Abstract Information


The Effects of an Exercise Program to Accompany Biologic or Therapeutic Clinical Trials in People with Chronic Spinal Cord Injury

1Gant K, 2Kathleen N, 1Cowan R, 3Field-Fote E, 4Nash M, 5Kressler J, 1Thomas C, 1Castellanos M, 6Widerstrom-Noga E
1Department of Neurological Surgery, Miami Project to Cure Paralysis, University of Miami Leonard M. Miller School of Medicine, Miami, FL, USA; 2Covance Central Laboratory Services, Indianapolis, IN, USA; 3Emory University School of Medicine, Division of Physical Therapy; Professor, Georgia Institute of Technology, School of Biological Sciences; Director, Spinal Cord Injury Research & The Hulse Spinal Cord Injury Laboratory, Shepherd Center, Atlanta, GA, USA; 4Department of Neurological Surgery, Department of Physical Medicine and Rehabilitation Medicine, Miami Project to Cure Paralysis, University of Miami Leonard M. Miller School of Medicine, Miami, FL, USA; 5Department of Exercise and Nutritional Sciences, College of Health and Human Services, San Diego State University, San Diego, CA, USA; 6Department of Neurological Surgery, Miami Project to Cure Paralysis, University of Miami Leonard M. Miller School of Medicine, 1095 NW 14th Terrace, Miami, FL 33136; Bruce W. Carter Department of Veterans Affairs Medical Center, Miami, FL, USA

Objective: Clinical trials that evaluate the safety and efficacy of pharmacologic and cellular transplantation strategies in people with spinal cord injury (SCI) are currently underway. There is agreement that rehabilitation protocols should accompany the use of drugs or cells in order to improve functional recovery in people with chronic SCI. However, adding an exercise component to a drug or cell-based intervention may confound the measurement of functional recovery, due to the conditioned state of the body or training-induced effects on neuroplasticity. For this reason, it is important to understand the potential effects of exercise conditioning prior to the administration of any biologic or pharmacologic therapeutic. This study describes the effect of 12 weeks of a multi-modal training program in people with thoracic-level, motor complete SCI.

Design/Methods: 8 participants with thoracic-level 2 (T2) to T12 chronic (at least 1 year post-injury), motor-complete SCI participated in this study. All participants had injuries classified as American Spinal Injury Association (ASIA) Impairment Scale (AIS) A or B, with no motor function in the lower extremities. The training program included body weight supported treadmill training (BWSTT) for locomotion, circuit resistance training (CRT) for upper body conditioning, functional electrical stimulation (FES) for activation of sublesional muscles, and wheelchair skills training (WST) for overall mobility. Outcome assessments were performed at various time points before and during the interventions, and included measures of strength and metabolic function, spasticity, pain, autonomic function, wheelchair skills, and functional independence.

Results: After 12 weeks of a multi-modal training program, upper extremity muscle strength improved significantly for all participants. Some participants experienced improvements in function, which may be explained by gains in strength. No changes in neurologic function occurred. Pain and spasticity were highly variable between participants.

Conclusion: This is the first study to show the effect of this combination of four training modalities in people with SCI.

Support: This study was funded by the Robert J. Kleberg, Jr. and Helen C. Kleberg Foundation.


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