Filatova O.A., Lunina N.V. Increasing the functional independence and psychoemotional state of persons with spinal cord injury in the course of physical rehabilitation

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Publication date: 15.06.2025
DOI: 10.24412/2782-6570-2025_04_02_5
UDC 376.2

INCREASING THE FUNCTIONAL INDEPENDENCE AND PSYCHOEMOTIONAL STATE OF PERSONS WITH SPINAL CORD INJURY IN THE COURSE OF PHYSICAL REHABILITATION

O.A. Filatova¹, N.V. Lunina^1,2

¹Russian University of Sports “GTSOLIFK”, Moscow, Russia

²North-Caucasian Federal Research-Clinical Center of Federal Medical and Biological Agency, Essentuki, Russia

Abstract. Objective of the study – to develop a physical rehabilitation method for improving functional independence and mental state of people with spinal cord injury. The study involved six male patients with spinal cord injury aged 30-40 years. Level of injury – chest area; motor disorders – incomplete paraplegia; rehabilitation period – restorative. The restorative period that lasted 3 months included following methods: morning hygienic gymnastics, therapeutic gymnastics, independent sessions, therapeutic massage, autogenic training, indoor games, mechanotherapy and special exercise. We have registered significant improvements in the indices of the Functional Independence Measure scale, the Functional assessment scale for patients with spinal cord injury, motor tests, the Recovery Locus of Control Scale, the State-Trait Anxiety Inventory, and the Wellbeing, Activity, Mood Scale.

Keywords: spinal cord injury, functional independence, physical rehabilitation, motor activity, psychoemotional state.

Introduction. Spinal cord injuries are one of the most important medical issues related to high incidence of the most severe structural and functional consequences, high level of disability, social and mental maladaptation and severe economic burden for those injured and their families. The vast majority of injured become disabled for a long time, and often for life [1-3]. In recent decades, due to urbanization and changes in lifestyle and labor activity, especially among residents of large cities, as well as a result of a large number of natural and man-made accidents, military conflicts and terrorist attacks, car and plane crashes, there has been an increase in the incidence of severe combine injuries. The above has also affected significant changes in characteristics of spinal cord injury: spine injuries have increasingly become complicated with the spinal cord and nerve root bruising or compression, a number of cervical spine injuries grows and the incidence of complete injuries is reduced [4].

Patients with spinal cord injury (SCI) are at risk of developing life-threatening secondary pathologies such as deep vein thrombosis, urinary tract infections, pressure ulcers, respiratory complications, etc. [5, 6] Moreover, patients with SCI are subjected for negative changes in psychoemotional and psychophysical terms, registered in 82,5% of cases [7, 8], which substantially reduces the rehabilitation potential. SCI and following immobility or limited motor activity entail the strongest mental stress, which without timely motor activation, including means of physical rehabilitation, serves as a source of personal maladaptation with its various manifestations, including in society [9-11]. Adequate and timely application of means and forms of physical rehabilitation would allow in varying degrees to alleviate negative signs of SCI, improve functional independence and psychoemotional state of the patients, which defines relevance of this study.

Objective: to develop a physical rehabilitation method for improving functional independence and mental state of patients with SCI.

Methods and organization. The study involved volunteers (n=6) with SCI in conditions of inpatient treatment during the restorative period. Inclusion criteria: gender – male; age – 30-40 years; level of injury – chest area; motor disorders – incomplete paraplegia; rehabilitation period – restorative.

The functional independence was assessed with the Functional Independence Measure (FIM, points) that allows estimating degree of independence and self-care [12]; with the Functional assessment scale for patients with spinal cord injury (VFM – Valutazione Funzionale Mielolesi, points), developed for assessment of functional independence of a patient with SCI [12].

Functional state of the musculoskeletal system of the test subjects was investigated by the following motor tests: “Standing by a Swedish wall in knee pads” (s) and “Squatting by a Swedish wall in knee pads” (number of squats). The psychoemotional state was estimated with: the Recovery Locus of Control Scale (points), the State-Trait Anxiety Inventory (points), the Wellbeing, Activity, Mood Scale (WAM, points).

