Rehabilitation Matters

Scottish Stem Cell Network - A Website

I found this site by the Scottish Stem Cell Network to be a good source of information and resources to keep informed on developments in this important area.  Stem Cell therapy is of interest to many of our clients who may have experienced a stroke, spinal cord injury or MS to name just a few conditions.  However, there are currently only a small number of treatments that have been shown to be effective in rigorous studies - and these are confined to diseases of the blood as well as skin grafts and corneal repair.  Best to be well-informed and check out any source of potential therapy very carefully.

 

FES Cycling Exercise - How intense does it need to be?

Yesterday, I met with two clients who tried an FES bike for the first time.   One client was injured 28 years ago - the other 3 years ago.   Both were C5/C6 level injuries and with complete lesions.  What was interesting was to constrast their expectations of what it would be like to see their own legs actively exercising again.  For some it is an emotional experience. 

Beyond that though, there are good reasons to take the steps, if possible, to commit to regular exercise.  What we still lack are precise guidelines on how to optimise training for each person.  Because we have worked with many individuals we do feel we have some experience in this area but that's never the same as having firm evidence on training principles.  The variation in response to stimulation is quite large and certainly sensitive to the stimulation parameters being used.

Improved care and management of secondary complications following a spinal cord injury (SCI) has improved life expectancy to levels approaching that of the able bodied population - the prognosis being better for young patients than for older patients. 

However, the SCI population is nonetheless predominantly very sedentary, and this brings with it the many co-morbidities associated with inactivity including: obesity, hypertension, impaired glucose metabolism and an atherogenic lipid profile, - potentially leading to diabetes mellitus and cardiovascular disease.  Physical activity can be a potent preventative for these conditions.  FES Cycling has, since the 1980's emerged as a safe, "do at home" activity, which - despite its relative inefficiency - still has a significantly beneficial impact on the users metabolism. But how much of this actually serves as a motivator to potential clients?

Body composition changes after SCI in response to reduced physical activity.  It's the bodies natural response - minimising it's effort to maintain "redundant" body systems such as the musculoskeletal system and the cardiovascular system.

This causes a reduction in metabolically active tissue and an increase in adiposity levels as energy balance becomes difficult to maintain.  In a cross sectional study of 133 SCI men, researchers found that body composition changes were exaggerated with advancing age and resulted in adiposity levels and loss of lean body mass significantly greater than those of  a matched, able bodied, cohort.

These factors, in addition to the lack of volitional control below the level of the lesion and the disruption to systemic autonomic control, provide challenges to anyone wishing to maintain or improve physical fitness after such an injury.

One of the more obvious changes is to skeletal muscle. Following an SCI, muscle fibres in the legs can rapidly change their structure and function.  When it can be used, FES helps reverse or maintain structure and functional deficits but not to the level of before injury.

With the two clients yesterday they were able to generate only relatively low levels of power (of the order of 3 or 4 W on average - peak of around 20W) in the first session.  One of the two, a sports oriented person, was quite disappointed not to be able to exercise to the point of being breathless.  What actually happened is that although he was able to actively cycle strongly for a few minutes, muscle fatigue prevented him from responding powerfully for long.  He had to accept that he would have to condition his muscles before being able to place too much demand on his body.

This experience was a useful reminder to me of how effective rehabilitation needs to take account of the users prior expectation and manage this - if you like "innoculating" the client against the gap between what they expected and what actually happened.  We may talk about health benefits - but because these may be vague concepts to the person and only available "in the long term" - there is a problem of motivation because mostly as humans we always respond best to short term positive feelings.