetic resonance imaging (MRI), and both ventral and dorsal tissue bridges are associated with recovery following SCI. Tissue bridges may also be important for responding to neuromodulation such as TSS. The purpose of this case series was to explore potential relationships between the presence of tissue bridges and responsiveness to TSS for recovery of upper extremity strength and function in research participants with cervical-level SCI. Methods This study involved six research participants who completed a clinical trial of rehabilitation paired with TSS to improve upper extremity strength and function. Ventral and dorsal midsagittal tissue bridges were quantified using T2-weighted MRI. Results Three participants classified as both strength and function responders showed presence of ventral tissue bridges, while the three strength-only responders did not. The same was found for dorsal tissue bridges, except for one strength-only responder that had a dorsal tissue bridge. Conclusions The findings of this case series shed light onto the potential importance of midsagittal tissue bridges – a proxy for spared sensorimotor tracts – for responsiveness to TSS for upper extremity recovery following SCI.

Ultrasound-guided cervical medial branch block (CMBB) is commonly performed to diagnose and treat head, neck, and shoulder pain. However, its use at the C7 level has been shown to be less accurate than at other levels, which may increase the chance of injury owing to the imprecision of needle site provided by the ultrasound guide. We report the first case of iatrogenic spinal cord injury from an ultrasound-guided C7 CMBB. The patient, upon receiving this procedure, had fainted shortly after experiencing an electrical sensation that ran from the neck to the toe. The patient complained of weakness and tingling sensation in the left upper extremity. Cervical magnetic resonance imaging revealed a hematoma in the cervical spinal cord, and an electrophysiological study, which was performed at 3 weeks after the incident, revealed an injury at the left C3-T2 anterior horn. After 2 months of rehabilitation, the patient showed moderate improvement in the strength of the left proximal upper extremity; however, there was no improvement in the strength of the left distal upper extremity. Therefore, we recommend caution when performing ultrasound-guided CMBB at the C7 level, as the guide particularly at this level is relatively inaccurate, posing a risk of spinal cord injury.

Although approximately half of all people with spinal cord injury (SCI) have upper extremity (UE) dysfunction, there is a great deal of technology and focus on improving leg strength and retraining gait after SCI and not on UE strength and function. The principles of activity-based interventions, which involve intense activity to access and improve spinal cord circuitry and to produce long-lasting neural and functional changes, are being routinely translated to rehabilitation of the lower extremities in individuals with SCI. Activity-based approaches may be useful for facilitating long-term neural and functional changes in the UE as well. Yet, the understanding of how to facilitate UE movement in tetraplegia and how to develop and apply new approaches or technology to improve UE function is significantly lacking. This article evaluates the literature pertaining to the use of activity-based interventions to improve UE function after SCI and discusses the relevance of evidence for activity-based interventions in the stroke population as well as that from the literature examining the effects of activity-based interventions for retraining the lower extremity after SCI to determine whether activity-based interventions may be useful for retraining arm and hand function after SCI.

Background:Gymnastics is a demanding sport that places unique forces on the upper extremity. The repetitive nature of the sport and the high-impact forces involved may predispose the gymnast to overuse injuries. Risk factors for injuries in gymnastics are not well understood.Purpose/Hypothesis:The purpose of this study was to ascertain whether preseason upper extremity range of motion (ROM) and strength differ between National Collegiate Athletic Association (NCAA) Division I collegiate gymnasts who sustain an in-season upper extremity injury and those who do not. We hypothesized that gymnasts who sustain an upper extremity injury would demonstrate reduced ROM and strength compared with noninjured gymnasts.Study Design:Cohort study; Level of evidence, 3.Methods:Over 4 seasons, from 2014 to 2018, a total of 15 female NCAA Division I collegiate gymnasts underwent preseason upper extremity ROM (shoulder: flexion, internal and external rotation; elbow: extension; wrist: extension) and strength (shoulder: internal and external rotation, and middle and lower trapezius) testing. Overuse upper extremity injuries were tracked in each subsequent season. Gymnasts were dichotomized into injured and noninjured groups, and a 2 × 2 analysis of variance was used to measure differences in preseason measures between the groups as well as within arms (injured vs noninjured arm for the injured group; dominant vs nondominant arm for the noninjured group).Results:A total of 12 overuse upper extremity injuries (10 shoulders; 2 wrist/forearm) occurred during 31 gymnast-seasons. There were no significant interactions for preseason ROM and strength measurements between groups (injured vs noninjured) or within arms (injured and noninjured arm for the injured group; dominant and nondominant arm for the noninjured group; P = .07).Conclusion:Preseason upper extremity ROM and strength were not different between gymnasts who sustained an in-season upper extremity overuse injury and those who did not. It is possible that ROM and strength measures used to screen other overhead athletes may not capture the unique features and requirements of gymnastics. Further, it may be challenging to discern differences in clinical measures of ROM and strength in gymnastics populations owing to the bilateral nature of the sport.

The predictors and patterns of upright mobility in children with a spinal cord injury (SCI) are poorly understood. The objective of this study was to develop a classification system that measures children's ability to integrate ambulation into activities of daily living (ADLs) and to examine upright mobility patterns as a function of their score and classification on the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) exam. This is a cross-sectional, multicenter study that used a convenience sample of subjects who were participating in a larger study on the reliability of the ISNCSCI. A total of 183 patients between 5 and 21 years old were included in this study. Patients were asked if they had participated in upright mobility in the last month and, if so, in what environment and with what type of bracing. Patients were then categorized into 4 groups: primary ambulators (PrimA), unplanned ambulators (UnPA), planned ambulators (PlanA), and nonambulators. Multivariate analyses found that only lower extremity strength predicted being a PrimA, whereas being an UnPA was predicted by both lower extremity strength and lack of preservation of S45 pinprick sensation. PlanA was only associated with upper extremity strength. This study introduced a classification system based on the ability of children with SCI to integrate upright mobility into their ADLs. Similar to adults, lower extremity strength was a strong predictor of independent mobility (PrimA and UnPA). Lack of pinprick predicted unplanned ambulation, but not being a PrimA. Finally, upper extremity strength was a predictor for planned ambulation.

Safety and Feasibility of Cervical and Thoracic Transcutaneous Spinal Cord Stimulation to Improve Hand Motor Function in Children With Chronic Spinal Cord Injury