Incomplete SCI Research Articles

Development of a Clinical Algorithm to Triage Potential Candidates for Upper Extremity Tendon Transfer Surgery in Individuals with Tetraplegia: A Retrospective Study

Background: Upper extremity (U/E) function may be greatly improved after reconstructive tendon transfer surgery in individuals with tetraplegia. An effective means of triaging potential candidates would optimize the referral process to rehabilitation and surgical teams. Objectives: To propose a set of criteria to target individuals with tetraplegia who may be potential candidates to undergo comprehensive assessment prior to reconstructive U/E surgery; to apply these criteria to a group of individuals with tetraplegia to determine the percentage of eligibility for presurgical assessment; and to compare these figures with those previously reported in the literature. Setting: A rehabilitation hospital offering specialized inpatient rehabilitation following spinal cord injury in Quebec, Canada. Methods: Retrospective chart review of individuals with tetraplegia discharged from a rehabilitation hospital between April 1, 2006 and March 31, 2010. Potential eligibility for surgery was assessed based on U/E motor function, age, medical comorbidities, compliance issues, and personal preferences. In subjects who were considered ineligible based on residual U/E strength, neurological level, injury severity and age were analysed to determine trends and significance. Results: Out of 221 individuals with tetraplegia, sixteen (7.2%) were deemed potential candidates, and three (1.3%) underwent reconstructive surgery within the defined time frame. One hundred and seventy six (176) individuals were considered ineligible for surgery due to sufficient (n=140; 63.3%) or insufficient (n=36; 16.3%) U/E motor function. Neurological level, injury severity and age were all significantly associated with potential surgery eligibility. Conclusion: The use of objective criteria is advocated to triage potential candidates to be referred for comprehensive assessment prior to planning reconstructive U/E surgery. A smaller percentage of individuals with tetraplegia seem eligible for reconstructive U/E surgery than previously reported. Most individuals considered ineligible for surgery had sufficient U/E motor function, were older and had sustained an incomplete SCI.

A comparison of customized strategies to manage muscle fatigue in isometric artificially elicited muscle contractions for incomplete SCI subjects

Muscle fatigue due to functional electrical stimulation still prevents its widespread use as a gait rehabilitation tool for spinal cord injured subjects. Although there is an active research towards optimization of pulse parameters to delay muscle fatigue, changes in stimulated muscle's performance during repeated contractions due to fatigue have not been yet determined. In this work, a study conducted in two phases with a sample of incomplete spinal cord injured patients is presented. In the first phase, a fatigue protocol based on submaximal isometric contractions allowed to obtain an objective criterion for estimation of fatigue of knee muscles from initial changes in muscle performance. The criterion is incorporated in the fatigue protocol in the second phase of the study, to compare two novel customized fatigue management strategies. Results showed that knee flexor muscles develop less force and lower fatigue than extensor muscles. Muscle fatigue management strategies based on customized modulations of stimulation frequency are valid to delay muscle fatigue.

Biomechanical, clinical and gait analysis’ effects of BoNTA injection in the rectus femoris muscle of incomplete SCI patients

Biomechanical, clinical and gait analysis’ effects of BoNTA injection in the rectus femoris muscle of incomplete SCI patients

Plasticity of the Injured Human Spinal Cord: Insights Revealed by Spinal Cord Functional MRI

