Motor Complete SCI Research Articles

Ergogenic effects of spinal cord stimulation on exercise performance following spinal cord injury.

Cervical or upper-thoracic spinal cord injury (SCI, ≥T6) often leads to low resting blood pressure (BP) and impaired cardiovascular responses to acute exercise due to disrupted supraspinal sympathetic drive. Epidural spinal cord stimulation (invasive, ESCS) and transcutaneous spinal cord stimulation (non-invasive, TSCS) have previously been used to target dormant sympathetic circuits and modulate cardiovascular responses. This case series compared the effects of cardiovascular-optimised ESCS and TSCS versus sham ESCS and TSCS on modulating cardiovascular responses and improving submaximal upper-body exercise performance in individuals with SCI. Seven males with a chronic, motor-complete SCI between C6 and T4 underwent a mapping session to identify cardiovascular responses to spinal cord stimulation. Subsequently, four participants (two ESCS and two TSCS) completed submaximal exercise testing. Stimulation parameters (waveform, frequency, intensity, epidural electrode array configuration, and transcutaneous electrode locations in the lumbosacral region) were optimised to elevate cardiovascular responses (CV-SCS). A sham condition (SHAM-SCS) served as a comparison. Participants performed arm-crank exercise to exhaustion at a fixed workload corresponding to above ventilatory threshold, on separate days, with CV-SCS or SHAM-SCS. At rest, CV-SCS increased BP and predicted left ventricular cardiac contractility and total peripheral resistance. During exercise, CV-SCS increased time to exhaustion and peak oxygen pulse (a surrogate for stroke volume), relative to SHAM-SCS. Ratings of perceived exertion also tended to be lower with CV-SCS than SHAM-SCS. Comparable improvements in time to exhaustion with ESCS and TSCS suggest that both approaches could be promising ergogenic aids to support exercise performance or rehabilitation, along with reducing fatigue during activities of daily living in individuals with SCI.

Lack of improvement in anorectal manometry parameters after implementation of a pelvic floor/anal sphincter biofeedback in persons with motor-incomplete spinal cord injury.

Effect of biofeedback on improving anorectal manometric parameters in incomplete spinal cord injury is unknown. A short-term biofeedback program investigated any effect on anorectal manometric parameters without correlation to bowel symptoms. This prospective uncontrolled interventional study comprised three study subject groups, Group 1: sensory/motor-complete American Spinal Injury Association Impairment Scale (AIS) A SCI (n = 13); Group 2 (biofeedback group): sensory incomplete AIS B SCI (n = 17) (n = 3), and motor-incomplete AIS C SCI (n = 8), and AIS D SCI (n = 6); and Group 3: able-bodied (AB) controls (n = 12). High-resolution anorectal manometry (HR-ARM) was applied to establish baseline characteristics in all subjects for anorectal pressure, volume, length of pressure zones, and duration of sphincter squeeze pressure. SCI participants with motor-incomplete SCI were enrolled in pelvic floor/anal sphincter bowel biofeedback training (2 × 6-week training periods comprised of two training sessions per week for 30-45 min per session). HR-ARM was also performed after each of the 6-week periods of biofeedback training. Compared to motor-complete or motor-incomplete SCI participants, AB subjects had higher mean intra-rectal pressure, maximal sphincteric pressure, residual anal pressure, recto-anal pressure gradient, and duration of squeeze (p < 0.05 for each of the endpoints). No significant difference was evident at baseline between the motor-complete and motor-incomplete SCI groups. In motor-incomplete SCI subjects, the pelvic floor/anal sphincter biofeedback protocol failed to improve HR-ARM parameters. Biofeedback training program did not improve anal manometric parameters in subjects with motor-incomplete or sensory-incomplete SCI. Biofeedback did not change physiology, and its effects on symptoms are unknown. Utility of biofeedback is limited in patients with incomplete spinal cord injury in terms of improving HR-ARM parameters.

Targeted transcutaneous spinal cord stimulation promotes persistent recovery of upper limb strength and tactile sensation in spinal cord injury: a pilot study.

