Systemic Inflammatory Changes in Spinal Cord Injured Patients after Adding Aquatic Therapy to Standard Physiotherapy Treatment.

Spinal cord injury (SCI) is a severe medical condition resulting in substantial physiological and functional consequences for the individual. People with SCI are characterised by a chronic, low-grade systemic inflammatory state, which contributes to further undesirable secondary injuries. This study aimed to evaluate the effect of adding aquatic therapy to the standard physiotherapy treatment, implemented in two different schedules, on systemic inflammation in SCI patients. Additionally, the relationship between cytokine blood levels and changes in functionality (measured with the 6MWT, 10MWT, WISCI, BBS, and TUG tests) throughout the study was assessed. A quantitative multiplexed antibody assay was performed to measure the expression level of 20 pro- and anti-inflammatory cytokines in blood samples from SCI patients at three time points: baseline, week 6, and immediately post-intervention (week 12). This study identified a complex signature of five cytokines (IL-12p70, IL-8, MCP-1, IL-1α, and IP10) associated with the time course of the two physiotherapy programs. Two other cytokines (IL-4 and TNF-α) were also associated with the functional recovery of patients. These could be important indicators for SCI prognosis and provide a basis for developing novel targeted therapies.

Telerehabilitation Use With Spinal Cord Injury: Occupational Therapists' Perspective.

IMPORTANCE: Telerehabilitation provides people with spinal cord injury (SCI) an alternative mode of accessing specialized health care. Further research on occupational therapy practitioners' perspectives of telerehabilitation may provide additional evidence for clinical practice implementation. OBJECTIVE: To explore urban occupational therapists' perspectives on the benefits of and barriers to telerehabilitation use with SCI. DESIGN: A qualitative study design using a demographic questionnaire and a single, individual semistructured interview. Thematic analyses included member checking, constant comparative analysis, triangulation, and self-description and self-reflexivity. SETTING: Residential and community settings. PARTICIPANTS: Six occupational therapists with a range of experience in SCI rehabilitation were recruited using purposeful sampling. RESULTS: Six participants were interviewed, and four primary themes emerged: (1) communication, (2) personal factors, (3) benefits, and (4) barriers. CONCLUSIONS AND RELEVANCE: Telerehabilitation offers numerous potential benefits for SCI intervention. This study provides an understanding of practitioner concerns and potential barriers to use. The results indicate that a hybrid model incorporating both in-person and distance-based treatment is likely optimal. What This Article Adds: Our results provide information that addresses practitioner concerns and recommendations for the use of telerehabilitation with people with SCI. As practitioner concerns are identified and addressed, telerehabilitation may increase in the U.S. health care system, potentially facilitating an alternative treatment delivery method for underserved populations.

Relationship of psychosocial factors and musculoskeletal pain among individuals with newly acquired spinal cord injury.

STUDY DESIGN: Cross-sectional analysis of baseline data of a longitudinal cohort study. OBJECTIVES: Little evidence exists on pain-related psychosocial factors in individuals with newly acquired spinal cord injury (SCI). To understand a biopsychosocial model of pain, we must first understand the presenting psychological pain-related factors at injury onset. Therefore, we assessed musculoskeletal pain and pain-related psychological constructs in a group of individuals with newly acquired SCI. We hypothesized that individuals with new SCI would report musculoskeletal shoulder pain with elevated levels of kinesiophobia and pain catastrophizing. SETTING: Data were collected in three rehabilitation hospitals located in urban and suburban communities. METHODS: Thirty-five individuals with newly acquired SCI participated. Demographics, Musculoskeletal Pain Survey shoulder subscale, Tampa Kinesiophobia Scale-11, Pain Catastrophizing Scale, Fear of Pain Questionnaire, Chronic Pain Coping Inventory-42, and Subjective Quality of Life Questionnaire were administered. Descriptive analysis of all measures was determined and relationships between pain and psychosocial measures determined. RESULTS: Moderate shoulder pain existed in 40% of people with new SCI along with clinically elevated kinesiophobia, pain catastrophizing, fear of pain, and reduced quality of life. Shoulder pain was statistically associated with pain catastrophizing (ρ = 0.41, p = 0.01). Kinesiophobia positively correlated with fear of pain (ρ = 0.38, p = 0.02) with an inverse relationship to quality of life (ρ = -0.47, p = 0.01). CONCLUSIONS: Elevated pain, and pain-related psychological characteristics, such as catastrophizing and kinesiophobia exist during the early stages after SCI. Early identification of pain-related factors can guide clinical intervention potentially ameliorating pain-linked functional impairments. TRIAL REGISTRY: This trial is registered with ClinTrial.gov ID NCT03137394.

