Paraplegic Spinal Cord Injury Research Articles

High-intensity interval training with functional electrical stimulation cycling for incomplete spinal cord injury patients: A pilot feasibility study.

Consequences of spinal cord injury (SCI) with a sedentary lifestyle will progress to muscle weakness and muscle atrophy, leading to muscle fatigue. This study aimed to determine the feasibility and preliminary effects of high-intensity interval training (HIIT) using functional electrical stimulation (FES) cycling on changes in thigh muscle volume and muscle strength, in patients with incomplete SCI. Eight incomplete SCI patients (mean age 50 years; 6 women) with stable SCI paraplegia (mean 6.75 years since injury) participated in the HIIT FES cycling (85%-90% peak Watts; 4 × 4-min intervals) three times a week (over 6 weeks). The main outcomes were adherence, participant acceptability, and adverse events. Secondary outcomes were muscle strength (peak torque) and leg volume changes. Our findings revealed that the program was well-received by participants, with high levels of adherence, positive feedback, and satisfaction, suggesting that it could be a promising option for individuals seeking to enhance their lower body strength and muscle mass. Additionally, all participants successfully completed the training without any serious adverse events, indicating that the program is safe for use. Finally, we found that the 6-week HIIT FES leg cycling exercise program resulted in notable improvements in isometric peak torque of the quadriceps (range 13.9%-25.6%), hamstring muscle (18.2%-23.3%), and leg volume (1.7%-18.2%). This study highlights HIIT FES leg cycling exercise program potential as an effective intervention for improving lower limb muscle function.

Ultrasound imaging in spinal cord injury patients with shoulder pain

Objective To examine shoulder ultrasound imaging in both tetraplegic and paraplegic spinal cord injury (SCI) patients with shoulder pain. Methods All 28 individuals with SCI with shoulder pain were enrolled in this study. Fifty-six shoulders were evaluated by ultrasound (US) imaging. Results Fourteen tetraplegics and 14 paraplegics were enrolled (age 45.4 ± 13.8 years [mean ± SD]). Median time post-SCI was 8.6 years. Twenty-three individuals (82.1%) were independent in transfer and four individuals (14.3%) were partially independent in transfer. The prevalence of shoulder pain was 78.6% in manual wheelchair ambulators, 10.7% in gait aids users, 7.1% in wheelchair sitters, and 3.6% in no assistive device individuals. Abnormal US imaging was found in 24/28 (85.7%) individuals. Total shoulder US abnormalities were 38 units. Most common abnormal US imaging was supraspinatous tendinosis (42.1%), biceps tendon effusion (23.7%), positive dynamic supraspinatus impingement (21.1%), and subdeltoid bursitis (18.4%). Conclusions Shoulder ultrasonographic abnormalities were common in the patients with SCI with shoulder pain. The supraspinatus tendinosis is the most common abnormal US imaging in patients with SCI with shoulder pain.

Lumbar epidural steroid injection for spasticity in paraplegic spinal cord injury: A case report

This is the case of a 33-year-old male with traumatic paraplegic lumbar spinal cord injury after knife assault, who was unable to participate in an intensive inpatient rehabilitation course due to bilateral lower limb spasticity. For therapeutic management of spasticity at the bedside in the inpatient rehabilitation setting, we performed an epidural steroid injection to the right L4-L5 interspace. After the intervention, a significant decrease in spasticity was noted. The patient could subsequently tolerate sit-to-stand transfers with a standing frame and ambulate with the an exoskeleton device in inpatient physical therapy, significantly improving his overall functional level in therapies. This case demonstrates that bedside epidural steroid injection can dramatically improve paraplegic spasticity secondary to lumbar spinal cord injury in the inpatient rehabilitation setting.

Lesion level-dependent systemic muscle wasting after spinal cord injury is mediated by glucocorticoid signaling in mice.

An incomplete mechanistic understanding of skeletal muscle wasting early after spinal cord injury (SCI) precludes targeted molecular interventions. Here, we demonstrated systemic wasting that also affected innervated nonparalyzed (supralesional) muscles and emerged within 1 week after experimental SCI in mice. Systemic muscle wasting caused muscle weakness, affected fast type 2 myofibers preferentially, and became exacerbated after high (T3) compared with low (T9) thoracic paraplegia, indicating lesion level-dependent ("neurogenic") mechanisms. The wasting of nonparalyzed muscle and its rapid onset and severity beyond what can be explained by disuse implied unknown systemic drivers. Muscle transcriptome and biochemical analysis revealed a glucocorticoid-mediated catabolic signature early after T3 SCI. SCI-induced systemic muscle wasting was mitigated by (i) endogenous glucocorticoid ablation (adrenalectomy) and (ii) pharmacological glucocorticoid receptor (GR) blockade and was (iii) completely prevented after T3 relative to T9 SCI by genetic muscle-specific GR deletion. These results suggest that neurogenic hypercortisolism contributes to a rapid systemic and functionally relevant muscle wasting syndrome early after paraplegic SCI in mice.

