Introduction: Activity-based therapy (ABT) for patients with SCI, which consists of repetitive use of muscles above and below the spinal lesion, improves locomotion and arm strength. Less data has been published regarding its effects on hand function. We sought to evaluate the effects of a weekly hand-focused therapy program on hand strength and function in a SCI cohort.
Methods: Patients with SCI were enrolled in a weekly program that involved activities with the MediSens (Los Angeles, CA) handgrip. These included maximum voluntary contraction (MVC) and a tracking task that required each subject to adjust his/her grip strength according to a pattern displayed on a computer screen. For the latter, performance was measured as mean absolute accuracy (MAA). The Spinal Cord Independence Measure (SCIM) was used to measure each subject’s independence prior to and after therapy.
Results: Seventeen patients completed the program with average participation duration of 21.3 weeks. The cohort included patients with ASIA A (n = 12), AIS B (n = 1), AIS C (n = 2), and AIS D (n = 2) injuries. The MVC scores for motor complete subjects increased from 2.6 N to 3.7 N and in motor incomplete subjects, the scores increased from 4.1 N to 21.2 N, but neither improvement was significant. Both groups showed significant improvement in MAA by the end of the study (motor complete: 5.7% to 20.7%, p = .001; motor incomplete: 12.8% to 35.1%, p = .04). At the end of the study, the average SCIM score for the motor complete group was unchanged. In the motor incomplete group it increased 2.75 points, but this was not significant.
Conclusions: A weekly handgrip-based ABT program is feasible and efficacious at increasing hand task performance in subjects with SCI. Those with incomplete motor injuries demonstrate larger task-specific improvements than subjects with complete motor injuries.
Patient Care: Our results provide further evidence that subjects with chronic SCI are capable of improving the function of damaged neural pathways through rehabilitation and do not have to rely on compensatory and adaptive techniques as once thought. Loss of hand function is a particularly devastating aspect of SCI that patients associate with a reduction in quality of life, and we have identified a form of rehabilitation to improve this.
Learning Objectives: By the conclusion of this session, participants should be able to:
1) Describe the form of hand-based physiotherapy that we found effective among SCI patients
2) Describe how SCI patients' hand function is affected by activity-based therapy
3) Identify which patients with SCI experience the greatest improvement in hand function from activity-based therapy