Topics in Spinal Cord Injury Rehabilitation, Apr 1, 2012
Objective: To compare the effects of inspiratory resistance training (IRT) and isocapnic hyperpne... more Objective: To compare the effects of inspiratory resistance training (IRT) and isocapnic hyperpnea (IH) versus incentive spirometry (placebo) on respiratory function, voice, and quality of life in individuals with motor complete tetraplegia. Methods: In this randomized controlled trial, 24 individuals with traumatic, motor complete (AIS A) tetraplegia (C5-C8), 6 to 8 months post injury, were randomly assigned to 1 of 3 groups. They completed either 90 repetitions of IRT, 10 minutes of IH, or 16 repetitions of placebo training in 32 supervised training sessions over 8 weeks. Before and after the training period, the following tests were performed: bodyplethysmography, inspiratory and expiratory muscle strength, subjective breathing parameters using the visual analogue scale (VAS), voice measurements, and an adapted SF-12 quality of life questionnaire. A Friedman test and Cohen's effect sizes for IRT and IH versus placebo were calculated for differences between pre-and posttraining values. Results: Compared to placebo training, IRT showed high effect sizes for inspiratory muscle strength (d = 1.19), VAS values of "cleaning the nose" (d = 0.99), and the physical component of subjective quality of life (d = 0.84). IH compared to placebo training showed only medium and low effect sizes. The Friedman analysis showed a significant effect for IRT versus placebo on inspiratory muscle strength (P = .030). Neither all other parameters of respiratory function nor voice measurements, subjective breathing parameters, or quality of life were significantly improved by one of the tested training methods. Conclusion: In individuals with motor complete tetraplegia, inspiratory muscle strength can be improved by IRT. Therefore, IRT is advantageous compared to IH for this group of patients and during the first year post injury.
Results: Of the 252 participants included, 62% were at risk for malnutrition 3 months post injury... more Results: Of the 252 participants included, 62% were at risk for malnutrition 3 months post injury and 40% at discharge (p = 0.000). Moderate to high risk of malnutrition was found regardless of age and BMI. The highest odds for an increased risk at 3 months post injury was identified in ventilator-dependent persons (OR 10.2). At discharge from inpatient rehabilitation, pressure injury (OR 16.3) was the most prominent risk factor. Conclusion: In the population with SCI the risk of malnutrition is widespread during inpatient rehabilitation, but also at discharge. Ventilated persons and persons with pressure injuries are clear risk groups and need special attention. Based on these findings and the known negative impact of malnutrition on clinical outcomes, the awareness of malnutrition should be increased in the population with SCI. Therefore, a regular and standardized screening of the malnutrition risk is highly recommended.
Study design: The study is conducted on the basis of comparative-repeated measures. Objectives: T... more Study design: The study is conducted on the basis of comparative-repeated measures. Objectives: The objective of this study is to assess the reliability of non-invasive cardiac output (CO) measurements in individuals with tetraplegia (TP) at rest and during exercise using Innocor, and to test the hypothesis that CO measurements are less reliable in TP than in able-bodied (AB) individuals. Setting: Ambulatory volunteers, Switzerland. Methods: Nine male motor-complete TP (C5-C7) and nine pair-matched AB performed repeated CO measurements at rest and during submaximal arm-crank and wheelchair exercises in four different test sessions. Within-and between-day reliabilities were compared between TP and AB. Results: Mean differences between measurements at rest (TP vs AB, within-day: 0.1±0.5 vs 0.2 ± 0.6 l min À1 , between-day: À0.7 ± 0.6 vs À0.1 ± 0.8 l min À1), during arm-crank (TP vs AB, withinday: 0.1±0.9 vs 0.5±0.7 l min À1 , between-day: À0.3±1.1 vs 0.0±1.1 l min À1) and wheelchair exercises (TP vs AB, within-day: 0.3 ± 1.2 vs-0.1 ± 0.8 l min À1 , between-day: 0.1 ± 1.1 vs 0.5±0.9 l min À1) were not significantly different between TP and AB (all P40.05). Coefficients of variation in TP (within-day, rest: 6.8%, arm-crank: 9.6% and wheelchair: 10.8%; between-day, rest: 11.9%, arm-crank: 11.2% and wheelchair: 10.3%) and in AB (within-day, rest: 7.7%, arm crank: 6.8% and wheelchair: 6.0%; between-day, rest: 9.2%, arm crank: 8.5% and wheelchair: 8.0%) indicated acceptable reliability. Conclusion: In contrast to our hypothesis, we found non-invasive CO measurements using Innocor to be as reliable in TP as they are in AB. Consequently, Innocor can be recommended for repeated assessments of CO in TP within routine diagnostics or for evaluation of training progress.
