Upper Limb Capabilities, Self-Care and Fine Motor Activities with and Without Equipment in Persons with Cervical Spinal Cord Injury at Discharge from Rehabilitation and 1 Year Post-Injury

Introduction: There is little information on the impact of assistive technology or devices (AT) on function. The purpose of this project was to explore the impact of AT on self-care (SC) and fine motor (FM) function in persons with cervical SCI, and to examine the functional capabilities of those who benefit from AT. Methods: Persons with acute cervical SCI, all levels and AIS grades, with an upper extremity motor score (UEMS) \u3e 0 were enrolled. At discharge from rehabilitation and 1 year post-injury we collected the Capabilities of Upper Extremity questionnaire (CUE-Q), and the combined SC and FM questions of the SCI Functional Index (SCI-FI) and SCI-FI/AT short forms. The arm with the highest CUE-Q side score was designated the better side. The impact of AT on SC and FM function was evaluated by looking at the difference in SCI-FI and SCI-FI/AT scores, and changes over time. Results: There were 67 participants with data at rehab discharge and 1-year post-injury, 50 male and 17 female, average age 43.3 ± 15.6 years. Median scores by neurologic groupings are shown in the table. All groups demonstrated improvements in CUE-Q and SCI-FI scores from discharge to 1 year post-injury (table and radar charts). By neurologic group, AT was useful for the greatest percentage of persons classified as C4-C5 AB for FM and C6-T1 AB for SC), least useful for C6-T1 CD (charts at right). AT was helpful for the greatest number of items for SC in the C4-C5 CD group at discharge (bolded numbers in table). There tended to be less use of AT for tasks at 1 year compared to rehab discharge. For example, the percentage of persons using AT for brushing teeth at discharge was 48%, while at 1 year it was only 25%. Conclusion: Many persons with tetraplegia are able to perform self-care and fine motor tasks easier using AT, but the benefit depends on the level and severity of injury. There is a decreased reliance on AT over time, which may in part be due to continued recovery after rehabilitation discharge.https://jdc.jefferson.edu/rmposters/1013/thumbnail.jp

Using Biofeedback to Reduce Spatiotemporal Asymmetry Impairs Dynamic Balance in People Post-Stroke

Background. People poststroke often walk with a spatiotemporally asymmetric gait, due in part to sensorimotor impairments in the paretic lower extremity. Although reducing asymmetry is a common objective of rehabilitation, the effects of improving symmetry on balance are yet to be determined. Objective. We established the concurrent validity of whole-body angular momentum as a measure of balance, and we determined if reducing step length asymmetry would improve balance by decreasing whole-body angular momentum. Methods. We performed clinical balance assessments and measured wholebody angular momentum during walking using a full-body marker set in a sample of 36 people with chronic stroke. We then used a biofeedback-based approach to modify step length asymmetry in a subset of 15 of these individuals who had marked asymmetry and we measured the resulting changes in whole-body angular momentum. Results. When participants walked without biofeedback, whole-body angular momentum in the sagittal and frontal plane was negatively correlated with scores on the Berg Balance Scale and Functional Gait Assessment supporting the validity of whole-body angular momentum as an objective measure of dynamic balance. We also observed that when participants walked more symmetrically, their wholebody angular momentum in the sagittal plane increased rather than decreased. Conclusions. Voluntary reductions of step length asymmetry in people poststroke resulted in reduced measures of dynamic balance. This is consistent with the idea that after stroke, individuals might have an implicit preference not to deviate from their natural asymmetry while walking because it could compromise their balance. Clinical Trials Number: NCT03916562

An Investigation of Bilateral Symmetry During Manual Wheelchair Propulsion

Studies of manual wheelchair propulsion often assume bilateral symmetry to simplify data collection, processing and analysis. However, the validity of this assumption is unclear. Most investigations of wheelchair propulsion symmetry have been limited by a relatively small sample size and a focus on a single propulsion condition (e.g., level propulsion at self-selected speed). The purpose of this study was to evaluate bilateral symmetry during manual wheelchair propulsion in a large group of subjects across different propulsion conditions. Three-dimensional kinematics and handrim kinetics along with spatiotemporal variables were collected and processed from 80 subjects with paraplegia while propelling their wheelchairs on a stationary ergometer during three different conditions: level propulsion at their self-selected speed (free), level propulsion at their fastest comfortable speed (fast), and propulsion on an 8% grade at their level, self-selected speed (graded). All kinematic variables had significant side-to-side differences, primarily in the graded condition. Push angle was the only spatiotemporal variable with a significant side-to-side difference, and only during the graded condition. No kinetic variables had significant side-to-side differences. The magnitudes of the kinematic differences were low, with only one difference exceeding five degrees. With differences of such small magnitude, the bilateral symmetry assumption appears to be reasonable during manual wheelchair propulsion in subjects without significant upper-extremity pain or impairment. However, larger asymmetries may exist in individuals with secondary injuries and pain in their upper extremity and different etiologies of their neurological impairment

Stationary Cycling and Children with Cerebral Palsy: Case Reports for Two Participants

ABSTRACT. These case reports describe a stationary cycling intervention and outcomes for two child participants (P1 and P2) with spastic diplegic cerebral palsy. Each child completed a 12-week, 30-session cycling intervention consisting of strengthening and cardiorespiratory fitness phases. P1 exhibited higher training intensities, particularly during the cardiorespiratory phase. Average training heart rates were 59% and 35% of maximum heart rate for P1 and P2, respectively. Lower extremity peak knee flexor and extensor moments, gross motor function (Gross Motor Function Measure (GMFM-66)), preferred walking speed (thirty-second walk test), and walking endurance (600-yard walk-run test) were measured pre-and postintervention. Changes in outcome measurements corresponded with differences in exercise intensity. Greater gains in peak knee extensor moments, GMFM-66 scores (+4.2 versus +0.9), 600-yard walk-run test (−29% versus 0%) occurred for P1 versus P2, respectively. Preferred walking speeds did not increase substantially for P1 and decreased for P2

The ability of male and female clinicians to effectively test knee extension strength using manual muscle testing

It has been suggested that the accuracy of manual muscle testing is dependent on examiner strength. Our purpose was to relate male and female clinicians\u27 upper extremity strength to their ability to challenge the quadriceps and detect weakness in patients using manual muscle testing. Quadriceps muscles of seven men and 12 women with postpoliomyelitis were tested manually by a male and female clinician while forces were recorded with a hand-held dynamometer. Patients\u27 maximal isometric knee extension force was recorded with a Lido dynamometer and clinicians\u27 maximal vertical push force was recorded with the hand-held dynamometer. Manual muscle testing forces, patient maximum quadriceps forces, and examiner push forces were compared with repeated measures analysis of variance. Female examiners\u27 maximal vertical push force (235.7 ± 54.3 N) was not significantly different from either female or male patients\u27 maximal quadriceps force (166.8 ± 66.7 N and 341.6 ± 123.7 N) but was only 60% and 40% of the isometric knee extension forces generated by a group of normal women and men. Male examiners were significantly stronger 057.0 ± 93.4 N) than the female but not the male patients and produced 90% and 60% of the normal isometric quadriceps forces for women and men. Examiners gave appropriate grades in 30 of 38 tests. Examiner strength limits detection of moderate quadriceps weakness with manual resistance. Most of the muscle test grades, however, were appropriate, given the examiner\u27s upper extremity strength. Clinicians using manual muscle testing should determine their maximal vertical push force and the extent of weakness they can detect