Effect of Driving Simulator Training on Patients' Driving Performance and Self-Efficacy with Paraplegia due to Spinal Cord Injury

Objective: The purpose of this study was to investigate the effect of driving simulator training on the driving performance and self-efficacy of paraplegic patients with spinal cord injury.
 Method: Driving simulator training was provided to 12 participants with within subjects design, three sessions of basic driving, seven sessions of driving on the driving simulator. After training, performance time and operational performance scores, self-efficacy were analyzed.
 Results: This study found that the intervention by the driving simulator had statistically significant effects on driving time, performance error, ‘Sudden start’, ‘No neutral gear when stopping’, and ‘Speed violation’ and ‘Social self-efficacy’ of paraplegic spinal cord injury patients (p<.05).
 Conclusion: Driving simulator training can be a strategy to improve driving performance and social self-efficacy of paraplegic patients with spinal cord injury. Also, patients need sufficient sessions more than 10 times of driving simulator training.

Changes in neuromuscular activation, heart rate and rate of perceived exertion over the course of a wheelchair propulsion fatigue protocol.

Shoulder pain is common in persons with spinal cord injury and has been associated with wheelchair use. Fatigue related compensation strategies have been identified as possibly impacting the development of shoulder injury and pain. The purpose of this study was to investigate the progression of performance fatigability (i.e., decline in objective measure of performance including neuromuscular activation and increase in heart rate) and perceived fatigability (i.e., increased perceived exertion) during a 15-min fatigue protocol including maximum voluntary overground wheelchair propulsion. Fifty participants with paraplegic spinal cord injury completed three 4-min rounds of wheelchair propulsion, separated by 90s of rest, on a figure-8 course consisting of two turns and full stops per lap in their manual wheelchairs (ClinicalTrials.gov: NCT03153033). Electromyography (EMG) signal of five muscles acting on the shoulder joint, heart rate (HR), and rate of perceived exertion (RPE) were measured at the beginning and end of every 4min of propulsion. Root Mean Square (RMS) and Mean Power Frequency were calculated from EMG data. There was a significant increase in %RMS of the pectoralis major pars sternalis and trapezius pars descendens, HR, and RPE with greatest changes during the first 4min of the protocol. The observed changes in neuromuscular activation in only two of the shoulder muscles may impact muscular imbalances and the development of shoulder injuries and should be further studied. The current study gives clearer insight into the mechanisms of performance fatigability and perceived fatigability throughout a wheelchair propulsion fatigue protocol.

Participation in Daily Activities and Quality of Life among Individuals with Paraplegic Spinal Cord Injury in Pakistan

Individuals with paraplegic Spinal Cord Injury (SCI) face various difficulties that limit participation in daily activities and lowered Quality of Life (QOL) after hospital discharge. This cross-sectional study aimed to investigate the level of participation in daily activities and QOL among individuals with paraplegic SCI and to examine the relationship between these two variables. The results revealed that individuals with paraplegic SCI faced significant challenges in social participation, life activities, mobility, getting along, self-care, and cognition, leading to a reduction in overall QOL. Occupational therapists prioritize post-discharge interventions targeting to improve participation and QOL for successful rehabilitation and community reintegration.

Psychological experiences of family carers of people with spinal cord injury paraplegia: an explorative qualitative study

Spinal cord injury paraplegia is a significant health problem in Sri Lanka. This study explores the psychological experiences of family carers of people with such a condition. A descriptive phenomenological study was conducted with 17 parent, sibling, spouse and adult carers. Thematic analysis revealed four themes related to: carer emotions regarding the caring process; feelings related to the family member’s condition; beliefs beyond the physical world; and behaviour changes due to psychological distress. The findings will help develop interventions for the psychological needs of Sri Lankan carers and may provide insight into the experiences of similar Asian communities living globally.

Walking Outcome After Traumatic Paraplegic Spinal Cord Injury: The Function of Which Myotomes Makes a Difference?