A comparison of prefabricated and custom made resting hand splints for individuals with cervical spinal cord injury: A randomized controlled trial.

OBJECTIVE: To compare prefabricated and custom resting hand splints and establish the feasibility of splinting research for larger scale trials. DESIGN: A Randomized controlled pilot study where the randomization unit was each hand, rather than each individual. SETTING: Thirty-two-bed spinal cord injury and multi-trauma rehabilitation unit in an urban academic rehabilitation center. SUBJECTS: Thirty-six hands from 19 individuals with cervical spinal cord injury were enrolled during their acute rehabilitation stay. INTERVENTIONS: Each eligible hand was randomized to receive a custom or prefabricated resting hand splint for night use. MAIN MEASURES: The Graded Redefined Assessment of Strength, Sensation and Prehension (GRASSP) was completed at both admission and discharge, and a structured interview was completed at discharge. RESULTS: No difference existed in GRASSP outcomes or user preference between custom and prefabricated resting hand splints. Mann-Whitney tests indicated that there was no significant difference in qualitative prehension scores (U = 141, P = 0.522) nor quantitative prehension scores (U = 135, P = 0.382) between groups. Adherence to the splinting program was high (18 out of 19 participants), and no adverse effects occurred. Four themes emerged from the participant comments: the participants felt splints were helpful in their recovery; they found it challenging to direct their caregivers to help with the splints; they needed to take ownership for managing their splints; and they wished they received more education on splint rationale. CONCLUSION: There was no obvious difference in outcome or user preference between prefabricated and custom resting hand splints.

Shoulder impairment and pain of individuals with newly acquired spinal cord injury compared to uninjured peers.

STUDY DESIGN: Cohort study. OBJECTIVES: Shoulder pain prevalence is high in those with spinal cord injury (SCI) and is associated with decreased function, participation restrictions and decreased quality of life. Limited evidence exists regarding physical impairments of newly acquired SCI. The current study compared musculoskeletal factors at rehabilitation initiation in individuals with newly acquired SCI to uninjured individuals. We hypothesized no impairment differences of shoulder pain, strength, mobility, muscle extensibility, or rotator cuff integrity would exist between groups. SETTING: Multi-site laboratory setting. METHODS: Thirty-five individuals with newly acquired SCI and age and gender-matched controls without SCI (n = 34) participated. Musculoskeletal Pain Survey, shoulder range of motion (ROM), strength, pectoralis minor muscle extensibility (PM) and tissue integrity [Ultrasound Pathology Rating Scale (USPRS)] were obtained. RESULTS: Higher pain was reported by individuals experiencing new SCI along with lower strength across all bilateral measures, reduced elevation, external rotation, and horizontal adduction ROM, with large effect sizes. PM bilateral extensibility was reduced compared to controls, with moderate between group effect size; however, no USPRS score difference existed. CONCLUSIONS: This study provided the first comprehensive clinical description for individuals with newly acquired SCI. In comparison to matched uninjured controls, participants with new SCI reported greater shoulder pain with impairments in mobility, strength, and extensibility. The identified early clinical impairments aligned with progressive impairment including further pain development and persistence. Awareness and modification of these early clinical impairments may lead to improved long-term outcomes, improving the overall health and well-being of individuals with newly acquired SCI. SPONSORSHIP: Spinal Cord Injury Research Program Investigator-Initiated Research Award under Award No. W81XWH-17-1-0476.

Current U.S. splinting practices for individuals with cervical spinal cord injury.