IntroductionWhile numerous studies have documented evidence for plasticity of the human brain there is little evidence that the human spinal cord can change after injury. Here, we employ a novel spinal fMRI design where we stimulate normal and abnormal sensory dermatomes in persons with traumatic spinal cord injury and perform a connectivity analysis to understand how spinal networks process information.MethodsSpinal fMRI data was collected at 3 Tesla at two institutions from 38 individuals using the standard SEEP functional MR imaging techniques. Thermal stimulation was applied to four dermatomes in an interleaved timing pattern during each fMRI acquisition. SCI patients were stimulated in dermatomes both above (normal sensation) and below the level of their injury. Sub-group analysis was performed on healthy controls (n = 20), complete SCI (n = 3), incomplete SCI (n = 9) and SCI patients who recovered full function (n = 6).ResultsPatients with chronic incomplete SCI, when stimulated in a dermatome of normal sensation, showed an increased number of active voxels relative to controls (p = 0.025). There was an inverse relationship between the degree of sensory impairment and the number of active voxels in the region of the spinal cord corresponding to that dermatome of abnormal sensation (R2 = 0.93, p<0.001). Lastly, a connectivity analysis demonstrated a significantly increased number of intraspinal connections in incomplete SCI patients relative to controls suggesting altered processing of afferent sensory signals.ConclusionsIn this work we demonstrate the use of spinal fMRI to investigate changes in spinal processing of somatosensory information in the human spinal cord. We provide evidence for plasticity of the human spinal cord after traumatic injury based on an increase in the average number of active voxels in dermatomes of normal sensation in chronic SCI patients and an increased number of intraspinal connections in incomplete SCI patients relative to healthy controls.

Article 11 The Impact of Locomotor Training on Cardiovascular Parameters in Patients with Incomplete Spinal Cord Injury

To examine cardiovascular health in a large cohort of individuals with incomplete spinal cord injury before and after Locomotor Training. Pre-Post Test. Out-Patient Locomotor Training Clinics within the Christopher and Dana Reeve Foundation NeuroRecovery Network. Three hundred and fifty individuals with incomplete American Spinal Injury Association Impairment Scores (AIS) C and D. Locomotor Training (LT). Heart rate, systolic and diastolic blood pressure during resting sitting, supine positions and after an orthostatic challenge before and after LT. Cardiovascular (CV) parameters significantly differed based on patient position. Neurological level (cervical, high and low thoracic) and age were most commonly associated with CV parameters where patients at the cervical level had the lowest resting CV parameters. After the othostatic challenge, blood pressure (BP) was highest for the low thoracic group and heart rate (HR) for the high thoracic group was higher. Time since SCI was negatively related to BP at rest but not after orthostatic challenge. Men exhibited higher SBP than women and lower HR. After LT for patients retested for CV parameters (n=151), diastolic BP and HR in supine (prior to orthostatic challenge) significantly decreased, and HR in the seated position (after orthostatic challenge) significantly decreased. Resting cardiovascular parameters of BP and HR are affected by position, age and neurological level. Changes in CV parameters as a result of LT were reduced on the average except for SBP. Results from this study provide reference for CV parameters for individuals with incomplete SCI.

Exercise Intensity during Treadmill Walking with Gait-Patterned FES among Patients with Incomplete Spinal Cord Injury: Case Series

Purpose. To determine the feasibility of increasing the cardiopulmonary exercise intensity during walking with gait-patterned functional electrical stimulation (GP-FES) among individuals with motor incomplete SCI. Methods. Two men with motor-incomplete SCI (Subjects A and B, age 45 and 50 years; Level of Injury: C4 and T10; AIS score: D and D, resp.) performed a three sequential four-minute continuous walking sessions [(1) regular gait (non-GP-FES-1); (2) gait with GP-FES (GP-FES); (3) regular gait (non-GP-FES-2)]. Oxygen consumption (Vo2) was measured continuously during trials. Results. Vo2 was higher during GP-FES (Subjects A and B; 14.5 and 19.1 mL/kg/min, resp.) as compared to regular gait (Non-GP-FES-1: Subjects A and B; 13.4 and 17.0: mL/kg/min, resp.; non-GP-FES-2: Subjects A and B; 13.1 and 17.5: mL/kg/min, resp.). Conclusion. The exercise intensity of GP-FES walking was higher than that of regular walking among individuals with motor incomplete SCI. Further investigations are required to determine the clinical relevance of the exercise.