BACKGROUND: Mechanical ventilation is widely used in ICU patients as a lifesaving intervention. D... more BACKGROUND: Mechanical ventilation is widely used in ICU patients as a lifesaving intervention. Diaphragmatic atrophy and thinning occur from lack of contractions of the diaphragm during mechanical ventilation. It may prolong weaning and increase the risk of respiratory complications. Noninvasive electromagnetic stimulation of the phrenic nerves may ameliorate the atrophy seen with ventilation. The objective of this study was to show that noninvasive repetitive electromagnetic stimulation is safe, feasible, and effective to stimulate the phrenic nerves in both awake individuals and anesthetized patients. METHODS: A single-center study with 10 subjects overall, 5 awake volunteers and 5 anesthetized subjects. We used a prototype electromagnetic, noninvasive, simultaneous bilateral phrenic nerve stimulation device in both groups. In the awake volunteers, we assessed time-to-first capture of the phrenic nerves and safety measures, such as pain, discomfort, dental paresthesia, and skin irritation. In the anesthetized subjects, time-to-first capture as well as tidal volumes and airway pressures at 20%, 30%, and 40% stimulation intensity were assessed. RESULTS: Diaphragmatic capture was achieved in all the subjects within a median (range) of 1 min (1 min to 9 min 21 s) for the awake subjects and 30 s (20 s to 1 min 15 s) for the anesthetized subjects. There were no adverse or severe adverse events in either group, nor any dental paresthesia, skin irritation, or subjective pain in the stimulated area. Tidal volumes increased in all the subjects in response to simultaneous bilateral phrenic nerve stimulation and increased gradually with increasing stimulation intensity. Airway pressures corresponded to spontaneous breathing of $2 cm H 2 O. CONCLUSIONS: Noninvasive phrenic nerve stimulation can be safely performed in awake and anesthetized individuals. It was feasible and effective in stimulating the diaphragm by induction of physiologic and scalable tidal volumes with minimum positive airway pressures.
51 Chapter 3 Time-Courses of Lung Function and Respiratory Muscle Pressure Generating Capacity af... more 51 Chapter 3 Time-Courses of Lung Function and Respiratory Muscle Pressure Generating Capacity after Spinal Cord Injury: A Prospective Cohort Study Gabi Mueller Sonja de Groot Lucas van der Woude Maria TE Hopman Journal of Rehabilitation Medicine, 2008; 40: 269 ...
AIMS OF THE STUDY Examinations and assessments can be used to ensure good quality rehabilitation.... more AIMS OF THE STUDY Examinations and assessments can be used to ensure good quality rehabilitation. Within the framework of a quality improvement project, the aims of the current analysis were: first, to analyse the time points of selected examinations and assessments in the rehabilitation process of patients with a newly acquired spinal cord injury. Second, to identify differences between the subgroups with different aetiologies, levels and completeness of spinal cord injuries. And third, to compare the examinations and assessments performed with the guideline recommendations and to use discrepancies as a starting point for a quality improvement project. METHODS In this retrospective chart analysis, adult patients with a newly acquired spinal cord injury who were admitted to a single specialised acute care and rehabilitation clinic for their first rehabilitation between December 2013 and December 2014 were included and assessed until discharge. The main objective was to assess the ti...
Pneumonia continues to complicate the course of spinal cord injury (SCI). Currently, clinicians a... more Pneumonia continues to complicate the course of spinal cord injury (SCI). Currently, clinicians and policy-makers are faced with only limited numbers of pneumonia incidence in the literature. A systematic review of the literature was undertaken to provide an objective synthesis of the evidence about the incidence of pneumonia in persons with SCI. Incidence was calculated per 100 person-days, and meta-regression was used to evaluate the influence of the clinical setting, the level of injury, the use of mechanical ventilation, the presence of tracheostomy, and dysphagia. For the meta-regression we included 19 studies. The incidence ranged from 0.03 to 7.21 patients with pneumonia per 100 days. The main finding of this review is that we found large heterogeneity in the reporting of the incidence, and we therefore should be cautious with interpreting the results. In the multivariable meta-regression, the incidence rate ratios showed very wide confidence intervals, which does not allow a...
The aim of this study was to describe the needs and research priorities of Swiss children/adolesc... more The aim of this study was to describe the needs and research priorities of Swiss children/adolescents and young adults (from here, “young people”) with spinal cord injury/disorder (SCI/D) or spina bifida (SB) and their parents in the health and life domains as part of the international Pan-European Pediatric Spinal Cord Injury (PEPSCI) collaboration. Surveys included queries about the satisfaction, importance, research priorities, quality of life (QoL), and characteristics of the young people. Fifty-three surveys with corresponding parent-proxy reports were collected between April and November 2019. The self-report QoL sum scores from young people with SCI/D and SB were 77% and 73%, respectively. Parent-proxy report QoL sum scores were lower, with 70% scores for parents of young people with SCI/D and 64% scores for parents of young people with SB. “Having fun”, “relation to family members”, and “physical functioning” were found to be highly important for all young people. “Physical ...