Long-term recovery of limb function is a significant unmet need in people with paralysis. Neuromodulation of the spinal cord through epidural stimulation, when paired with intense activity-based training, has shown promising results toward restoring volitional limb control in people with spinal cord injury. Non-invasive neuromodulation of the cervical spinal cord using transcutaneous spinal cord stimulation (tSCS) has shown similar improvements in upper-limb motor control rehabilitation. However, the motor and sensory rehabilitative effects of activating specific cervical spinal segments using tSCS have largely remained unexplored. We show in two individuals with motor-complete SCI that targeted stimulation of the cervical spinal cord resulted in up to a 1,136% increase in exerted force, with weekly activity-based training. Furthermore, this is the first study to document up to a 2-point improvement in clinical assessment of tactile sensation in SCI after receiving tSCS. Lastly, participant gains persisted after a one-month period void of stimulation, suggesting that targeted tSCS may lead to persistent recovery of motor and sensory function.

Spinal cord epidural stimulation for motor and autonomic function recovery after chronic spinal cord injury: A case series and technical note.

Traumatic spinal cord injury (tSCI) is a debilitating condition, leading to chronic morbidity and mortality. In recent peer-reviewed studies, spinal cord epidural stimulation (scES) enabled voluntary movement and return of over-ground walking in a small number of patients with motor complete SCI. Using the most extensive case series (n = 25) for chronic SCI, the present report describes our motor and cardiovascular and functional outcomes, surgical and training complication rates, quality of life (QOL) improvements, and patient satisfaction results after scES. This prospective study occurred at the University of Louisville from 2009 to 2020. scES interventions began 2-3 weeks after surgical implantation of the scES device. Perioperative complications were recorded as well as long-term complications during training and device related events. QOL outcomes and patient satisfaction were evaluated using the impairment domains model and a global patient satisfaction scale, respectively. Twenty-five patients (80% male, mean age of 30.9 ± 9.4 years) with chronic motor complete tSCI underwent scES using an epidural paddle electrode and internal pulse generator. The interval from SCI to scES implantation was 5.9 ± 3.4 years. Two participants (8%) developed infections, and three additional patients required washouts (12%). All participants achieved voluntary movement after implantation. A total of 17 research participants (85%) reported that the procedure either met (n = 9) or exceeded (n = 8) their expectations, and 100% would undergo the operation again. scES in this series was safe and achieved numerous benefits on motor and cardiovascular regulation and improved patient-reported QOL in multiple domains, with a high degree of patient satisfaction. The multiple previously unreported benefits beyond improvements in motor function render scES a promising option for improving QOL after motor complete SCI. Further studies may quantify these other benefits and clarify scES's role in SCI patients.

Preservation of functional descending input to paralyzed upper extremity muscles in motor complete cervical spinal cord injury

ObjectiveSpinal cord injury (SCI) is classified as complete or incomplete depending on the extent of sensorimotor preservation below the injury level. However, individuals with complete SCIs can voluntarily activate paralyzed lower limb muscles alone or by engaging non-paralyzed muscles during neurophysiological assessments, indicating presence of residual pathways across the injury. However, similar phenomena have not been explored for the upper extremity (UE) muscles following cervical SCIs. MethodsEighteen individuals with motor complete cervical SCI (AIS A or B) and five age-matched non-injured (NI) individuals performed various UE events against manual resistance during functional neurophysiological assessment (FNPA), and electromyographic (EMG) activity was recorded from UE muscles. ResultsOur findings demonstrated i) voluntary activation of clinically paralyzed muscles as evident from EMG readouts, ii) increased activity in these muscles during events engaging muscles above the injury level, iii) reduced spectral properties of paralyzed muscles in SCI compared to NI participants. ConclusionsFunctional EMG activity in clinically paralyzed muscles indicate presence of residual pathways across the injury establishing supralesional control over the sublesional neural circuitry. SignificanceThe findings may help explain the neurophysiological basis for UE recovery and can be exploited in designing rehabilitation techniques to facilitate UE recovery following cervical SCIs.

Effect of epidural spinal cord stimulation after chronic spinal cord injury on volitional movement and cardiovascular function: study protocol for the phase II open label controlled E-STAND trial

IntroductionSpinal cord injury (SCI) leads to significant changes in morbidity, mortality and quality of life (QOL). Currently, there are no effective therapies to restore function after chronic SCI. Preliminary studies...

Comparison of Various Indices in Identifying Insulin Resistance and Diabetes in Chronic Spinal Cord Injury.

