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Author Notes:

Correspondence to Dr. Trumbower: randy.trumbower@emory.edu

Heather B. Hayes, PhD, and Arun Jayaraman, PT, PhD, contributed to study design, participant recruitment, data collection, analyses, and interpretation.

Dr. Hayes also performed statistical analyses (with consultation from biostatistician Kirk Easley, Masters of Applied Statistics), wrote the first draft of manuscript, and contributed to manuscript revisions and approval of final submission.

Megan Herrmann, DPT, contributed to participant recruitment, screening, blind rating, data collection and analyses, as well as approval of final submission.

Gordon S. Mitchell, PhD, and William Z. Rymer, MD, PhD, contributed to development of study concept and design, as well as data interpretation, literature search, figures, and manuscript revisions and approval of final submission.

Randy D. Trumbower, PT, PhD, was the principal investigator for this study.

He contributed to development of study concept and design, as well as data analyses and interpretation, literature search, figures, and manuscript revisions.

As corresponding author, he had full access to all data and final responsibility for the decision to submit for publication.

The authors thank Mike Jones, PhD, and Keith Tansey, MD, PhD, for assistance with allocating personnel and participant recruitment from the Shepherd Center, Atlanta, GA; Leslie VanHeil, PT, DScPT, Lauren McCollough, DPT, Karly Bishop, DO, for their assistance with subject recruitment, screening, and blind rating; Ian Cooke, Matthew Freeman, Victoria Stahl, PhD, and Sean Deeny, PhD, for assistance with data collection; and Kirk Easley, MS, for assistance with statistical analyses.

The authors thank members of the Data Safety and Monitoring Board, particularly David Burke, MD, and Dale Strasser, MD.

The authors extend special thanks to all study participants.

H. Hayes reports no disclosures.

M. Herrmann reports no disclosures.

Dr. Rymer has served as a consultant for Allergan, a pharmaceutical company.

He is a member of the editorial board of the Journal of NeuroEngineering and Rehabilitation.

Subject:

Research Funding:

Support for this work was provided by the US Department of Defense Spinal Cord Injury Research Program grant SC090355P2.

A. Jayaraman received research support by Ottobock Corporation, a rehabilitation technology company, USAMRAA Department of Defense W81XWH-10-C-1055, the NIH 2R44HD044271, and US Department of Education NIDRR H133E120010.

He is funded by the NIH (HL69064;, HL80209;, HL111598;) and the Department of Defense (SC090355P2). W. Rymer serves as a member of the scientific advisory board of Hocoma International, a rehabilitation technology company, and the Neilsen Foundation, a spinal cord injury not-for-profit.

R. Trumbower received research support by the Craig H. Neilsen Foundation, the Department of Defense SC090355P2, and the NIH K12 HD055931.

Daily intermittent hypoxia enhances walking after chronic spinal cord injury A randomized trial

Tools:

Journal Title:

Neurology

Volume:

Volume 82, Number 2

Publisher:

, Pages 104-113

Type of Work:

Article | Final Publisher PDF

Abstract:

Objectives: To test the hypothesis that daily acute intermittent hypoxia (dAIH) and dAIH combined with overground walking improve walking speed and endurance in persons with chronic incomplete spinal cord injury (iSCI). Methods: Nineteen subjects completed the randomized, double-blind, placebo-controlled, crossover study. Participants received 15, 90-second hypoxic exposures (dAIH, fraction of inspired oxygen [Fio2] = 0.09) or daily normoxia (dSHAM, Fio2 = 0.21) at 60-second normoxic intervals on 5 consecutive days; dAIH was given alone or combined with 30 minutes of overground walking 1 hour later. Walking speed and endurance were quantified using 10-Meter and 6-Minute Walk Tests. The trial is registered at ClinicalTrials.gov (NCT01272349). Results: dAIH improved walking speed and endurance. Ten-Meter Walk time improved with dAIH vs dSHAM after 1 day (mean difference [MD] 3.8 seconds, 95% confidence interval [CI] 1.1–6.5 seconds, p = 0.006) and 2 weeks (MD 3.8 seconds, 95% CI 0.9–6.7 seconds, p = 0.010). Six-Minute Walk distance increased with combined dAIH + walking vs dSHAM + walking after 5 days (MD 94.4 m, 95% CI 17.5–171.3 m, p = 0.017) and 1-week follow-up (MD 97.0 m, 95% CI 20.1–173.9 m, p = 0.014). dAIH + walking increased walking distance more than dAIH after 1 day (MD 67.7 m, 95% CI 1.3–134.1 m, p = 0.046), 5 days (MD 107.0 m, 95% CI 40.6–173.4 m, p = 0.002), and 1-week follow-up (MD 136.0 m, 95% CI 65.3–206.6 m, p < 0.001). Conclusions: dAIH ± walking improved walking speed and distance in persons with chronic iSCI. The impact of dAIH is enhanced by combination with walking, demonstrating that combinatorial therapies may promote greater functional benefits in persons with iSCI. Classification of evidence: This study provides Class I evidence that transient hypoxia (through measured breathing treatments), along with overground walking training, improves walking speed and endurance after iSCI.

Copyright information:

© 2014 American Academy of Neurology

This is an Open Access work distributed under the terms of the Creative Commons Attribution-NonCommerical-NoDerivs 3.0 Unported License (http://creativecommons.org/licenses/by-nc-nd/3.0/).

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