IntroductionPneumonia is one of the leading complications and causes of death after a spinal cord... more IntroductionPneumonia is one of the leading complications and causes of death after a spinal cord injury (SCI). After a cervical or thoracic lesion, impairment of the respiratory muscles decreases respiratory function, which increases the risk of respiratory complications. Pneumonia substantially reduces patient’s quality of life, may prolong inpatient rehabilitation time, increase healthcare costs or at worse, lead to early death. Respiratory function and coughing can be improved through various interventions after SCI, but the available evidence as to which aspect of respiratory care should be optimised is inconclusive. Furthermore, ability of respiratory function parameters to predict pneumonia risk is insufficiently established. This paper details the protocol for a large-scale, multicentre research project that aims to evaluate the ability of parameters of respiratory function to predict and understand variation in inpatient risk of pneumonia in SCI.Methods and analysisRESCOM, ...
Objective: To determine and compare haemodynamic responses at maximal arm-crank (ACE) and wheelch... more Objective: To determine and compare haemodynamic responses at maximal arm-crank (ACE) and wheelchair exercise (WCE) in individuals with cervical spinal cord injury and pair-matched able-bodied individuals. Methods: Nine male, motor-complete cervical spinal cord injured and 9 able-bodied individuals performed graded, maximal ACE and WCE. Cardiac output, heart rate, and stroke volume were determined at rest and at maximal exercise in cervical spinal cord injured individuals. In able-bodied individuals, measurements were performed at rest and at the maximal workload of the matched cervical spinal cord injured individuals. Results: In cervical spinal cord injured, maximal cardiac output (ACE 7.4 (standard deviation (SD) 1.6); WCE 7.3 (SD 2.1) l/min) and heart rate (ACE 101 (SD 22); WCE 103 (SD 27) bpm) increased significantly compared with rest (4.6 (SD 1.0) l/min; 65 (SD 12) bpm), while stroke volume (ACE 77 (SD 22); WCE 73 (SD 21) ml) did not differ from rest (73 (SD 20) ml). In able-bodied individuals, cardiac output (rest 4.8 (SD 1.4); ACE 10.7 (SD 1.8); WCE 10.3 (SD 2.2) l/min), heart rate (rest 68 (SD 10); ACE 103 (SD 27); WCE 109 (SD 27) bpm), and stroke volume (rest 70 (SD 10); ACE 105 (SD 20); WCE 96 (SD 17) ml) increased significantly compared with rest. Cardiac output and stroke volume were significantly lower in cervical spinal cord injured compared with able-bodied individuals at the same workloads. Conclusion: Haemodynamic responses to maximal exercise were similar for both exercise modes in individuals with cervical spinal cord injury. The lower cardiac output in individuals with cervical spinal cord injury compared with able-bodied individuals at equivalent workloads reflects the inability of the circulatory system to increase stroke volume.
The aim of our study was to establish the exercise intensity with the highest fat oxidation rate ... more The aim of our study was to establish the exercise intensity with the highest fat oxidation rate in spinal cord-injured (SCI) people compared with able-bodied subjects on a stationary ergometer in order to provide recommendations for ergometer training. Ten endurance-trained wheelchair athletes [ VO(2peak,armcranking ) 35.9 (5.7) ml x kg(-1) min(-1); mean (SE)] and ten endurance-trained cyclists [ VO(2peak,cycling ) 62.3 (4.6) ml x kg(-1) min(-1)] were studied over 20 min at 55%, 65% and 75% VO(2peak,armcranking) or VO(2peak,cycling) on a cycling ergometer, respectively, in order to find the intensity with the highest fat oxidation. Total energy expenditure, and highest oxidation rate for fat and carbohydrate were highest at 75% VO(2peak,armcranking) and VO(2peak,cycling). Relative fat oxidation was highest at 55% VO(2peak,armcranking) and VO(2peak,cycling). Wheelchair athletes showed a tendency for higher lactate concentrations at each intensity compared to cyclists. Well-trained wheelchair athletes and cyclists reach the highest fat oxidation in arm cranking, respectively, in cycling on a stationary ergometer at the same relative intensity of 75% VO(2peak,armcranking) and VO(2peak,cycling). We presume that well-trained wheelchair athletes can perform ergometer training on a stationary ergometer at 75% VO(2peak,armcranking). Results are presented as mean (SE).