Patients with traumatic spinal cord injuries and their satisfaction with their general practitioner

The objective of this study was to examine how satisfied patients with traumatic spinal cord injury (TSCI) are with their general practitioners (GP). The study included patients with TSCI, injured in the period 1982-2001 and living in western Norway. We performed a structured telephonic interview of the patients in the period 2004-2007. A total of 105 (59.3%) patients participated. Patients with TSCI were in general satisfied with their GP. Older patients were most satisfied, and patients with incomplete thoracic SCI were least satisfied. Patients with anxiety and/or depression reported low satisfaction with their GP on several parameters. Patients with incomplete SCI were least satisfied probably because their physicians do not acknowledge their complicated medical complaints and do not meet the patient's expectations. Patients with anxiety and/or depression were more likely to report low satisfaction with their GP.

Guest Editorial: Wheelchair research progress, perspectives, and transformation

There is a growing and rich body of research and development being generated around the world. A simple search of PubMed using the search term wheelchair shows that 259 articles were published in the past year, 566 in the past 2 years, 1,315 in the past 5 years, and 2,241 over the past 10 years. If one narrows the search to the number of publications drops precipitously to 31 articles in the past year, 70 in the past 2 years, 156 in the past 5 years, and 265 in the last 10 years. The number of published articles drops even further if the search is specific to the design of new technologies. This simple investigation provides some insights worth examining. The output of research has risen over the past 10 years: there was a 17 percent increase in the number of total articles published in the last 5 years versus the previous 5 years, although there are natural annual fluctuations. Similarly, there has been about an 18 percent increase in the number of articles related to power wheelchairs, although the overall numbers are quite small. Most of the articles are related to usage and clinical assessment, with a few on training. Wheelchairs are an important modality for mobility, activity, and participation in life. For people with some forms of impairment (e.g., spinal cord injury [SCI]), wheelchairs are the primary means of mobility. Manual research seems to be fairly healthy even though many unanswered questions remain. Recent studies have indicated that there are challenges to obtaining high-quality manual wheelchairs. Liu et al. have shown that many ultralight wheelchairs are not compliant with Rehabilitation Engineering and Assistive Technology Society standards and fail prematurely [1]. This research is supported by a study of maintenance and repairs by McClure et al. showing that wheelchairs require frequent repairs and that those repairs start within the first few months of using a new chair [2]. More recently, Riggins et al. showed that there are still gaps in our knowledge about when to provide a wheelchair, to whom, and what training is necessary, even for people with SCI [3]. This study indicated that people with incomplete SCI, who focused on gait training, did not fare as well as their counterparts with complete or higher level lesions who received training in terms of community participation and quality of life. As a result of research conducted over the past 10 years, there is greater understanding of activity, service-delivery processes, manual skills training, and set-up of wheelchairs. There is a paucity of research into all aspects of power wheelchairs. This is somewhat surprising given the hundreds of thousands of people who use power wheelchairs, including scooters. Power-wheelchair users are also among the most vulnerable members of society in terms of ability to perform activities of daily living, community participation, and employment. Power-wheelchair users have also faced tremendous pressures from insurance providers to reduce costs. The challenges started when Medicare revised its reimbursement policy in 2007 and introduced new classifications for power wheelchairs that reduced the 42 procedural codes to 4 basic groups [4]. The groups are intended to be founded on performance and user needs. Unfortunately, one result of this process was to severely restrict access to the best wheelchairs, those in group 4, intended for active indoor and outdoor use. Many insurance companies have followed Medicare's lead and cover only power wheelchairs designed primarily for indoor use and light outdoor activities on well-conditioned surfaces. The Department of Veterans Affairs has bucked this trend since part of its mission is to promote independent living, return to employment, and full community participation. More research is needed to determine the long-term impact of these policy decisions on consumers and on power-wheelchair design. …

Autonomic function and symptoms of orthostatic hypotension in wheelchair athletes

Introduction: Heart rate variability (HRV) describes the cyclic changes of the heart period (R–R interval) over time. Analysis of HRV in the frequency domain delineates parasympathetic from sympathetic components of the ANS, and may also provide information about baroreflex function. High frequency (HF) components (0.15 to 0.4Hz) are an index of parasympathetic neural activity. Low frequency (LF) components (0.04 to 0.15Hz) are an index of sympathetic neural activity. We examined changes in HRV as well as symptoms of orthostatic hypotension (OH) during an orthostatic challenge in tetraplegic rugby players to examine changes in autonomic function and symptoms of OH in persons with cervical complete (CC) and cervical incomplete (CI) SCI.

