Essential training variables of arm-hand training in people with cervical spinal cord injury: A systematic review

Abstract

Objective: To identify and evaluate 3 training variables of motor training programmes involving people with a cervical spinal cord injury: i.e. motor training stra-tegies, therapy dosage, and persons' motivation for arm-hand functioning in subacute and chronic phases.Methods: PubMed, Cochrane, CINAHL, EMBASE, and DARE databases were searched for active arm-hand motor training programmes. Two independent revie-wers assessed methodological quality. Pre-post effect sizes were calculated using Hedge's g, and mean effect sizes were calculated to compare outcomes on the International Classification of Functioning, Disabi-lity, and Health levels of function and activity.Results: Twelve training programmes integrated mainly skill training alone or combined with strength and/or endurance training. Task-oriented training components included: multiple movement planes, functional movements, clear functional goals, and bimanual practice. Training duration of 8 weeks was common. Quantitative analyses of 8 training programmes showed an overall small effect (0.34) on function level and an overall moderate effect (0.55) on activity level. In depth-analysis of acti-vity level showed moderate effects of skill training only (0.55) or combined with strength and endu-rance training (0.53). Moderate effects (0.53-0.60) were found for integrating functional movements, clear functional goals, real-life object manipulation, multiple movement planes, total skill practice, con-text-specific environment, exercise variety, and bimanual practice. Training of minimum 8 weeks showed a moderate effect (0.60-0.69).Conclusion: Based on limited studies, arm-hand functioning aiming to improve activity level can be improved using skill training with at least 8 task-oriented training components, additional strength and endurance training, with a minimum training duration of 8 weeks.