The purpose of this screening and diagnostic study was to examine the accord among indices of glucose metabolism, including the Homeostatic Model Assessment for Insulin Resistance (HOMA), HOMA2, Matsuda Index, Quantitative Insulin-sensitivity Check Index (QUICKI), hemoglobin A1C (HbA1C), and fasting plasma glucose (FPG) against intravenous glucose tolerance test-measured insulin sensitivity (Si) in individuals with chronic motor complete SCI. Persons with chronic (≥12-months post-injury) SCI (n = 29; 79% men; age 42.2 ± 11.4; body mass index 28.6 ± 6.4 kg/m2; C4-T10) were included. Measures were compared using adjusted R2 from linear regression models with Akaike information criterion (AIC, a measure of error). QUICKI had the greatest agreement with Si (adjusted R2 = 0.463, AIC = 91.1, p = 0.0001), followed by HOMA (adjusted R2 = 0.378, AIC = 95.4, p = 0.0008), HOMA2 (adjusted R2 = 0.256, AIC = 99.7, p = 0.0030), and the Matsuda Index (adjusted R2 = 0.356, AIC = 95.5, p = 0.0004). FPG (adjusted R2 = 0.056, AIC = 107.5, p = 0.1799) and HbA1C (adjusted R2 = 0.1, AIC = 106.1, p = 0.0975) had poor agreement with Si. While HbA1C and FPG are commonly used for evaluating disorders of glucose metabolism, QUICKI demonstrates the best accord with Si compared to the other measures.

Effects of arm cranking exercise on muscle oxygenation between active and inactive muscles in people with spinal cord injury

Objective: We investigated the effects of the incremental arm-cranking exercise (ACE) on tissue oxygen saturation (StO2) between active and inactive muscles, and the relationship between peak oxygen uptake (VO2peak) and changes in the StO2 in inactive muscles. Design: Observational study. Setting: Community-based supervised intervention. Participants: The participants were individuals with motor and sensory complete spinal cord injury (complete SCI; n = 8) and motor complete but sensory incomplete SCI (incomplete SCI; n = 8), and able-bodied (AB) individuals (n = 8) matched for age, height, and body mass index. Intervention: The ACE was performed at a rate increasing by 10 watts min−1 until exhaustion. Outcome Measures: VO2peak, heart rate (HR), and StO2. Results: While VO2peak was similar among the groups, peak HR was significantly higher in both SCI groups than in the AB (P < 0.05). In active muscles (biceps brachii), no differences in the StO2 were observed among the groups (P > 0.05). In inactive muscles (vastus lateralis), the StO2 in the AB and the incomplete SCI began to decrease at approximately 40% of the peak work rate; however, they remained unchanged in the complete SCI. The reductions in StO2 in the AB were significantly greater than in the incomplete SCI. Conclusions: These results suggest that sympathetic vasoconstriction occurred in the incomplete SCI and AB, although it did not occur in the complete SCI, probably due to a reduction in sympathetic nerve activity. Sympathetic vasoconstriction in inactive muscles may not contribute to an individual’s VO2peak regardless of their group.

A STUDY OF RELATION OF LOWER LIMB SPASTICITY WITH LIPID PROFILE AND FASTING PLASMA GLUCOSE LEVELS IN CHRONIC MOTOR COMPLETE SPINAL CORD INJURY PATIENTS.

Background: Most common cause of spinal cord injury in India is fall from height followed by road accidents which may lead to incomplete or complete disruption of neural signal transmission across and below the level of injury. Spasticity is a common but not an inevitable complication following spinal cord injury.&#x0D; Study Objective: The present study tried to explore the correlation between the lower limb spasticity following spinal cord injury and the metabolic markers.&#x0D; Study design: Hospital-based cross-sectional study.&#x0D; Material and Methods: Fifty patients recruited from Department of Physical Medicine and Rehabilitation, Sawai Man Singh Hospital, Jaipur (Raj.), were categorized into mild (16),moderate (11), and severe (23)spastic groups based on assessment of ankle/knee extensor muscle group spasticity using the modified Ashworth scale. The metabolic profile markers such as Total Cholesterol (TC), Low-density Lipoprotein (LDL), High-Density Lipoprotein (HDL), Triglyceride (TG) and Fasting Plasma Glucose (FPG) were estimated and compared between the three groups.&#x0D; Results: The triglycerides, total cholesterol, low density lipoproteins and the fasting plasma glucose level were significantly negatively correlated with the grading of spasticity in lowerlimbs (P &lt;0.001). The high density lipoproteins level was higher in a severe spastic group as compared to the mild and moderate spastic groups; but this result was statistically non-significant (P=0.14).&#x0D; Conclusion: Spasticity in motor complete SCI may have beneficial effects in preserving glucose homeostasis and defending rise in adiposity, rationalizing the need for its judicious management to maintain the crucial balance between its beneficial and problematic effects.&#x0D; Keywords: Spasticity, Modified Ashworth score, Spinal cord injury, lipid profile, fasting plasma glucose.