Balance and Ambulation Improvements in Individuals With Chronic Incomplete Spinal Cord Injury Using Locomotor Training–Based Rehabilitation

Harkema SJ, Schmidt-Read M, Lorenz DJ, Edgerton VR, Behrman AL. Balance and ambulation improvements in individuals with chronic incomplete spinal cord injury using locomotor training–based rehabilitation. ObjectiveTo evaluate the effects of intensive locomotor training on balance and ambulatory function at enrollment and discharge during outpatient rehabilitation after incomplete SCI. DesignProspective observational cohort. SettingSeven outpatient rehabilitation centers from the Christopher and Dana Reeve Foundation NeuroRecovery Network (NRN). ParticipantsPatients (N=196) with American Spinal Injury Association Impairment Scale (AIS) grade C or D SCI who received at least 20 locomotor training treatment sessions in the NRN. InterventionsIntensive locomotor training, including step training using body-weight support and manual facilitation on a treadmill followed by overground assessment and community integration. Main Outcome MeasuresBerg Balance Scale; Six-Minute Walk Test; 10-Meter Walk Test. ResultsOutcome measures at enrollment showed high variability between patients with AIS grades C and D. Significant improvement from enrollment to final evaluation was observed in balance and walking measures for patients with AIS grades C and D. The magnitude of improvement significantly differed between AIS groups for all measures. Time since SCI was not associated significantly with outcome measures at enrollment, but was related inversely to levels of improvement. ConclusionsSignificant variability in baseline values of functional outcome measures is evident after SCI in individuals with AIS grades C and D and significant functional recovery can continue to occur even years after injury when provided with locomotor training. These results indicate that rehabilitation, which provides intensive activity-based therapy, can result in functional improvements in individuals with chronic incomplete SCI.

Effect of Electrical Stimulation Superimposed upon Isometric Voluntary Muscle Contractions in Incomplete SCI

Effect of Electrical Stimulation Superimposed upon Isometric Voluntary Muscle Contractions in Incomplete SCI

Reliability And Validity Of Peak Vo2 Assessments During Robotic Treadmill Training In Chronic Incomplete Sci

Reliability And Validity Of Peak Vo2 Assessments During Robotic Treadmill Training In Chronic Incomplete Sci

April 2011: This Month in JoVE

Protocol Methods to quantify pharmacologically induced alterations in motor function in human incomplete SCI Christopher K. Thompson , Arun Jarayaman, Catherine Kinnaird, T. George Hornby 3 Department of Kinesiology and Nutrition, University of Illinois at Chicago, Sensory Motor Performance Program, Rehabilitation Institute of Chicago, Department of Physical Therapy, University of Illinois at Chicago

Repetitive common peroneal nerve stimulation increases ankle dorsiflexor motor evoked potentials in incomplete spinal cord lesions

Plasticity of corticospinal tract (CST) activity likely plays a key role in motor function recovery after central nervous system (CNS) lesions. In non-injured adults, 30min of repetitive common peroneal nerve stimulation (rCPnS) increases CST excitability by 40-50% and the effect persists for at least 30min. The present study evaluated with transcranial magnetic stimulation (TMS) the changes in CST excitability after 30min of rCPnS in people with foot drop due to incomplete SCI. Suprathreshold rCPnS (25Hz, alternating 1s on 1s off stimulation cycle) was given for two 15-min periods, while the subject sat at rest with ankle and knee joints fixed. Before, between, and after the periods of stimulation, the tibialis anterior (TA) motor evoked potentials (MEPs) to TMS were measured at a TMS intensity that originally produced a half-maximum MEP (typically 10-20% above threshold) while the sitting subject provided 25-30% maximum voluntary TA contraction. In 10 subjects with SCI, the peak-to-peak TA MEP increased by 14±3% after rCPnS and the peak increase (+21±7%) occurred 15min after the cessation of rCPnS. The TA H-reflex, measured in separate experiments in 7 subjects, did not increase after rCPnS. The results indicate that rCPnS can increase CST excitability for the TA in people with incomplete SCI, although its effects appear smaller and shorter lasting than those found in non-injured control subjects. Such short-term plasticity in the CST excitability induced by rCPnS may contribute to long-term therapeutic effects of functional electrical stimulation previously reported in people with CNS lesions.