STUDY DESIGN: Survey research design. OBJECTIVE: To understand current splinting practices of occupational therapists working with individuals with spinal cord injury. SETTING: The United States. METHODS: An online survey was emailed to occupational therapists working in U.S. inpatient spinal cord rehabilitation facilities. The survey included questions about hand splinting practices in their patients with cervical spinal cord injury. RESULTS: Sixty-five occupational therapists in 21 different states completed the survey. They reported that current and predicted hand function was the primary principle guiding splint decision making. Across all levels of cervical SCI, resting hand splints are commonly prescribed for night use, and 64.6% of respondents stated they typically recommend them for individuals without active arm movement. Most respondents (73.8%) also report prescribing wrist splints for day use for individuals without active wrist movement. Survey results indicate that therapists are using splints less frequently overall for all levels of injury. The long-opponens splint is no longer being used regularly in SCI and the MCP block splint is being used more frequently. CONCLUSION: Survey responses indicated that splinting is standard care for individuals with cervical spinal cord injury and that the level of SCI dictates specific recommendations. Splint practice guidelines are a framework for intervention mediated by case-specific clinical reasoning and client input.

Functional passive range of motion of individuals with chronic cervical spinal cord injury.

OBJECTIVE: Functional passive range of motion (PROM) requirements for individuals with cervical spinal cord injury (SCI) are clinically accepted despite limited evidence defining the specific PROM needed to perform functional tasks. The objective of this investigation was to better define the minimum PROM needed for individuals with cervical SCI to achieve optimal functional ability, and as a secondary outcome gather self-reported standardized functional data via the Spinal Cord Independence Measure-III (SCIM-III), and the Spinal Cord Injury Functional Index (SCI-FI). DESIGN: Observational cohort. SETTING: 128-bed rehabilitation hospital with inpatient and outpatient spinal cord injury rehabilitation programs. PARTICIPANTS: A convenience sample of 29 community-dwelling individuals with chronic (greater than one year) tetraplegic SCI (C5-8) who use a wheelchair for mobility. INTERVENTIONS: None. OUTCOME MEASURES: Therapist goniometric measurement of upper and lower extremity PROM, and participant completion of a demographic questionnaire and two functional self-report measures (SCIM-III and SCI-FI) were completed. RESULTS: Compared to the general population, differences observed in our study participants included limitations in forearm pronation and elbow extension and increased shoulder extension and wrist extension (likely related to prop sitting). Elbow hyperextension was noted in one-third of the participants. Limitations in straight leg raise, hip flexion, abduction, and internal rotation, in combination with increased hip external rotation suggested these individuals with cervical SCI potentially completed activities of daily living (ADLs) in frog-sitting, rather than long-sitting. Ankle plantarflexion contractures were found in many participants. Shoulder horizontal adduction, elbow extension, hip flexion, knee flexion, ankle plantarflexion, and forefoot eversion ROM were associated with functional performance. CONCLUSION: Based on our results healthcare providers should work with individuals with cervical SCI to develop long term PROM plans to optimize functional abilities.

Comparison of peak oxygen consumption response to aquatic and robotic therapy in individuals with chronic motor incomplete spinal cord injury: a randomized controlled trial.

STUDY DESIGN: Randomized dual center controlled clinical trial. OBJECTIVE: To determine and compare the cardiorespiratory impact of 3 months of aquatic and robotic therapy for individuals with chronic motor incomplete spinal cord injury (CMISCI). SETTINGS: Two rehabilitation specialty hospitals. METHODS: Thirty-one individuals with CMISCI with neurological level between C2-T12 at least 1 year post injury were randomized to either aquatic or robotic treadmill therapy for 36 sessions. Customized sessions lasted 40-45 min at 65-75% heart rate reserve intensity with peak oxygen consumption (peak VO2) measured during arm ergometry at baseline and post intervention. Additional peak robotic treadmill VO2 assessments were obtained before and after training for participants randomized to robotic intervention. RESULTS: Peak VO2 measured with arm ergometry was not significantly different with either aquatic intervention (8.1%, p = 0.14, n = 15) or robotic intervention (-0.7%, p = 0.31, n = 17). Peak VO2 measured with robotic treadmill ergometry demonstrated a statistical improvement (14.7%, p = 0.03, n = 17, two-tailed t-test) across the robotic intervention. Comparison between the two interventions demonstrated a trend favoring aquatic therapy for improving arm ergometry peak VO2 (ANOVA, p = 0.063). CONCLUSIONS: Neither 3-month exercise interventions statistically improved arm cycle ergometry peak VO2, our cardiorespiratory surrogate marker, although percent improvement was greater in the aquatic exercise condition. Robotic ergometry peak VO2 did improve for the robotic intervention, confirming previous work. These results suggest that either intervention may hold utility in improving cardiorespiratory fitness in CMISCI, but peak VO2 measurement technique appears critical in detecting effects. SPONSORSHIP: DOD CDMRP SCI Research Program Clinical Trial Award SC090147, FY 2009. This study is registered under ClinicalTrials.gov Identifier: NCT01407354.