Methodological considerations for near-infrared spectroscopy to assess mitochondrial capacity after spinal cord injury

Background: Skeletal muscle mitochondrial activity is reduced by ∼ 50–60% after SCI, resulting in impaired energy expenditure, glucose utilization and insulin sensitivity. Near infra-red spectroscopy (NIRS) is a non-invasive tool that can be used to assess mitochondrial capacity. Objectives: (1) Highlight methodological limitations impacting data acquisition and analysis such as subcutaneous adipose tissue (SAT) thickness, movement artifacts, inadequate muscle stimulation, light interference, and ischemic discomfort. (2) Provide technical considerations to improve data acquisition and analysis. This may serve as guidance to other researchers and clinicians using NIRS. Study Design: cross-sectional observational design. Settings: Clinical research medical center. Participants: Sixteen men with 1 > year post motor complete SCI. Methods: NIRS signals were obtained from right vastus lateralis muscle utilizing a portable system. Signals were fit to a mono-exponential curve. Outcome Measures: Rate constant and r 2 values for the fit curve, indirectly measures mitochondrial capacity. Results: Only four participants produced data with accepted rate constants of 0.002–0.013 s−1 and r 2 of 0.71–0.87. Applications of studentized residuals ≥2.5 resulted in sparing data from another four participants with rate constants of 0.010–0.018 s−1and r 2 values ranging from 0.86–0.99. Conclusions: Several limitations may challenge the use of NIRS to assess mitochondrial capacity after SCI. Acknowledging these limitations and applying additional data processing techniques may overcome the discussed limitations and facilitate data sparing.

Bone changes in the lower limbs from participation in an FES rowing exercise program implemented within two years after traumatic spinal cord injury

Objective: To determine the effect of a functional electrical stimulation (FES) rowing program on bone mineral density (BMD) when implemented within two years after SCI.Design: Prospective.Setting: Health Care Facility.Participants: Convenience sample; four adults with recent (<2 years) traumatic, motor complete SCI (C7-T12 AIS A-B).Intervention: A 90-session FES rowing exercise program; participants attended 30-minute FES training sessions approximately three times each week for the duration of their participation.Outcome Measures: BMD in the distal femur and tibia were measured using peripheral Quantitative Computed Tomography (pQCT) at enrollment (T0) and after 30 (T1), 60 (T2), and 90 (T3) sessions. Bone stimulus was calculated for each rower at each time point using the average number of weekly loading cycles, peak foot reaction force, and bone mineral content from the previous time point. A regression analysis was used to determine the relationship between calculated bone stimulus and change in femoral trabecular BMD between time points.Results: Trabecular BMD in the femur and tibia decreased for all participants in T0-1, but the rate of loss slowed or reversed between T1-2, with little-to-no bone loss for most participants during T2-3. The calculated bone stimulus was significantly correlated with change in femoral trabecular BMD (P = 0.016; R2 = 0.458).Conclusion: Consistent participation in an FES rowing program provides sufficient forces and loading cycles to reduce or reverse expected bone loss at the distal femur and tibia, at least temporarily, in some individuals within two years after SCI.Trial Registration: NCT02008149.

