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2004 Directors' Summary Synopsis
IMPROVING FUNCTION AND FITNESS
To assist people with chronic SCI to improve their function and fitness, rehabilitation professionals are always looking for better therapies. For people with SCI and clinical professionals to embrace new treatments and insurance companies to pay for them, it is important to conduct studies to evaluate outcomes and establish the benefits of new therapies. Several laboratories at The Miami Project continue to carry out this line of research.
Electrical stimulation to assist paralyzed muscles to contract has been used in various applications: to allow some with chronic injury to stand and take steps, to improve grip strength in the hands, or to assist with upper extremity exercise. In people with SCI, excessive fatigue of paralyzed muscles activated by electrical stimulation is of concern. In a recent study performed in the Human Neurophysiology Laboratory, Dr. Christine Thomas and her colleagues showed that increasing systemic blood pressure in people with complete high-level SCI helped to improve the endurance of paralyzed muscles. This laboratory observation suggests that if blood pressure can be increased safely and reliably in tetraplegics, it may be useful in improving the ability to restore functional movements to paralyzed muscles. Further studies will be needed to confirm the therapeutic benefit of this observation.
An important goal in rehabilitation is for the person to perform daily activities successfully and safely. To accurately evaluate an individual’s progress in rehabilitation, clinicians need objective evidence-based tests that are relatively inexpensive and easy to use. Miami Project exercise physiologist Dr. Patrick Jacobs has examined the use of an exercise evaluation tool, the Wingate Anaerobic Test, in tetraplegics. This test, used widely in athletics and research with able-bodied individuals, is a relatively short and simple means of assessing anaerobic power capacity. This year, he and his colleagues conducted a study to determine the appropriate levels of resistance that needs to be used given the various degrees of upper extremity impairment seen in cervical injuries. They were able to define the appropriate parameters and determine the test’s reliability in tetraplegics.
Another goal in rehabilitation research is to determine what exercises and activities optimize long-term health and fitness. Fitness options for people with SCI are often limited to passive activities or arm exercises. To understand whether passive exercise has positive benefits, Drs. Mark Nash, Edelle Field-Fote and Patrick Jacobs collaborated on studies to evaluate the use of robotic-assisted treadmill walking in a body weight support (BWS) system. In a case study of one research volunteer with complete cervical SCI, they observed changes in heart rate and respiratory function during "robotic walking." While research with more people is needed to confirm beneficial results, the preliminary findings suggest that this type of passive exercise may offer exercise and fitness benefits. |
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