Search

Traumatic spinal cord injury (SCI) may result in tetraplegia (motor and/or sensory nervous system impairment of the arms, trunk and legs) or paraplegia (motor and/or sensory impairment of the trunk and/or legs only). The adverse effects of SCI on health, fitness and functioning are frequently compounded by profoundly sedentary behaviour. People with paraplegia (PP) and tetraplegia (TP) have reduced exercise capacity due to paralysis/paresis and reduced exercising stroke volume. TP often further reduces exercise capacity due to lower maximum heart-rate and respiratory function. There is strong, consistent evidence that exercise can improve cardiorespiratory fitness and muscular strength in people with SCI. There is emerging evidence for a range of other exercise benefits, including reduced risk of cardio-metabolic disease, depression and shoulder pain, as well as improved respiratory function, quality-of-life and functional independence. Exercise recommendations for people with SCI are: ≥30min of moderate aerobic exercise on ≥5d/week or ≥20min of vigorous aerobic ≥3d/week; strength training on ≥2d/week, including scapula stabilisers and posterior shoulder girdle; and ≥2d/week flexibility training, including shoulder internal and external rotators. These recommendations may be aspirational for profoundly inactive clients and stratification into "beginning", "intermediate" and "advanced" will assist application of the recommendations in clinical practice. Flexibility exercise is recommended to preserve upper limb function but may not prevent contracture. For people with TP, Rating of Perceived Exertion may provide a more valid indication of exercise intensity than heart rate. The safety and effectiveness of exercise interventions can be enhanced by initial screening for autonomic dysreflexia, orthostatic hypotension, exercise-induced hypotension, thermoregulatory dysfunction, pressure sores, spasticity and pain. [ABSTRACT FROM AUTHOR]

Objective: To test whether changes in the patient activation measure (PAM) are related to changes in health status and healthy behaviors. Methods: Data for this secondary analysis were taken from a group-randomized, controlled trial comparing a traditional health promotion program for employees with an activated consumer program and a control program. The study population included 320 employees (with and without chronic disease) from two U.S. companies: a large, integrated health care system and a national airline. Survey and biometric data were collected in Spring 2005 (baseline) and Spring 2007 (follow-up). Results: Change in PAM was associated with changes in health behaviors at every level (1–4), especially at level 4. Changes related to overall risk score and many of its components: aerobic exercise, safety, cancer risk, stress and mental health. Other changes included frequency of eating breakfast and the likelihood of knowing about health plans and how they compare. Conclusion: Level 4 of patient activation is not an end-point. People are capable of continuing to make significant change within this level. Practice implications: Interventions should be designed to encourage movement from lower to higher levels of activation. Even people at the most activated level improve health behaviors. [Copyright &y& Elsevier]

The article provides high-quality data on the prognosis of participants who presented with persistent undiagnosed wrist pain and underwent arthroscopic investigation. Wrist pain a common condition resulting in significant disability and time lost from work as well as the prevalence of wrist pain varies across age groups and occupations. It offers various methods conducted through setting and participants, outcome measures and analysis. The primary outcome measure was the patient rated wrist and hand evaluation (PRWHE). It suggests that participants who underwent arthroscopic investigation for persistent wrist pain improved on average by approximately 50% at one year.

Abstract: Kwah LK, Herbert RD, Harvey LA, Diong J, Clarke JL, Martin JH, Clarke EC, Hoang PD, Bilston LE, Gandevia SC. Passive mechanical properties of gastrocnemius muscles of people with ankle contracture after stroke. Objective: To investigate the mechanisms of contracture after stroke by comparing passive mechanical properties of gastrocnemius muscle-tendon units, muscle fascicles, and tendons in people with ankle contracture after stroke with control participants. Design: Cross-sectional study. Setting: Laboratory in a research institution. Participants: A convenience sample of people with ankle contracture after stroke (n=20) and able-bodied control subjects (n=30). Interventions: Not applicable. Main Outcome Measures: Stiffness and lengths of gastrocnemius muscle-tendon units, lengths of muscle fascicles, and tendons at specific tensions. Results: At a tension of 100N, the gastrocnemius muscle-tendon unit was significantly shorter in participants with stroke (mean, 436mm) than in able-bodied control participants (mean, 444mm; difference, 8mm; 95% confidence interval [CI], 0.2–15mm; P=.04). Muscle fascicles were also shorter in the stroke group (mean, 44mm) than in the control group (mean, 50mm; difference, 6mm; 95% CI, 1–12mm; P=.03). There were no significant differences between groups in the mean stiffness or length of the muscle-tendon units and fascicles at low tension, or in the mean length of the tendons at any tension. Conclusions: People with ankle contracture after stroke have shorter gastrocnemius muscle-tendon units and muscle fascicles than control participants at high tension. This difference is not apparent at low tension. [Copyright &y& Elsevier]

Background: People with tetraplegia often have extensive paralysis of the hand yet retain crude hand function. Their hand function is dependent on manipulating wrist position with the neurally-intact wrist extensor muscles to change the passive tension in paralysed thumb muscles. This moves the thumb in relation to the paralysed index finger enabling basic grasp. The aim of this study was to quantify the effect of wrist position on thumb flexor and adductor torques generated in paralysed hands of people with tetraplegia. Methods: Thumb flexor and adductor torques were measured as the wrist was passively moved from a fully flexed to a fully extended position in 10 people with tetraplegia who had paralysis of all thumb muscles. The relationships between thumb torques and wrist angles were quantified with torque–angle curves. Findings: There was a consistent curvilinear relationship between wrist angle and both thumb flexor and thumb adductor torques. Thumb flexor torques were greatest and thumb adductor torques were smallest when the wrist was fully extended. Interpretation: Wrist position influences the thumb flexor and adductor torques generated in the paralysed hand. This is probably due to the effect of wrist position on the passive tension of the thumb muscles spanning the wrist. These findings have implications for people with C6 and C7 tetraplegia who rely on the passive torques generated by the paralysed thumb muscles for hand function. [Copyright &y& Elsevier]