The discriminative ability of fraxto identify prevalent post-SCI lower extremity osteoporotic fractures

SCI causes rapid, severe osteoporosis. More than half of those with motor complete SCI will experience an osteoporotic fracture at some point following their injury. Despite the high prevalence, there is no SCI-specific fracture risk prediction tool. Therefore, we sought to compare the discriminative value of risk fracture scores used in the general population, (FRAX score, T -score, and Z -score) in adults with spinal cord injury. We also assessed the sensitivity and specificity of osteoporosis definitions based on FRAX and T -score. We assessed 318 adult men with chronic SCI (at least 1 year post-injury). Bone density at the hip (total hip, femoral neck), knee (distal femur, proximal tibia), and radius was determined by DXA scan. 10-year major osteoporotic fracture and hip fracture FRAX scores were calculated based on bone density at the femoral neck. Prevalent post-SCI fractures were categorized as osteoporotic or traumatic and only lower extremity osteoporotic fractures were considered in the analysis. The overall discriminative value of each score was assessed by calculating areas under the ROC curve. The prevalence of post-SCI lower extremity osteoporotic fracture was 22%. When comparing bone density at the hip (AUC 0.7681–0.7858), bone density at the knee (AUC 0.7821–0.7733), bone density at the radius (AUC 0.6263), T -score (AUC 0.7890), Z -score (AUC 0.7040), and FRAX scores, 10-year major osteoporotic FRAX score (AUC 0.8381) had the greatest discriminative ability to identify prevalent post-SCI lower extremity osteoporotic fractures. Major osteoporotic FRAX score cut-point of > 10% had greater sensitivity and specificity than the cut-point recommended in the general population (> 20% probability of fracture) recommended in the general population. 10-year major osteoporotic FRAX score may have clinical utility in fracture risk prediction after spinal cord injury. However, cut-points may need to be SCI-specific (> 10%) to improve predictive value.

Epidural stimulation with locomotor training improves body composition in individuals with cervical or upper thoracic motor complete spinal cord injury: A series of case studies

Context Four individuals with motor complete SCI with an implanted epidural stimulator who were enrolled in another study were assessed for cardiovascular fitness, metabolic function and body composition at four time points before, during, and after task specific training. Following 80 locomotor training sessions, a 16-electrode array was surgically placed on the dura (L1-S1 cord segments) to allow for electrical stimulation. After implantation individuals received 160 sessions of task specific training with epidural stimulation (stand and step). Outcome measures Dual-energy X-ray absorptiometry (DXA), resting metabolic rate and peak oxygen consumption (VO2peak) were measured before locomotor training, after locomotor training but before epidural stimulator implant, at mid-locomotor training with spinal cord epidural stimulation (scES) and after locomotor training with scES. Findings Participants showed increases in lean body mass with decreases on percentage of body fat, particularly android body fat, and android/gynoid ratio from baseline to post training; resting metabolic rate and VO2peak also show increases that are of clinical relevance in this population. Conclusions Task specific training combined with epidural stimulation has the potential to show improvements in cardiovascular fitness and body composition in individuals with cervical or upper thoracic motor complete SCI.

Anthropometric Prediction of Visceral Adipose Tissue in Persons With Motor Complete Spinal Cord Injury

BackgroundSpinal cord injury (SCI) results in increased accumulation of visceral adipose tissue (VAT). Anthropometrics may provide an alternative to estimate VAT cross-section area (CSA) compared to magnetic resonance imaging (MRI). ObjectiveTo validate the use of anthropometrics, including abdominal circumference and skinfold thickness (SFT) measurements against MRI to predict subcutaneous adipose tissue (SAT) and VAT cross-sectional areas in persons with SCI. DesignCross-sectional. SettingClinical research center ParticipantTwenty-two men with motor complete SCI MethodsAnthropometric measurements and MRI were taken during a single visit. Abdominal circumference and SFT were used to derive prediction equations for subcutaneous adipose tissue (SATAnthro-CSA) and VAT (VATAnthro-CSA). Three-axial MRI at the level of umbilicus was used to establish the prediction equations. VATAnthro-CSA was compared against body mass index (BMI), waist circumference, and SFT. Bland-Altman plots were used to determine limits of agreement between prediction equations and MRI. Main Outcome MeasurementsSAT and VAT cross-sectional areas. ResultsSATAnthro-CSA explained 76% of the variance in SAT cross-sectional area (r2 = 0.76, standard error of the estimate [SEE] = 49.5 cm2, P <.001). VATAnthro-CSA explained 72% of VAT cross-sectional area (r2 = 0.72, SEE = 45.8 cm2, P <.001). Compared to VATAnthro-CSA, BMI, waist circumference, and SFT explained only 37%, 63%, and 31%, respectively, in the variance of VAT MRI. ConclusionAbdominal circumference and SFT demonstrated an alternative way to predict VAT CSA. VATAnthro-CSA estimated VATMRI more accurately than BMI, waist circumference, and SFT in individuals with chronic SCI. Level of EvidenceI

Estimating the Basal metabolic rate from fat free mass in individuals with motor complete spinal cord injury.