Objective: Respiratory muscle endurance of able-bodied persons, assessed by normocapnic hyperpnoe... more Objective: Respiratory muscle endurance of able-bodied persons, assessed by normocapnic hyperpnoea at 70% of their maximal voluntary ventilation, usually ranges from 10 to 20 minutes. The aim of this study was to determine the level of ventilation that patients with paraplegia and tetraplegia can sustain for 10 Á 20 minutes to later be used as the guideline for respiratory muscle endurance training. Design: Pilot study; cross-over setting. Subjects: Two groups, 8 patients with paraplegia and 6 with tetraplegia. Methods: Respiratory muscle endurance tests were performed at 3 different intensities of normocapnic hyperpnoea, i.e. 20%, 40% and 60% maximal voluntary ventilation. Subjects performed partial re-breathing from a bag to assure normocapnia. Respiratory endurance was separately analysed for patients with paraplegia and tetraplegia. Results: Mean respiratory endurance times were 46.0, 18.9 and 4.2 minutes at 20%, 40% and 60% maximal voluntary ventilation in patients with tetraplegia and 51.8, 38.8 and 12.2 minutes in patients with paraplegia. The duration differed significantly at 60% maximal voluntary ventilation between the groups. Conclusion: Minute ventilation to perform respiratory muscle endurance training can be set at around 40% of maximal voluntary ventilation for patients with tetraplegia and around 60% of maximal voluntary ventilation for patients with paraplegia, as these levels can be sustained for 10 Á 20 minutes.
27 Background: Secretion removal is a key issue in patients with respiratory diseases and 28 know... more 27 Background: Secretion removal is a key issue in patients with respiratory diseases and 28 known to be most effective at vibration frequencies around 13 Hz and with the greatest 29 amplitudes possible. The Acapella ® devices and the water bottle are used for secretion 30 removal in daily clinical practice but without detailed knowledge on optimal settings. The aim 31 of this study was to evaluate the three different Acapella ® devices and the water bottle at 32 various settings and flows to determine the optimal device(s) and setting(s) for effective 33 secretion removal. 34 Methods: Three different Acapella ® devices were tested at flows of 6, 12, 20, 30, 40 and 50 35 L/min and at all five settings. The water bottle was filled with 5, 10 or 15 cm of water and 36 tested at flows of 3, 6, 10, 12 and 20 L/min. For all devices and combinations of settings, we 37 measured the frequency and amplitude of the vibrations as well as the required pressure to 38 generate vibrations. 39 Resul...
The Conconi test is an incremental exercise test characterised by stages of equal work. For analy... more The Conconi test is an incremental exercise test characterised by stages of equal work. For analysis PO (power output) and HR (heart rate) are used. The deflection point of the HR/PO graph marks the point where the linear relation between PO and HR changes to a curvilinear one. HR at deflection point correlates with the anaerobic threshold. The objective of this study was to evaluate the reproducibility of HR at deflection point of tests in cycling. In literature, only one study with tests in running examined the reproducibility of the Conconi test. Nineteen trained subjects performed 4 Conconi tests on an electronically breaked cycle ergometer on different days. Finally, 68 graphs of the PO/HR relationship were analysed by computer software as well as by three different observers. HRs at deflection point of the 4 Conconi tests of every subject were compared and coefficients of variation (CVs) were calculated. Mean CVs of HR at deflection point per subject were 3.36% for the computer program and for the three observers 2.99%, 2.51% and 2.53%, respectively. CVs below 3.5% represent a good reproducibility. The agreement between the three observers was statistically good with an ICC (intraclass correlation coefficients) of 0.828. The mean range of HR at deflection point per Conconi test comparing the three observers was 4.5 bpm corresponding 2.7% of HR at deflection point.
Study design Qualitative study Objectives The aim of this study was to evaluate peer counselling ... more Study design Qualitative study Objectives The aim of this study was to evaluate peer counselling during inpatient rehabilitation of patients with spinal cord injuries (SCI). This article describes the experience with peer counselling from the perspective of patients with SCI as well as from the perspective of the peer counsellors. Setting Inpatient rehabilitation of SCI in the Swiss Paraplegic Centre. Methods Six interviews with patients and one focus group interview with professional peer counsellors have been evaluated using qualitative content analysis. Results Patients experienced the peer counselling sessions as solution-oriented, practical, motivating and especially appreciated the authentic, open demeanor of the peer counsellors. Conversations about recreational activities, hobbies and interests supported the development of interpersonal relationships. Peer counsellors experienced the initial visits with patients with high level quadriplegia as a special challenge. The regular presence of all peer counsellors in the hospital facilitated an easier exchange with the patients. Conclusion Patients feel empowered by peer counselling. Special attention should be placed on the timing of the initial visit. Unplanned meetings between patient and peers seem to be essential and highly valued. Peer counsellors are confronted with stressful situations in their work, therefore the need for support and training of peer counsellors should be further investigated.
