Noreau L, Shephard R J
Department of Physiotherapy, Laval University, Quebec, Canada.
Sports Med. 1995 Oct;20(4):226-50. doi: 10.2165/00007256-199520040-00003.
The ultimate goal of comprehensive rehabilitation in individuals with spinal cord injury (SCI) has shifted over time from an extension of their life expectancy to attainment of an optimal level of independent living and quality of life. After World War II, the important influence of sport and exercise upon the course of rehabilitation following SCI was recognised. Nonetheless, 5 decades later, there remains a lack of understanding of how an exercise programme can contribute to an improvement of quality of life among individuals with SCI. In future, attention should be directed toward avoidance of secondary impairments, disabilities and handicaps. The World Health Organization model of disablement provides a suitable framework for addressing this issue. The most common benefits of exercise are biological in nature. They target a reduction in secondary impairments (loss of cardiorespiratory, and muscular function, metabolic alterations and systemic dysfunctions). This in turn could minimise the development of disabilities and the appearance of such handicaps as loss of mobility, physical dependence and poor social integration. A lack of physical fitness for specific tasks can be a serious obstacle to autonomy following SCI. In a very short period of time, physical deconditioning can significantly decrease quality of life in individuals with SCI, ultimately placing them in a state of complete dependency. Quality of life is closely associated with independent living and, increasingly, it is a key outcome when measuring the success of rehabilitation. Consequently, research designs that examine the impact of exercise upon individuals with disabilities should not only include objective outcome measures, but also subjective measures relating to life-satisfaction and quality of life.
脊髓损伤（SCI）患者综合康复的最终目标随着时间推移已从延长预期寿命转变为达到最佳独立生活水平和生活质量。第二次世界大战后，人们认识到运动和锻炼对SCI后康复进程具有重要影响。尽管如此，50年后，人们仍缺乏对运动计划如何有助于改善SCI患者生活质量的理解。未来，应将注意力转向避免继发性损伤、残疾和障碍。世界卫生组织的残疾模型为解决这一问题提供了合适的框架。运动最常见的益处本质上是生物学方面的。它们旨在减少继发性损伤（心肺和肌肉功能丧失、代谢改变和全身功能障碍）。这反过来可以最大限度地减少残疾的发展以及诸如行动能力丧失、身体依赖和社会融合不良等障碍的出现。缺乏完成特定任务所需的体能可能是SCI后实现自主的严重障碍。在很短的时间内，身体机能下降会显著降低SCI患者的生活质量，最终使他们处于完全依赖的状态。生活质量与独立生活密切相关，而且在衡量康复成功与否时，它日益成为一个关键结果。因此，研究运动对残疾个体影响的设计不仅应包括客观结果指标，还应包括与生活满意度和生活质量相关的主观指标。
