Assessment Item 2: Research Proposal. Peita Tsepetzis

Transcription

1 Assessment Item 2: Research Proposal Peita Tsepetzis

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3 1. Introduction 2. Synopsis of literature 3. Research questions and objectives 4. Methodology 5. Data collection and Analysis 6. Timetable

4 What is Spinal Cord Injury (SCI)? Damage or trauma to spinal cord Loss of motor control and sympathetic influence Tetraplegia: injury in cervical lesion Paraplegia: injury in thoracic, lumbar or sacral region Figure 1: Levels of spinal cord injury and extent of paralysis (Groah, 2003)

5 The Spinal Cord - Main pathway for information from brain to peripheral nervous system Figure 2: Neurological level and function in spinal cord injury (Groah, 2003) - Made up of 31 segments: 8 cervical 12 thoracic 5 lumbar 5 sacral 1 coccygeal -SCI: function of major organ systems altered -Complete or Incomplete

6 ASIA Classification Definition A= Complete No motor or sensory function is preserved in sacral segments S4-S5 B= Incomplete Sensory but not motor function is preserved below the neurological level and includes sacral segments S4-S5 C= Incomplete Motor function is preserved below the neurologic level, and more than half of the key muscles below the neurologic level have a muscle grade less than 3 D= Incomplete Motor function is preserved below the neurologic level, and at least half of the key muscles below the level of injury have a level of 3 or more E= Normal Motor and sensory functions are normal Muscle grades: (0) total paralysis; (2) active movement, full range of motion, gravity eliminated; (3) active movement, full range of motion, against gravity; (4) active movement, full range of movement, against gravity and provides some resistance; (5) active movement, full range of motion, against gravity and provides normal resistance.

7 Spinal Injury Association Australia: 9000 cases of SCI in Australia Paraplegia: 48%, Tetraplegia: 52% Australian Institute of Health and Welfare (Norton, 2010) in Australia during : SCI most common in year old age group Incidence of SCI ratio males to females- 5.3:1; males much higher across all age groups

8 Australian Institute of Health and Welfare (Norton, 2010) in Australia during : 80% cases occurred during sporting activities 14% occurred in workplace (including 6% occurred involved in personal activities or other unspecified

9 Paraplegia Sedentary, inactive lifestyle (associated with development of cardiovascular risks) Mortality from cardiovascular disease over 200% higher in SCI population than age and gender matched able bodied controls (Middleton, Leong & Mann, 2008). Ischaemic disease leading cause of death after SCI

10 Paraplegia: Suicide and alcohol related deaths major cause of death within SCI Suicide rate 10 times higher among SCI population to those without SCI. Regular exercise Physiological and psychological benefits Mental health benefits; reduce anxiety and depression, improve self esteem

11 Investigating the influence of a structured exercise program on the functional status and psychological well-being of subjects who have paraplegia. Will be anticipated that improvements in functional status and psychological well-being will be obtained.

12 -Davis G (1993) Exercise capacity of individuals with paraplegia. Medicine and Science in Sports Science 25(4): Outlines strategies for cardiorespiratory fitness assessment Discussed current levels of fitness in individuals with paraplegia Came to conclusion that cardiorespiratory fitness assessment and exercise training protocols should be made available to all

13 Jacobs P (2008) Effects of resistance and endurance training in persons with paraplegia. Medicine and Science in Sports Medicine 41(5) Effects of 12 week endurance training program with 12 weeks of resistance training on upper extremity strength and power output in paraplegics Significant improvements found in muscle strength, work capacity and power

14 Langbein E, Maki K, Edwards L, Hwang, M (1994) Initial clinical evaluation of a wheelchair ergometer for diagnostic testing: a technical note. Journal of rehabilitation research and development 31(4):317 Evaluation of new wheelchair ergometer and exercise test protocol in 49 men with lower disability Viable option for people who cannot perform treadmill or cycle ergometry exercises

15 Duran F, Lugo L, Ramirez L, Eusse E (2000) Effects of an exercise program on the rehabilitation of patients with spinal cord injury. Arch Phys Med Rehabil 82: Evaluated impact of directed physical exercise in patients with SCI measuring functional independence before and after program. Positive impact for most variables of the study

16 Hicks A, Martin K, Ditor D, Latimer A, Craven C, Bugaresti J, McCartney N (2003) Long term exercise training in persons with spinal cord injury: effects on strength, arm ergometry performance and psychological well being. Spinal Cord 41:34-43 Few studies were completed determining the effects of exercise on functional status along with psychological well-being. Examined the effect of 9 month exercise training on strength, arm ergometry performance and indices of psychological well being and quality of life. Significant gains in physical and psychological well-being at completion of study.