Is the outcome in acute spinal cord ischaemia different from that in traumatic spinal cord injury? A cross-sectional analysis of the neurological and functional outcome in a cohort of 93 paraplegics

Retrospective cohort study. To compare the neurological outcome between paraplegic patients with acute spinal cord ischaemia syndrome (ASCIS) or traumatic spinal cord injury (tSCI) and to investigate the influence of SCI aetiology on the total Spinal Cord Independence Measure (SCIM)-II score. Level 1 trauma centre. Initial (0-40 days) and chronic-phase (6-12 months) American Spinal Injury Association (ASIA) sensory scores, lower extremity motor score (LEMS) and chronic-phase total SCIM-II scores were analysed. Differences between ASCIS and tSCI patients were calculated using Student's t-tests and Wilcoxon signed-rank tests. To assess which variables give rise to the prediction of total SCIM-II score, a multiple linear regression analysis was used. These predictor variables included complete (ASIA impairment scale A) or incomplete SCI (AIS B, C, and D), aetiology, age and gender. Out of 93 included patients, 20 ASCIS and 73 tSCI patients were identified. In the complete SCI group, the initial pinprick scores were higher (P<0.05) in ASCIS patients compared with tSCI patients, 37.9 (95% Confidence Interval (CI), 23.3-52.5) and 27.3 (95% CI, 24.1-30.4), respectively. No other relevant differences in neurological outcome were identified between ASCIS and tSCI patients; however, the total SCIM-II scores were higher (P<0.05) in tSCI patients after 12 months. Using the linear regression analysis, we were able to predict 31.4% of the variability. The aetiology was not significant in this model. The neurological outcome was independent of the diagnosis ASCIS or tSCI. Furthermore, the diagnosis ASCIS or tSCI was not a significant predictor for total SCIM II scores after 12 months. This study was granted by the 'Internationale Stiftung für Forschung in Paraplegie' (IFP), Zürich, Switzerland.

Incidencia del dolor neuropático en el lesionado medular

Objective To understand the incidence of neuropathic pain (DN), through the DN4 questionnaire, in the chronic SCI patients, as there is little information in this regard. Design A prospective, randomized study. Participants It was performed with 245 patients with SCI in chronic phase to knowing the incidence of neuropathic pain (DN). Interventions DN4 test evaluated neurophatic pain. Methods We used to analyze the results the statistic program SPSS ® 15. Results The sample was 95 patients, 67% males and 33% women, with an average age of 42.91 years (SD 16.6). The time of evolution of SCI was 98.3 months (range 15–360). The proportion of patients with ASIA A was 50%. The prevalence of DN was 66.3%. The most common form of presentation of DN was numbness to 55% and electric shocks for 40%. There are correlation between DN with age p=0,005, but not with sex or the time of evolution of SCI. Conclusions 66,3% of patients with chronic LM presented DN. It is more frequent in the incomplete SCI, and it is correlated with age, but not with sex or the time of evolution of the SCI.

