benefits of fes cycling & locomotortraining approaches after sci
DESCRIPTION
Benefits of FES Cycling & LocomotorTraining Approaches after SCI. Deborah Backus, PT, PhD Associate Dir, SCI Research Shepherd Center Assistant Professor Emory University Atlanta, GA. Disclosures. Deborah Backus, PT, PhD has no financial interest or relationships to disclose - PowerPoint PPT PresentationTRANSCRIPT
Deborah Backus, PT, PhDAssociate Dir, SCI Research
Shepherd CenterAssistant ProfessorEmory University
Atlanta, GA
Benefits of FES Cycling & LocomotorTraining Approaches after
SCI
Academy Spinal Cord Injury ProfessionalsAnnual MeetingSeptember 2011
DisclosuresDeborah Backus, PT, PhD has no financial
interest or relationships to disclose
CME Staff DisclosuresProfessional Education Services Group staff and
planning committee have no financial interest or relationships to disclose.
Academy Spinal Cord Injury ProfessionalsAnnual MeetingSeptember 2011
Fact
People with SCI, as well as their caregivers and clinicians, are seeking
solutions to:
Increase function and recovery after SCI, as well as
Improve health and wellness
Academy Spinal Cord Injury ProfessionalsAnnual MeetingSeptember 2011
Potential Solutions?
Advances in neuroscience researchDevelopment of new technology
geared toward SCI Much focus on “activity-based” interventions and programs
Academy Spinal Cord Injury ProfessionalsAnnual MeetingSeptember 2011
Learning Objectives
Upon completion of this session, participants will:Define activity-based interventions and
discuss the relevance for improving neural activity and function, or health and wellness, in p with SCI;
Discuss the findings from relevant literature over the past 10 to 20 years related to the efficacy of activity-based interventions for improving health-related, neural and functional outcomes in p with spinal cord injury (SCI). Academy Spinal Cord Injury Professionals
Annual MeetingSeptember 2011
Activity-Based Interventions
Include any intervention focused on activating nerves, receptors & muscles below the level of injury rather than accommodating/compensating for the paralysis & sensory loss due to SCI by using the intact limbs only Functional electrical stimulation cycling (FES cycling)
Locomotor training (LT) approachesCompiled by the Shepherd Center Study Group in Atlanta, GA. Innovative Knowledge Dissemination & Utilization Project for Disability & Professional Stakeholder Organizations/ NIDRR
Grant # (H133A050006) at Boston University Center for Psychiatric Rehabilitation6
Rationale for Use of ABint for Neural & Functional Benefits?
Evidence from animal models of SCI:Use of intense and repeated sensory
stimulation, and intense motor practice, or exercise, can elicit plasticity throughout the neural axis (Hutchinson et al 2004;Ying wt al. 2008;Gazula et al. 2004;Goldschmidt et al. 2008; McDonald et al, 2002; Perez et al 2004)
Evidence from other patient populations (eg. Stroke):Intense, focused, repeated active
movement of impaired limbs, especially when combined with sensory augmentation, is beneficial for improving function, and inducing neural changes in the cerebral cortex
FES cycling and LT can provide these required elements
Question #1
What is the evidence in humans with SCI that the
application of these principles will lead to neural changes and/or functional benefits?
What is required to improve health and wellness after SCI?Need to place a demand on the
cardiovascular, respiratory and musculoskeletal systems, generally using large muscle groups, BUT:The large muscles are generally the ones that
are paralyzed or weakPeople with SCI have diminished cardiac
responsesAutonomic dysregulation is a problem for most
people with tetraplegia or high paraplegiaBoth FES cycling and LT:
Activate large musclesPlace demand on the cardiovascular and
respiratory systems
Question #2
What is the evidence that the use of activity-based interventions in humans
with SCI will lead to health and wellness benefits?
