Occupational Therapy Program Student Theses, Dissertations and Capstones

Document Type



Impact of a fitness program on the ability of long-term survivors of spinal cord injury to participate in daily living activities

Degree Name

Doctor of Philosophy (PhD) in Occupational Therapy

Copyright Statement

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College of Health Care Sciences – Occupational Therapy Department

First Advisor

Rosalie Miller

Publication Date / Copyright Date



Nova Southeastern University


Many long-term wheelchair users find themselves unable to accomplish their former daily routines due to fatigue and weakness caused by cardiopulmonary decompensation (CPD). This study showed that long-term survivors of quadriplegia can improve stamina and strength, and therefore participation in daily life occupations, through participation in a regular exercise program using equipment specifically designed for them.

Increased aerobic capacity, achieved through regular exercise, has proven with many populations to increase stamina and strength, thereby increasing participation in daily occupations. Whether decompensated survivors of quadriplegia could achieve this was unknown. Until recently there was no way to increase their aerobic capacity due to limited bodily function and lack of accessible fitness equipment.

In this study, UPPERTONE, a recently designed fitness system for quadriplegics, was used by six veterans who had survived C-5–C-7 quadriplegia for between 18 and 48 years. They exercised for approximately 45 minutes three times a week for 36 sessions. Baseline level of exercise intensity (weight hefted and number of repetitions as tolerated) and heart rate were recorded and changes were recorded throughout the program.

Subjects were interviewed regarding past and present daily life activities. They kept a daily log of activities throughout the study. Using the Canadian Occupational Performance Measure (COPM), subjects were pre-tested, rating their importance of self-identified problems with daily occupations caused by CPD and their performance in and satisfaction with those problem activities. Post-testing showed changes as a result of study participation. Subjects improved COPM scores an average of 7.4 points (greatest 17 points and least 1.5 points), reflecting satisfaction with their ability to perform identified daily activities with less fatigue. Weight hefted increased from an initial average of 22.35 lb. to 52.5 lb. Exercise heart rate increased from an average of 84.8 to 95.2.

Subjects were enthusiastic regarding ability to use UPPERTONE independently and their improved quality of life. Clinicians and long-term wheelchair users with a variety of disabilities should understand CPD, its ramifications and the benefits of exercise to this population. Clients who regain ability to care for themselves will enjoy improved quality of life and have less need for long-term care.


Occupational Therapy


Health and environmental sciences, Daily living, Fitness, Long-term survivors, Spinal cord injury

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