Abstract
Preclinical investigations in animal models demonstrate that enhanced upper limb (UL) activity during rehabilitation promotes motor recovery following spinal cord injury (SCI). Despite this, following SCI in humans, no commonly applied training protocols exist, and therefore, activity-based rehabilitative therapies (ABRT) vary in frequency, duration, and intensity. Quantification of UL recovery is limited to subjective questionnaires or scattered measures of muscle function and movement tasks. To objectively measure changes in UL activity during acute SCI rehabilitation and to assess the value of wearable sensors as novel measurement tools that are complimentary to standard clinical assessments tools. The overall amount of UL activity and kinematics of wheeling were measured longitudinally with wearable sensors in 12 thoracic and 19 cervical acute SCI patients (complete and incomplete). The measurements were performed for up to seven consecutive days, and simultaneously, SCI-specific assessments were made during rehabilitation sessions 1, 3, and 6 months after injury. Changes in UL activity and function over time were analyzed using linear mixed models. During acute rehabilitation, the overall amount of UL activity and the active distance wheeled significantly increased in tetraplegic patients, but remained constant in paraplegic patients. The same tendency was shown in clinical scores with the exception of those for independence, which showed improvements at the beginning of the rehabilitation period, even in paraplegic subjects. In the later stages of acute rehabilitation, the quantity of UL activity in tetraplegic individuals matched that of their paraplegic counterparts, despite their greater motor impairments. Both subject groups showed higher UL activity during therapy time compared to the time outside of therapy time. Tracking day-to-day UL activity is necessary to gain insights into the real impact of a patient's impairments on their UL movements during therapy and during their leisure time. In the future, this novel methodology may be used to reliably control and adjust ABRT and to evaluate the progress of UL rehabilitation in clinical trials.
Highlights
Cervical spinal cord injury (SCI) results in profound and devastating life changes for the affected individuals due to the loss of arm and hand function [1]
We show that subjects with cervical SCI significantly increase the overall amount of upper limb (UL) activity compared to their thoracic injured counterparts that did not experience significant changes
We aimed to compare UL activity during therapy in contrast to UL activity during leisure time, and we showed that all subjects have a significantly higher UL activity during therapy, whereas the increase was more pronounced in tetraplegic compared to paraplegic subjects
Summary
Cervical spinal cord injury (SCI) results in profound and devastating life changes for the affected individuals due to the loss of arm and hand function [1]. This is on the one hand, because there are few studies investigating this issue and on the other hand because the results that do exist are contradictory [15] Typical challenges to such studies are the limited sample size due to low incidence of SCI, frequent subject dropout, and poor adherence due to a high frequency of secondary complications in cervical patients as well as the fact that UL movements are complex because they involve a variety of non-cyclic movements that are difficult to measure objectively [1, 16]. Quantification of UL recovery is limited to subjective questionnaires or scattered measures of muscle function and movement tasks
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