Cross-sectional study. This study aimed to validate the existing basal metabolic rate (BMR) predictive equations that include fat free mass (FFM) as an independent variable and, based on the FFM assessment, to develop a new SCI population-specific equation. Outpatient clinic in a general hospital. Our study group was formed of 50 individuals with chronic motor complete SCI: 27 patients with tetraplegia and 23 with paraplegia. Both BMR and FFM values were measured by indirect calorimetry (IC) and the whole-body dual energy X-ray absorptiometry, respectively. The BMR values measured by IC were compared with the values estimated from the Cunningham equation. Multiple linear regression analysis was performed to develop a new FFM-based, BMR predictive equation. The mean value of BMR measured by IC was 1274.8 (s.d.=235.2) kcal day-1. The intra-class correlation coefficient (ICC) between values measured by IC and estimated from the Cunningham equation was 0.845 and the limits of agreement ranged from -30.6 to 241.3 kcal. SCI population specific BMR predictive equation was developed; BMR (kcal day-1)=24.5 × FFM (kg)+244.4. The newly developed equation showed ICC of 0.866 with the limits of agreement from -229.0 to 233.1 kcal day-1. A considerable bias from the BMR values measured by IC was still observed, which warrants clinical consideration when applying FFM-based BMR prediction equations to individuals with SCI.

Precision of dual-energy X-ray absorptiometry of the knee and heel: methodology and implications for research to reduce bone mineral loss after spinal cord injury.

Methodological validation of dual-energy x-ray absorptiometry (DXA)-based measures of leg bone mineral density (BMD) based on the guidelines of the International Society for Clinical Densitometry. The primary objective of this study was to determine the precision of BMD estimates at the knee and heel using the manufacturer provided DXA acquisition algorithm. The secondary objective was to determine the smallest change in DXA-based measurement of BMD that should be surpassed (least significant change (LSC)) before suggesting that a biological change has occurred in the distal femur, proximal tibia and calcaneus. Academic Research Centre, Canada. Ten people with motor-complete SCI of at least 2 years duration and 10 people from the general population volunteered to have four DXA-based measurements taken of their femur, tibia and calcaneus. BMDs for seven regions of interest (RIs) were calculated, as were short-term precision (root-mean-square (RMS) standard deviation (g cm-2), RMS-coefficient of variation (RMS-CV, %)) and LSC. Overall, RMS-CV values were similar between SCI (3.63-10.20%, mean=5.3%) and able-bodied (1.85-5.73%, mean=4%) cohorts, despite lower absolute BMD values at each RIs in those with SCI (35%, heel to 54%, knee; P<0.0001). Precision was highest at the calcaneus and lowest at the femur. Except at the femur, RMS-CV values were under 6%. For DXA-based estimates of BMD at the distal femur, proximal tibia and calcaneus, these precision values suggest that LSC values >10% are needed to detect differences between treated and untreated groups in studies aimed at reducing bone mineral loss after SCI.

Prevalence and Etiology of Hypogonadism in Young Men With Chronic Spinal Cord Injury: A Cross-Sectional Analysis From Two University-Based Rehabilitation Centers

BackgroundSpinal cord injury (SCI) triggers an “accelerated aging” process that may include development of hypogonadism, even among younger men with SCI; however, few studies have investigated the prevalence or etiology of hypogonadism in men with SCI. Young men with SCI also are at increased risk for developing metabolic dysfunction after injury, which may be exacerbated by concomitant testosterone (T) deficiency, thus identifying the prevalence and risk factors for T deficiency in men with SCI is important for their long-term health. ObjectiveTo investigate the prevalence, risk factors, and etiology of T deficiency (hypogonadism) in otherwise-healthy men with chronic, motor complete SCI. DesignSecondary cross-sectional analysis. SettingRehabilitation research centers in Washington, DC, and Miami, Florida. ParticipantsMen (n = 58) aged 18-45 years with chronic (≥1 year), motor complete SCI without comorbidities or use of testosterone therapy. MethodsPlasma concentrations of hormones were measured with standardized assays. Body composition was assessed with dual-energy x-ray absorptiometry scan. Main Outcome MeasurementsSerum total T and calculated free T. ResultsT deficiency was more common in men after SCI than in a matched cohort of similarly-aged men without SCI (25%, SCI versus 6.7%, non-SCI, P < .001). The risk of hypogonadism appeared to be increased in men with more extensive injury and with higher percent body fat. The majority of men with SCI with low T had low serum LH levels, suggesting that central suppression of the hypothalamic-pituitary-gonadal axis may be the most common etiology of hypogonadism after SCI. ConclusionsHypogonadism is more common in young men with SCI than in similarly aged men without SCI, suggesting that SCI should be identified as a risk factor for T deficiency and that routine screening for hypogonadism should be performed in the SCI population. Level of EvidenceII

