Welcome to SCIRE Professional

Acute (< 6 months) SCI

One good quality RCT examined the effect of an additional 3 weeks of task specific exercises on sitting balance in individuals with acute SCI following 6 weeks of standard inpatient rehabilitation consisting of practice of activities of daily living (N=32, AIS A=29, AIS B=2, AIS C=1) (Harvey et al., 2011). Participants were mainly motor complete paraplegics with a median time since injury of 11 weeks. Both experimental and control groups received 6 weeks of standard inpatient rehabilitation consisting of practice of activities of daily living. Despite receiving more training sessions, there was no additional benefit to the experimental group compared to the control group on functional outcomes of sitting balance.

Chronic (> 1 year) SCI

There were 5 studies that investigated the effects of various interventions (i.e. kayak ergometry, task specific exercises in unsupported sitting) on sitting balance. The majority of the participants had motor-complete SCI (N=76, AIS A=51, AIS B=23, AIS C=2). Sitting balance was significantly improved with kayak ergometer training in two Level 4 evidence trials with substantial transfer effects to functional tests in the wheelchair (Bjerkefors and Thorstensson, 2006; Bjerkefors et al., 2007). No significant effect was reported of 8 weeks open water kayak training vs. able-bodied control group who did not train (Grigorenko et al., 2004).

A good quality RCT assessed sitting balance in chronic SCI using the same task specific exercises as the study by Harvey et al (Harvey et al., 2011) in unsupported sitting for 6 weeks vs. a control group who received no training (N=30, AIS A=25, AIS B=15) (Boswell-Ruys et al., 2010). Overall improvements in both the training and control groups were reported. The addition of task-specific exercises using a rocker board to conventional physical therapy for 4 weeks yielded significant improvements in sit and reach tests as well as COP measures (N=12, AIS A=11, AIS B=1) (Kim et al. 2010). However, this was a relatively small study (N = 12) and it did not appear that participants were randomly assigned to the interventions.

Table 2: Sitting Balance

Author Year
Country
Score
Research Design
Total Sample Size
 

 

Methods

 

 

Outcome

 

Sitting Balance-Acute

 

 

 

 

 

Harvey et al. 2011

Australia/Bangledesh

RCT

PEDro=8

N=32

 

 

Population: 32 individuals- 30 males and 2 females; chronic SCI; motor level T1 – L1; 29 AIS A, 2 AIS B, 1 AIS C; age range= 24-31y; years post injury= 8-17 weeks

 

Treatment: In the control group, individuals received 6 weeks standard in patient rehabilitation. In the experimental group, participants received 6 weeks standard in patient rehabilitation + 3 additional 30-minute sessions/wk of 84 task specific exercises with 3 levels of difficulty (252 exercises) in unsupported sitting.

 

Outcome Measures: Maximal Lean Test (Maximal Balance Range), Maximal Sideward Reach Test.

1.     The mean between-group differences for the Maximal Lean Test, Maximal Sideward Reach Test and the Performance Item of the COPM were –20 mm, 5% arm length, and 0.5 points respectively.
 

Sitting Balance-Chronic (> 1 year SCI)

 

 

 

 

 

Boswell-Ruys et al. 2010

Australia

RCT

PEDro=8

N=30

 

Population: 30 participants- 25 males and 5 females; 25 AIS A, 15 AIS B; level of injury: T1-12; mean age=45y; mean years post injury= 14.5y

 

Treatment: Participants in the experimental group receieved 1hr of 84 task specific exercises with 3 grades of difficulty in an unsupported sitting 3 times a week for 6 weeks. The control group did not receive any intervention.

 

Outcome Measures: Primary measures were: Upper Body Sway Test, Maximal Balance Range Test; Secondary measures were: Alternating Reach test (supported and unsupported), Seated Reach Test 45°to right, Coordinated Stability Test (Version A), Upper Body Sway Test (lateral and antero-posterior components).

1.     The between-group mean difference for the maximal balance range was 64mm.
 

 

 

 

Kim et al. 2010

Korea

Prospective Controlled Trial

Level 2

N=12

 

Population: 12 individuals- 9 males and 3 females; 11 AIS A, 1 AIS B; level of injury: T6-12. mean age= 40.86y

 

Treatment: The control group received conventional PT. The experimental group received conventional PT and goal-oriented training on a rocker board. The patients sat on a stable surface with their legs straight on the floor. Reach forwarrd, left and right, were all measured. Sessions were 5 sets of 10 reps 5 times a week for 4 weeks.

 

Outcome Measures: Modified Functional Reach Test, sway area and sway velocity using the Balance Performance Monitor

1.     There was an increase in the MFRT distance in the experimental group.

2.     The experimental group showed a decrease in sway area with both opened and closed eyes after training.

3.     The experimental group showed a significant difference before and after training compared to the control, as shown by MFRT distance and swaying area.

 

Bjerkefors et al. 2006

Sweden

Pre-post

Level 4

N=10

 

Population: 10 individuals- 7 males and 3 females; 7 AIS A, 2 AIS B, 1 AIS C; level of injury between T3-12; mean age= 37.6 ± 12y; median years post-injury= 11.5y

 

Treatment: Participants paddled a modified kayak ergometer for 60 minutes 3 times a week for 10 weeks.

 

Outcome Measures: sit and reach tests

1.     Sit and reach tests significantly increased from 3.5cm at baseline to 5.8cm at the end of 10 weeks.

 

 

 

 

 

Bjerkefors et al. 2007

Sweden

Pre-post

Level 4

N=10

 

Population: 10 individuals- 7 males and 3 females; 7 AIS A, 2 AIS B, 1 AIS C; level of injury between T3-12; mean age= 37.6 ± 12y; median years post-injury= 11.5y

 

Treatment: Participants paddled a modified kayak ergometer for 60 minutes 3 times a week for 10 weeks.

 

Outcome Measures: anterior-posterior (A/P), medio-lateral (M/L) angular and linear and twisting (TW) displacements on support surface translations – forward (FWD), backward (BWD) and lateral (LAT); Kinematic Responses include: I-onset of acceleration (unpredictable), II-constant velocity, III-deceleration (predictable), IV-end of deceleration

1.     A/P angular and linear and TW angular during LAT translations for all kinematic responses were significantly decreased except II for A/P angular

2.     M/L angular displacements during LAT translations-significant decrease for kinematic response IV.

3.     M/L linear displacement during LAT translations-no significant effects for all kinematic responses.

[why not in the same format as the ones above? I like how you did those – they are much clearer to get through in table format]

 

 

 

 

 

Grigorenko et al. 2004

Sweden

Pre-post

Level 4

N=24

 

Population: Experimental group: 12 individuals- 9 males and 3 females; chronic SCI; 6 AIS A, 5 AIS B, 1 AIS C; level of injury: T2-11; mean age=40y; median years post-injury= 17y;

Control group: 12 able bodied participants who did not train

 

Treatment: Participants were involved in 2-3 modified kayak sessions on open water per week for 8 weeks.

 

Outcome Measures: sitting quietly on a force plate-standard deviation (SD), median velocity, median frequency

1.     Small effects in all 3 variables except on the median frequency in the sagittal plane (opposite to becoming normal)

2.     Before training and comparing to the control group, all variables differed.

3.     Small effects on balance variables-no significant effect.