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Published on: May 7, 2015
Effects of acute intermittent hypoxia on hand use after spinal cord trauma: A preliminary study
Randy D Trumbower1, Heather B Hayes2, Gordon S Mitchell2
1From the Department of Physical Medicine and Rehabilitation (R.D.T.), Harvard Medical School, Cambridge; Department of Physical Medicine and Rehabilitation (R.D.T.), Spaulding Rehabilitation Hospital, Charlestown, MA; Division of Physical Therapy (H.B.H., S.L.W., V.A.S.), Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA; Center for Respiratory Research and Rehabilitation (G.S.M.), Department of Physical Therapy, and McKnight Brain Institute (G.S.M.), University of Florida, Gainesville; and Center for Visual and Neurocognitive Rehabilitation (S.L.W.), Atlanta VA Medical Center, Decatur, GA. rtrumbower@partners.org.
Objective:
To test the hypothesis that daily acute intermittent hypoxia (AIH) combined with hand opening practice improves hand dexterity, function, and maximum hand opening in persons with chronic, motor-incomplete, cervical spinal cord injury.
Methods:
Six participants completed the double-blind, crossover study. Participants received daily (5 consecutive days) AIH (15 episodes per day: 1.5 minutes of fraction of inspired oxygen [FIo2] = 0.09, 1-minute normoxic intervals) followed by 20 repetitions of hand opening practice and normoxia (sham, FIo2 = 0.21) + hand opening practice. Hand dexterity and function were quantified with Box and Block and Jebsen-Taylor hand function tests. We also recorded maximum hand opening using motion analyses and coactivity of extensor digitorum and flexor digitorum superficialis muscles using surface EMG.
Results:
Daily AIH + hand opening practice improved hand dexterity, function, and maximum hand opening in all participants. AIH + hand opening practice improved Box and Block Test scores vs baseline in 5 participants (p = 0.057) and vs sham + hand opening practice in all 6 participants (p = 0.016). All participants reduced Jebsen-Taylor Hand Function Test (JTHF) time after daily AIH + hand opening practice (-7.2 ± 1.4 seconds) vs baseline; 4 of 6 reduced JTHF time vs sham + hand opening practice (p = 0.078). AIH + hand opening practice improved maximum hand aperture in 5 of 6 participants (8.1 ± 2.7 mm) vs baseline (p = 0.018) and sham + hand opening practice (p = 0.030). In 5 participants, daily AIH-induced changes in hand opening were accompanied by improved EMG coactivity (p = 0.029).
Conclusions:
This report suggests the need for further study of AIH as a plasticity "primer" for task-specific training in spinal cord injury rehabilitation. Important clinical questions remain concerning optimal AIH dosage, patient screening, safety, and effect persistence.
Clinicaltrialsgov Identifier:
NCT01272336.
