Context/objective: A 41-year-old man with a history of C6 American Spinal Injury Association (ASIA) Impairment Scale (AIS) C spinal cord injury (SCI), enrolled in an Institutional Review Board (IRB)-approved, robotic-assisted body weight-supported treadmill training (BWSTT), and aquatic exercise research protocol developed asymptomatic autonomic dysreflexia (AD) during training. Little information is available regarding the relationship of robotic-assisted BWSTT and AD. Findings: After successfully completing 36 sessions of aquatic exercise, he reported exertional fatigue during his 10th Lokomat intervention and exhibited asymptomatic or silent AD during this and the three subsequent BWSTT sessions. Standard facilitators of AD were assessed and no obvious irritant identified other than the actual physical exertion and positioning required during robotic-assisted BWSTT. Conclusions/clinical relevance: Increased awareness of potential silent AD presenting during robotic assisted BWSTT training for individuals with motor incomplete SCI is required as in this case AD clinical signs were not concurrent with occurrence. Frequent vital sign assessment before, during, and at conclusion of each BWSTT session is strongly recommended.
Study design Survey research design.Objective To understand current splinting practices of occupational therapists working with individuals with spinal cord injury.Setting The United States. Methods An online survey was emailed to occupational therapists working in U.S. inpatient spinal cord rehabilitation facilities. The survey included questions about hand splinting practices in their patients with cervical spinal cord injury. Results Sixty-five occupational therapists in 21 different states completed the survey. They reported that current and predicted hand function was the primary principle guiding splint decision making. Across all levels of cervical SCI, resting hand splints are commonly prescribed for night use, and 64.6% of respondents stated they typically recommend them for individuals without active arm movement. Most respondents (73.8%) also report prescribing wrist splints for day use for individuals without active wrist movement. Survey results indicate that therapists are using splints less frequently overall for all levels of injury. The longopponens splint is no longer being used regularly in SCI and the MCP block splint is being used more frequently. Conclusion Survey responses indicated that splinting is standard care for individuals with cervical spinal cord injury and that the level of SCI dictates specific recommendations. Splint practice guidelines are a framework for intervention mediated by case-specific clinical reasoning and client input.
What is aquatic exercise?Aquatic exercise is any water-based movement as therapy or exercise in a community or personal pool. Swimming; aerobic, strengthening, and balance training; Ai Chi; or Zumba in water can be beneficial for individuals with spinal cord injury (SCI).
What are the benefits of aquatic exercise?For people with SCI, aquatic exercise provides advantages over land exercise programs. Individual and group workouts can occur easily in water, and family and friends are able to participate. Most importantly, water allows freedom of movement restricted by gravity during land exercise.Water naturally supports your body weight, allowing you to move body parts that are difficult for you to move on land. You may also be able to walk or run in the water even if on land you use a wheelchair for mobility. Water pressure (hydrostatic) improves body awareness by signaling sensory receptors as well as reduces swelling. Warm water helps with muscle spasms, promotes relaxation, and may give pain relief. If you work hard in the water doing aerobic exercise or strength training, cooler water is better. If aquatic exercise seems right for you, more information is needed before you get in a pool.
Precautions and contraindicationsYou should check with your doctor or therapist before starting any exercise program including aquatic activity.
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