Topics in Spinal Cord Injury Rehabilitation, Apr 1, 2012
Objective: To compare the effects of inspiratory resistance training (IRT) and isocapnic hyperpne... more Objective: To compare the effects of inspiratory resistance training (IRT) and isocapnic hyperpnea (IH) versus incentive spirometry (placebo) on respiratory function, voice, and quality of life in individuals with motor complete tetraplegia. Methods: In this randomized controlled trial, 24 individuals with traumatic, motor complete (AIS A) tetraplegia (C5-C8), 6 to 8 months post injury, were randomly assigned to 1 of 3 groups. They completed either 90 repetitions of IRT, 10 minutes of IH, or 16 repetitions of placebo training in 32 supervised training sessions over 8 weeks. Before and after the training period, the following tests were performed: bodyplethysmography, inspiratory and expiratory muscle strength, subjective breathing parameters using the visual analogue scale (VAS), voice measurements, and an adapted SF-12 quality of life questionnaire. A Friedman test and Cohen's effect sizes for IRT and IH versus placebo were calculated for differences between pre-and posttraining values. Results: Compared to placebo training, IRT showed high effect sizes for inspiratory muscle strength (d = 1.19), VAS values of "cleaning the nose" (d = 0.99), and the physical component of subjective quality of life (d = 0.84). IH compared to placebo training showed only medium and low effect sizes. The Friedman analysis showed a significant effect for IRT versus placebo on inspiratory muscle strength (P = .030). Neither all other parameters of respiratory function nor voice measurements, subjective breathing parameters, or quality of life were significantly improved by one of the tested training methods. Conclusion: In individuals with motor complete tetraplegia, inspiratory muscle strength can be improved by IRT. Therefore, IRT is advantageous compared to IH for this group of patients and during the first year post injury.
Results: Of the 252 participants included, 62% were at risk for malnutrition 3 months post injury... more Results: Of the 252 participants included, 62% were at risk for malnutrition 3 months post injury and 40% at discharge (p = 0.000). Moderate to high risk of malnutrition was found regardless of age and BMI. The highest odds for an increased risk at 3 months post injury was identified in ventilator-dependent persons (OR 10.2). At discharge from inpatient rehabilitation, pressure injury (OR 16.3) was the most prominent risk factor. Conclusion: In the population with SCI the risk of malnutrition is widespread during inpatient rehabilitation, but also at discharge. Ventilated persons and persons with pressure injuries are clear risk groups and need special attention. Based on these findings and the known negative impact of malnutrition on clinical outcomes, the awareness of malnutrition should be increased in the population with SCI. Therefore, a regular and standardized screening of the malnutrition risk is highly recommended.
Study design: The study is conducted on the basis of comparative-repeated measures. Objectives: T... more Study design: The study is conducted on the basis of comparative-repeated measures. Objectives: The objective of this study is to assess the reliability of non-invasive cardiac output (CO) measurements in individuals with tetraplegia (TP) at rest and during exercise using Innocor, and to test the hypothesis that CO measurements are less reliable in TP than in able-bodied (AB) individuals. Setting: Ambulatory volunteers, Switzerland. Methods: Nine male motor-complete TP (C5-C7) and nine pair-matched AB performed repeated CO measurements at rest and during submaximal arm-crank and wheelchair exercises in four different test sessions. Within-and between-day reliabilities were compared between TP and AB. Results: Mean differences between measurements at rest (TP vs AB, within-day: 0.1±0.5 vs 0.2 ± 0.6 l min À1 , between-day: À0.7 ± 0.6 vs À0.1 ± 0.8 l min À1), during arm-crank (TP vs AB, withinday: 0.1±0.9 vs 0.5±0.7 l min À1 , between-day: À0.3±1.1 vs 0.0±1.1 l min À1) and wheelchair exercises (TP vs AB, within-day: 0.3 ± 1.2 vs-0.1 ± 0.8 l min À1 , between-day: 0.1 ± 1.1 vs 0.5±0.9 l min À1) were not significantly different between TP and AB (all P40.05). Coefficients of variation in TP (within-day, rest: 6.8%, arm-crank: 9.6% and wheelchair: 10.8%; between-day, rest: 11.9%, arm-crank: 11.2% and wheelchair: 10.3%) and in AB (within-day, rest: 7.7%, arm crank: 6.8% and wheelchair: 6.0%; between-day, rest: 9.2%, arm crank: 8.5% and wheelchair: 8.0%) indicated acceptable reliability. Conclusion: In contrast to our hypothesis, we found non-invasive CO measurements using Innocor to be as reliable in TP as they are in AB. Consequently, Innocor can be recommended for repeated assessments of CO in TP within routine diagnostics or for evaluation of training progress.