Background Accurate prediction of walking function after a traumatic spinal cord injury (SCI) is crucial for an appropriate tailoring and application of therapeutical interventions. Long-term outcome of ambulation is strongly related to residual muscle function acutely after injury and its recovery potential. The identification of the underlying determinants of ambulation, however, remains a challenging task in SCI, a neurological disorder presented with heterogeneous clinical manifestations and recovery trajectories. Objectives Stratification of walking function and determination of its most relevant underlying muscle functions based on stratified homogeneous patient subgroups. Methods Data from individuals with paraplegic SCI were used to develop a prediction-based stratification model, applying unbiased recursive partitioning conditional inference tree (URP–CTREE). The primary outcome was the 6-minute walk test at 6 months after injury. Standardized neurological assessments ≤15 days after injury were chosen as predictors. Resulting subgroups were incorporated into a subsequent node-specific analysis to attribute the role of individual lower extremity myotomes for the prognosis of walking function. Results Using URP–CTREE, the study group of 361 SCI patients was divided into 8 homogeneous subgroups. The node specific analysis uncovered that proximal myotomes L2 and L3 were driving factors for the differentiation between walkers and non-walkers. Distal myotomes L4–S1 were revealed to be responsible for the prognostic distinction of indoor and outdoor walkers (with and without aids). Conclusion Stratification of a heterogeneous population with paraplegic SCI into more homogeneous subgroups, combined with the identification of underlying muscle functions prospectively determining the walking outcome, enable potential benefit for application in clinical trials and practice.

Shoulder pain in persons with tetraplegia and the association with force application during manual wheelchair propulsion

Introduction
 Shoulder pain is highly prevalent in persons with spinal cord injury (Liampas et al., 2021) and restricts daily mobility and thus participation and quality of life. Shoulder loading activities, such as manual wheelchair propulsion or transfers, are seen as risk factors for shoulder pain. To minimize the risk for shoulder pain, clinical guidelines instruct persons with spinal cord injury to “use long, smooth strokes that limit high impacts on the pushrim”. Findings supporting this recommendation have been found for persons with paraplegia (Beirens et al., 2021). However, dependent on their lesion level, persons with tetraplegia do not have, full triceps function and are not able to grasp the hand rim properly, which will alter force application and may further impact shoulder pain. The aim of this study was to investigate the association between wheelchair propulsion biomechanics, including force application and spatio-temporal characteristics, and shoulder pain in persons with tetraplegia.
 Methods
 Sixteen community-dwelling, wheelchair dependent participants with tetraplegia (C7-C5, age 49.1 ±2.9 years, 23.4 ±2.4 years since injury, 94% male) were measured during wheelchair propulsion on a treadmill at two speed / power output conditions: 0.56 ms-1/10W and 0.83 ms-1/15W. A Smartwheel was fitted to the personal wheelchair to measure force application. The applied forces, their effectiveness (fraction of effective force) and smoothness (rate of rise of force, jerk), as well as push frequency, push angle and timing of the push cycles were analyzed. Based on the Wheelchair User Shoulder Pain Index (0-150), participants were stratified in groups with low (≤ 7), moderate (8-35) and high (≥ 36) shoulder pain. A mixed-effect multilevel analysis was used to identify the association between the dependent variables (propulsion biomechanics) and group of shoulder pain when controlling for sex, age, time since injury, lesion level, body weight and height.
 Results and Discussion
 The analysis showed that persons with high shoulder pain applied the force over a longer push angle (85.6°) and had a shorter recovery time (0.4s) and applied the force more effective (FEF = 40.7%) than persons with low pain (push angle = 81.2°, recovery time = 0.5s, FEF = 35.2%). In addition, persons with high shoulder pain applied less medial directed force (6.4 N) compared to persons with moderate pain (14.9 N). The results of this cross-sectional study on wheelchair propulsion in persons with tetraplegia are in contradiction to previously reported results in person with paraplegia (Beirens et al., 2021). Interestingly, tetraplegic persons with high shoulder pain are following clinical recommendation on how to propel the wheelchair optimally. These results support the importance of differentiating between lesions levels when further investigating force application as a risk factor for shoulder pain. In addition, the results ask for a close examination and possible adaptation of the clinical guidelines for persons with tetraplegia.
 References
 Beirens, B. J. H., Bossuyt, F. M., Arnet, U., van der Woude, L. H. V., & de Vries, W. H. K. (2021). Shoulder pain is associated with rate of rise and jerk of the applied forces during wheelchair propulsion in individuals with paraplegic spinal cord injury. Archives of Physical Medicine and Rehabilitation, 102(5), 856-864. https://doi.org/10.1016/j.apmr.2020.10.114
 Liampas, A., Neophytou, P., Sokratous, M., Varrassi, G., Ioannou, C., Hadjigeorgiou, G. M., & Zis, P. (2021). Musculoskeletal pain due to wheelchair use: A systematic review and meta-analysis. Pain and Therapy, 10, 973-984. https://doi.org/10.1007/s40122-021-00294-5

Protocol paper: kainic acid excitotoxicity-induced spinal cord injury paraplegia in Sprague-Dawley rats.

