Table 1.
Case studies, case series, and cross-sectional studies evaluating the effects of activity-based physical therapy (ABPT) and/or loading on bone mineral density (BMD) in adults with acute or subacute spinal cord injury (SCI).
| Author; Citation; Sample Size/Sex; Group (G): Modality |
SCI Level; Severity; Duration |
Training Duration; Frequency; Time; Parameters |
Skeletal Site Evaluated and Outcomes Reported | Baseline BMD | BMD (% Difference) | ||
|---|---|---|---|---|---|---|---|
| CASE STUDIES AND CASE SERIES | |||||||
| BWSTT | |||||||
| Giangregorio et al. [50] N = 2 M, 3 F BWSTT |
C3-C8; AIS B-C; 66–170 d |
6–8 mo (48 sessions); 2 d/wk; Three 5–15 min bouts/d Training parameters: 0–97% BWSTT, 0.6–2.0 km/h bodyweight support reduced, and speed and duration increased over time |
Total body aBMD Lumbar spine aBMD Proximal femur aBMD Distal femur aBMD Proximal tibia aBMD Femur diaphysis vBMD Tibia diaphysis vBMD |
Baseline 1.21 g/cm2 1.09 g/cm2 1.03 g/cm2 1.10 g/cm2 0.96 g/cm2 795 g/cm3 796 g/cm3 |
6–8 mo −2.7% −3.1% −2.9% −13% −4.3% −5.5% −6.2% |
||
| Lichy and Groah [38] N = 1 M BWSTT |
T4; AIS C; 11 wk |
3 mo; 3 d/wk; 1 h/d Training parameters: 16–32 kg BWSTT, 1.9–2.5 km/h, bodyweight support reduced and speed increased over time |
Lumbar spine aBMD Left proximal femur aBMD Right proximal femur aBMD |
Baseline 1.12 g/cm2 0.92 g/cm2 0.93 g/cm2 |
5 mo −2.8% −11% −4.0% |
1.5 yrs +2.5% −19% −5.0% |
|
| FES | |||||||
| Lambach et al. [106] N = 4 M FES KE/KF RT + FES rowing |
C7-T10; AIS A-B; 10–16 mo |
9–12 mo (90 sessions); 3 d/wk; 30–60 min/d Training parameters: FES RT: 0–120 mA, 40 Hz, 450 µs, 5 s on:1 s off FES Rowing: N/R |
Entire cohort Distal femur trabecular vBMD Distal tibia trabecular vBMD Acute cohort Distal femur trabecular vBMD Distal tibia trabecular vBMD |
Baseline 207 mg/cm3 168 mg/cm3 169 mg/cm3 121 mg/cm3 |
30 sessions −8.4% −14% −8.1% −19% |
60 sessions −5.9% −17% −3.9% −21% |
90 sessions −8.2% −19% −3.7% −24% |
| Note: Lambach et al. included N = 2 <1 yr and N = 2 chronic SCI. Baseline and % difference BMD values are reported separately for the entire cohort and the subacute SCI cohort. Values for the chronic cohort are in Table 3 | |||||||
| CROSS-SECTIONAL STUDIES | |||||||
| Goemaere et al. [107] N = 42 M, 11 F G1: Standing, N = 34 M, 4 F G2: Non-standing, N = 8 M, 7 F |
T-L; complete to incomplete; standing began as early as possible after SCI, usually within 3 mo |
12–180 mo; 3–7 d/wk; 1 h/d Training parameters: Long leg braces (N = 20), standing frame (N = 9), or standing wheelchair (N = 9) |
G1: L3 aBMD G2: L3 aBMD G1: L4 aBMD G2: L4 aBMD G1: Femur neck aBMD G2: Femur neck aBMD G1: Femur trochanter aBMD G2: Femur trochanter aBMD G1: Total hip aBMD G2: Total hip aBMD G1: Femur shaft aBMD G2: Femur shaft aBMD |
Baseline N/R N/R N/R N/R N/R N/R N/R N/R N/R N/R N/R N/R |
% uninjured value +0.0% −7.4% † +3.8% −4.7% −25% −25% −27% −30% −30% −31% −21% −29% † |
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G, Group; BWSTT, bodyweight-supported treadmill training; FES, functional electrical stimulation; RT, resistance training; KE/KF, knee extension/knee flexion; F, female; M, male; C, cervical; T, thoracic; AIS, American Spinal Injury Association Impairment Scale; SCI Duration: time since SCI in relation to start of intervention; aBMD, areal bone mineral density; vBMD, volumetric bone mineral density; min, minute; h, hour; d, day; wk, week; mo, month; N/R, not reported. The % change was reported in individual papers or was manually calculated from the data in tables and/or figures; † indicates a p value of <0.05 between the groups; a lack of symbols indicates no statistical differences that were reported versus the baseline or between the groups.