Shepherd Center Systematic Review Group Leadership team: Lesley Hudson, MS; David Apple, MD;
Deborah Backus, PhD, PT Reviewers:
Jennith Bernstein, PTAmanda Gillot, PT Jennifer Huggins, OTAshley Kim, PTElizabeth Sasso, PTKristen Casperson, PTBrian Smith, PTAnna Berry, PTAngela Cooke, RN
Data coordinator: Rebecca Acevedo
Compiled by the Shepherd Center Study Group in Atlanta, GA. Innovative Knowledge Dissemination & Utilization Project for Disability & Professional Stakeholder Organizations/ NIDRR Grant #
(H133A050006) at Boston University Center for Psychiatric Rehabilitation
Review conducted using a system for rating the rigor and meaning of disability research (Farkas, Rogers and Anthony, 2008). The first instrument in this system is: “Standards for Rating Program Evaluation, Policy or Survey Research, Pre-Post and Correlational Human Subjects” (Rogers, Farkas, Anthony & Kash, 2008) and “Standards for Rating the Meaning of Disability Research” (Farkas & Anthony, 2008).
Compiled by the Shepherd Center Study Group in Atlanta, GA. Innovative Knowledge Dissemination & Utilization Project for Disability & Professional Stakeholder Organizations/ NIDRR Grant #
(H133A050006) at Boston University Center for Psychiatric Rehabilitation
Definitions
“Neural recovery” or “changes in neural function”:Measurable changes in neural circuitry or
neuronal activity at any level of the neural axis in response to injury or learning
“Functional ability”:Includes any skill that leads to improved
mobility (locomotion, bed mobility, transfers) or activities of daily living:
Definitions
“Exercise effects”:Include changes or modifications in
cardiorespiratory or vascular responses, metabolism, and muscle parameters (size, girth, volume, blood flow, metabolism)
“Health-related benefits”:Include markers related to cardiac
function and indicators of cardiac disease, and metabolic function and indicators of diabetes or other metabolic instability or diseaseCompiled by the Shepherd Center Study Group in Atlanta, GA. Innovative Knowledge Dissemination &
Utilization Project for Disability & Professional Stakeholder Organizations/ NIDRR Grant # (H133A050006) at Boston University Center for Psychiatric Rehabilitation
Study Designs
Experimental: Employed methods including a random assignment and a control group or a reasonably constructed comparison group
Quasi-experimental: No random assignment, but either with a control group or a reasonably constructed comparison group
Descriptive: Neither a control group, nor randomization, is used. These included case studies and reports, studies employing repeated measures, and Pre-post designs.
Compiled by the Shepherd Center Study Group in Atlanta, GA. Innovative Knowledge Dissemination & Utilization Project for Disability & Professional Stakeholder Organizations/ NIDRR Grant #
(H133A050006) at Boston University Center for Psychiatric Rehabilitation
FES Cycling Studies
Compiled by the Shepherd Center Study Group in Atlanta, GA. Innovative Knowledge Dissemination & Utilization Project for Disability & Professional Stakeholder Organizations/ NIDRR Grant #
(H133A050006) at Boston University Center for Psychiatric Rehabilitation1.16
Restorative Therapies, Baltimore, MD
ERGYS Muscle Power
Neural-related Benefits of FES Cycling
Only one of 17 articles reviewed for neural and functional effects of FES Cycling in people with SCI between 1989 and 2009 (Griffin et al. 2008)
Compiled by the Shepherd Center Study Group in Atlanta, GA. Innovative Knowledge Dissemination & Utilization Project for Disability & Professional Stakeholder Organizations/ NIDRR Grant #