The data processing was carried out with the Statistica 13 software package. We also calculated the mean value (Х), standard deviation (σ). The Shapiro-Wilk test was used to identify the normalcy of distribution, the reliability of changes in the studied indices before and after the course was identified with the Wilcoxon's signed-rank test, p≤0.05.

Results and discussion. To improve functional independence of patients with SCI during the restorative period that lasted for 3 months, we applied the following forms of physical rehabilitation (PR): morning hygienic gymnastics (daily, 5-7 to 15 minutes), therapeutic gymnastics (daily, 5-7 to 30 minutes), independent sesisions (individual, small groups – daily, 2 times for 10-15 minutes), therapeutic massage (5 days a week for 15 minutes), autogenic training (daily for 5-10 minutes), indoor games (indoor badminton in particular – 3 times a week for 10-15 minutes), mechanotherapy (MOTOmed, Imitron, KORVIT – daily, 10 to 30 minutes). The special exercises included: active-passive exercises; resistance exercises; strength exercises; isometric exercises; exercises with equipment; balance exercises; exercises with autogenic training elements; relaxing, stretching exercises; exercises with game elements. The following initial positions were used (IP): supine, prone, sitting on a floor, genucubital position, crawling position; sitting and moving in a wheelchair. At the beginning of the course, the active-passive exercises were performed with the instructor’s help combined with ideomotor training.

The FIM study has allowed to identify degree of independence and self-care of the studied group. Before the course, the average score was 62.83±7.63 points, showing average degree of independence and self-care. After the course, an increase by 34.2% to 84.33±4.03 points has been registered, which corresponds with the higher than average degree of independence and self-care.

The VFM study has allowed to identify a complex level of the functional state of the studied group (table).

Table

Changes in the indices of the Functional assessment scale for patients with spinal cord injury during physical rehabilitation, points, X±σ

Indices (subscales) Physical rehabilitation stages	Bed mobility	Eating	Wheelchair use	Dressing	Moving	Mobility	Grooming	Social skills
Initial	12.17±2.32	28.17±1.17	25.67±1.97	1050±1.52	16.67±1.37	4.0±0.01	12.83±0.75	39.50±0.55
Final	22.0±1.26	29.17±1.17	35.50±1.52	31.83±2.93	33.00±1.55	5.00±0.89	27.17±0.75	41.00±0.01
P	≤0.05	≥0.05	≤0.05	≤0.05	≤0.05	≥0.05	≤0.05	≤0.05

The indicators have increased in the most VFM subscales (≤0.05) after application of the developed PR program. The most significant effect was achieved in the following parameters: the “Bed mobility” subscale has improved by 80.8%, from 12.17±2.32 to 22±1,26 points, i.e. from average to high level of proficiency of this motor skill; the “Dressing” subscale has improved by 203.1%, from 10.50±1.52 points to 31.83±2.93 points, i.e. from low to high level of proficiency; the “Moving” subscale has improved by 98.0%, from 16.67±1.37 to 33.00±1.55 points, i.e. from low to average level of proficiency; the “Grooming” subscale has improved by 111.8%, from 12.83±0.075 to 27.17±0.75 points, from low to higher than average level of proficiency.

In the “Wheelchair use” and “Social skills” subscales, we have also registered positive changes (р≤0.05) by 38.3% and 3.8% respectively. Changes in the “Wheelchair use” subscale were from 25.67±1.97 to 35.50±1.52 points. Dynamics in the “Social skills” subscale has improved from 39.50±0.55 to 41.00±0.01 points. At the same time, the values of the data obtained remained in the range of the average level before and after completing the PR course.

