-
1.
Well on wheels intervention: Satisfaction with life and health for adults with spinal cord injuries.
Silveira, SL, Ledoux, TA, Johnston, CA, Kalpakjian, C, O'Connor, DP, Cottingham, M, McGrath, R, Tate, D
The journal of spinal cord medicine. 2020;(1):60-68
-
-
Free full text
-
Abstract
Objective/Background: To examine how demographic and injury characteristics identify satisfaction with life (SWL), and assess the differential effects of a wellness intervention by baseline SWL groups.Design: Baseline and longitudinal analysis of a randomized controlled pilot intervention using decision tree regression and linear mixed models.Setting: Community based.Participants: Seventy-two individuals with spinal cord injury (SCI) were randomized to an intervention group (n = 39) or control group (n = 33). Participants were aged 44.1 ± 13.0 years and 13.1 ± 10.6 years post-injury. Most participants were male (n = 50; 69.4%) and had paraplegia (n = 38; 52.7%). Participants were classified as high versus low SWL at baseline using a cutoff score of 20.Interventions: The intervention aimed to increase self-efficacy, and in turn, increase engagement in health-promoting behaviors related to SWL. Six 4-hour in-person workshops were conducted over a 3-month period led by experts and peer-mentors who were available for support.Outcome measure(s): Self-efficacy for health practices, secondary condition severity, health-promoting behaviors, perceived stress, and SWL.Results: At baseline, participants with low SWL were recently injured (<4.5 years), while persons with high SWL were married and younger (<49 years old). Intervention participants with low SWL at baseline significantly improved SWL over time compared to those with high SWL (P = 0.02).Conclusion: Certain injury and demographic characteristics were associated with SWL, and intervention participants with low SWL at baseline improved their SWL over 2 years. Healthcare providers should consider time post-injury, marital status, and age in identifying individuals at risk for low SWL that may benefit from wellness interventions.
-
2.
Cardiovascular disease risk marker responses to breaking up prolonged sedentary time in individuals with paraplegia: the Spinal Cord Injury Move More (SCIMM) randomised crossover laboratory trial protocol.
Withers, TM, Croft, L, Goosey-Tolfrey, VL, Dunstan, DW, Leicht, CA, Bailey, DP
BMJ open. 2018;(6):e021936
Abstract
INTRODUCTION Sedentary behaviour is a distinct risk factor for cardiovascular disease (CVD) and could partly explain the increased prevalence of CVD in people with spinal cord injury (SCI). Interrupting prolonged sitting periods with regular short bouts of walking acutely suppresses postprandial glucose and lipids in able-bodied individuals. However, the acute CVD risk marker response to breaking up prolonged sedentary time in people with SCI has not been investigated. METHODS AND ANALYSIS A randomised two-condition laboratory crossover trial will compare: (1) breaking up prolonged sedentary time with 2 min moderate-intensity arm-crank activity every 20 min, with (2) uninterrupted prolonged sedentary time (control) in people with SCI. Outcomes will include acute effects on postprandial glucose, insulin, lipids and blood pressure. Blood samples will be collected and blood pressure measured at regular intervals during each 5½-hour condition. ETHICS AND DISSEMINATION This study was approved by the Cambridge South National Health Service Research Ethics Committee. This research will help determine if breaking up prolonged sedentary time could be effective in lowering CVD risk in people with SCI. The findings of the research will be published in a peer-reviewed journal and disseminated to relevant user groups. TRIAL REGISTRATION NUMBER ISRCTN51868437; Pre-results.
-
3.
Ergogenic Effects of Caffeine Consumption in a 3-min All-Out Arm Crank Test in Paraplegic and Tetraplegic Compared With Able-Bodied Individuals.
