Development and evaluation of rehabilitation technologies for early-stage spinal cord injury

T Technology (General);TA Engineering (General). Civil engineering (General);TJ Mechanical engineering and machinery

Craven, Colm Tadhg Donal ; Gollee, Henrik

University:University of Glasgow

Department:School of Engineering

关键词: Spinal cord injury, rehabilitation, whole body vibration, erigo, exercise, electromyography;   

Others  :  http://theses.gla.ac.uk/5898/1/2014CravenPhD.pdf

来源: University of Glasgow

【 摘 要 】

Exercise is fundamental to a return to normal living after a Spinal Cord Injury (SCI) but iscomplicated by a rapid decline in function and fitness immediately following the injury. Inaddition to muscle paralysis, Orthostatic Hypotension (OH), a decline in cardiopulmonaryand vascular fitness, extensive muscle atrophy and bone demineralization each contribute toan inability to carry out effective forms of exercise. Suitable rehabilitation technologies arecentral to overcoming these complications and to facilitate recovery. The aim of the workpresented in this thesis was to identify technologies which may be used for exercise during SCIrehabilitation, with a focus on early-stage SCI patients at the beginning of the rehabilitationprocess. Two such technologies were identified and investigated: Robotic Assisted Tilt TableTherapy (RATTT) and Whole Body Vibration (WBV). The suitability of these technologieswas evaluated by measuring the acute physiological responses of SCI patients during intensiveuse of these systems.Robotic Assisted Tilt Table Therapy is primarily used to treat OH in stroke and SCI patients.However, the potential therapeutic effect of RATTT as an exercise modality has so farnot been investigated. An investigation into the physiological responses of early-stage SCIpatients during intensive RATTT stepping was therefore carried out. The intention was todetermine whether RATTT may potentially be used for the combined purpose of increasingorthostatic tolerance, improving cardiopulmonary fitness and improving vascular health.RATTT is particularly suited to early-stage rehabilitation because orthostatic tolerance isnot a prerequisite for its use. Three motor-complete and three motor-incomplete early-stage SCI patients were recruited from the Queen Elizabeth National Spinal Injuries Unit(QENSIU) in Glasgow to participate in this cross-sectional study. The cardiopulmonary andvascular responses to different RATTT stepping conditions, including the combination ofRATTT stepping with Functional Electrical Stimulation (FES), were investigated. Increasesin oxygen uptake, respiratory exchange ratio, minute ventilation and heart rate were foundfor both motor-incomplete and motor-complete SCI participants. The responses were largestfor the motor-incomplete volunteers with Metabolic Equivalent (MET) values between 1.5 -3.1. These results confirmed that RATTT can be used as an exercise modality during early-stage SCI rehabilitation.Whole Body Vibration was initially developed and commercialised for application duringexercise in a general population with no neurological deficit, and while the physiologicalmechanisms which underly the response to WBV are still relatively poorly understood,current research suggests that WBV may lead to increases in muscle strength, power,bone mineral density and flexibility. It is hypothesised that the neuromuscular responseto WBV is achieved through reflex activity, though the specific neural pathway is broadlydebated. Nonetheless, an increase in neuromuscular activity duringWBV has been confirmed,suggesting that it may potentially be used to increase muscle mass, strength and power, andtherefore counteract muscle atrophy and bone demineralization in SCI. However, little isknown about the neuromuscular response of SCI patients to WBV, and it is not clear howto best administer WBV to this patient group or which vibration parameters should beapplied. A WBV platform was therefore integrated with a partial Body Weight Support(pBWS) system in order to investigate the application of WBV during SCI rehabilitation.The feasibility of this approach was determined in the first instance in experiments withparticipants from a general population with no neurological deficit, followed by an evaluationwith a SCI population. The aim was to determine if the stimulus from WBV applied inconjunction with pBWS was sufficient to elicit an increased neuromuscular response, and ifso, to characterise the magnitudes and trends of the responses.Ten participants with no neurological deficit were recruited to investigate the feasibilityof WBV-pBWS and to establish a normative data set with which to compare the resultsfrom 14 SCI participants recruited from QENSIU. The main factors under investigation werevibration frequency, vibration amplitude, level of pBWS, muscle group and classification ofSCI. It was shown that WBV did elicit an increase in neuromuscular activity and that themagnitude of the response could be moderated by vibration frequency, vibration amplitudeand level of pBWS. Average changes relative to baseline measurements were up to 71% forthe neurologically intact participants, and between 44% to 66% for the SCI participantsdepending on classification of injury. Neuromuscular activity was characteristic for eachmuscle group and the characteristic was principally moderated by the proximity of the muscleto the WBV platform and peak platform acceleration. Despite the relatively large changein neuromuscular activity when compared to baseline, the absolute changes in activity wererelatively small and likely to be of insufficient magnitude to result in muscle hypertrophy.Results from this study indicated that WBV was of sufficient intensity to elicit a responsefrom the �-motoneuron but of insufficient intensity to increase muscle strength. Based onthis, the potential use of WBV as a non-pharmacological treatment of spasm was identifiedby stimulating part of the neural pathway upon which spasm acts and therefore providea mechanism to moderate the threshold for spasm, without the risk of increasing musclestrength and therefore potential for injury during a spastic episode.In summary, this thesis presents RATTT and WBV-pBWS as two modalities suitable foruse in early-stage SCI rehabilitation. While RATTT can elicit substantial cardiopulmonaryresponses in this patient group, the evaluation of WBV showed limited effects on muscleactivation, but suggested potential application in the treatment of spasticity.