Effect of Eight-Week Dynamic Neuromuscular Stabilization (DNS) Training With and Without Abdominal Drawing-In Maneuver (ADIM) on Balance, Pulmonary Function Indices, Motor Performance, and Quality of Life in Individuals with Incomplete Paraplegic Spinal Cord Injury
To compare the effect of eight weeks of dynamic neuromuscular stability training (DNS) with no abdominal maneuver (ADIM) on balance, pulmonary indices, performance, and lifestyle in people with spinal cord injury.
Design
The target population of this study includes individuals aged 20 to 45 years with spinal cord injury (SCI) with incomplete paraplegia (ASIA classification C or D) at the lumbar levels (L1-L5) who have had at least 6 months of injury (chronic).
Purposeful sampling will be performed among individuals with spinal cord injury (SCI) with incomplete paraplegia (ASIA classification) at the lumbar levels (L1-L5).
Settings and conduct
These individuals are selected from the Hana Rehabilitation Center of Isfahan. The selection of this age group and level of injury is due to their relative ability to perform seated exercises and their potential for functional improvement.
Participants/Inclusion and exclusion criteria
Inclusion criteria:
• Diagnosis of SCI (paraplegia-incomplete) by a specialist doctor
• Voluntary consent to participate in the study
• Absence of other neurological diseases such as MS and ...
• Ability to perform ADIM and DNS exercises (modified)
• Ability to sit independently
Exclusion criteria:
• Absence of more than 3 consecutive sessions or 5 alternating sessions
• Pain or any problem that makes the subject's presence in the study impossible
• Voluntary withdrawal from the study
• Chest deformity and respiratory problems
Intervention groups
A minimum of 30 subjects (15 subjects per group: DNS with ADIM and DNS without ADIM) was required. Considering a 15% probability of attrition, the final sample size was increased to 34 subjects (17 subjects per group) to maintain statistical accuracy.
Main outcome variables
sitting balance; pulmonary function; the strength of the core muscles of the trunk; Endurance of central trunk muscles; Pasteur stability; quality of life
General information
Reason for update
Acronym
IRCT registration information
IRCT registration number:IRCT20260128068685N1
Registration date:2026-08-06, 1405/05/15
Registration timing:prospective
Last update:2026-08-06, 1405/05/15
Update count:0
Registration date
2026-08-06, 1405/05/15
Registrant information
Name
Mohammad Hossein Jafari
Name of organization / entity
The University of Isfahan
Country
Iran (Islamic Republic of)
Phone
+98 31 3457 2317
Email address
mh.jafari@spr.ui.ac.ir
Recruitment status
recruiting
Funding source
Expected recruitment start date
2026-08-09, 1405/05/18
Expected recruitment end date
2026-10-12, 1405/07/20
Actual recruitment start date
empty
Actual recruitment end date
empty
Trial completion date
empty
Scientific title
Effect of Eight-Week Dynamic Neuromuscular Stabilization (DNS) Training With and Without Abdominal Drawing-In Maneuver (ADIM) on Balance, Pulmonary Function Indices, Motor Performance, and Quality of Life in Individuals with Incomplete Paraplegic Spinal Cord Injury
Public title
The effect of dynamic neuromuscular stability (DNS) exercises with and without abdominal maneuver (ADIM)
Purpose
Supportive
Inclusion/Exclusion criteria
Inclusion criteria:
Diagnosis of SCI (paraplegia-incomplete) by a specialist doctor
Voluntary consent to participate in the research
Absence of other neurological diseases such as MS and ...
Ability to perform ADIM and DNS exercises (modified)
Ability to sit independently
Minimum 20 years and maximum 45 years
Exclusion criteria:
Absence of more than 3 consecutive sessions or 5 alternate sessions
Pain or any problem that makes the subject's presence in the study impossible
Voluntary withdrawal from the study
History of spinal surgery or hip fracture
Chest deformity and respiratory problems
Failure to complete the tests
Minimum 20 years and maximum 45 years
Age
From 20 years old to 45 years old
Gender
Both
Phase
N/A
Groups that have been masked
No information
Sample size
Target sample size:
30
Randomization (investigator's opinion)
Randomized
Randomization description
Participants were assigned to two intervention groups (DNS with ADIM and DNS without ADIM) using a paired random allocation method based on the ASIA scale using Randomizer.org software. This method maintains balance between groups and reduces selection bias.
Injury of lumbar and sacral spinal cord and nerves at abdomen, lower back and pelvis level
Primary outcomes
1
Description
Maximum functional reach distance in the Modified Functional Reach Test (MFRT) in centimeters, measured before the start of the intervention and immediately after the end of the 8-week intervention.
Timepoint
Measurements were taken at two time points, including before the start of the intervention (pre-test) and immediately after the end of the 8-week intervention period (post-test).