Positive changes of the “Eating” and “Mobility” subscales, observed with unreliable shifts (≥0.05) was 3.6% and 25.0% and improved from 28.17±1.17 to 29.17±1.17 points and from 4.00±0.01 to 5.00±0.89 points respectively. The unreliability of shifts in the “Eating” subscale is due to the fact that the level of proficiency in the skills assessed in this subscale was already high in the study population at the beginning of the program, with the average value close to the maximum possible. The unreliability of shifts in the “Mobility” subscale is due to the fact that in the specified recovery period, significant changes in mastering the skills included in this subscale were not expected in the chosen group, in accordance with the clinical picture. The results obtained indicate an expansion of the possibilities of movement and self-care for people with SCI.

Adaptation to verticalization of patients with SCI is mainly due to the functional state of the musculoskeletal system, which allows the subjects to take and hold vertical position with external support from the position of sitting in a wheelchair. In realization of the developed PR method, motor test indices have (р≤0.05) significantly improved. In the “Standing by a Swedish wall in knee pads” test, the average time has increased by 342.7%, from 23.00±8.51 s to 101.83±34.72 s. In the “Standing by a Swedish wall in knee pads” test, the average number of squats has increased by 179.9%, from 4.17±2.14 to 11.67±2.16 times. The obtained results (р≤0.05) reflect improvements in the musculoskeletal system’s functional state and adaptation to verticalization of patients with SCI.

Results of the Recovery Locus of Control Scale (points) allowed making conclusions on the level of motivation of the subjects to recovery during the course. Before PR, the index amounted to 20.83±2.14, reflecting average level of motivation of the subjects to improve their health. After the course, the index has increased by 60.0% and amounted to 33.33±1.51, corresponding with high level of motivation. The observed positive changes shows improvements in motivation of the studied group to recover. 

The State-Trait Anxiety Inventory study results have shown signs of anxiety as a trait, as well as the state of the subjects as a response to the current situation. According to the “State anxiety” and “Trait anxiety” scales, positive changes (р≤0.05) have been registered by 16.0 and 14.4% respectively. The dynamics of the “State anxiety: scale ranged from 58.50±3.21 to 49.17±2.71 points. The dynamics of the “Trait anxiety” scale improved from 56.67±3.27 points to 48.50±3.62 points. At the same time, the values of the data obtained remained in the range of high anxiety levels before and after completing the course.

The WAM scale study has assessed total psychoemotional state of the test subjects. The average scores on the WAM scale before the experiment were 30.33±4.50, 39.17±4.22 and 36.83±2.93 points, respectively, i.e. they were below the level of favorable psychoemotional state. After the course, the indicators on the “Wellbeing” scale increased by 55.0%, on the “Activity” scale – by 37.4%, on the “Mood” scale – by 23.1% and amounted to 47.00 ±2.83, 53.83±1.17 and 45.33 ±4.18 points respectively, demonstrating a significant improvement in the psychoemotional state of people with SCI.

Conclusion. Application of the developed PR method for people with SCI has contributed to an improvement of functional independence and psychoemotional state. We have registered positive changes in the indices of the Functional Independence Measure scale, the Functional Assessment Scale for Patients with SCI, motor tests, the Recovery Locus of Control Scale, the State-Trait Anxiety Inventory, and the Wellbeing, Activity, Mood Scale.

Conflict of interest. The authors declare no conflict of interest.

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INFORMATION ABOUT THE AUTHORS:
Olesya V. Filatova – Master of the Department of Physical Rehabilitation, Massage and Health-improving Physical Culture named after I.M. Sarkizov-Serazini, Russian University of Sport “GTSOLIFK”, Moscow.
Natalya V. Lunina – Candidate of Biological Sciences, Associate Professor of the Department of Physical Rehabilitation, Massage and Health-improving Physical Culture named after I.M. Sarkizov-Serazini, Russian University of Sport “GTSOLIFK”, Moscow; Senior Researcher, North-Caucasian Federal Research-Clinical Center of Federal Medical and Biological Agency, Essentuki, e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.. 

For citation: Filatova O.A., Lunina N.V. Increasing the functional independence and psychoemotional state of persons with spinal cord injury in the course of physical rehabilitation. Russian Journal of Sports Science: Medicine, Physiology, Training, 2025, vol. 4, no. 2(14). DOI: 10.24412/2782-6570-2025_04_02_5