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Non-Drug Rehabilitation Therapies for SLOP Rehabilitation therapies for SLOP focus on muscle contraction, stimulation and/or weight bearing activities, intended to simulate typical mechanical stresses on the bone, in order to activate bone formation. Common SLOP rehabilitation interventions include functional electrical stimulation (FES), electrical stimulation (ES), standing and walking, body weight support treadmill training (BWSTT) and ultrasound. FES involves the use of surface or implanted electrodes to stimulate regional lower extremity muscle contractions, to facilitate standing, ambulation or cycle ergometry, with the goal of increasing regional BMD. FES cycle ergometry (FES-CE) requires a series of electrodes placed over the hamstrings, quadriceps and gluteal muscles of the legs, to simulate a cycling pattern (Figure 6.0). Weightbearing activities include either passive standing (tilt-table or standing frame, Figure 7.0) or active standing, with or without FES, to assist with knee extension. Relative contraindications, for these therapies, include a subluxed or dislocated hip, hip and knee flexion contractures totalling > 30 degrees combined, nonunion of lower extremity fractures, and a strong hip flexor synergy. A systematic review by Biering-Sorensen et al.16 provides a detailed evaluation of the non-pharmacological interventions for prevention of SLOP, and highlights the lack of efficacy of rehabilitation interventions. Among individuals with chronic SCI and SLOP, rehabilitation interventions may be ineffective, due to prolonged suppression of osteocyte and osteoblast activity. It is also plausible that insufficient mechanical stresses and short durations of therapy have resulted in the modest treatment effects, to date. Unfortunately, the therapeutic effects observed with Electrical Stimulation (ES) and Functional Electrical Stimulation (FES) are isolated to the area stimulated and return to baseline within months of stopping therapy. Up to now, no rehabilitation intervention has led to sustained increases in hip or knee region BMD, in chronic SCI subjects with SLOP. FES cycle ergometry or passive standing may be offered to individuals as SLOP treatment - provided patients understand it is a lifetime prescription, as the therapeutic benefits abate, with therapy cessation. Rehabilitation interventions may be offered as SLOP treatment options, provided their potential risks and limited efficacy have been discussed, prior to initiation. Clinical decision making regarding the relative efficacy of therapy is further Figure 6.0 FES Cycle-ergometry. complicated by many studies that have enrolled participants, with both acute and chronic injuries, making it difficult to identify interventions as primarily for SLOP prevention or treatment. Figure 7.0 Pasive Standing Using a Standing Frame. 120 CAPTURING CAPACITY IN CANADIAN SCI REHABILITATION


L - Skeletal Integrity
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