Thesis

Characterisation of bone loss and development of an electrostimulation intervention to improve bone health in adults with spinal cord injury

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Awarding institution
  • University of Strathclyde
Date of award
  • 2023
Thesis identifier
  • T16630
Person Identifier (Local)
  • 201889694
Qualification Level
Qualification Name
Department, School or Faculty
Abstract
  • Bone loss following spinal cord injury (SCI) is typically more rapid compared to that associated with aging or postmenopause, leading to high susceptibility to fragility fractures, subsequent health complications and reduced quality of life. Characteristics of this complex form of bone loss have not been fully studied or understood. Furthermore, most of the available rehabilitation approaches are limited by different factors ranging from the low muscle forces that are achievable to safety considerations. Therefore, the aims of this thesis were to develop a more detailed characterisation of bone loss in the paralysed limbs following SCI, and to assess the feasibility and effectiveness of a novel approach of Recruiting Antagonistic Muscle Pairs using Electrical Stimulation (RAMP-ES) to maximise the muscle forces produced and its potential to achieve bone stimulation. In this thesis, longitudinal bone loss in the fibula and the regional variation in bone loss across tibia cross-sections over twelve months following SCI were studied for the first time. Furthermore, RAMP-ES protocols were developed and tested in able-bodied participants before assessing the effectiveness of the novel approach on muscle and bone health in people with chronic SCI. Longitudinal loss in BMC and BMD in the fibula was found to be smaller compared to the tibia (-6.9±5.1% and -6.6± 6.0% vs -14.8 ±12.4% and -14.4±12.4%, p=0.02 and p=0.03, respectively), in line with previous cross-sectional reports. In the tibia, bone loss was found to vary regionally in the diaphysis, with total loss at four months being a strong predictor of total loss after twelve months postinjury (r=0.84 and r=0.82 for 4% and 66% tibial sites, respectively, both P < 0.001). The novel RAMPES protocol was developed and tested in able-bodied participants and was found to be practical. A four-month RAMP-ES training schedule improved muscle size (7.3-19.8%) and strength in people with chronic SCI, but it had no clear effect on bone density. These findings contribute a better characterisation of bone loss and showed that the RAMP-ES intervention can improve muscle health following SCI. More studies should be done to further assess or improve the effectiveness of RAMP-ES for bone health applications.
Advisor / supervisor
  • Ireland, Alex
  • Coupaud, Sylvie
  • Kerr, Andrew, Ph. D.
  • Purcell, Mariel
Resource Type
DOI
Date Created
  • 2022

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