Affiliations: [a] Clinical Fellow, Division of Physiatry, Department of Medicine, University of Toronto, Toronto, ON, Canada | [b] Department of Physical Medicine and Rehabilitation, Christian Medical College, Vellore, Tamil Nadu, India | [c] Department of Bioengineering, Christian Medical College, Vellore, Tamil Nadu, India
Correspondence:
[*]
Corresponding author: Rohit Prakash Bhide, Clinical Fellow, Division of Physiatry, Department of Medicine, University of Toronto, UHN - Toronto Rehabilitation Institute, 550 University Avenue, Toronto, M5G 2A2 Ontario, Canada. Tel.: +1 416 6252843; E-mail:bhide.rohit@gmail.com,rohit.bhide@uhn.ca
Abstract: BACKGROUND:
Upper extremity strengthening and gait training with orthoses form a major
part of inpatient rehabilitation of paraplegic patients in developing
countries. This helps to overcome architectural barriers and limited
wheelchair accessible environment in the community. OBJECTIVES:
To evaluate the changes in physiological properties of the Triceps Brachii
muscle following exercise training in individuals with paraplegia. The
authors also explored the correlation between muscle property changes and
gait parameters using orthoses in paraplegic persons. METHODS:
Twelve subjects with complete paraplegia and neurological level of injury
(NLI) from T9 to L1, underwent exercise training for a mean 64.1 ± 4.1
days. Triceps brachii was chosen as the sample muscle. Variables like arm
circumference, time to fatigue and mean power frequency (MF) (surface EMG
parameter), were recorded at the beginning and the end of training, during a
sub-maximal isometric elbow extension. Non-parametric tests were
used to assess statistical significance between the two recordings.
Additionally, gait parameters like walking speed and distance (with the help
of orthoses) were obtained and compared with the above variables, to
determine impact of upper extremity strengthening on gait improvements in
such patients. RESULTS:
Statistically significant changes were noted in bilateral arm circumferences
(p= 0.003 bilaterally) and MF drop, expressed as percentage (right p= 0.04, left
p= 0.01), indicative of better muscle resilience and adaptation. Significant
positive correlation was observed between `time to fatigue' and the
orthoses-aided total walking distance (right ρ = 0.65, left ρ = 0.69). CONCLUSIONS:
Exercise training induces noticeable changes in the muscles of upper
extremities favoring better muscle adaptation. Furthermore, positive
correlation between `time to fatigue' and (orthotic) aided walking distance
highlights the positive impact of strengthening program on gait parameters
in paraplegic patients. These findings are important and relevant in
developing countries with environmental barriers. Upper extremity
strengthening should be included in the rehabilitation of paraplegic
patients who are being trained for ambulation with orthoses.
