Page 8

L - Skeletal Integrity

Table 5.0 Summary of Rehabilitation Interventions. The initiation of SLOP therapy necessitates repeat BMD testing to evaluate treatment effectiveness and periodic assessment of adherence. Non-response to drug or rehabilitation therapy should prompt therapy cessation or a trial of alternate therapy. Little is known about the efficacy of combination therapy although evolving research has begun to explore the therapeutic potential of a variety of intervention combinations. Available Systematic Reviews • Ashe MC, Craven C, Krassioukov A, Eng JJ. Bone health following spinal cord injury. In: Eng JJ, Teasell RW, Miller WC, et al., eds. Spinal Cord Injury Rehabilitation Evidence. Version 3.0. Vancouver, BC; 2010:1-26. • Craven BC, Giangregorio LM, Robertson LA, Delparte JJ, Ashe MC, Eng JJ. Sublesional osteoporosis prevention, detection and treatment: a decision guide for rehabilitation clinicians treating patients with spinal cord injury. Crit Rev Phys Rehabil Med. 2008;20(4):277–321. • Biering-Sorenson F, Hansen B, Lee BS. Non-pharmacological treatment and prevention of bone loss after spinal cord injury: a systematic review. Spinal Cord. 2009;47(7):508–18. Key References to Inform Practice 1. Papaioannou A, Morin S, Cheung AM, et al. 2010 clinical practice guidelines for the diagnosis and management of osteoporosis in Canada: summary. CMAJ.2010; 182(17):1864-73. 2. Bauman WA, Emmons RR, Cirnigliaro CM, Kirshblum SC, Spungen AM. An effective oral vitamin D replacement therapy in persons with spinal cord injury. J Spinal Cord Med. 2011;34(5):455-60. 3. Craven BC, Robertson LA, McGillivray CF, Adachi JD. Fragments 1.0. Toronto, ON: Toronto Rehabilitation Institute; 2010. www.scifragments.com Accessed September 20, 2012. 4. Craven BC, Robertson LA, McGillivray CF, Adachi JD. Detection and treatment of sublesional osteoporosis among patients with chronic spinal cord injury: proposed paradigms. Top Spinal Cord Inj Rehabil. 2009;14(4):1–22. 5. Hummel K, Craven BC, Giangregorio L. Serum 25(OH)D, PTH and correlates of suboptimal 25(OH)D levels in persons with chronic spinal cord injury published online ahead of print June 19 2012. Spinal Cord. 2012. http://www.nature.com/sc/journal/ vaop/ncurrent/full/sc201267a.html. Accessed September 26, 2012. 6. Oleson CV, Patel PH, Wuermser LA, Influence of season, ethnicity, and chronicity on vitamin D deficiency in traumatic spinal cord injury. J Spinal Cord Med. 2010;33(3):202-13. 7. Walters JL, Buchholz AC, Martin Ginis KA, SHAPE-SCI Research Group. Evidence of dietary inadequacy in adults with chronic spinal cord injury. Spinal Cord. 2009;47(4):318-22. Author, Year Intervention N Duration (Mos) Result Standing Kaplan 1981 Standing 10 6 or 12-18 Urinary calcium Kunkel 1993 Standing 6 5 Neutral BMD Needham Standing/ Walking 16 2 No effect Shropshire 1997 Electrical Simulation ( ES) Rodgers 1991 ES 12 3 Neutral BMD Functional Electrical Stimulation (FES) Pacy 1988 FES Cycling 4 ? Neutral BMD Leeds 1990 FES Cycling 6 6 No BMD change, formation markers, resorption markers Hangartner 1994 FES Cycling 15 6-8 Neutral tibia BeDell 1996 FES Cycling 10 13 BMD Mohr 1997 FES Cycling 12 ? BMD (tibia), no treatment effect Chen 2005 FES Cycling 30 6 BMD (femur & tibia) BMD (hip) Frotzler 2008 FES Cycling 11 12 BMD (femur), neutral tibia Ashe 2010 FES Cycling 3 6 BMD (lower extremity) Walking Ogilvie 1993 Walking 4 Avg 5 BMD (hip), no treatment effect at spine Thoumie 1995 Walking 7 3-14 mos No effect Body Weight Support Treadmil Training (BWSTT) Giangregorio 2005 BWSTT 5 8 BMD (femur & tibia) Giangregorio 2006 BWSTT 14 12 Neutral BMD Carvahlo 2006 BWSTT/ES 21 6 Formation markers, resorption markers Coupaud 2009 BWSTT with FES 1 2 BMD and BMC (tibia) SKELETAL INTEGRITY | BODY STRUCTURE AND FNUCTION 121


L - Skeletal Integrity
To see the actual publication please follow the link above