Does tele-exercise training for tetraplegia meet the spinal cord injury-specific physical activity guidelines? A 7-month longitudinal study.

INTRODUCTION: Tele-exercise, defined as an intervention that offers physical training provided remotely, represents an alternative for remote care during social isolation and the absence of in-person interventions, considering the difficulties of regular exercise engagement in tetraplegia. The current study aimed to examine whether tele-exercise training in individuals with tetraplegia meets the recommendations proposed by the spinal cord injury (SCI)-specific guidelines, and the adherence. METHODS: Twenty SCI tetraplegia performed tele-exercise training. The weekly training load of the tele-exercise training during the 27 weeks was compared to the estimated training load of SCI-specific guidelines: TW vigorous guideline: vigorous intensity of guideline proposed for Tweedy et al.; MG vigorous guideline: vigorous intensity of guideline proposed for Martin Ginis et al.; MG moderate guideline: moderate intensity of guideline proposed for Martin Ginis et al. Adherence was obtained weekly during 27 weeks. RESULTS: The tele-exercise training load was 22.0% higher than the MG moderate guideline and 21.6% and 47.7% lower than the MG vigorous and TW vigorous guidelines, respectively. The tele-exercise training loads for men and women were, respectively, 2.3% and 35.0% higher than the MG moderate guideline; 34.0% and 13.2% lower than the MG vigorous guideline; and 56.1% and 42.1% lower than the TW vigorous guideline. Adherence was 45.1%. CONCLUSION: The tele-exercise training in men and women with tetraplegia for 7 months met the moderate intensity of recommendation proposed by one SCI exercise guideline. The adherence was 45.1%, with higher values for men compared to women. This finding shows that tele-exercise training may be an alternative exercise training intervention for tetraplegia and prompts reflexion on the inclusion of tele-exercise training in SCI exercise guidelines.

Mechanical diagnosis and therapy in musculoskeletal pain of individuals with spinal cord injury.

CONTEXT/OBJECTIVE: Musculoskeletal pain (MSKP) has high prevalence in individuals with spinal cord injury (SCI). Mechanical Diagnosis and Therapy (MDT) is a method focused on identifying the pain source in the musculoskeletal system and presents good results in pain relief in people without neurological impairment. However, no studies have investigated the use of MDT in SCI population. The objective was to evaluate the applicability and outcomes of MDT treatment in pain relief and independence improvement in daily activities of individuals with SCI presenting MSKP. DESIGN: Single-arm trial. SETTING: Rehabilitation Hospital. PARTICIPANTS: Twenty-four individuals with SCI who presented MSKP. INTERVENTION: MDT-certified physical therapist conducted assessments and treatments of pain according to the MDT approach. OUTCOMES MEASURES: Numeric rating scale (NRS) was used to measure pain and Pain Disability Index (PDI) and Patient-Specific Functional Scale (PSFS) to evaluate daily activities. RESULTS: Significant median decreases were found for NRS (from 7 to 2) and PDI (from 27 to 8) after MDT, whereas PSFS score presented a significant mean increase (from 3.2-7.7). The average decrease in pain after MDT treatment was 70.9% (5.36 on the NRS). CONCLUSION: MDT can reduce pain and enhance independence in daily activities in individuals with SCI and MSKP.

Feasibility and validity of the push-up test for synchronous and asynchronous strength tele-assessment in spinal cord injury individuals with paraplegia.

