Multimodal cortical and subcortical exercise compared with treadmill training for spinal cord injury.
BACKGROUND AND PURPOSE:Spared fibers after spinal cord injury (SCI) tend to consist predominantly of subcortical circuits that are not under volitional (cortical) control. We aim to improve function after SCI by using targeted physical exercises designed to simultaneously stimulate cortical and spar...
| Main Authors: | , , , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Public Library of Science (PLoS)
2018-01-01
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| Series: | PLoS ONE |
| Online Access: | http://europepmc.org/articles/PMC6084979?pdf=render |
| _version_ | 1819080591206776832 |
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| author | Stephanie A Martinez Nhuquynh D Nguyen Eric Bailey Denis Doyle-Green Henry A Hauser John P Handrakis Steven Knezevic Casey Marett Jennifer Weinman Angelica F Romero Tiffany M Santiago Ajax H Yang Lok Yung Pierre K Asselin Joseph P Weir Stephen D Kornfeld William A Bauman Ann M Spungen Noam Y Harel |
| author_facet | Stephanie A Martinez Nhuquynh D Nguyen Eric Bailey Denis Doyle-Green Henry A Hauser John P Handrakis Steven Knezevic Casey Marett Jennifer Weinman Angelica F Romero Tiffany M Santiago Ajax H Yang Lok Yung Pierre K Asselin Joseph P Weir Stephen D Kornfeld William A Bauman Ann M Spungen Noam Y Harel |
| author_sort | Stephanie A Martinez |
| collection | DOAJ |
| description | BACKGROUND AND PURPOSE:Spared fibers after spinal cord injury (SCI) tend to consist predominantly of subcortical circuits that are not under volitional (cortical) control. We aim to improve function after SCI by using targeted physical exercises designed to simultaneously stimulate cortical and spared subcortical neural circuits. METHODS:Participants with chronic motor-incomplete SCI enrolled in a single-center, prospective interventional crossover study. Participants underwent 48 sessions each of weight-supported robotic-assisted treadmill training and a novel combination of balance and fine hand exercises, in randomized order, with a 6-week washout period. Change post-intervention was measured for lower extremity motor score, soleus H-reflex facilitation; seated balance function; ambulation; spasticity; and pain. RESULTS:Only 9 of 21 enrolled participants completed both interventions. Thirteen participants completed at least one intervention. Although there were no statistically significant differences, multimodal training tended to increase short-interval H-reflex facilitation, whereas treadmill training tended to improve dynamic seated balance. DISCUSSION:The low number of participants who completed both phases of the crossover intervention limited the power of this study to detect significant effects. Other potential explanations for the lack of significant differences with multimodal training could include insufficient engagement of lower extremity motor cortex using skilled upper extremity exercises; and lack of skill transfer from upright postural stability during multimodal training to seated dynamic balance during testing. To our knowledge, this is the first published study to report seated posturography outcomes after rehabilitation interventions in individuals with SCI. CONCLUSION:In participants with chronic incomplete SCI, a novel mix of multimodal exercises incorporating balance exercises with skilled upper extremity exercises showed no benefit compared to an active control program of body weight-supported treadmill training. To improve participant retention in long-term rehabilitation studies, subsequent trials would benefit from a parallel group rather than crossover study design. |
| first_indexed | 2024-12-21T19:47:19Z |
| format | Article |
| id | doaj.art-64e0186f940040f2a55a100f5d377312 |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-12-21T19:47:19Z |
| publishDate | 2018-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj.art-64e0186f940040f2a55a100f5d3773122022-12-21T18:52:18ZengPublic Library of Science (PLoS)PLoS ONE1932-62032018-01-01138e020213010.1371/journal.pone.0202130Multimodal cortical and subcortical exercise compared with treadmill training for spinal cord injury.Stephanie A MartinezNhuquynh D NguyenEric BaileyDenis Doyle-GreenHenry A HauserJohn P HandrakisSteven KnezevicCasey MarettJennifer WeinmanAngelica F RomeroTiffany M SantiagoAjax H YangLok YungPierre K AsselinJoseph P WeirStephen D KornfeldWilliam A BaumanAnn M SpungenNoam Y HarelBACKGROUND AND PURPOSE:Spared fibers after spinal cord injury (SCI) tend to consist predominantly of subcortical circuits that are not under volitional (cortical) control. We aim to improve function after SCI by using targeted physical exercises designed to simultaneously stimulate cortical and spared subcortical neural circuits. METHODS:Participants with chronic motor-incomplete SCI enrolled in a single-center, prospective interventional crossover study. Participants underwent 48 sessions each of weight-supported robotic-assisted treadmill training and a novel combination of balance and fine hand exercises, in randomized order, with a 6-week washout period. Change post-intervention was measured for lower extremity motor score, soleus H-reflex facilitation; seated balance function; ambulation; spasticity; and pain. RESULTS:Only 9 of 21 enrolled participants completed both interventions. Thirteen participants completed at least one intervention. Although there were no statistically significant differences, multimodal training tended to increase short-interval H-reflex facilitation, whereas treadmill training tended to improve dynamic seated balance. DISCUSSION:The low number of participants who completed both phases of the crossover intervention limited the power of this study to detect significant effects. Other potential explanations for the lack of significant differences with multimodal training could include insufficient engagement of lower extremity motor cortex using skilled upper extremity exercises; and lack of skill transfer from upright postural stability during multimodal training to seated dynamic balance during testing. To our knowledge, this is the first published study to report seated posturography outcomes after rehabilitation interventions in individuals with SCI. CONCLUSION:In participants with chronic incomplete SCI, a novel mix of multimodal exercises incorporating balance exercises with skilled upper extremity exercises showed no benefit compared to an active control program of body weight-supported treadmill training. To improve participant retention in long-term rehabilitation studies, subsequent trials would benefit from a parallel group rather than crossover study design.http://europepmc.org/articles/PMC6084979?pdf=render |
| spellingShingle | Stephanie A Martinez Nhuquynh D Nguyen Eric Bailey Denis Doyle-Green Henry A Hauser John P Handrakis Steven Knezevic Casey Marett Jennifer Weinman Angelica F Romero Tiffany M Santiago Ajax H Yang Lok Yung Pierre K Asselin Joseph P Weir Stephen D Kornfeld William A Bauman Ann M Spungen Noam Y Harel Multimodal cortical and subcortical exercise compared with treadmill training for spinal cord injury. PLoS ONE |
| title | Multimodal cortical and subcortical exercise compared with treadmill training for spinal cord injury. |
| title_full | Multimodal cortical and subcortical exercise compared with treadmill training for spinal cord injury. |
| title_fullStr | Multimodal cortical and subcortical exercise compared with treadmill training for spinal cord injury. |
| title_full_unstemmed | Multimodal cortical and subcortical exercise compared with treadmill training for spinal cord injury. |
| title_short | Multimodal cortical and subcortical exercise compared with treadmill training for spinal cord injury. |
| title_sort | multimodal cortical and subcortical exercise compared with treadmill training for spinal cord injury |
| url | http://europepmc.org/articles/PMC6084979?pdf=render |
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