PEDS 409 RESEARCH DESIGN

1. PEDS 409 RESEARCH DESIGN BY: Deanna, Jen and Jarred Quasi-experimental

2. Our study: • Functional Electric Stimulation-Assisted Rowing: Increasing Cardiovascular Fitness Through Functional Electric Stimulation Rowing Training in Persons With Spinal Cord Injury

3. Authors and Affiliations • Garry D Wheeler, PhD CPsych • Steadward Centre, Faculty of Physical Education and Recreation, U of A • Brian Andrews, PhD • Dept. of Biomedical Engineering, Faculty of Medicine, U of A • Robert Lederer, MA • Art and Design Department, Faculty of Arts- Industrial Design Program, U of A • Rhahman Davoodi, PhD • Dept. of Biomedical Engineering, Faculty of Medicine, U of A • Karen Natho, MSc • Steadward Centre, Faculty of Phys. Ed and Rec, U of A

4. Authors and Affiliations (Cont.) • Christina Weiss, MSc • Steadward Centre, Faculty of Phys. Ed and Rec, U of A • Justin Jean, MSc • Steadward Centre, Faculty of Phys. Ed and Rec, U of A • Yagesh Bhambhani, PhD • Dept. of Occupational Therapy, Faculty of Rehabilitation Medicine, U of A • Robert D. Steadward, PhD • Steadward Centre, Faculty of Phys. Ed and Rec, U of A

5. Research Questions • The authors addressed 3 questions: • Is functional electric stimulation rowing effective in improving cardiovascular fitness of people with spinal cord damage? • Is functional electrical stimulation a safe training method for people with spinal cord damage? • Is functional electrical stimulation an acceptable training option/ alternative for people with a spinal cord injury?

6. Type of Research • Repeated-measures training study: • pre and post tests were done to gather peak O2 consumption under 3 different conditions (upper extremity rowing only, functional electric stimulation bilateral lower-extremity extension and flexion, and hybrid exercise)

7. Type of Research (cont.) • Quasi-experimental design: pre-assigned groups (Paraplegia- class A and Quadriplegia- class C) • Upper- extremity rowing only • FES bilateral lower-extremity extension and flexion • Hybrid exercise (FES stimulation row)

8. Type of Research (cont.) • Within-person data comparison: • The comparison of results/information between/from person to person • Data analyzed by a multivariate analysis of variance program for repeated measures.

9. Research Methods • Participants: • 5 with paraplegia, T4-12 • 1 with quadriplegia, C7 • Mean age- 42.5 ± 17.9 years • Mean time since injury- 13.8 ± 11.6 years • FES experience ranged from none to 1 year • Study was approved by local health authority ethics committee and all participants provided informed consent.

10. The Exercise Device • The prototype ROWSTIM I was modified (ROWSTIM II) to incorporate several important features: • The seating system was specialized with back rests and cushions • Control of extension/flexion was given to the participant via thumb-operated variable pressure sensors on the rowing handle • A mechanical braking system was added • Wheel base was extended to accommodate increased torque • A spring was added to the seat to assist return • Hand grip sites were added for easy transfer

11. Pre-Post Test Protocol • Upper Extremity Rowing (ARM) • Row with arms only at an initial pull force of 10 W for 2 min, increase force 10 W every 2 min until peak O2 consumption is achieved • FES Bilateral lower extremity extension and flexion (CFES) • Starts at 8 strokes per min and increases by 4 strokes after every 2 min stage until peak O2 consumption is achieved or until participant is unable to maintain frequency

12. Pre-Post Test Protocol (cont.) • Hybrid Exercise (FESROW) • Begins at 10 W arm pull force combined with 8 stokes per min of CFES. Arm pull force increased by 10 W and CFES frequency increased by 4 strokes per min after every 2 min stage until peak O2 consumption is achieved

13. Training Protocol • Individuals participated in 3 sessions/week at a HR equivalent to 75-80% of peak O2 consumption • Began doing 6 sets of 5 min of rowing with 2.5 min of rest between sets • Next step was 2, 15 min sets with 2.5 min of rest between sets • Then a 20 min set followed with a 10 min set with a 2.5 min rest • Until 1 continuous set of 30 min us attained

14. Main Findings • There was a significant increase in VO2 peak and oxygen pulse in FESROW without change in peak HR values: • 1.81 ± 0.41 L/min to 2.01 ± 0.28 L/min • 10.86 ± 2.54 mlO2/beat to 12.40 ± 1.97 mlO2/beat • No change in ARM or CFES conditions • Max HR increased from pre to post test in CFES test only • Total distance rowed in the 30 min training sessions increased significantly from 3027.8 m ± 619.6 m to 4011.8 m ± 587.8 m

15. Conclusions • Is functional electric stimulation rowing effective in improving cardiovascular fitness of people with spinal cord damage? YES • Is functional electrical stimulation a safe training method for people with spinal cord damage? YES • Is functional electrical stimulation an acceptable training option/ alternative for people with a spinal cord injury? YES

16. Critique • Small sample size • Test did not elicit maximal oxygen consumption which allows for a lot of variation in results • Confounding variables that are unaccounted for: experience with FES, lesion level of SCI • Safety concerns, skin burns, lower back injuries

17. Suggestions for future researchers • Larger sample size • Quadriplegia explored further • Biochemical markers to help explain the increase in O2 consumption? • Applying FES to other types of exercise

18. Other kinds of questions this research addresses • Applications to other types of whole body activities • What is the source of increased O2 consumption with FES in individuals with a SCI? • Exercise adherence patterns and motivation?

19. Reference • Wheeler GD, Andrews B, Lederer R, Davoodi R, Natho K, Weiss C, Jeon J, Bhambhani Y, Steadward RD. Functional electrical stimulation-assisted rowing: increasing cardiovascular fitness through functional electrical stimulation rowing training in persons with spinal cord injury. Arch Phys Med Rehabil 2002; 83: 1093-9.