Resistance Training to Improve Strength and Functional Trunk Stability in Adults With Paraplegia
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 发起方
- 入组人数
- 11
- 主要终点
- Change in Balance
研究概览
简要总结
The purpose of this study is to examine the effectiveness of an 8- week resistance training routine to improve functional trunk strength, muscle activation, and physical functioning in exercise in 30 adults with paraplegic SCI. This study will also examine outcomes of confidence in one's ability to avoid falling during balance challenges, and self-efficacy for participating in exercise activity.
详细描述
I. BACKGROUND AND SIGNIFICANCE Trunk stability and mobility are essential to engage in everyday life. In general, adults in the United State have weak "core" or trunk strength, resulting from weak abdominal and back musculature as well as weak muscles that assist in moving the trunk. After a spinal cord injury (SCI), the trunk becomes even less stable as there are fewer innervated muscles available to support trunk control and movement. In the absence of strong or innervated trunk-stabilizing muscles, adults with paraplegia may use compensatory patterns of maintaining an upright posture during balance challenges, which could lead to pain and musculoskeletal injury.
For these adults with paraplegia, dynamic seated postural control is greatly needed during wheelchair mobility, transfers, and safe performance of activities of daily living. This trunk control enables the individual to bend down, lean from side to side, and recover from these positions without fear of falling. Additionally, increasing trunk strength and posture and control may result in enhanced functional independence, with greater range of motion and ability to efficiently mobilize the upper extremities.
Evidence clearly indicates that strength and function declines in adults with chronic SCI can be mitigated by regular exercise, and the ability to stabilize the trunk has been thought to increase during upper body resistance training among adults with chronic paraplegia. Effective interventions that enhance trunk control and strength in this population are lacking, with preliminary studies including trunk strengthening as a preparatory activity for assisted ambulation. Furthermore, trunk strengthening is not addressed as a preventive intervention in rehabilitation for adults with paraplegia, though it is important to train whichever trunk muscles are available to support functional independence and safety.
The purpose of this study is to examine the effectiveness of an 8- week resistance training routine to improve functional trunk strength, muscle activation, and physical functioning in exercise in 30 adults with paraplegic SCI. This study will also examine outcomes of confidence in one's ability to avoid falling during balance challenges, and self-efficacy for participating in exercise activity. Participants will serve as their own control in this pre-post design.
II. SPECIFIC AIMS
研究设计
- 研究类型
- Interventional
- 分配方式
- Na
- 干预模型
- Single Group
- 主要目的
- Prevention
- 盲法
- None
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •To be included in the study, all subjects must be adults (>18 years of age) and:
- •Be in good health (asymptomatic for acute treatable illness)
- •Be able to understand, communicate with and be understood by research personnel and interpreters
- •Be interested in participating and provide informed consent
- •Have a SCI with residual deficits (AIS A, B, C), and from the neurological level of T2 and lower to allow at least partial use of trunk muscles
- •Use a wheelchair as primary means of mobility (≥6 hours/day)
排除标准
- •Participants must not be enrolled in any strengthening protocol or rehabilitation therapy for strengthening during the time of the study. Participants must not have serious comorbidities that could interfere with the ability to participate in an exercise program (musculoskeletal, cardiovascular, and neurological [other than SCI]). Specifically, participants will be excluded if they have: 1) Musculoskeletal injuries that have not healed completely, 2) Had heart surgery or are status post-myocardial infarction (MI) in the last 4 to 6 months, 3) Unstable angina, 4) Uncontrolled hypertension (systolic blood pressure ≥160 mm Hg and/or diastolic blood pressure ≥100 mm Hg), 5) uncontrolled dysrhythmias, 6) Recent history of congestive heart failure that has not been evaluated and effectively treated, 7) Severe stenotic or regurgitant valvular disease, or 8) Hypertrophic cardiomyopathy.
结局指标
主要结局
Change in Balance
时间窗: Baseline, and weeks 4 & 8
Items from the Activity-based Balance Level Evaluation (ABLE) Sitting Balance subscale: Participants perform the following activities, which are scored according to ability and quality of movement: 1.Sitting with back unsupported but feet supported on floor or on a foot stool; 2. Modified functional reach test; 3. Seated lateral reach; 4. Pick up an object from the floor from a seated position; 5. Scooting forward in a chair; and 6. External perturbations in sitting. This measure typically takes 15 minutes to administer.
Change in Strength
时间窗: . Testing will be repeated at weeks 4 & 8. Maximum strength values established during Baseline and 4th week testing will be used to calculate the exercise workloads for the next four weeks of training
Maximum strength: Subjects will be given a set of ten repetitions with a light weight, as a warm-up prior to testing. The weight stack will then be adjusted to a load intended to induce muscular fatigue within ten repetitions. The subject will perform as many complete repetitions as possible. Once the subject fails to perform a repetition through the complete range of motion, they will have reached fatigue, and the weight and number of repetitions will be recorded. If the number of repetitions exceeds ten, then the weight will be increased and the subject will be given a three-minute rest interval before repeating the test. A regression equation 4 will then be used to calculate maximum strength
次要结局
- Change in SCI Exercise Self-Efficacy Scale (SCI ESES)(Baseline and 8 weeks)
- Change in SCI-Functional Index (SCI-FI)(Baseline and 8 weeks)
- Change in Falls Concern Scale for people with SCI (SCI-FCS)(Baseline and 8 weeks)
研究者
Hannah W Mercier
Postdoctoral Research Fellow
Spaulding Rehabilitation Hospital