The relationship between balance control and thigh muscle strength and muscle activity in persons with incomplete spinal cord injury.

STUDY DESIGN: Cross-sectional study. OBJECTIVES: A spinal cord injury (SCI) can compromise the ability to maintain sufficient balance control during activities in an upraised position. The objective of the study was to explore the relationship between balance control and muscle strength and muscle activation in the lower extremities in persons with incomplete SCI (iSCI). SETTING: Sunnaas Rehabilitation Hospital, Norway. METHODS: Thirteen men and two women with iSCI and 15 healthy, matched controls were included. Performance of the Berg Balance Scale (BBS) short version (7 items) was used to indicate balance control. Maximal voluntary contraction (MVC) was performed to measure isometric muscle strength in thigh muscles (knee extension/flexion), while surface electromyography (EMG) was measured from M. Vastus Lateralis and M. Biceps Femoris. The relative activation of each muscle during each of the BBS tasks was reported as the percentage of the maximal activation during the MVC (%EMGmax). RESULTS: The iSCI participants had a significantly lower BBS sum score and up to 40% lower muscle strength in knee- flexion and extension compared to the matched healthy controls. They also exhibited a significantly higher %EMGmax, i.e. a higher muscle activation, during most of the balance tests. Univariate regression analysis revealed a significant association between balance control and mean values of %EMGmax in Biceps Femoris, averaged over the seven BBS tests. CONCLUSIONS: The participants with iSCI had poorer balance control, reduced thigh muscle strength and a higher relative muscle activation in their thigh muscles, during balance-demanding activities.

Exercise intensity during exergaming in wheelchair-dependent persons with SCI.

STUDY DESIGN: Cross-sectional study. OBJECTIVES: It is challenging for persons with SCI, especially those who are wheelchair dependent, to find suitable and motivating aerobic exercise modes. Exergaming might be a good option, since it is relatively cheap and can be played at home, alone or with others. However, it is unknown if exergaming is performed at a sufficient exercise intensity. SETTING: Sunnaas Rehabilitation Hospital, Norway. METHODS: Twenty-two men and two women (n = 24) with chronic SCI (AIS A-C), all wheelchair users, were included during inpatient rehabilitation. All participant performed a maximal graded arm-crank test (pretest), while measuring peak oxygen uptake (VO2peak) and peak heart rate (HRpeak). The day after they had a practice playing session with three different exergames (X-box Kinect, Fruit Ninja; Nintendo Wii, Wii Sports Boxing; VR Oculus Rift, boxing). The following day, participants played each exergame for 15 min. During these 45 min of exergaming, exercise intensity, based on VO2peak and HRpeak from the pretest, was monitored. RESULTS: Approximately 30 of the 45 min of exergaming was performed at moderate or high intensity. Participants exercised on average 24.5 min (95%CI 18.7-30.5) at moderate intensity (>50-80% VO2peak) and 6.6 min (95%CI 2.2-10.8) at high intensity (>80% VO2peak). CONCLUSIONS: The participants were able to exercise at moderate or high intensity during exergaming in a considerable amount of time. Exergaming seems to be suitable for aerobic exercise at an intensity that can provide health benefits in wheelchair-dependent persons with SCI.

A qualitative interview study on how people with incomplete spinal cord injury experience high-intensity walking exercise.

STUDY DESIGN: Qualitative, in-depth research interviews. OBJECTIVE: To provide new insight into how people with a recent incomplete spinal cord injury (SCI) experience high-intensity walking exercise after discharge from subacute inpatient rehabilitation. SETTING: Informants for this interview study participated in a previous randomized controlled trial (RCT) that was conducted at Sunnaas Rehabilitation Hospital, Norway. METHODS: Four individual face-to-face interviews were conducted with the participants in natural setting. The interviews were analyzed through systematic text condensation and discussed in the context of experiences of bodily changes. RESULTS: Four themes emerged that described positive but also challenging bodily experiences related to performing high-intensity walking exercise: "Expectations and motivation"-reasons for participating, "Challenging bodily changes"-impacts on walking ability, "Adaptation strategies"-achieving the high-intensity target level, and "Integrating exercise into a new daily life"-combining participation, new body and new life. CONCLUSIONS: This study indicates the importance of participating in a specific exercise program at discharge from subacute inpatient rehabilitation for ambulant people with SCI. However, high-intensity walking exercise may be too demanding to perform during this time period. The insights from the study provide new knowledge that can contribute to improving clinical rehabilitation practice.

Changes in physical activity and basic psychological needs related to mental health among people with physical disability during the COVID-19 pandemic in Norway.

BACKGROUND: People with a physical disability are more inactive than the general population. Due to the positive effects of physical activity (PA) on physical and mental health, maintaining a physically active lifestyle is important especially during challenging periods of life. OBJECTIVE: Explore whether people with a physical disability experienced changes in PA, health status, and psychological need satisfaction (autonomy, competence and relatedness) during the first wave of the COVID-19 pandemic in Norway. Further, explore whether changes in psychological need satisfaction were associated with changes in PA level and mental health. METHODS: Cross-sectional retrospective study using an online self-reported questionnaire after the first wave during the COVID-19 pandemic. RESULTS: Of the 298 participants with physical disabilities (AgeM = 49yr; 62% females; 66% using mobility aids), 66% reported decreased PA compared to the same period in the previous year, 45% reported declined health status due to increased pain and reduced physical functioning. Regarding psychological need satisfaction, it was primarily the change in need for autonomy and competence for PA that were associated with change in PA and mental health. CONCLUSIONS: Most of the participants indicated decreased PA and about half decreased Health status during the COVID-19 pandemic. Further, the results indicated that it is important to nurture the basic psychological needs of autonomy and competence for PA when aiming to maintain or increase PA levels and mental health for this population living under restrictions of a pandemic.