Effect of intensive exercise therapy with and without gravity compensation on upper extremity function in subjects with chronic cervical spinal cord injury.

Rationale:

The consequences of Spinal Cord Injury (SCI) are diverse and complex. Subjects with a tetraplegia have impaired upper extremity function limiting the ability of individuals with cervical SCI to perform manual activities of daily living. Training of upper extremity function in tetraplegics is of great importance. Conventional training methods based on motor relearning principles require great physical effort from the patient which can limit the intensity of the training due to fatigue. New technological innovations in rehabilitation make it easier to control and report these variables. Studies have shown that by using a mechanical device to counteract the influence of gravity, active arm movements may be facilitated in stroke patients by reducing the required muscle activity to maintain a particular arm orientation. According to principles of motor relearning in stroke and SCI patients gravity compensation in addition to intensive exercise therapy could result in a greater improvement in upper extremity function.


Objective:

To investigate the effect of gravity compensation in combination with intensive exercise therapy on upper extremity function in subjects with SCI. Hypothesis: gravity compensation in addition to intensive exercise therapy will result in a greater improvement in upper extremity function compared to intensive exercise therapy alone.


Study design:

Cross-over, single blinded experimental design.


Study population:
Ten subjects with chronic SCI, between 18-65 years old with SCI level C5-C7, ASIA A-C.


Intervention:
A mechanical, passive device called Freebal will be used to counteract the influence of gravity on the upper extremity. An intensive exercise therapy program consisting of training of the upper extremity function by an occupational therapist for one and a half hours three times a week will be applied with and without gravity compensation for the duration of two periods of four weeks.


Main study parameters/endpoints:
The main study parameter is the change in upper extremity function using two VLT tasks, seven WMFT tasks and the sf-QIF. Change in motor control parameters will be measured using surface EMG and VICON.

Gravity compensation in addition to intensive exercise therapy will result in a greater improvement in upper extremity function compared to intensive exercise practice without gravity compensation.

The subjects were tested at the start of the training, after 4 and 8 weeks of training and finaly an follow-up measurement after 4 weeks.

A mechanical, passive device called Freebal will be used to counteract the influence of gravity on the upper extremity. An intensive exercise therapy program consisting of training of the upper extremity function for 1.5 hours 3 times a week will be applied 4 weeks with and 4 weeks without gravity compensation.