Excitotoxicity-induced in vivo injury models are vital to reflect the pathophysiological features of acute spinal cord injury (SCI) in humans. The duration and concentration of chemical treatment controls the extent of neuronal cell damage. The extent of injury is explained in relation to locomotor and behavioural activity. Several SCI in vivo methods have been reported and studied extensively, particularly contusion, compression, and transection models. These models depict similar pathophysiology to that in humans but are extremely expensive (contusion) and require expertise (compression). Chemical excitotoxicity-induced SCI models are simple and easy while producing similar clinical manifestations. The kainic acid (KA) excitotoxicity model is a convenient, low-cost, and highly reproducible animal model of SCI in the laboratory. The basic impactor approximately cost between 10,000 and 20,000 USD, while the kainic acid only cost between 300 and 500 USD, which is quite cheap as compared to traditional SCI method. In this study, 0.05mM KA was administered at dose of 10µL/100g body weight, at a rate of 10µL/min, to induce spinal injury by intra-spinal injection between the T12 and T13 thoracic vertebrae. In this protocol, detailed description of a dorsal laminectomy was explained to expose the spinal cord, following intra-spinal kainic acid administration at desired location. The dose, rate and technique to administer kainic acid were explained extensively to reflect a successful paraplegia and spinal cord injury in rats. The postoperative care and complication post injury of paraplegic laboratory animals were also explained, and necessary requirements to overcome these complications were also described to help researcher. This injury model produced impaired hind limb locomotor function with mild seizure. Hence this protocol will help researchers to induce spinal cord injury in laboratories at extremely low cost and also will help to determine the necessary supplies, methods for producing SCI in rats and treatments designed to mitigate post-injury impairment. Kainic acid intra-spinal injection at the concentration of 0.05mM, and rate 10µL/min, is an effective method create spinal injury in rats, however more potent concentrations of kainic acid need to be studied in order to create severe spinal injuries.

Glutathione in the Pons Is Associated With Clinical Status Improvements in Subacute Spinal Cord Injury.

In spinal cord injury (SCI), the primary mechanical injury is followed by secondary sequelae that develop over the subsequent months and manifests in biochemical, functional, and microstructural alterations, at the site of direct injury but also in the spinal cord tissue above and below the actual lesion site. Noninvasive magnetic resonance spectroscopy (MRS) can be used to assess biochemical modulation occurring in the secondary injury phase, in addition to and supporting conventional MRI, and might help predict and improve patient outcome. In this article, we aimed to examine the metabolic levels in the pons of subacute SCI by means of in vivo proton MRS at 3 T and explore the association to clinical scores. In this prospective study, between November 2015 and February 2018, single-voxel short-echo MRS data were acquired in healthy controls and in SCI subjects in the pons once during rehabilitation. Besides the single-point MRS examination, in addition, in participants with SCI, the clinical status (ie, motor, light touch, and pinprick scores) was assessed twice: (1) around the MRS session (approximately 10 weeks postinjury) and (2) before discharge (at approximately 9 months postinjury). The group differences were assessed with Kruskal-Wallis test, the post hoc comparison was assessed with Wilcoxon rank sum test, and the clinical correlations were conducted with Spearman rank correlation test. Bayes factor calculations completed the statistical part providing relevant evidence values. Twenty healthy controls (median age, 50 years; interquartile range, 41-55 years; 18 men) and 18 subjects with traumatic SCI (median age, 50 years; interquartile range, 32-58 years; 16 men) are included. Group comparison showed an increase of total N -acetylaspartate and combined glutamate and glutamine levels in complete SCI and a reduction of total creatine in incomplete paraplegic SCI. The proton MRS-based glutathione levels at baseline correlate to the motor score improvement during rehabilitation in incomplete subacute SCI. This exploratory study showed an association of the metabolite concentration of glutathione in the pons assessed at approximately 10 weeks after injury with the improvements of the motor score during the rehabilitation. Pontine glutathione levels in subjects with traumatic subacute incomplete SCI acquired remote from the injury site correlate to clinical score and might therefore be beneficial in the rehabilitation assessments.

