Training variables to optimize arm/hand training in subacute cervical spinal cord injury

Abstract

Background Motor training may enhance arm-hand functioning in people with cervical spinal cord injury (pwC-SCI), but the optimal training variables remain unknown.

Objectives To identify crucial training variables of arm-hand training in pwC-SCI. Method This project optimizes arm-hand training for pwC-SCI through (1) a systematic review evaluating motor training strategies and dosages, (2) a multi-center longitudinal observation study examining motor training strategies and therapy dosages in usual care, and (3) focus groups with experienced therapists capturing practice-based evidence. Results Literature suggests enhancing arm-hand function with skill training involving at least 8 task-oriented training components and additional strength and endurance training over a minimum of 8 weeks. Contrarily, the observation study revealed that 31% of the time is allocated to skill training, 32.2% to strength and endurance training, and the remaining 36.8% to analytical training. Active training constitutes 56.3% of the total time, with patients reporting a mean subjective difficulty of 4.1/10 and a mean perceived intensity of 4/10. Focus groups emphasize the importance of individualized training through ongoing analysis of the person, therapy, and goals within a multidisciplinary approach. Discussion Conventional arm/hand rehabilitation for pwC-SCI diverges from literature recommendations. Therapists call for individualized rehabilitation programs but struggle with dosing.