(H133A050006) at Boston University Center for Psychiatric Rehabilitation
Griffin et al. 2008
Evaluated the efficacy of FES cycling on ASIA sensory and motor scores (neural, no functional data)
18 adults with chronic paraplegia or tetraplegiaMajority classified with incomplete
injuries (n=13)Remainder classified as complete
The method for determining these classifications was not provided
Compiled by the Shepherd Center Study Group in Atlanta, GA. Innovative Knowledge Dissemination & Utilization Project for Disability & Professional Stakeholder Organizations/ NIDRR
Grant # (H133A050006) at Boston University Center for Psychiatric Rehabilitation18
Outcome Measures & Training (Griffin et al 2008)
ASIA assessed before and after a 10-week intervention
Training 2 to 3 times/week for 10 weeks on FES cycle in an inpatient hospital
Stimulation frequency for the FES cycle = 50 Hz
Maximal stimulation intensity = 140 mA, Adjusted to maintain a cadence of 49 rpm
Resistance was only increased by 1 kp after subject was able to cycle for three consecutive sessions for 30 minutes without interruption
Compiled by the Shepherd Center Study Group in Atlanta, GA. Innovative Knowledge Dissemination & Utilization Project for Disability & Professional Stakeholder Organizations/ NIDRR
Grant # (H133A050006) at Boston University Center for Psychiatric Rehabilitation19
Neural Outcomes (Griffin et al. 2008)
Significant improvements in ASIA LEMS scores & sensory scores
Improvements coincided with increases in cycling power over the duration of the intervention period
Suggest that the FES cycle might be a viable alternative for improving motor function in the lower extremities for individuals with incomplete SCI
BUT requires much more study
Compiled by the Shepherd Center Study Group in Atlanta, GA. Innovative Knowledge Dissemination & Utilization Project for Disability & Professional Stakeholder Organizations/ NIDRR
Grant # (H133A050006) at Boston University Center for Psychiatric Rehabilitation20
Health-related Benefits of FES Cycling
10 papers report on cardiorespiratory, pulmonary, metabolic, muscle or vascular effects of FES Cycling in people with SCI between 1989 and 2009Experimental approach n=2Quasi-experimental approach n=1Descriptive n=7
Compiled by the Shepherd Center Study Group in Atlanta, GA. Innovative Knowledge Dissemination & Utilization Project for Disability & Professional Stakeholder Organizations/ NIDRR Grant #
(H133A050006) at Boston University Center for Psychiatric Rehabilitation
Summary: Participant Characteristics
n AIS Classification Level Acute/Chronic Sex Age
A B C /DTetr
aPara Acute Chronic M F
Arnold et al. 1992
12 11*** 0 1*** 7 53
months22 yrs 10 2 16-46
Bhambhani et al. 2000
14 X* X na 3 4 na 1-29 yrs 5 2 26-65
Demchak et al. 2005
10 8 2 na 5 5 X## Na 8 2 17-50
Faghri et al. 1992
13 5** 3** 5** 7 6 na 3-16 yrs 12 1 21-41
Fornusek & Davis 2008
9 9 na na 0 9 na 1-11 yrs 7 2 26-48
Hooker et al. 1992
18 11*** 4*** 3*** 10 86
months15 yrs 17 1 20-56
Johnston et al. 2007
4 4 na na 2 2 na 2-8 yrs 2 2 7, 9
Johnston et al. 2009
30 22 6 2 11 19 na 1-12 yrs 17 135 to 13
Theisen et al. 2002
5 5 na na na 6 na2.9-8.1
yrs4 1 25-41
Zbogar et al. 2008
4 1 2 1 2 2 na2.5-16
yrs0 4 19-51
Summary: Participant Characteristics
n AIS Classification Level Acute/Chronic Sex Age
A B C /DTetr
aPara Acute Chronic M F
Arnold et al. 1992
12 11*** 0 1*** 7 53
months22 yrs 10 2 16-46
Bhambhani et al. 2000
14 X* X na 3 4 na 1-29 yrs 5 2 26-65
Demchak et al. 2005
10 8 2 na 5 5 X## Na 8 2 17-50
