UBC Theses and Dissertations
Physical activity during inpatient spinal cord injury rehabilitation Zbogar, Dominik
Introduction Rehabilitation activities of a sufficient intensity are necessary for optimal recovery in individuals with spinal cord injury (SCI). Optimizing rehabilitation and activity prescription requires quantification of physical activity and its predictors during this time. Purpose To determine, during inpatient rehabilitation, the: 1) reliability and validity of measures of physical activity. 2) level of physical activity using objective and self-report measures. 3) level of cardiovascular stress experienced during physical therapy (PT) and occupational therapy (OT). 4) variables associated with greater time spent at higher heart rate during PT. 5) number of active movement repetitions occurring during PT and OT. Methods Design: A test retest design was used to determine the reliability of physical activity measures. A longitudinal observation design was used to determine movement repetitions and physical activity levels. A cross-sectional observational design was used to determine the level of cardiovascular stress. Subjects: Participants (n=108) were recruited from consecutive admissions to rehabilitation. Results Good reliability for accelerometry and step counts, and moderate reliability for self-report, was demonstrated. Validity was demonstrated for wrist accelerometry and step counts but not self-report physical activity. For most groups and variables, no changes occurred during therapy time from admission to discharge. Outside of therapy all groups increased from admission to discharge in accelerometer measured activity kilocounts but not self-report minutes, where the majority of time was spent in leisure time sedentary activity (~4.5 hours). The average time spent at a heart rate within the cardiovascular training zone was 6.0±9.0 minutes in PT and lower in OT. Lower spasticity, higher exercise self-efficacy, and better orthostatic tolerance correlated with a greater amount of time within a cardiovascular training zone. Average repetitions for PT and OT combined did not exceed 300 for the upper or lower extremity. Most repetition variables remained unchanged over the inpatient rehabilitation stay while clinical outcomes improved significantly. Conclusions Individuals report that a large amount of time is spent engaged in higher intensity activities. Measurement of heart rate during therapy sessions shows little time is spent at intensities sufficient to accrue cardiovascular benefits. Repetitions in therapy are low compared to the motor learning literature.
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Attribution-NonCommercial-NoDerivs 2.5 Canada