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

Abstract

Objectives and main message of presentation The project aims to identify crucial training components of arm-hand training in people with cervical spinal cord injury (pwC-SCI) in order to develop an arm-hand training framework guiding therapists to improved clinical practice. Background and aim Motor training may enhance arm-hand functioning in pwC-SCI. While the literature recommends task-specific motor training with a certain dose, the optimal training variables, motor training strategies, and dosages remain unknown.

Method This study presents a multi-phase approach to optimize arm/hand training for pwC-SCI by developing a framework. (1) A systematic literature review to assess motor training strategies and dosages employed in active arm-hand motor training. (2) A longitudinal observational study across three rehabilitation centers in Belgium and the Netherlands to observe motor training strategies and therapy dosages in usual active arm-hand training. (3) Three focus groups comprising experienced therapists from the aforementioned rehabilitation centers to capture practice-based evidence and identify needs to optimize arm/hand training. Results The systematic review revealed that enhancing arm-hand functioning at the activity level can be achieved through skill training involving at least 8 task-oriented training components and additional strength and endurance training, with a minimum training duration of 8 weeks. On the contrary, the observational study demonstrates that motor training strategies are distributed as follows: 31% skill training, 25.9% strength training, and 6.3% endurance training, with the remainder 36.8% dedicated to analytical training. Actual session length fulfills 75% of the planned duration; within arm-hand training session length 56.3% comprises active training. Patients reported a mean subjective difficulty level of 4.1/10 and a mean perceived intensity of 4/10. Focus groups ass the importance of the centrality of the person, his motivational aspects, and the client system in the rehabilitation. Therapists want to individualize the training based on the continued analysis of the person, therapy, and goals within a multidisciplinary approach. However, it is challenging for therapists to individualize therapy doses. Discussion Conventional arm/hand rehabilitation in pwC-SCI does not align with the literature's recommendations on motor training strategies and therapy dose. Therapists call for individualized rehabilitation programs but struggle with dosing customization. Therefore, we propose and assess a framework for arm/hand training incorporating the crucial training variables.