Method of measurement
Modified Functional Reach Test
2
Description
Forced expiratory volume in one second (FEV1) measured by digital spirometry in liters, before the start of the intervention and immediately after the end of the 8-week intervention.
Timepoint
Measurements were taken at two time points, including before the start of the intervention (pre-test) and immediately after the end of the 8-week intervention period (post-test).
Method of measurement
Digital spirometer device
3
Description
Forced vital capacity (FVC) measured by digital spirometry in liters, before the start of the intervention and immediately after the end of the 8-week intervention.
Timepoint
Measurements were taken at two time points, including before the start of the intervention (pre-test) and immediately after the end of the 8-week intervention period (post-test).
Method of measurement
Digital spirometer device
4
Description
Core trunk muscle endurance based on the duration of maintaining the position in the modified Planck test, in seconds, measured before the start of the intervention and immediately after the end of the 8-week intervention.
Timepoint
Measurements were taken at two time points, including before the start of the intervention (pre-test) and immediately after the end of the 8-week intervention period (post-test).
Method of measurement
Modified Plank test
5
Description
قدرت عضلات فلکسور تنه اندازهگیریشده با دینامومتر، بر حسب نیوتن، پیش از شروع مداخله و بلافاصله پس از پایان مداخله ۸ هفتهای.
Timepoint
Measurements were taken at two time points, including before the start of the intervention (pre-test) and immediately after the end of the 8-week intervention period (post-test).
Method of measurement
Dynamometer device
6
Description
Trunk extensor muscle strength measured with a dynamometer, in Newtons, before the start of the intervention and immediately after the end of the 8-week intervention.
Timepoint
Measurements were taken at two time points, including before the start of the intervention (pre-test) and immediately after the end of the 8-week intervention period (post-test).
Method of measurement
Dynamometer device
7
Description
Intra-abdominal pressure measured with a manometer, in centimeters of water (cmH₂O), before the start of the intervention and immediately after the end of the 8-week intervention.
Timepoint
Measurements were taken at two time points, including before the start of the intervention (pre-test) and immediately after the end of the 8-week intervention period (post-test).
Method of measurement
Manometer (intra-abdominal pressure gauge)
8
Description
The kyphosis angle of the back region measured with a kyphometer, in degrees, before the start of the intervention and immediately after the end of the 8-week intervention.
Timepoint
Measurements were taken at two time points, including before the start of the intervention (pre-test) and immediately after the end of the 8-week intervention period (post-test).
Method of measurement
Kyphometer device
9
Description
Quality of Life Index (QLI) score, measured before the start of the intervention and immediately after the end of the 8-week intervention.
Timepoint
Measurements were taken at two time points, including before the start of the intervention (pre-test) and immediately after the end of the 8-week intervention period (post-test).
Method of measurement
Quality of Life Index
Secondary outcomes
1
Description
Quality of life index score, measured before the start of the intervention and immediately after the end of the 8-week intervention.
Timepoint
Measurements were taken at two time points, including before the start of the intervention (pre-test) and immediately after the end of the 8-week intervention period (post-test).
Method of measurement
Quality of Life Index
Intervention groups
1
Description
Intervention group: Participants will perform dynamic neuromuscular stability exercises with abdominal drawing-in maneuvers under the supervision of a therapist for 8 weeks, 3 sessions per week, 45 minutes each session. The exercise program includes modified core stability patterns in seated functional positions appropriate to the ability of individuals with spinal cord injury, and the intensity and progression of the exercises will gradually increase over the course. All sessions will be performed with the same protocol and under the supervision of the researcher.
Category
Rehabilitation
2
Description
Control group: Participants will receive the same dynamic neuromuscular stability exercises with the same order, duration, intensity, and number of sessions for 8 weeks, 3 sessions per week, each session lasting 45 minutes, except that the abdominal drawing-in maneuver is not performed during the exercises. All sessions will be supervised by the researcher and will follow the same protocol.
Category
Rehabilitation
Recruitment centers
1
Recruitment center
Name of recruitment center
Isfahan Spinal Cord Injury Patients Support Charity (Hana)
Full name of responsible person
Dr. Gholamreza Pistei
Street address
Alley of Timurid Martyrs, next to Atashgah Mountain, Atashgah Street, Isfahan
City
Isfahan
Province
Isfehan
Postal code
8188753664
Phone
+98 31 3766 0176
Email
info@hana-charity.org
Web page address
https://hana-charity.org/
Sponsors / Funding sources
1
Sponsor
Name of organization / entity
University of Isfahan
Full name of responsible person
Dr. Mohammadreza Abedi
Street address
University of Isfahan, Azadi Square, Isfahan
City
Isfahan
Province
Isfehan
Postal code
۸۱۷۴۶۷۳۴۴۱
Phone
+98 31 3793 2128
Email
info@ui.ac.ir
Grant name
Grant code / Reference number
Is the source of funding the same sponsor organization/entity?