BACKGROUND: Mechanical ventilation is widely used in ICU patients as a lifesaving intervention. D... more BACKGROUND: Mechanical ventilation is widely used in ICU patients as a lifesaving intervention. Diaphragmatic atrophy and thinning occur from lack of contractions of the diaphragm during mechanical ventilation. It may prolong weaning and increase the risk of respiratory complications. Noninvasive electromagnetic stimulation of the phrenic nerves may ameliorate the atrophy seen with ventilation. The objective of this study was to show that noninvasive repetitive electromagnetic stimulation is safe, feasible, and effective to stimulate the phrenic nerves in both awake individuals and anesthetized patients. METHODS: A single-center study with 10 subjects overall, 5 awake volunteers and 5 anesthetized subjects. We used a prototype electromagnetic, noninvasive, simultaneous bilateral phrenic nerve stimulation device in both groups. In the awake volunteers, we assessed time-to-first capture of the phrenic nerves and safety measures, such as pain, discomfort, dental paresthesia, and skin irritation. In the anesthetized subjects, time-to-first capture as well as tidal volumes and airway pressures at 20%, 30%, and 40% stimulation intensity were assessed. RESULTS: Diaphragmatic capture was achieved in all the subjects within a median (range) of 1 min (1 min to 9 min 21 s) for the awake subjects and 30 s (20 s to 1 min 15 s) for the anesthetized subjects. There were no adverse or severe adverse events in either group, nor any dental paresthesia, skin irritation, or subjective pain in the stimulated area. Tidal volumes increased in all the subjects in response to simultaneous bilateral phrenic nerve stimulation and increased gradually with increasing stimulation intensity. Airway pressures corresponded to spontaneous breathing of $2 cm H 2 O. CONCLUSIONS: Noninvasive phrenic nerve stimulation can be safely performed in awake and anesthetized individuals. It was feasible and effective in stimulating the diaphragm by induction of physiologic and scalable tidal volumes with minimum positive airway pressures.
51 Chapter 3 Time-Courses of Lung Function and Respiratory Muscle Pressure Generating Capacity af... more 51 Chapter 3 Time-Courses of Lung Function and Respiratory Muscle Pressure Generating Capacity after Spinal Cord Injury: A Prospective Cohort Study Gabi Mueller Sonja de Groot Lucas van der Woude Maria TE Hopman Journal of Rehabilitation Medicine, 2008; 40: 269 ...
AIMS OF THE STUDY Examinations and assessments can be used to ensure good quality rehabilitation.... more AIMS OF THE STUDY Examinations and assessments can be used to ensure good quality rehabilitation. Within the framework of a quality improvement project, the aims of the current analysis were: first, to analyse the time points of selected examinations and assessments in the rehabilitation process of patients with a newly acquired spinal cord injury. Second, to identify differences between the subgroups with different aetiologies, levels and completeness of spinal cord injuries. And third, to compare the examinations and assessments performed with the guideline recommendations and to use discrepancies as a starting point for a quality improvement project. METHODS In this retrospective chart analysis, adult patients with a newly acquired spinal cord injury who were admitted to a single specialised acute care and rehabilitation clinic for their first rehabilitation between December 2013 and December 2014 were included and assessed until discharge. The main objective was to assess the ti...
Pneumonia continues to complicate the course of spinal cord injury (SCI). Currently, clinicians a... more Pneumonia continues to complicate the course of spinal cord injury (SCI). Currently, clinicians and policy-makers are faced with only limited numbers of pneumonia incidence in the literature. A systematic review of the literature was undertaken to provide an objective synthesis of the evidence about the incidence of pneumonia in persons with SCI. Incidence was calculated per 100 person-days, and meta-regression was used to evaluate the influence of the clinical setting, the level of injury, the use of mechanical ventilation, the presence of tracheostomy, and dysphagia. For the meta-regression we included 19 studies. The incidence ranged from 0.03 to 7.21 patients with pneumonia per 100 days. The main finding of this review is that we found large heterogeneity in the reporting of the incidence, and we therefore should be cautious with interpreting the results. In the multivariable meta-regression, the incidence rate ratios showed very wide confidence intervals, which does not allow a...
The aim of this study was to describe the needs and research priorities of Swiss children/adolesc... more The aim of this study was to describe the needs and research priorities of Swiss children/adolescents and young adults (from here, “young people”) with spinal cord injury/disorder (SCI/D) or spina bifida (SB) and their parents in the health and life domains as part of the international Pan-European Pediatric Spinal Cord Injury (PEPSCI) collaboration. Surveys included queries about the satisfaction, importance, research priorities, quality of life (QoL), and characteristics of the young people. Fifty-three surveys with corresponding parent-proxy reports were collected between April and November 2019. The self-report QoL sum scores from young people with SCI/D and SB were 77% and 73%, respectively. Parent-proxy report QoL sum scores were lower, with 70% scores for parents of young people with SCI/D and 64% scores for parents of young people with SB. “Having fun”, “relation to family members”, and “physical functioning” were found to be highly important for all young people. “Physical ...
