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Excerpt
PURPOSE: To investigate changes in gross mechanical efficiency (ME), i.e. task proficiency of hand rim wheelchair propulsion, during the rehabilitation of persons with a spinal cord injury (SCI). METHODS: Within a Dutch multi-center prospective cohort study, SCI were tested at the beginning of their clinical rehabilitation (T1), 3 months later (T2) and at time of discharge from rehabilitation (T3). If subjects were able to, they performed 2 blocks of 3min. submaximal steady-state treadmill exercise in a standardized hand rim wheelchair. ME values were calculated for both exercise blocks during the last minute. Tests (T1-T3), lesion level and completeness were used as independent variables in a multi-level regression analysis with 4 hierarchical levels (exercise block, test, subject, center)(p<0.05). Incomplete subject data sets could thus be included in this procedure, leading to different numbers of subjects per trial: N = 103–130 subjects with paraplegia (PP) and N = 37–56 subjects with tetraplegia (TP) for the 3 tests when both blocks were included in one model. RESULTS: ME showed a small but significant increase during rehabilitation. Block 1: TP: T1: 3.3% ± 1.2 to T3: 3.4% ± 1.5 vs. PP: T1: 4.8% ± 1.8 to T3: 4.9% ± 1.8;Block 2: TP: T1: 4.6% ± 1.4 to T3: 4.7% ± 1.7 vs. PP: T1: 6.5% ± 1.9 to T3: 7.1% ± 2.0. A significant effect of lesion level and completeness on the change in ME over time was shown between T1 & T2 and between T2 & T3. After correcting for power output (PO), no significant difference in ME was found between PP and TP or Complete and Incomplete. This generates the following multi-level model: ME = 1.588 (0.272) −0.256 (0.115)*dummy1 + 0.062 (0.107)*dummy2 + 0.237 (0.134) *lesion + 0.035 (0.110) *completeness + 0.274 (0.016) *PO (dummy1 & dummy2 are T1: 1 & 0, T2: 0 & 0, T3: 0 & 1; Lesion: TP = 0, PP = 1; Incomplete = 0, Complete = 1). Also, no significant interaction effect was found for lesion level and time regarding ME, indicating that the development in ME was not different between PP and TP. CONCLUSION: Results showed an improved task proficiency, indicated by a small improvement in ME during rehabilitation. When correcting for the large differences in PO between individuals, the pattern over time was similar for PP and TP.
