None listed
Conditions
Brief summary
An important goal of physiotherapy for people with spinal cord injuries is to increase strength. In those who are very weak (with muscle groups of less than grade 3 strength), physiotherapists tend to rely on repetitious contractions to increase strength. This is based on theories about neural plasticity and the need for repeated movement to prompt neural recovery. Despite the widespread use of repetitious contractions to increase strength in very weak muscles, it is not known whether this is an effective training paradigm. The trial will be a pragmatic multi-centre, assessor-blinded between participant randomised controlled trial. The aim of our project is to determine the best way of providing physiotherapy treatment, specifically to compare the therapeutic benefits of repetitious practise with usual care, to usual care alone to increase strength in very weak partially-paralysed muscles of people with recent spinal cord injury. One target muscle group with less than grade 3 strength will be selected on one side of the body from the following muscles: the elbow flexors, elbow extensors, wrist flexors, wrist extensors, knee flexors, knee extensors, ankle dorsiflexors or ankle plantarflexors. Eligible participants will be randomised to either the Treatment group or the Control group. Participants allocated to the Treatment group will do 200 repetitions of isolated contractions of the target muscle on one side of their body as well as usual care. Participants allocated to the Control group will receive usual care alone. The intervention will be provided for 8 weeks. All outcomes will be collected at baseline and at 8 weeks.
Interventions
One target muscle group will be selected on one side of the body from the following muscles: the elbow flexors, elbow extensors, wrist flexors, wrist extensors, knee flexors, knee extensors, ankle dorsiflexors or ankle plantarflexors. This will be chosen by the physiotherapist in consultation with the participant. A target muscle group in participants allocated to the Treatment group will be trained once a day, six times a week for 8 weeks. The sessions will be supervised in the hospital or reh
One target muscle group will be selected on one side of the body from the following muscles: the elbow flexors, elbow extensors, wrist flexors, wrist extensors, knee flexors, knee extensors, ankle dorsiflexors or ankle plantarflexors. This will be chosen by the physiotherapist in consultation with the participant. A target muscle group in participants allocated to the Treatment group will be trained once a day, six times a week for 8 weeks. The sessions will be supervised in the hospital or rehabilitation centre at which the participant is an inpatient. Training on five of the days will be supervised by a qualified therapist, while the other day will be supervised by a family member/carer where possible or a qualified therapist if they are available. Participants will aim to perform 200 repeat contractions of the target muscle group during each session, and this will be completed within a 30-minute time frame. The strength training will be progressed as possible. Initially, participants who are very weak and unable to move through a full range of motion (ROM) with gravity eliminated will be encouraged to focus on increasing their ROM during the 200 contractions. Once a participant can readily move 200 times through a full ROM with gravity eliminated, they will be required to move against gravity. Again, initially they will focus on attaining full ROM against gravity during all 200 contractions. Once participants can move 200 times through full ROM against gravity then resistance will be slowly introduced. In addition, participants will also continue to receive usual care (see Control group). The details of the training provided to participants will be recorded by the therapist in a training diary.
Sponsors
Northern Sydney Local Health District (Kolling Institute, Royal North Shore Hospital), John Walsh Centre for Rehabilitation Research
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Blinded (masking used) (Outcomes Assessor)
Eligibility
Sex/Gender
All
Age
16 Years to No maximum
Healthy volunteers
No
Inclusion criteria
A person will be eligible to participate if they: * have a recent complete or incomplete SCI (as defined by the International Standards for Neurological classification of SCI) that was sustained less than six months prior * have partial paralysis in a major muscle group on one side of the body (i.e., elbow flexors or extensors, wrist flexors or extensors, knee flexors or extensors, ankle dorsiflexors or plantarflexors) * have less than grade 3 strength in the target muscle as measured by a manual muscle test (MMT). * are an inpatient of one of the participating SCI units and are likely to remain there for the duration of their involvement in the trial (i.e., approximately 9 weeks, or are being discharged home to the local area surrounding the hospital) * are aged 16 years or over at the time of consent * are willing to participate in the trial
Exclusion criteria
People will be excluded if they: * have any condition preventing testing or training of the target muscle group * have any other known neurological condition or neurological injury other than SCI * are unable to co-operate (e.g. have a serious medical condition, cognitive impairment, drug dependency, psychiatric illness, or behavioural problems) * do not speak the national language sufficiently well to provide informed consent.
Outcome results
None listed