Systematic review of the effects of exercise therapy on the upper extremity of patients with spinal-cord injury.

OBJECTIVE: To assess the effects of exercise therapy (ET) on motor control and functional ability of the upper extremity in patients with cervical spinal cord injury (SCI). METHODS: An extensive systematic literature search in five databases was performed to identify clinical and (randomized) controlled trials, evaluating the effects of ET on motor control and functional ability in patients with SCI. The methodological quality of the selected studies was systematically assessed by three reviewers. RESULTS: Eight studies were included. Seven had good-to-fair methodological quality, six reported positive effects of ET on motor control (for example, muscle strength or muscle grade) and four also reported positive effects on functional ability. Five of these studies focused on patients with long-lasting SCI. A great variety of therapeutic approaches were applied, even within ET there was a wide range of training characteristics. CONCLUSION: Although ET is a cornerstone in the treatment of the upper extremity in patients with SCI, only a small number of studies were included in the present review. Most of the included studies reported a positive effect of ET on upper extremity motor control and functional ability in SCI patients. As ET is effective in patients with SCI in the chronic stage, this might have implications for the follow up and further treatment of these patients. Future studies should be more specific in describing the characteristics of ET to verify that the ET is in accordance with the current standards for training and motor relearning.