Passive limb movement intervals results in repeated hyperemic responses in those with paraplegia.

STUDY DESIGN: Repeated measures. OBJECTIVES: Reports suggest passive limb movement (PLM) could be used as a therapy to increase blood flow and tissue perfusion in the paralyzed lower limbs of those with spinal cord injuries. However, the hyperemic response to PLM appears to be transient, lasting only 30-45 s despite continued limb movement. The purpose of this investigation was to determine whether the hyperemic response is repeatable across multiple short bouts of passive limb movement. SETTING: Cleveland Veterans Affairs Medical Center. METHODS: Nine individuals with paraplegia 46 ± 6 years of age, 17 ± 12 years post injury (range: 3-33 years) with complete T3-T11 injuries were subject to 5 × 1 min bouts of passive knee extension/flexion at 1 Hz with a 1 min recovery period between each bout. Heart rate (HR), mean arterial pressure (MAP), femoral artery blood flow (FABF), skin blood flow (SBF), and tissue perfusion in the lower limb were recorded during baseline and throughout each bout of PLM. RESULTS: Despite no increase in HR (p ≥ 0.8) or MAP (p ≥ 0.40) across all four bouts of PLM, the average increase in FABF during each bout ranged from 71 ± 87% to 88 ± 93% greater than baseline (p ≤ 0.043). SBF also increased between 465 ± 302% and 582 ± 309% across the five bouts of PLM (p ≤ 0.005). CONCLUSIONS: Repeated bouts of PLM in those with SCI while in an upright position resulted in a robust and steady increase in FABF and SBF which could have implications for improving vascular health and tissue perfusion in the lower limbs of those with paraplegia.

Interdisciplinary bodyweight management program for persons with SCI.

Objective: Persons with spinal cord injury (SCI) have a higher prevalence of being overweight than the general population, which is thought to be due to a variety of metabolic, physiologic and psychological changes. The quality improvement project described in this work was designed to help overweight persons with SCI lose bodyweight through nutrition, exercise, and behavioral management strategies.Methods: Eighteen persons with SCI who were overweight were enrolled in a 12-week interdisciplinary weight management program. Participants were limited to persons at least one-year post-acute SCI with an established overweight status. Measurements, including a person's weight, body mass index, and waist circumference (WaC), were taken at the program's start, at its end, and six months post program.Results: Seventeen out of 18 participants experienced weight loss, (WaC) decreased (P < 0.001), and the program was effective at reducing weight (P < 0.001). Six months following participation in the program participants did experience a significant change in weight or waist size six months post program, thus indicating that subjects did not regain weight after completion of the program.Conclusion: This quality improvement project provided indications of the benefits of an SCI-specific interdisciplinary weight management program. Clinical research evaluating methods for helping persons with SCI achieve a healthy bodyweight is indicated.

The Feasibility of Blood Flow Restriction Exercise in Patients With Incomplete Spinal Cord Injury.

BACKGROUND: Blood flow restriction (BFR) exercise, which already has shown promise in the able-bodied population, may be a novel method for improving muscle function in the incomplete spinal cord injury (iSCI) population. However, the feasibility and tolerance for BFR exercise in this population is unknown. OBJECTIVE: To determine the feasibility and safety of BFR exercise in the iSCI population, with special attention paid to acute hemodynamic changes and the risk of deep vein thrombosis (DVT). DESIGN: Within-subjects repeated measures design. SETTING: Outpatient SCI rehabilitation unit in a Veterans Affairs medical center. PARTICIPANTS: Nine individuals with varying levels of iSCI and varying functional abilities. METHODS: Subjects performed a trial of unilateral BFR knee extension (3 × 10) with, and without, BFR (125% of venous occlusion pressure) in a counterbalanced order. MAIN OUTCOME MEASUREMENTS: Acute autonomic dysreflexia risk, total work, pain, perceived difficulty, muscle activation, lactate, hemodynamics, and tissue oxygenation were compared between conditions. Each subject was screened for a DVT at baseline and returned for a quantitative D-dimer assessment 3-4 days after the protocol. RESULTS: All subjects were able to complete each BFR trial without showing signs of autonomic dysreflexia or DVT formation. No differences were observed for pain, perceived effort, muscular activation, or lactate between BFR and control exercise. Mean arterial pressure and systolic pressure both increased with exercise (18.8% and 17.6% in BFR, and 19.4% and 19.6% in control, respectively; P < .05) but were not different between conditions. Oxyhemoglobin and deoxyhemoglobin saturation both increased during BFR exercise (+12.3 ± 96.7 and +105.4 ± 76.7, respectively), whereas tissue oxygenation index decreased (-6.5 ± 3.0%; P < .05 for all comparisons). CONCLUSIONS: Results suggest that controlled BFR exercise can be safely performed by individuals with iSCI without added cardiovascular strain or heightened pain. LEVEL OF EVIDENCE: IV.