RESEARCH


Research is a vital component to the foundation of our business and it is one of the differentiators that separates Neuro Ex from many other facilities and programs. We partner with universities, hospitals, and manufacturers to investigate the effects of current techniques and novel interventions on the populations that we serve. Our goal is to continue to seek out the knowledge necessary to design an optimal training program for each of our clients.

Below you will find descriptions of current research projects we are involved in as well as abstracts from manuscripts published in peer reviewed journals. We invite you to review some of our ground-breaking work and we welcome your questions.

CURRENT PROJECTS

RESEARCH PARTICIPANTS NEEDED FOR INTENSE EXERCISE STUDY

Men and women ages 18 – 60 years old with spinal cord injury who are currently completing regular physical activity are needed to participate in a study investigating the practicality and utility of interval exercise (brief, intense bouts of exercise). The study requires:

  1. prospective participants to be healthy and not currently taking medications affecting physical function.
  2. four (4) visits to CSU—San Marcos over a 2 to 3 week period for a total time commitment of about 3 hours.
  3. during each visit, you will complete intense bouts of arm cranking during which various physical and perceptual measures will be performed.
  4. you will be paid $25.00 per visit for a total of $100.00 upon completion of this 4-day study.

Please contact Dr. Todd A. Astorino, Professor, Dept. of Kinesiology, CSU—San Marcos, astorino@csusm.edu or 760-750-7351, for more information about this study.

RESEARCH PAPERS

Increasing activity and exercise is essential for health and quality of life for people living with spinal cord injury (SCI). Obesity, cardiovascular disease, and diabetes are 2 to 4 times higher for people with SCI compared to the general population. This is due, in part, to low levels of activity, limited access and opportunities to participate in exercise, as well as changes in muscle and heart function that are common after injury. Exercise is necessary to improve fitness and reduce long-term health complications after SCI. Below are exercise recommendations for improving cardiovascular health, muscular strength and endurance, and flexibility for people with SCI.

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Multimodal IE can significantly improve motor function in subjects with chronic SCI. An organized program may provide greater motor benefits than a self-regulated program; load bearing might be of particular value. IE might have therapeutic value in chronic SCI, and as an adjunct to other restorative therapies.

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Data revealed that multi-modal ABT increases VO2 in persons with SCI, but energy expenditure is relatively low. Strategies must be identified to optimize energy expenditure in the SCI to reduce health risks. Modalities involving load bearing seem to be superior to non-load-bearing activities. VO2 was greater in response to load-bearing modalities than non-load-bearing modalities. It remains to be determined whether chronic ABT enhances cardiovascular fitness and reduces disease risks in this population.

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Spinal cord injury (SCI) results in a loss of motor and sensory function and is consequent with reductions in locomotion, leading to a relatively sedentary lifestyle which predisposes individuals to premature morbidity and mortality. Many exercise modalities have been employed to improve physical function and health status in SCI, yet they are typically expensive, require many trained clinicians to implement, and are thus relegated to specialized rehabilitation centers. These characteristics of traditional exercise-based rehabilitation in SCI make their application relatively impractical considering the time-intensive nature of these regimens and patients’ poor access to exercise. A promising approach to improve physical function in persons with SCI is exposure to acute intermittent hypoxia (IH) in the form of a small amount of sessions of brief, repeated exposures to low oxygen gas mixtures interspersed with normoxic breathing. This review summarizes the clinical application of IH in humans with SCI, describes recommended dosing and potential side effects of IH, and reviews existing data concerning the efficacy of relatively brief exposures of IH to modify health and physical function. Potential mechanisms explaining the effects of IH are also discussed. Collectively, IH appears to be a safe, time-efficient, and robust approach to enhance physical function in chronic, incomplete SCI.

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Osteoporosis is a severe complication of spinal cord injury (SCI). Many exercise modalities are used to slow bone loss, yet their efficacy is equivocal. This study examined the effect of activity-based therapy (ABT) targeting the lower extremities on bone health in individuals with SCI.

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This article summarizes presentations of a symposium examining the potential impact of activity-based therapies (ABT) in promoting neurological and functional recovery after spinal cord injury (SCI). The symposium addressed 3 key questions concerning activity-based therapy in SCI: (1) What clinical approaches are used? (2) Is there empirical evidence supporting efficacy of ABT in promoting neurological recovery and improving overall function, health, and quality of life? (3) What are the issues related to long-term viability of ABT?

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Chronic ABT focusing on the lower extremity does not slow muscle atrophy or alter body fat, body mass, or regional depots of FFM in persons with SCI. Further, it does not induce beneficial changes in adiponectin, myostatin, or IGF-I. Alternative exercise-based therapies are needed in SCI to reverse muscle atrophy and minimize the onset of related health risks.

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Regular exercise is required in persons with spinal cord injury (SCI) to reduce the deleterious effects of chronic paralysis. The primary aims of the study were to examine responses to passive and active exercise on a new rehabilitative device for persons with SCI and to examine reliability of these responses over 2 days of testing.

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Activity-based therapy (ABT) focuses on regaining motor and sensory function below the level of the lesion in persons with a spinal cord injury (SCI). This is accomplished through repetitive training of specific motor tasks. Research has shown that ABT may increase neuroplasticity in the rat and human spinal cord.

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The primary aim of the study was to examine substrate metabolism during combined passive and active exercise in individuals with spinal cord injury (SCI). Nine men and women with SCI (mean age 40.6 ± 3.4 years) completed two trials of submaximal exercise 1 week apart. Two maintained a complete injury and seven had an incomplete injury. Level of injury ranged from thoracic (T4–T6 and T10) to cervical (four C5–C6 and three C6–C7 injuries). During two bouts separated by 1 week, subjects completed two 30 min sessions of active lower-body and passive upper-body exercise, during which heart rate (HR) and gas exchange data were continuously assessed. Oneway analysis of variance with repeated measures was used to examine differences in all variables over time. Results demonstrated significant increases (P\0.05) in HR and oxygen uptake (VO2) from rest to exercise. Respiratory exchange ratio (RER) significantly increased (P\0.05) during exercise from 0.85 ± 0.02 at rest to 0.95 ± 0.01 at the highest cadence, reflecting increasing reliance on carbohydrate from 50.0 to 83.0% of energy metabolism. Data demonstrate a large reliance on carbohydrate utilization during 30 min of exercise in persons with SCI, with reduced contribution of lipid as exercise intensity was increased. Strategies to reduce carbohydrate utilization and increase lipid oxidation in this population should be addressed.

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We developed a method for remote measurement of balance and leg force in patients with spinal cord injury (SCI). In a group of 21 patients, both telemedicine and conventional clinical assessments were conducted at baseline and six months later. Telemedicine assessments were successfully acquired and transmitted at first attempt. The time required to set up the telemedicine equipment, position the subject, perform the measurements, and then send the data to the university laboratory was approximately 30 minutes. After six months, several motor and sensory functions showed significant changes. There were significant correlations between changes in remotely-measured leg force and changes in several of the American Spinal Injury Association (ASIA) sensory and motor scores. Changes in balance did not show any significant correlations with changes in the ASIA scores. Intra-rater reliability was better than inter-rater reliability. Use of telemedicine to remotely monitor changes in patients with SCI appears promising.

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