Flueck, JL, Liener, M, Schaufelberger, F, Krebs, J, Perret, C
International journal of sport nutrition and exercise metabolism. 2015;(6):584-93
Abstract
The aim of our study was to investigate the effect of caffeine supplementation on 3-min all-out arm crank exercise performance in paraplegic (P) and tetraplegic (T) compared with able-bodied (AB) participants. A placebo-controlled, randomized, crossover, and double-blind study design was chosen to investigate the differences between caffeine (CAF) and placebo (PLC). In total, 34 healthy, trained participants were tested. Seventeen were AB (median [minimum; maximum] VO2peak: 33.9 mL/min/kg [23.6; 57.6]), 10 were P (VO2peak: 34.4 mL/min/kg [19.5; 48.8]), and 7 were T (VO2peak: 13.6 mL/min/kg [8.6; 16.3]). All participants performed two 3-min all-out tests on an arm crank ergometer following the ingestion of either PLC or CAF. Power output parameters, plasma caffeine (PC), epinephrine (EPI), and norepinephrine (NOR) concentrations were assessed. CAF significantly increased average power over the first 30 s (p = .028) and 60 s (p = .005) in P, but not in T (p = .61; p = .87) nor in AB (p = .25; p = .44). Peak power was increased in the CAF trial in AB (+46 W) as well as in P (+21 W) but was not significantly different from PLC (AB: p = .10; P: p = .17). PC significantly increased in all groups (AB: p = .002; P: p = .005; T: p = .018) whereas EPI showed a significant increase only in AB (p = .002) and in P (p = .018). NOR increased significantly in AB (p = .018) but did not increase in the other groups. Caffeine seems to enhance short-duration exercise performance in P. In contrast, T showed a high interindividual variability and overall no ergogenic effect was detected in this group.
-
4.
Design of a randomized-controlled trial on low-intensity aerobic wheelchair exercise for inactive persons with chronic spinal cord injury.
van der Scheer, JW, de Groot, S, Postema, K, Veeger, DH, van der Woude, LH
Disability and rehabilitation. 2013;(13):1119-26
Abstract
PURPOSE To investigate effects and working mechanisms of low-intensity aerobic wheelchair exercise on fitness, (upper-body) health and active lifestyle in inactive persons with chronic spinal cord injury (SCI). METHODS A multicenter randomized-controlled trial (RCT) in 40 inactive manual wheelchair users (aged 28-65y) with chronic paraplegia or tetraplegia (time since injury >10y). Subjects will be randomly assigned to an intervention or a control group. The intervention will consist of 16 weeks (2 times per week, 30 min per session) of low-intensity aerobic handrim wheelchair exercise (30-40% HRR) on a treadmill. Repeated measurements will be performed before starting the intervention or entrance of the control group, and after week 8, 16 and 42 following the start. The primary outcome will be wheelchair-specific physical fitness. Secondary outcomes will be upper-body pain and discomfort, shoulder load, propulsion technique, wheelchair skill performance and physical activity levels. CONCLUSIONS Results of this first RCT on low-intensity aerobic wheelchair exercise for inactive persons with chronic SCI can improve SCI-specific exercise guidelines and provide an evidence-base for an aftercare program aimed at preserving fitness, health and active lifestyle of persons aging with SCI.
-
5.
The effects of experience on the energy cost of wheelchair propulsion.