OBJECTIVES: This study aimed to determine whether the synchronous and asynchronous push-up tele-assessment in individuals with spinal cord injury (SCI) is feasible and valid and to identify the relationship between the participants' self-reported asynchronous strength tele-assessment and asynchronous push-up tele-assessment. STUDY DESIGN: Cross-sectional study. METHODS: Thirty-three men and women with SCI were included in this study. The participants were assessed using the one-maximum repetition test (1RM), the maximum repetitions with 60% of 1RM (MRT) of the bench press exercise, and synchronous and asynchronous push-up tele-assessment. The videos and the total repetitions performed were recorded. The primary outcomes were 1RM, MRT, synchronous push-up tele-assessment and asynchronous volume loads, and the participants' self-reported asynchronous strength tele-assessment volume load. RESULTS: The synchronous push-up tele-assessment and asynchronous volume loads presented significant correlations with 1RM (0.73 and 0.45, p < 0.001, respectively) and MRT volume loads (0.87 and 0.66, p < 0.001, respectively). The asynchronous push-up tele-assessment presented significant correlations with the synchronous version (intraclass correlation coefficient, ICC = 0.86; 95% CI: 0.72-0.93, p < 0.001) and participants' self-reported asynchronous strength tele-assessment volume loads (ICC = 0.88; 95% CI: 0.75-0.94, p < 0.001). The difference between the synchronous push-up tele-assessment and asynchronous volume load means was 254.9 kg, and the interval around the differences was 1856.1 kg. The difference between asynchronous push-up tele-assessment and participants' self-reported asynchronous strength tele-assessment means was -239.4 kg, and the interval around these was 1884.1 kg. CONCLUSION: The synchronous push-up tele-assessment is a feasible and valid way to assess the maximum resistance strength of individuals with SCI. Although the asynchronous push-up tele-assessment demonstrated excellent and significant correlations with the synchronous push-up tele-assessment and participants' self-reported asynchronous strength tele-assessment, the test repetitions and the volume loads were underestimated by 15.5% (synchronous push-up tele-assessment vs. asynchronous) and overestimated by 17.3% (asynchronous push-up tele-assessment vs. participants' self-reported asynchronous strength tele-assessment), and the effect sizes ranged from 0.19-0.38. The authors suggest emphasizing the criteria of repetition validity to reduce test error.

Validation of the Repetitions in Reserve Rating Scale in Paralympic Powerlifting Athletes.

The present study aimed to validate the perceived exertion scale based on the repetitions in reserve (RIR) of Paralympic Powerlifting (PP) athletes. Twenty-one PP athletes were assessed in the one-maximum repetition test (1RM) of the bench press exercise, maximum repetition strength tests with loads corresponding to 90, 85, 80, and 75% of 1RM, and 4-repetitions strength tests (4-repST) with 100, 90, 85, 80, and 75% of the 1RM. The RIR scale was assessed after each set of the 4-repST and compared to the 1RM and maximum strength tests. For criterion validity, the total estimated repetition was significantly lower compared to the maximum strength test repetitions in the lower scores of the RIR scale (median=7.0 vs. 9.0 for 75% of 1RM). The total estimated repetition correlation with maximum strength was very high and significant (ICC=0.91). Using the Bland and Altman method, the difference between means was 0.9 reps, and the interval around differences was 6.4 reps. For construct validity, and the RIR scale presented high correlation with 1RM intensities (rho=0.86, p≤0.05). The RIR scale was validated and coaches and sports trainers can use this monitoring tool to ensure submaximal loads when improving lift technique, which is extremely rigorous in PP.

Peak Torque Prediction Using Handgrip and Strength Predictors in Men and Women With Motor Complete Spinal Cord Injury.

OBJECTIVES: To establish predictive equations for peak torque of muscle groups with totally and partially preserved innervation in individuals with motor complete spinal cord injury (SCI), based on hand dynamometry and strength predictor variables. METHODS: The cross-sectional study conducted at a rehabilitation hospital consecutively recruited 108 men and women with SCI. All participants performed maximum peak torque tests for shoulder abduction/adduction (isokinetic), trunk flexion/extension (isometric), and handgrip strength testing (hand dynamometer) to establish predictive peak torque equations. The primary outcomes were peak torque variables. Handgrip strength, age, injury level, time since injury, age at injury, body mass, height, body mass index, and physical activity level were the secondary outcomes used as strength predictor variables. RESULTS: Handgrip strength was a predictor variable for shoulder abduction/adduction peak torque. The best predictive models for shoulder abduction/adduction peak torque exhibited R 2 = 0.57 and R 2 = 0.60, respectively (p ≤ .05). Injury level showed the highest significant predictive capacity for trunk flexion/extension peak torque models (R 2 = 0.38 and R 2 = 0.29; p ≤ .05). CONCLUSION: Shoulder abduction/adduction peak torque predictive equations may be an alternative for use in an accessible strength tool (hand dynamometry) to evaluate training and rehabilitation programs. Trunk flexion/extension peak torque equations exhibited moderate correlations and high standard error of the estimates and should be used with caution.

