Adherence and perceptions of a home sports video gaming program in persons with spinal cord injuries: A pilot study.

OBJECTIVE: Sports video-gaming can facilitate increased activity levels in persons with limited exercise options. Understanding how persons with spinal cord injuries (SCI) participate in home-based video-gaming and its potential impact on maintaining or enhancing physical function remains largely unexplored. The purpose of this study was to evaluate adherence, perceptions, and potential physical effects of a home sports video-game program for persons with chronic SCI. PARTICIPANTS: Fourteen individuals with chronic SCI (9 tetraplegia, 5 paraplegia). DESIGN: This was a prospective study. Wii video-gaming systems that included four sports games were provided to participants for home use. Participants were instructed to play for 8 weeks 3-4 days/week. The video consoles recorded the time and number of sessions played. OUTCOME MEASURES: At baseline and at the conclusion of the program, measurements were made of upper extremity strength, perceived exertion, active heart rate, pain, balance, and a functional upper extremity (UE) test. The total time and number of sessions were compared to the prescribed game play as a measure of adherence. Scores from a self-reported survey were used to gauge participants' satisfaction and perceptions of their gaming experience. RESULTS: Overall mean gaming adherence was 85% during the first 4 weeks and 69% for the second 4 weeks. There were no significant changes in upper extremity strength, active heart rate, balance, pain, or functional UE test for either group. All of the participants rated video gaming as enjoyable and 85.7% perceived that it could be used as a form of exercise. CONCLUSION: The Wii sports home video-gaming intervention elicited overall high adherence rates and was well received by study participants indicating that it may have value as an adjunctive tool for increasing physical activity for individuals with SCI.

Quantitative electrodiagnostic patterns of damage and recovery after spinal cord injury: a pilot study.

Study design: Prospective observational pilot study. Objectives: To compare quantitative electromyographic (EMG), imaging and strength data at two time points in individuals with cervical spinal cord injury (SCI). Setting: SCI center, Veterans Affairs Health Care System, Palo Alto, California, USA. Methods: Subjects without suspected peripheral nerve injury were recruited within 3 months of injury. Needle EMG examination was performed in myotomes above, at, and below the SCI level around 11- and 12-months post injury. EMG data were decomposed using custom software into constituent motor unit trains and each distinct motor unit was analyzed for firing rate and amplitude. Strength measurements were made with dynamometry and according to the International Standard of Neurologic Classification of SCI (ISNCSCI). Cervical magnetic resonance images (MRI) were evaluated by two neuroradiologists for gray and white matter damage around the SCI. Here, we compare the EMG, strength, and imaging findings of the one of the four participants who completed both 3- and 12-month EMG evaluations. Results: There was an increase in force generation in all muscles tested at 1 year. Localized findings of very fast firing motor units helped localize spinal cord damage and revealed gray matter damage in spinal segments where MRI was normal. Meanwhile, improvement in strength over time corresponded with different electrophysiologic patterns. Conclusions: Electromyographic decomposition at two time points provides valuable information about localization of spinal cord damage, integrity of motor neuron pools and may provide a unique understanding of neural recovery mechanisms.

Upper limb muscle activation during sports video gaming of persons with spinal cord injury.

OBJECTIVE: Video gaming as a therapeutic tool has largely been studied within the stroke population with some benefits reported in upper limb motor performance, balance, coordination, and cardiovascular status. To date, muscle activation of upper limb muscles in persons with spinal cord injuries (SCI) has not been studied during video game play. In this paper, we provide descriptive and comparative data for muscle activation and strength during gaming for players with tetraplegia and paraplegia, as well as, compare these results with data from traditional arm exercises (ie, biceps curl and shoulder press) with light weights which are commonly prescribed for a home program. PARTICIPANTS: Fourteen individuals with chronic SCI (9 tetraplegia, 5 paraplegia). DESIGN: We measured upper limb muscle activation with surface electromyography (EMG) during Wii Sports video game play. Muscle activation was recorded from the playing arm during 4 selected games and normalized to a maximum voluntary contraction (MVC). OUTCOME MEASURES: Heart rate and upper limb motion were recorded simultaneously with EMG. Wilcoxon signed rank tests were used to analyze differences in muscle activation between participants with paraplegia versus tetraplegia and compare gaming with traditional arm exercises with light weights. A Friedman 2-way analysis of variance identified key muscle groups active during game play. RESULTS: Overall muscle activation across the games was not different between those with paraplegia and tetraplegia. Heart rate during video game play for tennis and boxing were on average 10 to 20 beats/minute above resting heart rate. The magnitude of EMG was relatively greater for traditional arm exercises with light weights compared with game play. CONCLUSION: The selected Wii games were able to elicit upper extremity muscle activation and elevated heart rates for individuals with SCI that may be used to target therapeutic outcomes.