Croft, L, Lenton, J, Tolfrey, K, Goosey-Tolfrey, V
European journal of physical and rehabilitation medicine. 2013;(6):865-73
Abstract
BACKGROUND Gross mechanical efficiency (GE) of experienced wheelchair users is significantly higher than novice able-bodied individuals suggesting energy expenditure (EE) may be reduced in experienced individuals. With knowledge of the energy expended during wheelchair propulsion, nutritional recommendations can be provided for individuals in their early stages of rehabilitation and for habituated wheelchair users. AIM: To investigate the effects of experience on EE during wheelchair propulsion at fixed power outputs (PO's). DESIGN This was an experimental study. SETTING The experiment was conducted in a controlled University laboratory. POPULATION Thirty-one individuals took part in this study. METHODS Participants were assigned to a group in accordance to their wheelchair propulsion experience: 1) novice able-bodied individuals (NOV; N.=11), 2) able-bodied individuals habituated to three weeks practice (PRAC; N.=11) and 3) experienced paraplegic daily-wheelchair users (EXP; N.=9). Oxygen uptake, EE, GE% and HR were measured during wheelchair propulsion on a motorised treadmill at 10, 18 and 26 W. RESULTS Energy expenditure analysis revealed a significant main effect of PO and group (P<0.01) and a significant group by PO interaction (P<0.01). Follow-up pair-wise comparisons revealed significantly lower EE in EXP compared to both other groups (P<0.01), but no difference was shown between NOV and PRAC (P=0.15). A lower relative EE of 20, 22 and 32% was reported in the EXP group compared to the NOV group at 10, 18 and 26 W respectively. In comparison to the PRAC group, the EE of the EXP group was 10, 16 and 26% lower in relative terms at the same PO's respectively. CONCLUSION The EXP expended less EE compared to both NOV and PRAC. CLINICAL REHABILITATION IMPACT This finding has great implications for nutritionists and health care professionals working in the field of physical activity and weight management since the EE is influenced by experience.
-
6.
Temporary paraplegia resulting from Gorham's disease involving the third lumbar vertebra and proximal femur: a five-year follow-up and review of the literature.
Esmailiejah, AA, Kamalian, N, Abbasian, M
Archives of Iranian medicine. 2013;(11):686-90
Abstract
Gorham's disease is a rare musculoskeletal disease of unknown etiology characterized by progressive osteolysis and massive bone destruction. Here, we report an extremely rare case of Gorham's disease involving two far sites in the lumbar spine and trochanteric region, gradually resulting in paraplegia. The patient underwent cord decompression and chemotherapy, and resumed her normal life; she was followed up for nearly five years.
-
7.
[Paraplegia after inadvertent epidural administration of potassium chloride].
Belyamani, L, Elmoqadem, A, Elbaite, A, Mounir, K, Drissi Kamili, N
Annales francaises d'anesthesie et de reanimation. 2008;(1):111-3
-
8.
Influence of pre-exercise glucose ingestion of two concentrations on paraplegic athletes.
Spendiff, O, Campbell, IG
Journal of sports sciences. 2005;(1):21-30
Abstract
In this study, we assessed the influence that pre-exercise glucose ingestion of two concentrations has on the physiological responses of paraplegic athletes. Eight men with paraplegia ingested a drink containing 4% (low) or 11% (high) carbohydrate in a randomized double-blind crossover design, 20 min before exercise. The participants performed wheelchair exercise at 65% of peak oxygen uptake for 1 h followed by a 20 min performance test. During both trials, the physiological responses were similar and indicated steady-state exercise. At the onset of exercise, blood glucose concentrations in both trials increased after carbohydrate ingestion (P < 0.05) before returning to resting values after 20 min of exercise and there were no differences between trials. Free fatty acid concentrations increased from rest to 1 h of exercise in both trials, with a greater increase during the low carbohydrate trial that led to a difference in free fatty acids between trials at the end of the 1 h tests (P < 0.05). There was a tendency for the performance distances and power outputs achieved during the high carbohydrate trial to be greater than those achieved during the low carbohydrate trial (P= 0.08). In conclusion, when paraplegic athletes ingested low and high carbohydrate drinks before exercise, the decline in blood glucose concentrations was similar. The tendency for higher blood glucose concentrations, respiratory exchange ratios and power outputs and lower free fatty acid concentrations (P < 0.05) during the high carbohydrate trial suggests that a higher concentration of carbohydrate in a sports drink might be a better choice for paraplegic athletes.
-
9.
Prevention of bone loss in paraplegics over 2 years with alendronate.
