Spinal cord injury (SCI) disrupts somatic and autonomic nervous system.

Many body systems are affected; the degree of
muscle paralysis, sensory loss, and autonomic impairment vary greatly.

American Spinal Injury Association Impairment Scale

Congenital SCI presents at birth with incomplete formation and closure of neural and skeletal bony elements.

Effects of level of injury on Somatic and Autonomic Function

Myotomes & dermatomes

Arm crank ergometer is the most often used test mode with SCI.

Wheelchair ergometry is mobility specific for most SCI patients.

Externally applied electrical stimulation of neuromuscular elements to activate paralyzed muscles in a precise sequence and at a precise intensity to restore
muscular function.

Due to sympathetic impairment, peak heart rate rarely exceeds 120 beats/min in those with complete tetraplegia and T1-T3 paraplegia.

Variable responses occur in T4-T6

Most persons with SCI below T7 are able to reach their age-adjusted peak heart rate.

VO2peak and peak power output are significantly diminished in patients with SCI.
The lower the injury, the less the impairment

Persons with resting systolic BP lower than 100 mmHg should be closely monitored during exercise for the hypotensive response.

Tilt person back in wheelchair to promote venous return if symptomatic hypotension occur.

Normally innervated muscles in persons with SCI is tested very similar to that in persons without SCI

Provided that the trunk is stabilized, balanced is ensured, and excessive axial loading of the spine or weight-
bearing skin is avoided.

Anaerobic Wingate arm ergometry can be used in testing with younger fit individuals and
athletes.

Joints should be moved passively, or actively, but always slowly, gently, and painlessly, especially if spasticity, tightness, or contracture is present.

Abdominal binders and leg wraps facilitate improved pulmonary dynamics and greater venous return

Functional electrical stimulation – leg cycling exercise (expensive to purchase an maintain)

Upper armband (Coban type) to prevent abrasions with wheelchair propulsion

Velcro straps and cuffed weights used for resistance exercise to improve or create grip

Lesions ↑ C4: limited to functional electrical stimulation (arm, trunk, leg paralysis)

Lesions ↑ C4: Manual resistive exercise for inspiration

Barriers: transportation availability, assistance & finances (↓ed compliance)

Lesions ↑ C4: Passive range of motion exercises

Appropriate seating NB! To ↓ pressure ulcers, autonomic dysreflexia, spasticity and musculoskeletal trauma

Hybrid exercises – Functional electrical stimulation – leg cycling Promising exercise mode for cardiorespiratory training

Exercise in mildly temperate climate due to ↓ed thermoregulatory ability

Initial stages of program: focus on developing habit of exercise as adherence is low:
Succinct precise, and quantifiable goals optimize chances
Develop positive connection to exercise

Limited increase in cardiac contractility, stroke volume and arterial blood pressure

Characterised by lower increase in cardiac output per unit increase in VO2

Caloric expenditure: Decreases CVD risk and weight management
Upper extremity overuse syndrome: Rather perform exercise session in bouts to avoid. Strain from too high volume of exercise

Paralyzed lower extremities and truncal musculature significantly reduce a person’s ability to balance even small objects when lying supine or when seated without significant truncal support..

Wheelchair brakes should be set before lifting and care should be taken not to exceed the weight and stress limitations of the
wheelchair.

Maintain shoulder range of motion, especially external rotation and retraction and upward rotation of the scapula.

• Incorporate both active and passive stretching.

• Be carful during passive stretching in joints lacking sensation (individual cannot determine when maximal range of joint has been reached).

Standing Frame - Should be medically cleared for full weight bearing

Patients with longstanding (> 20 yr) SCI require greater physical assistance as they age.

% of maximal heart rate during performance of Activities of Daily Living and community mobility tasks is higher in people with tetraplegia than in those
paraplegia

Due to the large number of shoulder and upper extremity musculoskeletal problems encountered by persons with SCI, a prophylactic, structured, and progressively resistive strengthening program that focuses on scapular, rotator cuff, and pectoral muscles is likely to increase strength and reduce the risk of overuse injury.