Persons with spinal cord injury (SCI) exhibit deficits in volitional motor control and sensation that limit not only the performance of daily tasks but also the overall activity level of these persons. This population has been characterised as extremely sedentary with an increased incidence of secondary complications including diabetes mellitus, hypertension and atherogenic lipid profiles. As the daily lifestyle of the average person with SCI is without adequate stress for conditioning purposes, structured exercise activities must be added to the regular schedule if the individual is to reduce the likelihood of secondary complications and/or to enhance their physical capacity. The acute exercise responses and the capacity for exercise conditioning are directly related to the level and completeness of the spinal lesion. Appropriate exercise testing and training of persons with SCI should be based on the individual's exercise capacity as determined by accurate assessment of the spinal lesion. The standard means of classification of SCI is by application of the International Standards for Classification of Spinal Cord Injury, written by the Neurological Standards Committee of the American Spinal Injury Association. Individuals with complete spinal injuries at or above the fourth thoracic level generally exhibit dramatically diminished cardiac acceleration with maximal heart rates less than 130 beats/min. The work capacity of these persons will be limited by reductions in cardiac output and circulation to the exercising musculature. Persons with complete spinal lesions below the T(10) level will generally display injuries to the lower motor neurons within the lower extremities and, therefore, will not retain the capacity for neuromuscular activation by means of electrical stimulation. Persons with paraplegia also exhibit reduced exercise capacity and increased heart rate responses (compared with the non-disabled), which have been associated with circulatory limitations within the paralysed tissues. The recommendations for endurance and strength training in persons with SCI do not vary dramatically from the advice offered to the general population. Systems of functional electrical stimulation activate muscular contractions within the paralysed muscles of some persons with SCI. Coordinated patterns of stimulation allows purposeful exercise movements including recumbent cycling, rowing and upright ambulation. Exercise activity in persons with SCI is not without risks, with increased risks related to systemic dysfunction following the spinal injury. These individuals may exhibit an autonomic dysreflexia, significantly reduced bone density below the spinal lesion, joint contractures and/or thermal dysregulation. Persons with SCI can benefit greatly by participation in exercise activities, but those benefits can be enhanced and the relative risks may be reduced with accurate classification of the spinal injury.

https://www.exeter.ac.uk/media/universityofexeter/internationalexeter/documents/iss/LC_Jacobs_and_Nash_2004.pdf

Exercise recommendations for individuals with spinal cord injury.

https://www.archives-pmr.org/article/S0003-9993(01)13197-7/pdf

Chronic pain associated with spinal cord injuries: A community survey

https://www.archives-pmr.org/article/S0003-9993(01)24311-1/pdf

Chronic pain after spinal injury: interference with sleep and daily activities.

Obesity after spinal cord injury.

JACOBS, P. L., M. S. NASH, and J. W. RUSINOWSKI, JR. Circuit training provides cardiorespiratory and strength benefits in persons with paraplegia. Med. Sci. Sports Exerc., Vol. 33, No. 5, 2001, pp. 711‐717. Purpose: This study tested the safety and the effects of circuit resistance training (CRT) on peak upper extremity cardiorespiratory endurance and muscle strength in chronic survivors of paraplegia due to spinal cord injury. Methods: Ten men with chronic neurologically complete paraplegia at the T5‐L1 levels participated in the study. Subjects completed 12 wk of CRT, using a series of alternating isoinertial resistance exercises on a multi-station gym and high-speed, low-resistance arm ergometry. Peak arm ergometry tests, upper extremity isoinertial strength testing, and testing of upper extremity isokinetic strength were all performed before and after training. Results: None of the subjects suffered injury from exercise training. Significant increases were observed in peak oxygen consumption (29.7%, P , 0.01), time to fatigue (P , 0.01), and peak power output during arm testing (P , 0.05). Significant increases in isoinertial strength for the training maneuvers ranged from 11.9% to 30% (Ps , 0.01). Significant increases in isokinetic strength were experienced for shoulder joint internal rotation, extension, abduction, adduction, and horizontal adduction (Ps , 0.05). Conclusion: Chronic survivors of paraplegia safely improve their upper extremity cardiorespiratory endurance and muscle strength when undergoing a short-term circuit resistance training program. Gains in fitness and strength exceeded those usually reported after either arm endurance exercise conditioning or strength

George A. Drysdale

Papers

Shoulder pain in wheelchair users with tetraplegia and paraplegia.