Zehnder, Y, Risi, S, Michel, D, Knecht, H, Perrelet, R, Kraenzlin, M, Zäch, GA, Lippuner, K
Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research. 2004;(7):1067-74
-
-
Free full text
-
Abstract
UNLABELLED To assess the effects of long-term treatment of bone loss with alendronate in a group of paraplegic men, 55 patients were evaluated in a prospective randomized controlled open label study that was 2 years in duration comparing alendronate and calcium with calcium alone. Bone loss was stopped at all cortical and trabecular infralesional sites (distal tibial epiphysis, tibial diaphysis, total hip) with alendronate 10 mg daily. INTRODUCTION Bone loss after spinal cord injury (SCI) leads to increased fracture risk in the lower limbs of paraplegics. The aim of this study was to document long-term treatment of bone loss with alendronate in a group of paraplegic men with complete motor lesion after SCI. MATERIALS AND METHODS Sixty-five men with complete motor post-traumatic medullary lesion between T1 and L2 with total motor and sensory loss (Frankel classification, stage A) or with total motor and partial sensory loss (Frankel classification, stage B) after SCI were included in this prospective randomized controlled open label study that was 2 years in duration. The patients were randomized to either the treatment group with alendronate 10 mg daily and elemental calcium 500 mg daily or to the control group with elemental calcium 500 mg daily alone. The primary endpoint was defined as the effect over 24 months of alendronate and calcium compared with calcium alone on the BMD values at the distal tibial epiphysis (as a surrogate for trabecular bone in the paralyzed zone). The secondary endpoints were changes in BMD at supra- and infralesional sites of measurement. Biochemical markers of bone turnover were assessed. RESULTS Fifty-five subjects, 0.1-29.5 years post-SCI, completed the study over 24 months. BMD at the distal tibial epiphysis significantly decreased from baseline in the calcium group (-10.8 +/- 2.7% at 24 months, p < 0.001), whereas it remained stable in the alendronate plus calcium group (-2.0 +/- 2.9% at 24 months, p = not significant versus baseline), leading to a significant intergroup difference over time (p = 0.017). At the tibial diaphysis, similar significant results were observed. At the ultradistal radius and the radial shaft, BMD did not change significantly from baseline in either treatment group. At the total hip, BMD decreased significantly in the calcium group (-4.1 +/- 1.6%, p = 0.038) but remained stable in the alendronate plus calcium group (+0.43 +/- 1.2%), with a significant intergroup difference (p = 0.037). At the lumbar spine, BMD increased significantly (p < 0.0001) from baseline in both groups. Biochemical markers of bone resorption were significantly decreased with alendronate versus baseline and control. Alendronate and calcium were generally safe and well tolerated. CONCLUSIONS In paraplegic men, SCI bone loss was stopped at all measured cortical and trabecular infralesional sites over 24 months with alendronate 10 mg daily.
-
10.
[Post-inpatient after-care of paraplegic patients: selected internal medicine aspects].
Cavigelli, A, Dietz, V
Schweizerische medizinische Wochenschrift. 2000;(22):851-60
Abstract
In-hospital rehabilitation of para-/tetraplegic patients is followed by the family doctor's long-term surveillance supported by annual checkups in the rehabilitation clinic. The family doctor bears a heavy burden of responsibility. Loss of sensation may cover a wide range of complications. Most of these functional disorders are the consequence of reduced physical activity and a disturbed autonomic nervous system. There is a significantly high incidence of pulmonary infection, in particular pneumonia and atelectasis, coronary heart disease, autonomic dysreflexia, urinary tract infections, kidney stones, renal and hepatic insufficiency, gallstones, constipation and ileus, as well as decubitus, osteoporosis and so on. Chronic severe pain and spasm also require optimum therapy, in view of their potential to reduce quality of life and working capacity. This article provides an overview of several relevant problems in internal medicine involving diagnosis, therapy and long-tem surveillance of patients with spinal cord injuries.