Faghri et al. 1992
13 5** 3** 5** 7 6 na 3-16 yrs 12 1 21-41
Fornusek & Davis 2008
9 9 na na 0 9 na 1-11 yrs 7 2 26-48
Hooker et al. 1992
18 11*** 4*** 3*** 10 86
months15 yrs 17 1 20-56
Johnston et al. 2007
4 4 na na 2 2 na 2-8 yrs 2 2 7, 9
Johnston et al. 2009
30 22 6 2 11 19 na 1-12 yrs 17 135 to 13
Theisen et al. 2002
5 5 na na na 6 na2.9-8.1
yrs4 1 25-41
Zbogar et al. 2008
4 1 2 1 2 2 na2.5-16
yrs0 4 19-51
Summary: Participant Characteristics
n AIS Classification Level Acute/Chronic Sex Age
A B C /DTetr
aPara Acute Chronic M F
Arnold et al. 1992
12 11*** 0 1*** 7 53
months22 yrs 10 2 16-46
Bhambhani et al. 2000
14 X* X na 3 4 na 1-29 yrs 5 2 26-65
Demchak et al. 2005
10 8 2 na 5 5 X## Na 8 2 17-50
Faghri et al. 1992
13 5** 3** 5** 7 6 na 3-16 yrs 12 1 21-41
Fornusek & Davis 2008
9 9 na na 0 9 na 1-11 yrs 7 2 26-48
Hooker et al. 1992
18 11*** 4*** 3*** 10 86
months15 yrs 17 1 20-56
Johnston et al. 2007
4 4 na na 2 2 na 2-8 yrs 2 2 7, 9
Johnston et al. 2009
30 22 6 2 11 19 na 1-12 yrs 17 135 to 13
Theisen et al. 2002
5 5 na na na 6 na2.9-8.1
yrs4 1 25-41
Zbogar et al. 2008
4 1 2 1 2 2 na2.5-16
yrs0 4 19-51
Summary: Participant Characteristics
n AIS Classification Level Acute/Chronic Sex Age
A B C /DTetr
aPara Acute Chronic M F
Arnold et al. 1992
12 11*** 0 1*** 7 53
months22 yrs 10 2 16-46
Bhambhani et al. 2000
14 X* X na 3 4 na 1-29 yrs 5 2 26-65
Demchak et al. 2005
10 8 2 na 5 5 X## Na 8 2 17-50
Faghri et al. 1992
13 5** 3** 5** 7 6 na 3-16 yrs 12 1 21-41
Fornusek & Davis 2008
9 9 na na 0 9 na 1-11 yrs 7 2 26-48
Hooker et al. 1992
18 11*** 4*** 3*** 10 86
months15 yrs 17 1 20-56
Johnston et al. 2007
4 4 na na 2 2 na 2-8 yrs 2 2 7, 9
Johnston et al. 2009
30 22 6 2 11 19 na 1-12 yrs 17 135 to 13
Theisen et al. 2002
5 5 na na na 6 na2.9-8.1
yrs4 1 25-41
Zbogar et al. 2008
4 1 2 1 2 2 na2.5-16
yrs0 4 19-51
Summary: Participant Characteristics
n AIS Classification Level Acute/Chronic Sex Age
A B C /DTetr
aPara Acute Chronic M F
Arnold et al. 1992
12 11*** 0 1*** 7 53
months22 yrs 10 2 16-46
Bhambhani et al. 2000
14 X* X na 3 4 na 1-29 yrs 5 2 26-65
Demchak et al. 2005
10 8 2 na 5 5 X## Na 8 2 17-50
Faghri et al. 1992
13 5** 3** 5** 7 6 na 3-16 yrs 12 1 21-41
Fornusek & Davis 2008
9 9 na na 0 9 na 1-11 yrs 7 2 26-48
Hooker et al. 1992
18 11*** 4*** 3*** 10 86
months15 yrs 17 1 20-56
Johnston et al. 2007
4 4 na na 2 2 na 2-8 yrs 2 2 7, 9
Johnston et al. 2009
30 22 6 2 11 19 na 1-12 yrs 17 135 to 13
Theisen et al. 2002
5 5 na na na 6 na2.9-8.1
yrs4 1 25-41
Zbogar et al. 2008
4 1 2 1 2 2 na2.5-16
yrs0 4 19-51
Summary: Participant Characteristics
n AIS Classification Level Acute/Chronic Sex Age
A B C /DTetr
aPara Acute Chronic M F
Arnold et al. 1992
12 11*** 0 1*** 7 53
months22 yrs 10 2 16-46
Bhambhani et al. 2000
14 X* X na 3 4 na 1-29 yrs 5 2 26-65
Demchak et al. 2005
10 8 2 na 5 5 X## Na 8 2 17-50
Faghri et al. 1992
13 5** 3** 5** 7 6 na 3-16 yrs 12 1 21-41
Fornusek & Davis 2008
9 9 na na 0 9 na 1-11 yrs 7 2 26-48
Hooker et al. 1992
18 11*** 4*** 3*** 10 86
months15 yrs 17 1 20-56
Johnston et al. 2007
4 4 na na 2 2 na 2-8 yrs 2 2 7, 9
Johnston et al. 2009
30 22 6 2 11 19 na 1-12 yrs 17 135 to 13
Theisen et al. 2002
5 5 na na na 6 na2.9-8.1
yrs4 1 25-41
Zbogar et al. 2008
4 1 2 1 2 2 na2.5-16
yrs0 4 19-51
Summary: Participant Characteristics
n AIS Classification Level Acute/Chronic Sex Age
A B C /DTetr
aPara Acute Chronic M F
Arnold et al. 1992
12 11*** 0 1*** 7 53
months22 yrs 10 2 16-46
Bhambhani et al. 2000
14 X* X na 3 4 na 1-29 yrs 5 2 26-65
Demchak et al. 2005
10 8 2 na 5 5 X## Na 8 2 17-50