1012 CORTICAL SUBSTRATE OF BLADDER CONTROL IN SCI AND THE EFFECT OF PERIPHERAL DORSAL GENITAL NERVE STIMULATION

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Neurogenic Voiding Dysfunction1 Apr 20101012 CORTICAL SUBSTRATE OF BLADDER CONTROL IN SCI AND THE EFFECT OF PERIPHERAL DORSAL GENITAL NERVE STIMULATION Monika-Zita Zempleni, Lars Michels, Ulrich Mehnert, Brigitte Schurch, and Spyros Kollias Monika-Zita ZempleniMonika-Zita Zempleni More articles by this author , Lars MichelsLars Michels More articles by this author , Ulrich MehnertUlrich Mehnert More articles by this author , Brigitte SchurchBrigitte Schurch More articles by this author , and Spyros KolliasSpyros Kollias More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.2026AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES We investigated (i) the central representation of LUT control and (ii - iii) the acute and short-term central neuromodulatory effect of peripheral dorsal genital nerve (DGN) stimulation in incomplete SCI patients using functional magnetic resonance imaging (fMRI). METHODS After ethical approval, incomplete SCI subjects (ASIA B-C) were included. During a 1st fMRI (3-Tesla) session, the urinary bladder of the patients was repeatedly filled and emptied using a catheter (i). Subsequently, filling and emptying of the bladder was repeated with simultaneous peripheral DGN stimulation (ii). Following a two-week training of twice daily external electrical DGN stimulation (square wave, 0.2 ms, 20 Hz), a 2nd fMRI session was performed (iii). RESULTS 8 subjects completed the 1st fMRI session, showing supraspinal activation in the cerebellum, thalamus, putamen, left superior and middle frontal gyrus, insula, inferior frontal gyrus, anterior cingulated gyrus (ACG), and right precuneus (i). Compared to previously investigated healthy subjects, activations were less robust and showed a feft hemisheric dominance in frontal activation. Simultaneous DGN stimulation caused a reduction in activation in the right insula, left middle frontal gyrus, right temporal and hippocampal regions, and left cerebellum (ii). 6 subjects completed the 2 weeks stimulation training and the 2nd fMRI session, which showed an increase of activation in the caudate nuclei, left parahippocampal region, right middle temporal gyrus, right insula, right orbito-frontal, middle and superior frontal gyrus, right cerebellum, and right ACG (iii). 4 of the 6 subjects showed urodynamical improvements such as improved bladder sensibility, increased compliance, and improved voluntary voiding. CONCLUSIONS Our results suggest that the central representation of bladder filling sensation is partly preserved in the subacute stage of incomplete SCI (i). However, the decreased response in right prefrontal areas and the left hemispheric dominance, might indicate diminished inhibitory micturition control as well as, compensatory or decompensatory reorganization of bladder control. We also provide evidence for a neuromodulatory effect of acute DGN stimulation (ii). DGN stimulation training induced significant neuromodulation, predominantly signal increases in areas previously described as cortical network of bladder control in healthy (iii). Correlations with the patient's urological status indicate that this neuromodulatory effect may reflect the clinical improvement following training. Zurich, Switzerland© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e393-e394 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Monika-Zita Zempleni More articles by this author Lars Michels More articles by this author Ulrich Mehnert More articles by this author Brigitte Schurch More articles by this author Spyros Kollias More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Inflammatory mediators of cerebrospinal fluid from patients with spinal cord injury

Background The guidelines of MP treatment for acute SCI are still under debate. We examined the inflammatory mediators of CSF in patients with SCI and assessed the effect of MP treatment. Methods We studied 7 patients with acute SCI at the cervical level and examined the mediators of CSF in patients by cytokine antibody array, ELISA and gelatin zymography. Results We found that levels of IL-6, IL-8, monocyte chemoattractant protein-1, neutrophil-activating peptide 2, intracellular adhesion molecule-1, soluble Fas, tissue inhibitors of metalloproteinase 1, and matrix metalloproteinases-2 and -9 were upregulated in patients with complete SCI without MP treatment as compared to patients with MP treatments, incomplete SCI, or controls. Nerve growth factor was upregulated in patients with MP treatment. Conclusions We suggest that a neuroinflammatory CSF profile after complete SCI could be suppressed with MP treatment via downregulating the expression of various cytokines.

