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E xercise rehabilitation after spinal cord injury: How, where and why…

E xercise rehabilitation after spinal cord injury: How, where and why…. Dr. David S. Ditor , PhD Department of Kinesiology Brock University, St. Catharines , Ontario Canada. Presentation Outline:. What forms of exercise are available and effective?. Exercise prescription:

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E xercise rehabilitation after spinal cord injury: How, where and why…

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  1. Exercise rehabilitation after spinal cord injury: How, where and why… Dr. David S. Ditor, PhD Department of Kinesiology Brock University, St. Catharines, Ontario Canada

  2. Presentation Outline: • What forms of exercise are available and effective? • Exercise prescription: • How much is enough? • Does one size fit all? • Which piece of equipment should I use? • Home vs. Away…

  3. How physically active are people with SCI? From SHAPE-SCI study (n=693) evaluating leisure time physical activity (LTPA) in people with SCI: 50% of adults with SCI engage in no LTPA whatsoever!

  4. Is exercise an important therapeutic priority for individuals with SCI? • Surveyed 681 individuals with SCI • 96.5% of respondents considered exercise to be an important aspect of functional recovery • Of this 96.5%, almost 20% did not have access to exercise

  5. What forms of exercise are available and effective?

  6. 1. Aerobic training

  7. 2. Hybrid training

  8. 3. Resistance training

  9. 3. Resistance training

  10. 4. Functional Electrical Stimulation(FES)

  11. 5. Body weight-supported treadmill training (BWSTT)

  12. 6. Use of Robotics Lokomat ZeroG

  13. 7. Exoskeletons ReWalk Ekso

  14. Exercise prescription: • How much is enough?

  15. Physical Activity Guidelines for Canadians with a Spinal Cord Injury • Evidence-based for people with SCI • Launched in March, 2011 • Funded by the Rick Hansen Institute

  16. Physical Activity Guidelines Toolkit

  17. Physical Activity Guidelines Toolkit

  18. Exercise prescription: • Are the physical activity guidelines truly effective?

  19. Implementation of the Physical Activity Guidelines for Adults with Spinal Cord Injury: Effects on Aerobic Capacity and Muscle Strength • Pelletier CA, Totosyde Zepetnek J, MacDonald MJ, Hicks AL. • Submitted to Arch Phys Med Rehabil • Methods: • 16 participants recruited from the community • 16-week randomized controlled trial • PAG group (n=8): • 2x/week, • 20 minutes aerobic exercise, • 3x10 reps resistance exercise • CON group (n=8): • active control

  20. Implementation of the Physical Activity Guidelines for Adults with Spinal Cord Injury: Effects on Aerobic Capacity and Muscle Strength • Pelletier CA, Totosy de Zepetnek J, MacDonald MJ, Hicks AL. Results:

  21. Implementation of the Physical Activity Guidelines for Adults with Spinal Cord Injury: Effects on Aerobic Capacity and Muscle Strength • Pelletier CA, Totosy de Zepetnek J, MacDonald MJ, Hicks AL. Results:

  22. Exercise prescription: • Does one size fit all?

  23. Case #1: • Dave is a 42 year old man with T10 complete SCI (AIS A). He is a competitive wheelchair athlete who wants to improve his upper limb strength and his aerobic capacity. He is also concerned about his general health and the prevention of secondary complications • Case #2: • Judy is a 50 year old woman with C5 incomplete SCI (AIS D). She can walk with a walker for short distances, but is primarily reliant on a wheelchair in the community. She would like to improve her walking speed and endurance. She is also concerned about her general health and the prevention of secondary complications

  24. Exercise prescription: • Which piece of equipment should I use?

  25. Exercise prescription: • Which piece of equipment should I use? • Aerobic Exercise • and • Resistance Training

  26. The Optimal Modes of Exercise for Individuals with Spinal Cord Injury: Consumer Preference and Metabolic Demand Pelletier CA, Ditor DS, Latimer-Cheung AE, Warburton DE, Hicks AL. • Methods: • 36 participants recruited from 4 community exercise programs • 20 minutes of submaximal aerobic exercise • HR, RPE, oxygen uptake (n = 9) • Arm only exercise: Arm-ergometry, Vitaglide, • Hybrid arm-leg exercise: NuStep, SCI Fit Pro • 3 sets of 10 repetitions resistance exercise • Wall pulleys, weight stacks • Questionnaire to evaluate consumer opinion

  27. Results: • No cardiovascular advantage to hybrid vs. arm only exercise • No significant equipment differences in VO2 or HR Arm-ergometry PP Vitaglide PP NuStep PP Arm-ergometry TP Vitaglide TP NuStep TP • Arm-only exercise was perceived as safer than hybrid modes • No piece of equipment preferred over another

  28. Exercise prescription: • Which piece of equipment should I use? • Ambulation Training

  29. The advantages and disadvantages of body-weight supported treadmill training

  30. FES-ambulation training and functional recovery Does the stimulation provide additional benefit?

  31. Spinal Cord (2006) 44: 357-361 • n=74; T10 or above; Incomplete SCI (AIS C-D) • Randomized into • Manual BWSTT (TM) • Treadmill with stimulation (TS) (only to common peroneal) • Overground with stimulation (OG) (only to common peroneal) • Treadmill with robotic assistance (LR) • 5 sessions/week, 12 weeks

  32. Results: • Improved walking speed in OG, TS, TM groups • Improved walking distance in OG and TS • Minimally important difference • 0.05 m/s (10 meter walk test) • 4 meters (2 minute walk test)

  33. FES-ambulation with the RT600 Functional recovery after SCI

  34. FES-ambulation with the RT600 • 16 stimulation channels • Closed-loop coupling of stimulation and weight-bearing • The stimulation parameters for each channel can be individually set, in real time, for optimal effect and comfort • Can be easily used with one therapist

  35. The effects of FES-ambulation training on locomotor function and health-related quality of life in individuals with incomplete spinal cord injury Sharif H, Gammage K, Chun S, Ditor DS Topics in Spinal Cord Injury Rehabilitation; In press • Participants:

  36. The effects of FES-ambulation training on locomotor function and health-related quality of life in individuals with incomplete spinal cord injury Sharif H, Gammage K, Chun S, Ditor DS Topics in Spinal Cord Injury Rehabilitation; In press Exercise training: • FES-ambulation, 3 sessions/week, 12-weeks • 2-minute passive warm-up, followed by a max of 60 minutes of active exercise • Progressed as individually tolerated • Increase duration by 2-3 minutes per session • Increase speed by 2-4 steps/min per session • Reduce weight-support as tolerated

  37. Results: Locomotor Function

  38. Results: Quality of Life

  39. Results: Quality of Life

  40. Home vs. Away…

  41. Away… • Advantages: • A variety of (expensive) equipment • Supervision • PEER SUPPORT • Disadvantages: • Transportation can be difficult

  42. Home… • Advantages: • No transportation required • Disadvantages: • No peer support • Limited equipment • Sometimes a lack of supervision • Sometimes a lack of knowledge

  43. THANK YOU Dr. David S. Ditor, PhD Department of Kinesiology Brock University, St. Catharines, Ontario Canada dditor@brocku.ca

  44. A free, nation-wide telephone-based physical activity counseling service for adults with SCI. • McMaster University, Health and Exercise Psychology lab

  45. Get in Motion Service One-on-one activity counseling Welcome package motion@mcmaster.ca http://sciactioncanada.ca

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