Faghri et al. 1992
13 5** 3** 5** 7 6 na 3-16 yrs 12 1 21-41
Fornusek & Davis 2008
9 9 na na 0 9 na 1-11 yrs 7 2 26-48
Hooker et al. 1992
18 11*** 4*** 3*** 10 86
months15 yrs 17 1 20-56
Johnston et al. 2007
4 4 na na 2 2 na 2-8 yrs 2 2 7, 9
Johnston et al. 2009
30 22 6 2 11 19 na 1-12 yrs 17 135 to 13
Theisen et al. 2002
5 5 na na na 6 na2.9-8.1
yrs4 1 25-41
Zbogar et al. 2008
4 1 2 1 2 2 na2.5-16
yrs0 4 19-51
Summary: Outcome Measures
Outcome Measures
Cardio/Resp
Muscular MetabolicVascula
rOther
Arnold et al. 1992 X X X
Bhambhani et al. 2000
X X
Demchak et al. 2005
Xave weekly
power output
Faghri, Glaser, Faghri 1992
X
Fornusek & Davis et al. 2008
XPower output
Hooker et al. 1992 X XPower output
Johnston et al. 2007
X X XLipid levels,
BMDJohnston et al. 2009
X XLipids,
cholesterol
Theisen et al. 2002 X XPower output
Zbogar et al. 2008 X
Summary: Outcome Measures
Outcome Measures
Cardio/Resp
Muscular MetabolicVascula
rOther
Arnold et al. 1992 X X X
Bhambhani et al. 2000
X X
Demchak et al. 2005
Xave weekly
power output
Faghri, Glaser, Faghri 1992
X
Fornusek & Davis et al. 2008
XPower output
Hooker et al. 1992 X XPower output
Johnston et al. 2007
X X XLipid levels,
BMDJohnston et al. 2009
X XLipids,
cholesterol
Theisen et al. 2002 X XPower output
Zbogar et al. 2008 X
Representation of FES Cycling Parameters in RCT
Conditioning
CyclingOther info or
training
Device(s) used
Stim paramet
ersFreq
Duration
Demchak et al. 2005
30 reps of knee ext
with estim and 1 kg weight or able to
cycle with 2.4 watts
Began at 2 watts; 50rpm
Increased every 3, 30 min
sessions by 6.1 watts
Stimaster Clinical
Ergometry system
2 watts; max stim 140 mA
30 mins/da
y; 3
days/wk
13 weeks
Johnston et al. 2009
Lower extremity stretching
prior to cycling
At home; 50rpm
RT300-P (FES) or RT100
(passive)
33Hz, 140mA
1 hour/da
y, 3X/wk
6 months
Results from RCTs (Demchak et al 2005 & Johnston et al. 2009)
Those who exercise with FES cycling demonstrated a non-significant 63% increase in muscle CSA after training (p=0.172), which was 171% greater than the CSA in persons in the SCI control group (p=0.05) (Demchak et al. 2005)
Children were safe using FES cyclingChildren who used FES had greater increases
in VO2 than those who used passive cycling (Johnston et al. 2009)
Compiled by the Shepherd Center Study Group in Atlanta, GA. Innovative Knowledge Dissemination & Utilization Project for Disability & Professional Stakeholder Organizations/ NIDRR
Grant # (H133A050006) at Boston University Center for Psychiatric Rehabilitation32
Other Findings from FES Cycling Studies
All people with acute or chronic SCI were able to increase time and resistance with FES cycling (Faghri et al. 1992; Hooker et al. 1992)
Participants all demonstrated an acute exercise response (Faghri et al. 1992; Bhambhani et al 2000)
Increase in small artery compliance by 63% (p=0.05) (Zbogar et al. 2008)
Muscle oxygenation responses were quite different from able-bodied participants (Bhambani et al. 2000)
Exercising at different cadences did not appear to affect cardiorespiratory or muscle oxygenation outcomes (Fornusek et al. 2008)Compiled by the Shepherd Center Study Group in Atlanta, GA. Innovative Knowledge
Dissemination & Utilization Project for Disability & Professional Stakeholder Organizations/ NIDRR Grant # (H133A050006) at Boston University Center for
Psychiatric Rehabilitation
Other Findings from FES Cycling StudiesPeople with tetraplegia do not respond the
same as those with paraplegia (cardiorespiratory and vascular responses)People with tetraplegia may have more autonomic
