Comparison of abdominal compression devices in persons with abdominal paralysis due to spinal cord injury.
Hastings J, De Groot M, Swartz J
University of Puget Sound, Tacoma, WA, USA
Objective: In the United States the incidence of spinal cord injury (SCI) is approximately 17,000 new cases a year and there are estimated to be 282,000 persons living with SCI. Approximately 80% of those injured sustain neurologic lesions that impair the function of the abdominal musculature. In the non-disabled population it is well understood that the strength of the abdominal wall is key to prevention of musculoskeletal pain and improving postural control. The abdominal wall functions to maintain intra-abdominal cavity pressure which in a healthy system works in coordination with intra-thoracic cavity pressure. Paralysis of the abdominal musculature impairs the function of the diaphragm. Use of an abdominal binder is a common intervention following acute SCI. However, the long term daily use of abdominal binders is not common among individuals living with SCI. The purpose of this study is to compare the effectiveness and usability of alternative commercial abdominal compression garments with the usual medical device.
Design/Methods: This study follows a single subject design with 5 participants. Inclusion: SCI T6 or above, currently using abdominal binder when seated in the wheelchair, able to don the binder independently or with caregiver assistance. Exclusion: Unable to speak English and communicate either written or electronically, or current skin breakdown. Data was collected over 3 periods of 1 week at a time; participants wore the compression garment for 5 days followed by a rest period of 2 days. In week 1, the participant wore their current abdominal binder. In weeks 2 and 3, an alternative compression device was worn. The alternatives were a compressive tank top and a compressive unisuit (shorts and tank). Physiological measurements and photographs were taken with the current binder, then after a 5 minute acclimation period each without any binder and then the alternative garment. Outcome measures: blood pressure, blood oxygen saturation, forced exhalation volume in 1 second (FEV1), and heart rate. A daily log was completed twice daily for 5 days per garment with questions asking about participants’ experience.
Results: Participants were 4 men and 1 woman aged 28-65 with SCI between C 3 and T4, 1-47 years post SCI. The use of a personal binder resulted in significant increases in systolic blood pressure (SBP) and FEV1. The other parameters were not significantly different with or without the personal binder. There was no difference in SBP between the test garments and the personal binders, but the test garments’ support of FEV1 was significantly less. Graphic analysis of experiential trends will be presented.
Conclusion: Abdominal compression improves respiratory function and supports BP. The alternative devices provided similar BP support, but less respiratory support. Alternative devices required caregiver assistance. Lack of full UE ROM made the tank option unfeasible. The unisuit offended sensibilities and therefore is not an acceptable device.
Support: This study received support from the University of Puget Sound.
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