Dudley-Javoroski Shauna, Shields Richard K
Physical Therapy and Rehabilitation Science, University of Iowa, Iowa City, Iowa, USA.
Phys Ther. 2008 Mar;88(3):387-96. doi: 10.2522/ptj.20070224. Epub 2008 Jan 17.
The interpretation of the results of previous anti-osteoporosis interventions after spinal cord injury (SCI) is undermined by incomplete information about the intervention dose or patient adherence to dose requirements. Rehabilitation research as a whole traditionally has struggled with these same issues. The purpose of this case report is to offer proof of the concepts that careful dose selection and surveillance of patient adherence should be integral components in rehabilitation interventions.
A 21-year-old man with T4 complete paraplegia (7 weeks) enrolled in a unilateral soleus muscle electrical stimulation protocol. Compressive loads applied to the tibia approximated 1.4 times body weight. Over 4.8 years of home-based training, data logging software provided surveillance of adherence. Soleus muscle torque and fatigue index adaptations to training as well as bone mineral density (BMD) adaptations in the distal tibia were measured.
The patient performed nearly 8,000 soleus muscle contractions per month, with occasional fluctuations. Adherence tracking permitted intervention when adherence fell below acceptable values. The soleus muscle torque and fatigue index increased rapidly in response to training. The BMD of the untrained tibia declined approximately 14% per year. The BMD of the trained tibia declined only approximately 7% per year. The BMD was preferentially preserved in the posterior half of the tibia; this region experienced only a 2.6% annual decline.
Early administration of a load intervention, careful estimation of the loading dose, and detailed surveillance of patient adherence aided in the interpretation of a patient's adaptations to a mechanical load protocol. These concepts possess wider applicability to rehabilitation research and should be emphasized in future physical therapy investigations.
脊髓损伤（SCI）后既往抗骨质疏松干预结果的解读因干预剂量信息不完整或患者对剂量要求的依从性而受到影响。传统上，整个康复研究都在努力解决这些相同的问题。本病例报告的目的是提供证据证明，仔细的剂量选择和对患者依从性的监测应成为康复干预的组成部分。
一名21岁、T4完全性截瘫（7周）男性参加了一项比目鱼肌单侧电刺激方案。施加于胫骨的压缩负荷约为体重的1.4倍。在4.8年的家庭训练中，数据记录软件提供了依从性监测。测量了比目鱼肌扭矩和疲劳指数对训练的适应性以及胫骨远端骨密度（BMD）的适应性。
患者每月进行近8000次比目鱼肌收缩，偶尔有波动。当依从性低于可接受值时，依从性跟踪允许进行干预。比目鱼肌扭矩和疲劳指数对训练反应迅速增加。未训练侧胫骨的骨密度每年下降约14%。训练侧胫骨的骨密度每年仅下降约7%。胫骨后半部分的骨密度得到优先保留；该区域每年仅下降2.6%。
早期进行负荷干预、仔细估计负荷剂量以及详细监测患者依从性有助于解释患者对机械负荷方案的适应性。这些概念在康复研究中具有更广泛的适用性，应在未来的物理治疗研究中得到强调。