disruptionExercise programs designed for people with
tetraplegia may need to be different from those with paraplegia
Passive cycling may lead to cardiorespiratory benefits in some people with SCIRequires careful comparison between passive and
FES cycling in people with SCICost/value
Compiled by the Shepherd Center Study Group in Atlanta, GA. Innovative Knowledge Dissemination & Utilization Project for Disability & Professional Stakeholder
Organizations/ NIDRR Grant # (H133A050006) at Boston University Center for Psychiatric Rehabilitation
Summary: FES Cycling Studies
Methodological ConsiderationsEach study addressed different health-related
problems in people with different levels, chronicity and completeness of SCIDifficult to draw conclusions for the general SCI population
Training duration was different for these studiesDemchak et al. -13 weeksJohnston et. al. - 6 monthsBhambhani et al. - a single testing sessionDifficult to know which training paradigm would lead to the
changes reported, and if another paradigm would lead to better or worse effects
Compiled by the Shepherd Center Study Group in Atlanta, GA. Innovative Knowledge Dissemination & Utilization Project for Disability & Professional Stakeholder Organizations/ NIDRR
Grant # (H133A050006) at Boston University Center for Psychiatric Rehabilitation
Locomotor Training Studies
Compiled by the Shepherd Center Study Group in Atlanta, GA. Innovative Knowledge Dissemination & Utilization Project for Disability & Professional Stakeholder Organizations/ NIDRR Grant #
(H133A050006) at Boston University Center for Psychiatric Rehabilitation1.36
Neural & Functional Benefits of LT
Purpose: To evaluate all literature between 1998 and 2008 related to the efficacy for improving neural activity and function with the use of locomotor training (LT)
40 articles pulled from the literature and 21 articles met rigor and meaningfulness criteria:Experimental (n=3) Quasi-experimental (n=2)Descriptive (n=16)
Compiled by the Shepherd Center Study Group in Atlanta, GA. Innovative Knowledge Dissemination & Utilization Project for Disability & Professional Stakeholder Organizations/ NIDRR
Grant # (H133A050006) at Boston University Center for Psychiatric Rehabilitation37
Neural & Functional-related Benefits of LT
Humans with INcomplete SCI trained on treadmill with manual facilitation and assistance can improve gait and overground walking (Adams et al. 2006; Hicks et al. 2005; Hornby et al, 2005; Behrman AL & Harkema SJ, 2000; Wernig et al. 1995)
Compiled by the Shepherd Center Study Group in Atlanta, GA. Innovative Knowledge Dissemination & Utilization Project for Disability & Professional Stakeholder Organizations/ NIDRR
Grant # (H133A050006) at Boston University Center for Psychiatric Rehabilitation38
Health-related benefits of LT
n=8No reports of randomized controlled trials (RCT)
evaluating the exercise or health-related benefits of BWSTT in SCI
3 employed a control group in a quasi-experimental design, but no randomization
Remaining 5 used a descriptive study designUsed different approaches to BWSTT
BWSTTManual (M)Robotic (R)
BWSTT combined with neuromuscular electrical stimulation (NMES)39
Compiled by the Shepherd Center Study Group in Atlanta, GA. Innovative Knowledge Dissemination & Utilization Project for Disability & Professional Stakeholder Organizations/ NIDRR Grant # (H133A050006) at Boston University
Center for Psychiatric Rehabilitation
Summary of participant characteristics in
LT Studies
NAIS
Classification
LevelAcute/Chronic
Sex Age
A B C /D