Participation in leisure activities and tourism among older people with and without disabilities in Poland.

Health conditions associated with aging might be related to disability and lead to decreased independence. Physical activity assists in maintaining independence throughout life as well as improves quality of life. Individuals with disabilities demonstrate overall less activity than sedentary persons without disabilities. Efforts to reduce age-related functional autonomy decline and to increase physical activity may require separate approaches for older adults with and without disabilities. The aim of the study was to compare physical activity and participation in leisure activities and tourism among older people with and without disabilities in Poland. A cross-sectional, multicenter study (PolSenior) randomly recruited participants aged 65 years and over, in a stratified, proportional draw performed in three stages from all 16 Polish provinces. 3743 people, 2653 (70.9%) without disabilities, and 1090 (29.1%) with disabilities responded providing general sociodemographic characteristics and various health behaviors including subjective physical activity level, leisure time activities, tourism and activity limitations. Older males without disability reported more physical activity than women with disability, while no differences were observed for females with and without disability. Polish older people with and without disability were more involved in gardening and staying in a garden allotment or a holiday home rather than participating in organized forms of sport, physical activity, and tourism. Health conditions arose as the most frequently indicated barrier toward participation in sport physical activity and tourism. In conclusion, strategies and programs to increase physical activity among older Polish people, with and without disability, should focus on preserving health and physical function.

Complementary and alternative medicine inclusion in physical therapist education in the United States.

PURPOSE: The purpose of this study was to determine the current prevalence, and at what level, complementary and alternative medicine (CAM) content is included in physical therapist (PT) education in the United States. This survey study provides self-report data regarding reasons why faculty members choose to include or not include CAM into programme content. BACKGROUND/SIGNIFICANCE: This study investigates the current prevalence of CAM content, and what level of inclusion (minimal, moderate, advanced) in PT curricula will assist programmes as they modify existing curricula and develop new programmes. SUBJECTS: All 196 US-accredited programmes were included in our survey. MATERIALS AND METHODS: An IRB-approved (Investigational Review Board), pilot-tested, two-page survey was emailed to all programme chairpersons of accredited PT programmes. A hard copy survey was mailed to non-responding programmes. ANALYSES: Returned surveys were analyzed descriptively to characterize the data shape, tendency and variability. Data were summarized in a frequency distribution and graphically depicted in a histogram for each category. In addition, qualitative analysis was completed for the explanatory data. RESULTS: Forty-seven per cent (92) of all accredited PT programmes (196) responded. Most commonly included CAM areas were: manipulative and body-based methods, alternative medical systems and biologically based therapies. Most frequent responses to limitations to including CAM in PT curriculum were: limited curriculum time, lack of evidence supporting CAM practices and trouble locating qualified CAM presenters. CONCLUSIONS: This survey suggests the following: CAM techniques are included in entry-level PT education in the United States; the majority of these techniques are offered at the minimum or exposure level; manipulative and body-based methods, alternative medical systems and biologically based therapies are the most frequently included CAM techniques.

Exploration of a variation of the bottle buoyancy technique for the assessment of body composition.

Hydrostatic weighing has long been recognized as a reliable and valid method for the assessment of body composition. An alternative method known as bottle buoyancy (BB) was introduced by Katch, Hortobagyi, and Denahan in 1989. The purpose of this clinical investigation was to determine the accuracy of the BB technique using an 11-L container. Sixteen individuals (8 men, 8 women) were weighed hydrostatically using a chair/scale and the BB technique. The overall intraclass correlation coefficient for the two techniques was 0.9537. A 2-variable ANOVA was significant for gender but not for technique, and there was no interaction between variables. Thus, the BB technique appears to be an accurate substitute for the chair/scale technique for hydrostatic weighing. The BB method does not involve elaborate equipment and is portable. It could be improved with the use of multiple bottles of various volumes or a calibrated bottle to minimize the number of trials needed for accurate measurements. BB is a valuable, simple clinical tool for assessing body composition based on the principles of hydrostatic weighing and can be performed in any high school, college, or community swimming pool.