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

Spinal Cord volume 63, pages 557–565 (2025)Cite this article

Subjects

Abstract

Study design

Longitudinal observational study.

Objectives

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.

Setting

Three rehabilitation centers in Belgium and the Netherlands.

Methods

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.

Results

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.

Conclusion

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.

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Fig. 1: Objective therapy dose dimensions across measuring time points.
Fig. 2: Total Repetitions during active arm-hand time.
Fig. 3

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Data availability

Additional data are available from the corresponding author on reasonable request.

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Acknowledgements

We want to thank the patients and SCI therapy teams of Adelante Zorggroep, University Hospitals Leuven, and University Hospital Ghent for participating in the study. We want to thank the rehabilitation and occupational science students for helping with the data collection and analysis. During the preparation of this work the author(s) used ChatGPT 3.5 and DeepSeek-V3 in order to improve the readability and language of the manuscript. After using this tool/service, the author(s) reviewed and edited the content as needed and take(s) full responsibility for the content of the publication.

Funding

Bijzonder Onderzoeksfonds (BOF) UHasselt 21OWB23.

Author information

Authors and Affiliations

  1. Hasselt University, Rehabilitation Research Center REVAL, Diepenbeek, Belgium

    Nele Bertels & Annemie Spooren

  2. Adelante Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, Netherlands

    Yvonne Janssen-Potten & Charlotte van Laake-Geelen

  3. Maastricht University, Research School CAPHRI, dept. of Rehabilitation Medicine, Maastricht, Netherlands

    Yvonne Janssen-Potten & Charlotte van Laake-Geelen

  4. University Hospitals Leuven, Department of Physical and Rehabilitation Medicine, Pellenberg, Belgium

    Kathleen Borgions

  5. Ghent University Hospital, Department of Physical Medicine and Rehabilitation, Ghent, Belgium

    Kristine Oostra

Authors
  1. Nele Bertels
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  2. Yvonne Janssen-Potten
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  3. Charlotte van Laake-Geelen
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  4. Kathleen Borgions
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  5. Kristine Oostra
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  6. Annemie Spooren
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Contributions

NB, YJ, and AS conceived and designed the study. NB, KB, CV, and KO acquired the data. NB, YJ, and AS analyzed and interpreted the data. NB drafted the original manuscript. YJ, AS, KB, CV, and KO reviewed and edited the manuscript. NB administered the project, and YJ and AS provided supervision. All authors approved the final version of the manuscript and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Nele Bertels.

Ethics declarations

Competing interests

The authors declare no competing interests.

Ethical approval

All methods were performed in accordance with the relevant guidelines and regulations. The study was approved by the ethical committees of Adelante Zorggroep (NL81062.015.22), University Hospitals Leuven (S66546), University Hospital Ghent (ONZ-2022-0187), and Hasselt University (CME2022/007).

Informed consent

All participants provided written informed consent prior to study enrollment.

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Bertels, N., Janssen-Potten, Y., van Laake-Geelen, C. et al. Arm-hand training strategies and therapy dose dimensions during the subacute rehabilitation of people with cervical spinal cord injury: a longitudinal observational study. Spinal Cord 63, 557–565 (2025). https://doi.org/10.1038/s41393-025-01120-x

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