Abstract: Boswell-Ruys CL, Sturnieks DL, Harvey LA, Sherrington C, Middleton JW, Lord SR. Validity and reliability of assessment tools for measuring unsupported sitting in people with a spinal cord injury. Objectives: To develop simple tests to assess the abilities of people with spinal cord injury (SCI) to sit unsupported and to assess the construct validity and test-retest reliability of these tests. Design: Cross-sectional comparisons, convenience sample. Setting: Biomechanical laboratory. Participants: People (N=30) with SCI between the C6 and the L2 level of 2 months to 37 years duration before assessment. The sample was stratified by impairment level (at T8) and time since injury (1y postinjury). Interventions: Not applicable. Main Outcome Measures: On 2 separate occasions, participants performed tests that measured the distance of upper-body sway and maximal torso leaning, errors made during a coordinated stability task, timed dressing/undressing of the upper body and alternating arm reaching, and percentage change in seated upper body/arm reaching. Results: All tests showed good construct validity in that they distinguished between participants with higher (C6-T7) and lower (T8-L2) level impairments (P<.05) and between participants with acute (≤1y) and chronic (>1y) lesions (P<.05). The tests also showed good to excellent test-retest reliability (intraclass correlation coeffiecient3,1 range, .51–.91). Conclusions: These simple and quick-to-administer tests have both construct validity and test-retest reliability. They would be appropriate for research and clinical purposes to quantify the abilities of people with SCI to sit unsupported. [Copyright &y& Elsevier]

Abstract: Background: Ankle plantarflexion contractures are common in adults with neurological disorders and known to cause secondary gait deviations. However, their impact on the knee joint is not fully understood. The aims of this study are to describe the effect of simulated plantarflexion contractures on knee biomechanics during the stance phase and on the spatiotemporal characteristics of gait. Methods: Mild (10–degree plantarflexion) and severe (20–degree plantarflexion) ankle contractures were simulated in thirteen able-bodied adults using an ankle-foot-orthosis. A no contracture condition was compared with two simulated contracture conditions. Findings: There was an increase in knee extension, sometimes resulting in hyperextension, throughout stance for the two contracture conditions compared to the no contracture condition (mean increase in knee extension ranged from 5° to 9°; 95% CI 0° to 17°). At the same time, there were reductions in extension moment and power generation at the knee. Simulated plantarflexion contractures also reduced gait velocity, bilateral step length and cadence. All these changes were more pronounced in the severe contracture condition than mild contracture condition. While the majority of participants adopted a foot-flat pattern on landing and exhibited an increase in knee extension during stance, two participants used a toe-walking pattern and exhibited an increase in knee flexion. Interpretation: Ankle plantarflexion contractures are associated with an increase in knee extension during stance phase. However, some people with simulated ankle contractures may walk with an increase in knee flexion instead. Ankle plantarflexion contractures also adversely affect gait velocity, step length and cadence. [Copyright &y& Elsevier]

Abstract: Background: People with spinal cord injury sometimes develop abnormally compliant hamstring muscle-tendon units. This study investigated whether the increased muscle-tendon compliance is due to a change in the passive properties of the muscle fascicles or tendons, or to muscle tears. Methods: Semimembranosus muscle fascicle lengths were measured from ultrasound images obtained from 15 spinal cord injured subjects and 20 control subjects while the hip was passively flexed with the knee extended. Semimembranosus muscles of spinal cord injured subjects were inspected for tears using ultrasound imaging. Findings: The mean (SD) hip angle at 30Nm was 97 (SD 24) degrees in spinal cord injured subjects and 70 (SD 11) degrees in control subjects, indicating that spinal cord injured subjects had very compliant hamstring muscle-tendon units. The ratio of change in fascicle length to change in muscle-tendon length was not statistically different between spinal cord injured subjects and control subjects: muscle fascicles lengthened by 0.30 (SD 0.24) mm/mm in spinal cord injured subjects and 0.42 (SD 0.29) mm/mm in control subjects. These data were used to show that there was evidence of increased tendon compliance of spinal cord injured subjects compared to control subjects, but no evidence of increased muscle fascicle compliance. No tears were observed in semimembranosus muscles of spinal cord injured subjects. Interpretation: The increased hamstring muscle-tendon compliance apparent in some spinal cord injured subjects is due, at least in part, to increased tendon compliance. There was no evidence that the increased muscle-tendon compliance was due to muscle tears. [Copyright &y& Elsevier]

Objective: Evaluate the Patient Activation Measure (PAM) in relation to personal characteristics in employed populations. Further validate the PAM for use in improving clinical or employer-based health-intervention programs. Methods: Data for analysis were taken from baseline survey information and health screenings collected during a randomized, controlled trial testing two different health promotion programs. Study population included 625 employees (predominantly white collar) from two companies in the northern Midwest of the United States: a large, integrated health care system and a national airline. Results: PAM''s psychometric properties are robust in two employed populations. Activation is directly related not only to health status, but also to job performance measures. The strong positive relationship of PAM to measures of healthy behavior, health information-seeking and readiness-to-change further validate the measure. Commonly, a difference of 5 points on the PAM separated healthy from less healthy behaviors. Conclusion: Activation can be understood in a broader population health context and need not be restricted to people with chronic illnesses. The study provides guidance on how to interpret PAM scores. Practice implications: The PAM can be used as part of any health-intervention program designed to improve patients’ or employees’ self-management skills, whether the program is clinic-based or employer-based. [Copyright &y& Elsevier]