Neuromotor response of the leg muscles following a supine, stand retraining with/without neuromuscular electrical stimulation training intervention for individuals with SCI: A case series.

The goal of this paper is to study the effects of supine and stand retraining (SRT) interventions with and without multi muscle neuromuscular electrical stimulation (NMES) on the neuromuscular EMG responses of the leg muscles for individuals with motor complete SCI during walking on a body-weight support (BWS) treadmill. The main outcome variables were EMG amplitude, integrated EMG and co-contraction indices (co-excitation and co-activation) collected during a 10-minute walking treadmill trial. Data was analyzed for the first, fifth and tenth minute of walking. Results showed that both Supine+NMES and SRT+NMES interventions increased spatial-temporal aspects of muscle activity (mean EMG amplitude and integrated EMG) of lower limb muscles. SRT+NMES (loading) showed greater gains in the proximal anterior leg compartments. On the contrary, SRT without NMES (SRT only) exhibited deterioration of activity within the same muscle groups. Co-contraction indices increased for both post-NMES interventions suggesting that task-specificity of training is important to achieve the fundamental reciprocal firing known to able-bodied gait. These results show that combination of NMES+loading during passive rhythmic gait will induce neuroplasticity in the lower limbs that ultimately provides a potential effective means to recover gait in individuals with SCI.

Effects of lower limb electrical stimulation on trunk stability in persons with SCI during walking: a case series.

The purpose of the present case series was to investigate whether three lower limb rehabilitation training approaches have any effects on trunk stability of persons with motor complete SCI during a 10-minute assisted walk. These trainings included electrical stimulation (ES), standing retraining (SRT), and a novel multi-modality approach that combined ES with SRT. We observed that multi-muscle ES directed at the lower limbs had a prominent, indirect effect on the upper and lower muscles of the trunk. More specifically, trunk muscle activations of the ES+SRT subject increased after training for the more distal muscles of the trunk. This study provides preliminary evidence that combining lower limb ES with SRT may provide beneficial effects in improving trunk control and stability.

Longitudinal changes in body composition and metabolic profile between exercise clinical trials in men with chronic spinal cord injury

Study design: Longitudinal design.Objectives: The study was undertaken to determine the effects of cessation of exercise interventions on body composition and metabolic profiles in men with chronic SCI.Settings: Clinical trials within a Medical Center.Methods: Eleven men with motor complete SCI were followed on average over a period of 2.5 years. Six men were involved in two different exercise interventions (functional electrical stimulation cycling versus arm cycling ergometer), 5 days/week for 16 weeks (exercise group), and five men served as a control (control group). Anthropometrics and dual energy X-ray absorptiometry (DXA) were captured to measure changes in lean mass (LM), fat mass (FM), percentage FM before, immediately after exercise, and after a period of 2.5 years. Basal metabolic rate (BMR) and lipid panel were also measured.Results: Thigh circumference increased by 8.5% following exercise (P = 0.042) and remained 6.4% greater than baseline measurements (P = 0.012). Leg LM increased by 9% following the exercise intervention (P = 0.03) and decreased by 16% in the follow-up visit (P = 0.02). Percentage trunk and total body FM increased by 4.5% (P = 0.008) and 3.5% (P = 0.019) in the follow-up visit, respectively, and whole body LM increased by 8.4% and decreased back by 5.4% following a 2.5 year-period. BMR significantly decreased by 15.5% following the exercise (P = 0.029) interventions.Conclusion: Exercise training is accompanied with positive changes in body composition as well as compensatory decrease in BMR, that regressed back following 2.5 years of exercise cessation. Participation in an exercise trial is unlikely to confound the measurements of a follow-up trial.