Physical capacity in wheelchair-dependent persons with a spinal cord injury: a critical review of the literature

Abstract

Study design: Review of publications. Objective: To assess the level of physical capacity (peak oxygen uptake, peak power output, muscle strength of the upper extremity and respiratory function) in wheelchair-dependent persons with a spinal cord injury (SCI). Setting: Erasmus MC, University Medical Centre Rotterdam, The Netherlands. Methods: Pubmed (Medline) search of publications from 1980 onwards. Studies were systematically assessed. Weighted means were calculated for baseline values. Results: In tetraplegia, the weighted mean for peak oxygen uptake was 0.89 l/min for the wheelchair exercise test (WCE) and 0.87 l/min for arm-cranking or hand-cycling (ACE). The peak power output was 26 W (WCE) and 40 W (ACE). In paraplegia, the peak oxygen uptake was 2.10 l/min (WCE) and 1.51 l/min (ACE), whereas the peak power output was 74 W (ACE) and 85 W (WCE). In paraplegia, muscle strength of the upper extremity and respiratory function were comparable to that in the able-bodied population. In tetraplegia muscle strength varied greatly, and respiratory function was reduced to 55-59% of the predicted values for an age-, gender-and height-matched able-bodied population. Conclusions: Physical capacity is reduced and varies in SCI. The variation between results is caused by population and methodological differences. Standardized measurement of physical capacity is needed to further develop comparative values for clinical practice and rehabilitation research.

Prognostic Models for Physical Capacity at Discharge and 1 Year Postdischarge From Rehabilitation in Persons With Spinal Cord Injury

“…As expected, the multivariate models showed that level of lesion and sex were important predictors of physical capacity. 14,23,26,40 These models also identified other predictors, however, which made small but significant contributions to the explained variance, some of which are modifiable.…”

“…Furthermore, the prognostic models that were developed had different shortcomings. 13,14 First, the outcome measure may have been limited by a ceiling effect, which would hamper the prediction of outcome at a later phase of recovery. 2,4,14 Second, often only 1 component of physical capacity was investigated, whereas the simultaneous assessment of different aspects (eg, endurance capacity, muscle strength, respiratory function) may more specifically indicate the required treatment strategy.…”

“…13,14 First, the outcome measure may have been limited by a ceiling effect, which would hamper the prediction of outcome at a later phase of recovery. 2,4,14 Second, often only 1 component of physical capacity was investigated, whereas the simultaneous assessment of different aspects (eg, endurance capacity, muscle strength, respiratory function) may more specifically indicate the required treatment strategy. 1,14 Furthermore, because most people with SCI use wheelchairs, the endurance capacity (ie, the peak oxygen uptake [VO 2 peak] and peak power output [POpeak] during a wheelchair exercise test) is related to functioning.…”

“…2,4,14 Second, often only 1 component of physical capacity was investigated, whereas the simultaneous assessment of different aspects (eg, endurance capacity, muscle strength, respiratory function) may more specifically indicate the required treatment strategy. 1,14 Furthermore, because most people with SCI use wheelchairs, the endurance capacity (ie, the peak oxygen uptake [VO 2 peak] and peak power output [POpeak] during a wheelchair exercise test) is related to functioning. Therefore, the endurance capacity may give a more valid functional prognosis than would muscle strength alone.…”

A theoretical analysis of the influence of wheelchair seat position on upper extremity demand

“…In addition, inter-subject variability in body anthropometrics was not considered, with the musculoskeletal model representing a 50th percentile able-bodied male. However, the physical capacity of wheelchair users varies with age, gender and nature of impairment and is generally less than that of nonwheelchair users (e.g., Janssen et al, 2002;Haisma et al, 2006). Future work should include the development of subject-specific models (e.g., Zajac et al, 2002;Fregly et al, 2012) to help determine the optimal seat position for individual users.…”