New training modules aimed at improving upper extremity skilled performance in persons with a cervical spinal cord injury

In persons with a cervical spinal cord injury (C-SCI) arm and hand impairments
play a major role in the rehabilitation. The current rehabilitation program
for persons with C-SCI is a comprehensive package in which persons are trained
on function and activity level according to lesion level and lesion
completion. However, the program is not explicitly focused on the client*s
individual needs. Donnelly (2004) describes that patients tend to be more
pro-active if they are involved in the rehabilitation process and that results
of therapy are better if the rehabilitation was client-centred (Wressle
2002). Theories about motor learning emphasise the importance of training
tasks at the level of activities and training the actual skill. (Shumway-Cook
2001). The NVDG considers modifying the rehabilitation program in order to
reduce the length of the inpatients stay, to offer a program that focuses on
the personal needs of each patient and to offer therapy modules.

In this project a specific client-centred task-oriented training module to
improve upper extremity skilled performance in persons with C-SCI will be
developed and evaluated.

The aim of the study is to develop and evaluate a specific client centred
task-oriented training module for upper extremity skilled performance in
persons with C-SCI.

The research questions are:
1. Does an 8-weeks client-centred task-oriented training module for upper
extremity skilled performance improve the specific tasks?
2. Does an 8-weeks client-centred task-oriented training module for upper
extremity skilled performance improve general arm hand skilled performance?
3. Does an 8-weeks client-centred task-oriented training module for upper
extremity skilled performance improve the quality of life?

Methodology

This is a longitudinal intervention study in which 2 groups of persons i.e.
persons with a C-SCI during their active rehabilitation program and persons
with a C-SCI who have finished their active rehabilitation program, will
participate. The amount of progress on arm-hand skilled performance (AHSP)
after the specific training will be assessed. Firstly, results of measurements
on AHSP of the proposed study will be compared with data of earlier research in
which persons received the therapy as usual. Furthermore, data collected
before the start of the patient-dedicated AHSP training program will be
compared to those collected after cessation of this therapy module and at a
follow-up measurement.

Data-analyses

To answer the different research questions data of the 3 measurements moments
will be compared using a Friedman-test. Furthermore, data of the training
group will be compared to data of the reference group using a Mann-Withney-U
test.


Plan of action

In phase 1 (march 2007-march 2008) patients will be recruited. In phase 2
(March 2007-april 2008) participants will be trained. In phase 3 (May
2008-June 2008) data will be analysed. In phase 4 (July 2008-september 2009)
results will be reported.

Intervention consists of an 8 weeks client-centred task-oriented training
module for arm hand skilled performance. Three self-chosen tasks according to
upper extremity performance will be trained.
Progress on specific tasks, on general arm-hand-skilled performance and on
quality of life will be evaluated.

The risks during the project do not exceed the risk associated with normal
daily activities.

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