17 Hicks A, Martin K, Ditor D, Latimer A, Craven C, Bugaresti J, McCartney N (2003) Long term exercise training in persons with spinal cord injury: effects on strength, arm ergometry performance and psychological well being. Spinal Cord 41:34-43 Although were successful, longitudinal study over 9 months difficult for subject adherence. Mentioned to be the first randomised controlled trial of exercise training in people with SCI looking at both physiological and psychological outcome measures.

18 Current study involves the investigation of single subject case studies, refined to subjects who have injury at or below sixth thoracic vertebrae (T6) as function of upper body is required (Porth, 2009).

19 Initial Assessment Physiological measurements: blood pressure, resting heart rate, waist circumference, weight, height, BMI, cardiorespiratory test (Toronto Arm Crank Protocol) (Davis, 1993), submaximal strength test (10-RM Protocol) (Dohoney et al, 2002). Psychological assessment: two quality of life questionnaires; Hospital Anxiety and Depression Scale (HADS) and Perceived Quality of Life Scale (PQol).

20 Toronto Arm Crank Protocol (Davis, 1993) Discontinuous procedure to assess heart rate and power output relationship at three submaximal workloads Three 5-7min steady-state workloads will be performed at 40%, 60% and 80% of predicted age adjusted maximal heart rate. Estimated VO 2 calculated in same manner mentioned by Davis (1993) described for disabled males and females: For males: VO 2 (ml.min -1 ) = Power Output (w) x For females: VO 2 (ml.min -1 ) = Power Output (w) x

21 Submaximal 10-Repetition Maximum (10-RM) Protocol (Dohoney et al., 2002): Chest press and seated row Modified 1-RM test to act as an estimated measure of 1-RM First weight trialled approximately 50% estimated 1-RM. Load will increase to achieve a maximal load for 10 repetitions, with 3-5 attempts

22 HADS: Chronic conditions commonly associated with psychological conditions of anxiety and depression Scale is a brief measure of current symptoms over the past week PQol: Determine each subjects overall perceived satisfaction with fundamental needs of daily living Physical, social and cognitive health satisfaction.

23 Data collected from initial assessment (Week 0) will be recorded as baseline levels used for comparison with data collected at completion of study (Week 8) Physiological assessment data presented as mean of total subjects along with standard deviation, i.e. mean ± SD

24 Psychological Assessment: HADS: 7 item questionnaire Score analysis: 0-7 (Non case) 8-10 (Doubtful case) (Definite case) PQol: 19 item questionnaire Score analysis: <7.5: perceived unhappiness >7.5: perceived happiness

25 Percentile differences will be determined. Adherence of total subjects taken into consideration Any drop outs Attendance rates It will be anticipated that there will be progressive increases in cardiorespiratory and strength fitness, along with improved psychological assessment values once the 8 weeks have completed.

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28 Davis G (1993) Exercise capacity of individuals with paraplegia. Medicine and Science in Sports Science 25(4): Duran F, Lugo L, Ramirez L, Eusse E (2000) Effects of an exercise program on the rehabilitation of patients with spinal cord injury. Arch Phys Med Rehabil 82: Jacobs P (2008) Effects of resistance and endurance training in persons with paraplegia. Medicine and Science in Sports Medicine 41(5) Langbein E, Maki K, Edwards L, Hwang, M (1994) Initial clinical evaluation of a wheelchair ergometer for diagnostic testing: a technical note. Journal of rehabilitation research and development 31(4):317 Porth, C. M. (2008). Pathophysiology: Concepts of altered health states (8th edition). Philadelphia: Lippincott, Williams & Wilkins Webborn N, Tolfrey V (2008) Exercise physiology in special populations Elsevier Ltd.