IntroductionPneumonia is one of the leading complications and causes of death after a spinal cord... more IntroductionPneumonia is one of the leading complications and causes of death after a spinal cord injury (SCI). After a cervical or thoracic lesion, impairment of the respiratory muscles decreases respiratory function, which increases the risk of respiratory complications. Pneumonia substantially reduces patient’s quality of life, may prolong inpatient rehabilitation time, increase healthcare costs or at worse, lead to early death. Respiratory function and coughing can be improved through various interventions after SCI, but the available evidence as to which aspect of respiratory care should be optimised is inconclusive. Furthermore, ability of respiratory function parameters to predict pneumonia risk is insufficiently established. This paper details the protocol for a large-scale, multicentre research project that aims to evaluate the ability of parameters of respiratory function to predict and understand variation in inpatient risk of pneumonia in SCI.Methods and analysisRESCOM, ...
Objective: To determine and compare haemodynamic responses at maximal arm-crank (ACE) and wheelch... more Objective: To determine and compare haemodynamic responses at maximal arm-crank (ACE) and wheelchair exercise (WCE) in individuals with cervical spinal cord injury and pair-matched able-bodied individuals. Methods: Nine male, motor-complete cervical spinal cord injured and 9 able-bodied individuals performed graded, maximal ACE and WCE. Cardiac output, heart rate, and stroke volume were determined at rest and at maximal exercise in cervical spinal cord injured individuals. In able-bodied individuals, measurements were performed at rest and at the maximal workload of the matched cervical spinal cord injured individuals. Results: In cervical spinal cord injured, maximal cardiac output (ACE 7.4 (standard deviation (SD) 1.6); WCE 7.3 (SD 2.1) l/min) and heart rate (ACE 101 (SD 22); WCE 103 (SD 27) bpm) increased significantly compared with rest (4.6 (SD 1.0) l/min; 65 (SD 12) bpm), while stroke volume (ACE 77 (SD 22); WCE 73 (SD 21) ml) did not differ from rest (73 (SD 20) ml). In able-bodied individuals, cardiac output (rest 4.8 (SD 1.4); ACE 10.7 (SD 1.8); WCE 10.3 (SD 2.2) l/min), heart rate (rest 68 (SD 10); ACE 103 (SD 27); WCE 109 (SD 27) bpm), and stroke volume (rest 70 (SD 10); ACE 105 (SD 20); WCE 96 (SD 17) ml) increased significantly compared with rest. Cardiac output and stroke volume were significantly lower in cervical spinal cord injured compared with able-bodied individuals at the same workloads. Conclusion: Haemodynamic responses to maximal exercise were similar for both exercise modes in individuals with cervical spinal cord injury. The lower cardiac output in individuals with cervical spinal cord injury compared with able-bodied individuals at equivalent workloads reflects the inability of the circulatory system to increase stroke volume.
The aim of our study was to establish the exercise intensity with the highest fat oxidation rate ... more The aim of our study was to establish the exercise intensity with the highest fat oxidation rate in spinal cord-injured (SCI) people compared with able-bodied subjects on a stationary ergometer in order to provide recommendations for ergometer training. Ten endurance-trained wheelchair athletes [ VO(2peak,armcranking ) 35.9 (5.7) ml x kg(-1) min(-1); mean (SE)] and ten endurance-trained cyclists [ VO(2peak,cycling ) 62.3 (4.6) ml x kg(-1) min(-1)] were studied over 20 min at 55%, 65% and 75% VO(2peak,armcranking) or VO(2peak,cycling) on a cycling ergometer, respectively, in order to find the intensity with the highest fat oxidation. Total energy expenditure, and highest oxidation rate for fat and carbohydrate were highest at 75% VO(2peak,armcranking) and VO(2peak,cycling). Relative fat oxidation was highest at 55% VO(2peak,armcranking) and VO(2peak,cycling). Wheelchair athletes showed a tendency for higher lactate concentrations at each intensity compared to cyclists. Well-trained wheelchair athletes and cyclists reach the highest fat oxidation in arm cranking, respectively, in cycling on a stationary ergometer at the same relative intensity of 75% VO(2peak,armcranking) and VO(2peak,cycling). We presume that well-trained wheelchair athletes can perform ergometer training on a stationary ergometer at 75% VO(2peak,armcranking). Results are presented as mean (SE).