Tetra
Para Acute Chronic
M F
Adams et al. 2006
1 X X X X 27
Carvalho & Cliquet 2005
21 X X X X X 24-40
Carvalho et al. 2005
31 X X X X X X 23-40
Carvalho, Zanchetta, Sereni, Cliquet 2005
31 X X X X X X 22-51
Ditor et al. 2005 6 X X X X X X X 19-57
Giangregorio et al. 2005
5 X X X X X X 19-40
Giangregorio et al. 2006
14 X X X X X X 20-53
Israel et al. 2006 12 X X X X (1) X X 15-59
Summary of participant characteristics in
LT Studies
NAIS
Classification
LevelAcute/Chronic
Sex Age
A B C /D
Tetra
Para Acute Chronic
M F
Adams et al. 2006
1 X X X X 27
Carvalho & Cliquet 2005
21 X X X X X 24-40
Carvalho et al. 2005
31 X X X X X X 23-40
Carvalho, Zanchetta, Sereni, Cliquet 2005
31 X X X X X X 22-51
Ditor et al. 2005 6 X X X X X X X 19-57
Giangregorio et al. 2005
5 X X X X X X 19-40
Giangregorio et al. 2006
14 X X X X X X 20-53
Israel et al. 2006 12 X X X X (1) X X 15-59
Summary of participant characteristics in
LT Studies
NAIS
Classification
LevelAcute/Chronic
Sex Age
A B C /D
Tetra
Para Acute Chronic
M F
Adams et al. 2006
1 X X X X 27
Carvalho & Cliquet 2005
21 X X X X X 24-40
Carvalho et al. 2005
31 X X X X X X 23-40
Carvalho, Zanchetta, Sereni, Cliquet 2005
31 X X X X X X 22-51
Ditor et al. 2005 6 X X X X X X X 19-57
Giangregorio et al. 2005
5 X X X X X X 19-40
Giangregorio et al. 2006
14 X X X X X X 20-53
Israel et al. 2006 12 X X X X (1) X X 15-59
Summary of participant characteristics in
LT Studies
NAIS
Classification
LevelAcute/Chronic
Sex Age
A B C /D
Tetra
Para Acute Chronic
M F
Adams et al. 2006
1 X X X X 27
Carvalho & Cliquet 2005
21 X X X X X 24-40
Carvalho et al. 2005
31 X X X X X X 23-40
Carvalho, Zanchetta, Sereni, Cliquet 2005
31 X X X X X X 22-51
Ditor et al. 2005 6 X X X X X X X 19-57
Giangregorio et al. 2005
5 X X X X X X 19-40
Giangregorio et al. 2006
14 X X X X X X 20-53
Israel et al. 2006 12 X X X X (1) X X 15-59
Summary of participant characteristics in
LT Studies
NAIS
Classification
LevelAcute/Chronic
Sex Age
A B C /D
Tetra
Para Acute Chronic
M F
Adams et al. 2006
1 X X X X 27
Carvalho & Cliquet 2005
21 X X X X X 24-40
Carvalho et al. 2005
31 X X X X X X 23-40
Carvalho, Zanchetta, Sereni, Cliquet 2005
31 X X X X X X 22-51
Ditor et al. 2005 6 X X X X X X X 19-57
Giangregorio et al. 2005
5 X X X X X X 19-40
Giangregorio et al. 2006
14 X X X X X X 20-53
Israel et al. 2006 12 X X X X (1) X X 15-59
Summary of interventions & outcome measures in the LT
studiesType Freq Durati
onOutcome Measures
M R NMES
Cardio/
Resp
Muscular
Metabolic
Vascular
Adams et al. 2006
X 3x/wk 4 mos X
Carvalho & Cliquet 2005
2x/wk 6 mos X
Carvalho et al. 2005a
3X test only
X
Carvalho, Zanchetta, Sereni, Cliquet 2005
X X 1X test only
X
Ditor et al. 2005
X 3X/wk 4 mos X X
Giangregorio et al. 2005
6-8 mos
X
Giangregorio et al. 2006
X 12-15 mos
X
Israel et al. 2006
X 1X test only
X
Summary of interventions & outcome measures in the LT
studiesType Freq Durati
onOutcome Measures
M R NMES
Cardio/
Resp
Muscular
Metabolic
Vascular
Adams et al. 2006
X 3x/wk 4 mos X
Carvalho & Cliquet 2005
2x/wk 6 mos X
Carvalho et al. 2005a
3X test only
X
Carvalho, Zanchetta, Sereni, Cliquet 2005
X X 1X test only
X
Ditor et al. 2005
X 3X/wk 4 mos X X
Giangregorio et al. 2005
6-8 mos
X
Giangregorio et al. 2006
X 12-15 mos
X
Israel et al. 2006
X 1X test only
X
Summary of interventions & outcome measures in the LT
studiesType Freq Durati
onOutcome Measures
M R NMES
Cardio/
Resp
Muscular
Metabolic
Vascular
Adams et al. 2006
X 3x/wk 4 mos X
Carvalho & Cliquet 2005
2x/wk 6 mos X
Carvalho et al. 2005a
3X test only
X
Carvalho, Zanchetta, Sereni, Cliquet 2005