Estimating MET Values of Persons with SCI Using Heart Rate

MET values in the compendium of physical activities (PA) are frequently used to estimate energy expenditure (EE) of PA, but most MET values cannot be applied to persons with disabilities (PD) because the values may differ for a specific disability subpopulation and only a few disability-specific activities are included. Therefore, development of a supplement PA compendium (SPAC) for PD is urgently needed. A simple and accurate way to estimate METs is needed and heart rate (HR) may be a solution using the ratio of PA HR and resting HR. PURPOSE: To determine the accuracy of the HR ratio method estimating PA MET values of persons with spinal cord injury (PSCI). METHODS: Thirty one PSCI were recruited, including 19 males and 12 females with complete and incomplete SCI T3-T12; 161.26±22.99 cm; 60.52±15.32 kg; and 18-45 yrs old. Ten PAs used including reading (RD), watching TV (TV), working on a computer (CM), vacuuming (VM), mopping (MP), moving chairs (MC), pushing a wheelchair-tile floor-own pace (TL), -sidewalk-40% faster than TL (SW), -ramp (RP) and arm ergometer-60rpm/60W(EX). RMR and 10-min VO epochs of the 10 PAs were measured by indirect calorimetry. The MET values of each PA were calculated based on collected RMR and PA oxygen uptake and the HR ratio METs were calculated by dividing HR of the PA with the resting HR. Correlation and regression analysis were employed to determine the relationship between measured METs and those estimated by the HR ratio method. RESULTS: The directly measured and HR ratio estimated MET values (M±SD) were respectively: CM=1.3±0.2 / 1.2±0.1, TV=1.2±0.2 / 1.2±0.2, RD=1.3±0.3 / 1.2±0.2, TL=2.7±0.6 / 1.7±0.4, VM=3.3±0.5 / 1.8±0.3, MP=3.9±0.7 / 1.9±0.5, MC=4.2±0.8 / 1.9±0.5, SW=4.4±1.3 / 2.2±0.5, RP=4.4±0.9 / 2.1±0.5, & EX=5.8±0.9 / 2.4±0.5; Mean correlation between individual direct METs and HR ratio estimated METs is r = 0.93 (SD=.05, R2 = .87±.09 & SEE = .58±.19), but it decreased to r = 0.71 when using the above group mean values. CONCLUSION: The HR ratio method is a valid method for estimating PA METs and individual calibration may further improve prediction accuracy. Acknowledgement: Study supported by ACSM Foundation's Carl V. Gisolfi Memorial Research Fund

Foot control in incomplete SCI: distinction between paresis and dexterity

Objective: To complement the clinical assessment of motor impairment after incomplete spinal cord injury (iSCI) by introducing a test that reliably distinguishes between muscle weakness (paresis) and impairment of dexterity in a simple foot motor task.Methods: Auditory-paced ankle dorsi- and plantarflexion, in a supine position, was studied in 30 controls (to establish control values and to test reliability) and in 16 iSCI patients (test validation). The subjects were instructed to initiate dorsi- and plantarflexion as accurately in timing and with the largest range of motion (ROM) possible. For each frequency, accuracy of timing, ROM, peak velocity of dorsi- and plantarflexion and a time quotient for changing from dorsi- to plantarflexion and vice versa were determined. In iSCI subjects, these parameters were related to clinical measures of paresis, spasticity and proprioception.Results: The test parameters showed good to very good reliability. The iSCI subjects were able to follow the target frequency with high accuracy, while ROM and peak velocity for dorsi- and plantarflexion were significantly reduced. Furthermore, there was a strong correlation between ROM/peak velocities and motor scores within the iSCI patients.Discussion: Repetitive foot dorsi- and plantarflexion enables a distinction to be made between muscle weakness and reduced dexterity as the underlying cause of affected foot control. This distinction between and quantification of these two movement components complements the existing clinical examination, and in follow-up works, the recovery of these components may provide further insight into the mechanisms underlying motor function improvement after iSCI.