Objective: Respiratory muscle endurance of able-bodied persons, assessed by normocapnic hyperpnoe... more Objective: Respiratory muscle endurance of able-bodied persons, assessed by normocapnic hyperpnoea at 70% of their maximal voluntary ventilation, usually ranges from 10 to 20 minutes. The aim of this study was to determine the level of ventilation that patients with paraplegia and tetraplegia can sustain for 10 Á 20 minutes to later be used as the guideline for respiratory muscle endurance training. Design: Pilot study; cross-over setting. Subjects: Two groups, 8 patients with paraplegia and 6 with tetraplegia. Methods: Respiratory muscle endurance tests were performed at 3 different intensities of normocapnic hyperpnoea, i.e. 20%, 40% and 60% maximal voluntary ventilation. Subjects performed partial re-breathing from a bag to assure normocapnia. Respiratory endurance was separately analysed for patients with paraplegia and tetraplegia. Results: Mean respiratory endurance times were 46.0, 18.9 and 4.2 minutes at 20%, 40% and 60% maximal voluntary ventilation in patients with tetraplegia and 51.8, 38.8 and 12.2 minutes in patients with paraplegia. The duration differed significantly at 60% maximal voluntary ventilation between the groups. Conclusion: Minute ventilation to perform respiratory muscle endurance training can be set at around 40% of maximal voluntary ventilation for patients with tetraplegia and around 60% of maximal voluntary ventilation for patients with paraplegia, as these levels can be sustained for 10 Á 20 minutes.
27 Background: Secretion removal is a key issue in patients with respiratory diseases and 28 know... more 27 Background: Secretion removal is a key issue in patients with respiratory diseases and 28 known to be most effective at vibration frequencies around 13 Hz and with the greatest 29 amplitudes possible. The Acapella ® devices and the water bottle are used for secretion 30 removal in daily clinical practice but without detailed knowledge on optimal settings. The aim 31 of this study was to evaluate the three different Acapella ® devices and the water bottle at 32 various settings and flows to determine the optimal device(s) and setting(s) for effective 33 secretion removal. 34 Methods: Three different Acapella ® devices were tested at flows of 6, 12, 20, 30, 40 and 50 35 L/min and at all five settings. The water bottle was filled with 5, 10 or 15 cm of water and 36 tested at flows of 3, 6, 10, 12 and 20 L/min. For all devices and combinations of settings, we 37 measured the frequency and amplitude of the vibrations as well as the required pressure to 38 generate vibrations. 39 Resul...
The Conconi test is an incremental exercise test characterised by stages of equal work. For analy... more The Conconi test is an incremental exercise test characterised by stages of equal work. For analysis PO (power output) and HR (heart rate) are used. The deflection point of the HR/PO graph marks the point where the linear relation between PO and HR changes to a curvilinear one. HR at deflection point correlates with the anaerobic threshold. The objective of this study was to evaluate the reproducibility of HR at deflection point of tests in cycling. In literature, only one study with tests in running examined the reproducibility of the Conconi test. Nineteen trained subjects performed 4 Conconi tests on an electronically breaked cycle ergometer on different days. Finally, 68 graphs of the PO/HR relationship were analysed by computer software as well as by three different observers. HRs at deflection point of the 4 Conconi tests of every subject were compared and coefficients of variation (CVs) were calculated. Mean CVs of HR at deflection point per subject were 3.36% for the computer program and for the three observers 2.99%, 2.51% and 2.53%, respectively. CVs below 3.5% represent a good reproducibility. The agreement between the three observers was statistically good with an ICC (intraclass correlation coefficients) of 0.828. The mean range of HR at deflection point per Conconi test comparing the three observers was 4.5 bpm corresponding 2.7% of HR at deflection point.
Study design Qualitative study Objectives The aim of this study was to evaluate peer counselling ... more Study design Qualitative study Objectives The aim of this study was to evaluate peer counselling during inpatient rehabilitation of patients with spinal cord injuries (SCI). This article describes the experience with peer counselling from the perspective of patients with SCI as well as from the perspective of the peer counsellors. Setting Inpatient rehabilitation of SCI in the Swiss Paraplegic Centre. Methods Six interviews with patients and one focus group interview with professional peer counsellors have been evaluated using qualitative content analysis. Results Patients experienced the peer counselling sessions as solution-oriented, practical, motivating and especially appreciated the authentic, open demeanor of the peer counsellors. Conversations about recreational activities, hobbies and interests supported the development of interpersonal relationships. Peer counsellors experienced the initial visits with patients with high level quadriplegia as a special challenge. The regular presence of all peer counsellors in the hospital facilitated an easier exchange with the patients. Conclusion Patients feel empowered by peer counselling. Special attention should be placed on the timing of the initial visit. Unplanned meetings between patient and peers seem to be essential and highly valued. Peer counsellors are confronted with stressful situations in their work, therefore the need for support and training of peer counsellors should be further investigated.
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