X X 1X test only
X
Ditor et al. 2005
X 3X/wk 4 mos X X
Giangregorio et al. 2005
6-8 mos
X
Giangregorio et al. 2006
X 12-15 mos
X
Israel et al. 2006
X 1X test only
X
Health-related Benefits of LT
Increased muscle mass acutely (Giangregorio et al. 2005), and chronically (Adams et al. 2006):Increases in muscle fiber area and in
type 1 fibers (Adams et al. 2006)Increased in femoral artery
compliance (Ditor et al. 2005)Increased VO2, VCO2, and energy
consumption (Carvalho et al. 2005, 2006)Compiled by the Shepherd Center Study Group in Atlanta, GA. Innovative Knowledge
Dissemination & Utilization Project for Disability & Professional Stakeholder Organizations/ NIDRR Grant # (H133A050006) at Boston University Center for Psychiatric Rehabilitation
48
Methodological Considerations LT Studies
The data varies based on the training paradigm, the participant characteristics (level, extent and chronicity of injury), and the outcome measures used
Studies employing similar participants training with identical programs, and receiving the same outcome measures will provide valuable insight related to the positive and negative health effects of BWSTT
Compiled by the Shepherd Center Study Group in Atlanta, GA. Innovative Knowledge Dissemination & Utilization Project for Disability & Professional Stakeholder Organizations/ NIDRR Grant # (H133A050006) at Boston University Center for Psychiatric Rehabilitation
Conclusions from Systematic Reviews
The evidence related to neural and functional effects suggests that only people with INcomplete SCI benefit from these approaches
There are health benefits following FES cycling or LT for people with either complete or incomplete SCIChanges in heart rate and blood pressure vary based on
level of injuryPeople with SCI who desire pursuing FES cycling or
LT should discuss which approach is best for them individually with their health care provider based on the level, extent and chronicity of their SCI.
NOT ONE SIZE FITS ALLCompiled by the Shepherd Center Study Group in Atlanta, GA. Innovative Knowledge
Dissemination & Utilization Project for Disability & Professional Stakeholder Organizations/ NIDRR Grant # (H133A050006) at Boston University Center for Psychiatric Rehabilitation
Conclusions: Further Study Required to:Explore more fully the health-related effects of FES
cycling and LT Variable responses in arterial compliance and lipid profiles Impact on ANS
Compare FES cycling & LT in relation to the benefitsShould include cost-benefit analyses
Elucidate the differential responses/benefits to FES cycling & LT approaches for different levels, completeness and chronicity of SCI
Compare FES cycling, LT approaches and upper extremity exercise for their relative contributions to health-related benefits in SCI
Compiled by the Shepherd Center Study Group in Atlanta, GA. Innovative Knowledge Dissemination & Utilization Project for Disability & Professional Stakeholder Organizations/
NIDRR Grant # (H133A050006) at Boston University Center for Psychiatric Rehabilitation
Thank you!
National Institute on Disability and Rehabilitation Research
Shepherd Center Lesley Hudson, MS David Apple, MD Jennith Bernstein, PT Amanda Gillot, PT Ashley Kim, PT Elizabeth Sasso, PT Kristen Casperson, PT Brian Smith, PT Anna Berry, PT Angela Cooke, RN
Compiled by the Shepherd Center Study Group in Atlanta, GA. Innovative Knowledge Dissemination & Utilization Project for Disability & Professional Stakeholder Organizations/ NIDRR Grant #
(H133A050006) at Boston University Center for Psychiatric Rehabilitation