Arm-hand training strategies and therapy dose dimensions during the subacute rehabilitation of people with cervical spinal cord injury: a longitudinal observational study

Longitudinal observational study. To explore motor training strategies, therapy dosage, and motivation in subacute arm-hand rehabilitation for individuals with cervical spinal cord injury and their change over a 6-month rehabilitation period. Three rehabilitation centers in Belgium and the Netherlands. Individuals with lesions between C1-Th1 and AIS A–D were included between 4–8 weeks post-injury and observed for three weeks with an eight-week interval. Regular arm-hand training sessions, with at least 25% arm-hand training, were analyzed. Motor training strategies, therapy dosage, and motivation were collected by two trained observers, video recordings and patient-reported outcome measures. 240 Sessions from thirteen participants (mean age 54.4 ± 12.9; C1-C5; AIS B–D) were included. Analytical training showed the highest active arm-hand use (30.3%), followed by skill training (26.6%). Of the 15 task-oriented components, only multiple movement planes, functional movements, and feedback were used in ≥60% of sessions. Actual session time averaged 78.3% of the planned duration. During the arm-hand session, 52.1% of the time involved active time. Skill training showed the lowest number of repetitions (MED: 66.5). Participants reported low physical fatigue (4/10) and difficulty (4/10) but high motivation (7/10). Limited changes in training variables were observed over six months. Our findings reveal a gap between clinical practice and evidence-based guidelines for arm-hand training. Despite its importance, skill training and key task-oriented components are underused. Low perceived difficulty and intensity, contrasted with high motivation, suggest the potential to increase therapy doses for better rehabilitation outcomes.