Leg skin temperature with body-weight-supported treadmill and tilt-table standing training after spinal cord injury

Abstract

Study design: Randomized crossover. Objectives: Effects of body-weight-supported treadmill (BWST) and tilt-table standing (TTS) training on skin temperature and blood flow after spinal cord injury (SCI). Setting: McMaster University, Canada. Methods: Seven individuals with SCI participated in BWST and TTS training (3 times per week for 4 weeks, 4-week detraining between protocols). Skin temperature was measured before and after a single session of BWST or TTS, pre-and post-training. Leg blood flow was measured at rest pre-and post-training. Results: Resting skin temperature decreased at four sites after 4 weeks of BWST training in comparison with the pre-training. Four weeks of TTS training resulted in resting skin temperature decreases posttraining at the right thigh only. Both BWST and TTS training resulted in altered reactivity of skin temperature at all sites except the right calf in response to a single session of BWST and TTS. Post-BWST training, a single session of BWST stimulated increased temperature at all sites, whereas after TTS training a single session of TTS resulted in temperature decreases at two of the six sites. No changes were observed in resting blood flow with either BWST or TTS training. Conclusion: Increased resting skin temperature and decreased skin temperature reactivity have been linked to the development of pressure sores. BWST and TTS may stimulate different skin temperature responses and the impact on pressure sore development warrants further investigation. Sponsorship: NSERC, ONF and GSSI.

Systematic review and clinical recommendations for dosage of supported home-based standing programs for adults with stroke, spinal cord injury and other neurological conditions

“…No SS differences in spasticity or spasm although downward trend seen Ben et al 2001 [ 33 ] RCT Moderate risk (moderate quality) 20 Sub-acute SCI Tilt-table, vertical 30 mins, 3× wk × 12 weeks (90 mins/week) Mean treatment effect on ankle ROM of 4° and on femur BMD of 0.005 Bohannon & Larkin 1985 [ 34 ] Case series Moderate risk (moderate quality) 20 Sub-acute and chronic SCI Tilt table, 70° 30 mins × 2.3–6.4 × wk (69–192 mins/week) Passive ankle dorsiflexion ROM increases in all subjects of between 3 and 17° at a calculated rate of 0.11 to 1.0° a day Bohannon 1993 [ 35 ] Case study N/A (low quality) 1 Chronic SCI Tilt table, 80° 30 mins × 5 sessions (150 mins/week) Each day’s standing trial followed by immediate reduction in lower extremity spasticity (modified Ashworth scale and pendulum testing). Spasms reduced until following morning-helpful for performance of car transfers Cotie et al 2010 [ 36 ] Randomized crossover Moderate risk (moderate quality) 7 Chronic SCI Tilt table, to maximum angle tolerated or 80° 30 mins, 3 × wk × 4 weeks (90 mins/week) Resting skin temperature decreased at 4 sites after 4 weeks BWSTT. Resting skin temp decreased at right thigh only after 4 weeks standing.…”

“…Increased resting skin temperature and decreased skin temperature reactivity have been linked to development of pressure sores. In subjects with SCI, a single session of standing resulted in temperature decreases at two sites as well as altered reactivity of skin temperature at all sites except the right calf [ 36 ]. Surveys of adults with SCI suggest that supported standing may help decrease incidence of pressure ulcers [ 20 , 22 , 38 ].…”

“…Improvements in kidney drainage [ 67 ] and reduction in renal calculi [ 68 ] suggest a possible link between standing and bone loss. While very weak quality evidence [ 36 ] suggests a positive effect on skin function, supported standing has been shown to off-load and unweight the ischial tuberosities [ 69 ].…”

Treino locomotor com suporte parcial de peso corporal na reabilitação da lesão medular: revisão da literatura

“…In addition to the traditional benefits, such as musculoskeletal, kinematics, psychological, and cardiorespiratory improvements, LTBWS leads to improved sensory system (sensory and proprioceptive), which works by coordinating motor control, lipid profile, decreased heart rate after training (77), besides improved blood flow in the legs, preventing pressure ulcers (23).…”

“…LTBWS may be associated to techniques such as virtual reality (12) or functional electrical stimulation (2,28). The protocols use different speeds, weight bearing ranges, and times, such as the speed of 2.7 km/h, 80% of body weight discharge, training time of 10 minutes (25), or the speed of 0.6 km/h, 60% of body weight discharge, and 60 minutes of training time (23).…”