Medicine Ball Throw Responsiveness to Measure Wheelchair Basketball Mobility in Male Players.

CONTEXT: Monitoring training loads and consequent fatigue responses are usually a result of personal trainers' experiences and an adaptation of methods used in sports for people without disabilities. Currently, there is little scientific evidence on the relationship between training load and fatigue resulting from training sessions in wheelchair sports. Analogous to the vertical jump, which has been associated with competitive performance and used to assess fatigue in Olympic sports, the medicine ball throw (MBT) is a fast, feasible, and accessible test that might be used to measure performance outcomes in Paralympic athletes. OBJECTIVE: To test the MBT responsiveness to detect meaningful changes after training sessions in beginner wheelchair basketball players (WBP). DESIGN: Cross-sectional study. SETTING: Rehabilitation Hospital Network, Paralympic Program. PARTICIPANTS: Twelve male WBP. MAIN OUTCOMES MEASURES: The participants performed 3 consecutive days of training sessions involving exercises of wheelchair basketball skills, strength, and power. The MBT test was performed pre and post training sessions. RESULTS: The smallest worthwhile change for MBT was 0.10 cm, and the lower and upper limits were 3.54 and 3.75 m, respectively. On the first day, the MBT started below the smallest worthwhile change lower limit and increased above the upper limit (3.53 and 3.78 m, respectively). On the second day, the MBT pretraining and posttraining session results were near the sample mean (3.62 and 3.59 m, respectively). On the third day, the WBP started the MBT test training higher than the upper limit (3.78 m) and decreased to near the mean (3.58 m). CONCLUSIONS: During 3 consecutive days of training sessions, the magnitude-based inference model presented meaningful changes in MBT test performance. The accurate association of the magnitude-based inference model with the MBT allows coaches and sports team staff to interpret the correct magnitude of change in WBP performance.

Does prolonged walking cause greater muscle fatigability in individuals with incomplete spinal cord injury compared with matched-controls?

BACKGROUND: Individuals with incomplete spinal cord injury (iSCI) might show muscle fatigability during walking, primarily over long distances. The cause can be related to the motor impairment and walking compensations identified in this population. However, evidence on the occurrence of muscle fatigability after prolonged walking in individuals with iSCI is conflicting. RESEARCH QUESTION: Does prolonged walking cause higher muscle fatigability in individuals with iSCI compared with matched-controls? METHODS: We adopted a repeated measures design, in which maximal voluntary isometric contractions were performed before and after a walking test to induce the fatigability, in 24 individuals with iSCI and 24 matched-controls. Body weight-normalized peak torque (PT/BW), rate of force development (RFD), root mean square (RMS) and neuromuscular efficiency were used to assess the muscle fatigability. A mixed model ANOVA (2 × 2) was used for between-group and within-group comparisons. The significance was set in 5%. RESULTS: Individuals with iSCI showed a greater decline in the PT/BW and RMS after the walking test. However, the RFD presented a greater decrease in the control group. SIGNIFICANCE: Our results showed that prolonged walking caused higher muscle fatigability in individuals with iSCI compared to healthy individuals. Therefore, muscle fatigability should be considered during the rehabilitation planning and in activities of daily living of individuals with iSCI. Moreover, the identification of muscle fatigability in individuals with iSCI might be useful to prevent high levels of physical exertion and, possibly, the risk of fall.