Multicenter Survey of the Effects of Rehabilitation Practices on Pinch Force Strength After Tendon Transfer to Restore Pinch in Tetraplegia.

OBJECTIVE: To identify key components of conventional therapy after brachioradialis (BR) to flexor pollicis longus (FPL) transfer, a common procedure to restore pinch strength, and evaluate whether any of the key components of therapy were associated with pinch strength outcomes. DESIGN: Rehabilitation protocols were surveyed in 7 spinal cord injury (SCI) centers after BR to FPL tendon transfer. Key components of therapy, including duration of immobilization, participation, and date of initiating therapy activities (mobilization, strengthening, muscle reeducation, functional activities, and home exercise), were recorded by the patient's therapist. Pinch outcomes were recorded with identical equipment at 1-year follow-up. SETTING: Seven SCI rehabilitation centers where the BR to FPL surgery is performed on a routine basis. PARTICIPANTS: Thirty-eight arms from individuals with C5-7 level SCI injury who underwent BR to FPL transfer surgery (N=34). INTERVENTION: Conventional therapy according to established protocol in each center. MAIN OUTCOME MEASURES: The frequency of specific activities and their time of initiation (relative to surgery) were expressed as means and 95% confidence intervals. Outcome measures included pinch strength and the Canadian Occupational Performance Measure (COPM). Spearman rank-order correlations determined significant relations between pinch strength and components of therapy. RESULTS: There was similarity in the key components of therapy and in the progression of activities. Early cast removal was associated with pinch force (Spearman ρ=-.40, P=.0269). Pinch force was associated with improved COPM performance (Spearman ρ=.48, P=.0048) and satisfaction (Spearman ρ=.45, P=.0083) scores. CONCLUSIONS: Initiating therapy early after surgery is beneficial after BR to FPL surgery. Postoperative therapy protocols have the potential to significantly influence the outcome of tendon transfers after tetraplegia.

Unexpected recovery after robotic locomotor training at physiologic stepping speed: a single-case design.

OBJECTIVES: To investigate the effect of walking speed on the emergence of locomotor electromyogram (EMG) patterns in an individual with chronic incomplete spinal cord injury (SCI), and to determine whether central pattern generator activity during robotic locomotor training (RLT) transfers to volitional EMG activity during overground walking. DESIGN: Single-case (B-A-B; experimental treatment-withdrawal-experimental treatment) design. SETTING: Freestanding rehabilitation research center. PARTICIPANT: A 50-year-old man who was nonambulatory for 16 months after incomplete SCI (sub-T11). INTERVENTIONS: The participant completed two 6-week blocks of RLT, training 4 times per week for 30 minutes per session at walking speeds up to 5km/h (1.4m/s) over continuous bouts lasting up to 17 minutes. MAIN OUTCOME MEASURES: Surface EMG was recorded weekly during RLT and overground walking. The Walking Index for Spinal Cord Injury (WISCI-II) was assessed daily during training blocks. RESULTS: During week 4, reciprocal, patterned EMG emerged during RLT. EMG amplitude modulation revealed a curvilinear relationship over the range of walking speeds from 1.5 to 5km/h (1.4m/s). Functionally, the participant improved from being nonambulatory (WISCI-II 1/20), to walking overground with reciprocal stepping using knee-ankle-foot orthoses and a walker (WISCI-II 9/20). EMG was also observed during overground walking. These functional gains were maintained greater than 4 years after locomotor training (LT). CONCLUSIONS: Here we report an unexpected course of locomotor recovery in an individual with chronic incomplete SCI. Through RLT at physiologic walking speeds, it was possible to activate the central pattern generator even 16 months postinjury. Further, to a certain degree, improvements from RLT transferred to overground walking. Our results suggest that LT-induced changes affect the central pattern generator and allow supraspinal inputs to engage residual spinal pathways.