Upper Limb Table 9 Subacute Phase of Rehabilitation

Author Year
Country
Research Design
Score

Total Sample Size

Methods

Outcome

Stahl et al. 2015
USA
Post-Test
N=16

Population: SCI population (n=8): Mean age: 37±4.4 yr; Gender: males=7, females=1; Level of injury: AIS C4-C7=1, AIS C5=1, AIS C5-C7=6; Mean time since injury: 10.9 yr. Healthy controls (n=8): Mean age: 26.6±2.4 yr; Gender: males=6, females=2.
Intervention: Measured hand kinematics and surface electromyography from seven muscles of the hand and wrist during attempts at maximum hand opening as well as reaching for four balls of different diameters.
Outcome Measures: Hand kinematics, Surface electromyography (EMG) of wrist and hand muscles, Peak aperture, Box-and-Blocks Test (BBT), Jebsen-Taylor Hand Function (JTHF).
  1. Maximum hand opening was reduced in SCI participants as compared to controls (p=0.002).
  2. No correlation between maximum voluntary hand opening and hand function with BBT (p=0.934) and JTHF (p=0.701).
  3. SCI participants had greater EMG activity in AD (anterior deltoid) (p=018), TRI (triceps brachii) (p=0.009), FCU (flexor carpi ulnaris (p=0.020), and FDS (flexor digitorum superficialis) (p=0.051) as compared to AB group.
  4. Co-activation ratios at wrist and hand were reduced for the SCI group compared to the control group (wrist: p=030, hand: p=0.006).
  5. Peak aperture for balls B, C, and D was larger in the AB group than the SCI group (all p≤042), while peak aperture for the smallest ball A was not different (p=0.163).
  6. AB participants utilized less of their aperture range compared to the SCI group (p=035).
  7. There was no difference in number of muscle coordination patterns (p=0.227) as both groups required three patterns to sufficiently account for >90% of EMG data variance.
  8. For the SCI group, the wrist flexion muscle coordination pattern (p=002) increased activation as the ball size increased.
  9. The wrist extension muscle coordination pattern also showed a nonsignificant trend to increase activation as ball size increased (p>0.05).

Barbetta et al. 2016
Brazil
Case Series
N=564

Population: Mean age: 34.0 yr; Gender: males=446, females=118; Mean BMI: 22.4±4.8 kgm2; Level of injury: C1-5=32, C6-1=189, T2-6=146, T7-S5=197; Severity of injury: AIS A=317, AIS B=85, AIS C=48, AIS D=54; Mean time since injury: 5.0 yr.
Intervention: No intervention. Retrospective charts were reviewed analyze impact of demographic (gender, age, body mass index (BMI)) and injury based variables (level of injury, severity of injury, time of injury, type of mobility, locomotion aid) on occurrence of musculoskeletal pain.
Outcome Measures: Musculoskeletal pain.
  1. Prevalence of musculoskeletal UE pain was 27.7% (CI 95%, 24.0–31.4).
  2. In groups with and without pain, age (p=0.185), BMI (p=0.312) and mobility aid (p=0.101) showed no statistically significant difference.
  3. Gender (p=0.007), time of injury (p<0.001), level (p<0.001) and completeness of injury (p=0.039), and locomotion (p<0.001) were significantly different between pain and no pain groups.
  4. Women are twice as likely to experience UE pain as men (95% CI, 1.3-3.4).
  5. Individuals aged ≥41 yr are twice as likely to have pain as are patients <24.7 yr of age (95% CI, 0.3-0.9).
  6. Individuals with injury that has lasted <1 yr have a greater risk of pain than individuals in other quartiles; the former are two times more likely to experience UE pain than are individuals with 1.1–2.8 yr of injury (95% CI, 0.2-0.7) and three times more likely than individuals with 2.9–6.8 (95% CI, 0.2-0.5) and 6.9+yr of injury (95% CI, 0.2-0.6).
  7. The individuals exclusively using wheelchairs for locomotion had twice the risk of pain than did those in the ‘wheelchair+orthostatism’ (95% CI, 0.3-0.8) and ‘wheelchair+walking exercise’ groups (95% CI, 0.3-1.0).
  8. There was no difference in a comparison with the ambulators.
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