Functional activity of upper extremities to improve trunk function after chronic incomplete spinal cord injury

van Helden, Joeri F. L. (2024). Functional activity of upper extremities to improve trunk function after chronic incomplete spinal cord injury. University of Birmingham. Ph.D.

Preview

vanHelden2024PhD.pdf
Text
Available under License All rights reserved.
Download (4MB) | Preview

Abstract

A spinal cord injury (SCI) impairs both motor and sensory functions. Improving trunk function is an important factor to increase quality of life for those living with SCI. However, traditional rehabilitation methods in the United Kingdom (UK) can be complex for individuals living with a chronic SCI due to current challenges in the national health services (NHS), trips to exercise clinics for guidance from physiotherapists. These challenges constrain the time available for exercise. Hence, there is a pressing need for innovative rehabilitation strategies for improving trunk function. Arm cycling is a suitable form of exercise that can be performed independently at home without the need of direct feedback from clinicians. With the current challenges for continuing rehabilitation in the chronic phase of SCI, this thesis investigates the effects of a home-based arm cycling program on trunk function in individuals living with chronic SCI.
In the first chapter, the literature was reviewed to define SCI and the trunk, and to describe the neuromuscular and neurophysiological consequences of SCI in the trunk, as well as current approaches to SCI trunk rehabilitation in the UK. Subsequently, therapeutic interventions targeting the trunk musculature in SCI are described, as well as its assessment methodologies such as electromyography (EMG), kinematics and transcranial magnetic stimulation (TMS). Then, the main question and its objective are outlined.
The second chapter describes a reliability study assessing a novel electromyographic method named high-density surface electromyography (HDEMG) that enables measuring the muscle’s spatial characteristics. The reliability of several HDEMG parameters was examined. The results demonstrate that root mean square (RMS), a metric for quantifying muscle activity, and mean frequency were consistently reliable both within and between sessions during voluntary trunk movements and reaching tasks. The reliability of the barycentre, a measure of the centre of the distribution of muscle activity, varied depending on the task. The technique is found to be appropriate to use in intervention studies.
The third chapter reports an experiment characterising the differences in thoracic trunk muscle function between able-bodied individuals (control group) and individuals with an incomplete SCI (SCI group). All participants performed postural tasks and reaching tasks. During postural tasks, the SCI group demonstrated a more caudal distribution of erector spinae muscle activity compared to the control group. During the reaching tasks, distinct patterns of muscle activity were observed in the control group that was absent in the SCI group, highlighting the injury-related differences between the two groups.
The fourth chapter was an observational study to assess the feasibility and effects of a six-week home-based arm cycling exercise training programme on improving trunk control in individuals with chronic SCI. Before and after the exercise programme, the corticospinal excitability was assessed during rest, as well as the activation of the erector spinae muscles during multidirectional reaching tasks and two postural tasks (rapid shoulder flexion task and external perturbation task). Improvements were observed after the exercise programme, including a slightly higher reaching distance during forward reaching and a higher total trajectory of the trunk and centre of pressure during the perturbation task. Furthermore, a higher corticospinal excitability and higher trunk muscle activity were observed in the post-assessment. The exercise programme was found to be feasible, as demonstrated by a high adherence to the exercise.
The fifth chapter describes the preliminary results of an ongoing randomised control trial (RCT) study in which the effectiveness of arm cycling was compared to conventional physiotherapy exercise to improve trunk function in people with SCI. Participants were randomly allocated to the arm cycling exercise group or conventional physiotherapy exercise group. Both groups performed additional upper-body exercise videos. Descriptive analyses were applied due to the low sample size. The same postural and reaching tasks were performed as in Chapters 3 and 4. A qualitative assessment was carried out to investigate perceptions of the participants on the home-based exercise programme. In the post-assessment, a slightly greater reaching distance and higher trunk- and centre of pressure displacements were found in both groups. The erector spinae activation pattern differed between the two groups, with lower and more cranially located erector spinae activity in the arm cycling group during the reaching tasks. In contrast, the upright sitting group demonstrated a higher and more caudally located erector spinae activity. The results of the qualitative assessment emphasised the role of intrinsic motivation and social support from family as relevant factors to adherence to the study.
The sixth and final chapter is a general discussion of the overall findings and their implications. In addition, recommendations are made for further research in this area.

Type of Work:

Thesis (Doctorates > Ph.D.)

Award Type:

Doctorates > Ph.D.

Supervisor(s):