Effect of electromyography biofeedback training of the abdominal muscles on bladder function in paraplegic spinal cord injury patients

IntroductionTo investigate the efficacy of biofeedback abdominal muscles training on the bladder control and the quality of life in paraplegic patients.MethodsOverall, 60 male and female paraplegic patients aged 20–40 years were randomly divided into 2 groups. The patients in the study group were treated with abdominal muscles biofeedback strength training, and the control group received pelvic floor biofeedback strength training 2 times per week. The subjects in both groups were evaluated before and after the treatment by (1) measuring post-void urine residual volume, (2) overactive bladder questionnaire, the Arabic version.ResultsThere was a significant difference between the 2 groups. In the study group, the urine residual volume decreased to the normal range and the quality of life questionnaire score decreased, which showed good improvement. In the control group, there was no significant difference, with minimal changes: the urine residual volume was still high and the quality of life questionnaire score remained high.ConclusionsAbdominal muscles biofeedback training must be a main point in the bladder rehabilitation program for paraplegic patients as it decreases the urine residual volume and optimizes quality of life.

Hip-Spine Syndrome in Patients With Spinal Cord Injuries: Hyperlordosis Associated With Severe Hip Flexion Contracture.

Aim: Spinal cord injury (SCI)-related flaccid paralysis may result in a debilitating hyperlordosis associated with a progressive hip flexion contracture. The aim of this study was to evaluate the correction of hip flexion contractures and lumbar hyperlordosis in paraplegic patients that had a history of spinal cord injuries.Methods: A retrospective review was performed on 29 hips of 15 consecutive patients who underwent corrective surgeries for severe hip flexion deformity from 2006 to 2018. The mean age at surgery was 10.1 years (2.7 to 15.8), and the mean follow-up was 68 months (7 to 143). Relevant medical, surgical, and postoperative information was collected from the medical records and radiographs.Results: Improvements were seen in the mean hip flexion contracture (p < 0.001) with 100% hip correction at surgery and 92.1% at the latest follow-up. Mean lumbar lordosis decreased (p = 0.029) while the mean Cobb angle increased (p = 0.001) at the latest follow up. Functional score subdomains of the Spinal Cord Independence Measure, Functional Independence Measure, and modified Barthel activities of daily living (ADL) scores remained the same at the final follow-up.Conclusion: For paraplegic SCI patients, we found an association between treating the hip flexion contracture and indirect correction of their lumbar hyperlordosis. We recommend the surgeon carefully examine the hip pathology when managing SCI-related spinal deformities, especially increased lumbar lordosis.

Assessment of neuropathic pain after spinal cord injury using quantitative pain drawings

Study designClinimetric cross-sectional cohort study in adults with paraplegic spinal cord injury (SCI) and neuropathic pain (NP).ObjectiveTo assess the reliability of standardized quantitative pain drawings in patients with NP following SCI.SettingHospital-based research facility at the Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland.MethodsTwenty individuals with chronic thoracic spinal cord injury and neuropathic pain were recruited from a national and local SCI registry. A thorough clinical examination and pain assessments were performed. Pain drawings were acquired at subsequent timepoints, 13 days (IQR 7.8–14.8) apart, in order to assess test-retest reliability.ResultsThe average extent [%] and intensity [NRS 0–10] of spontaneous NP were 11.3% (IQR 4.9–35.8) and 5 (IQR 3–7), respectively. Pain extent showed excellent inter-session reliability (intraclass correlation coefficient 0.96). Sensory loss quantified by light touch and pinprick sensation was associated with larger pain extent (rpinprick = −0.47, p = 0.04; rlight touch = −0.64, p < 0.01).ConclusionAssessing pain extent using quantitative pain drawings is readily feasible and reliable in human SCI. Relating information of sensory deficits to the presence of pain may provide distinct insights into the interaction of sensory deafferentation and the development of neuropathic pain after SCI.

The Effects of The ReWalk^(TM) Robotic System on Walking Capability in Paraplegic Spinal Cord Injury Patients in Taiwan

背景：腳立可走系統為針對雙下肢癱瘓之脊髓損傷患者步行所開發的外骨骼機器腳系統。本研究的目的在探討腳立可走系統用在台灣雙下肢癱瘓之脊髓損傷患者的安全性以及其步行效益。方法：本研究於2015年4月至2016年4月間收錄8位T4至T11脊髓損傷併雙下肢偏癱病患接受立可走機器腳系統訓練。在完成訓練後接續進行評估測試，評估項目包含最長連續步行時間、最長步行距離、10公尺步行速度及6分鐘步行距離。結果：8位病人中，共有5位完成室內及室外至少40小時的訓練。他們平均步行距離為2937.6公尺，最長連續步行時間為1.6小時；10公尺步行測試中病人平均速度為0.4公尺／秒且最大速度為0.68公尺／秒；6分鐘步行測試中病人平均行走距離為132.48公尺，最大行走距離則為144公尺。過程當中沒有出現明顯的副作用。結論：腳立可走系統是一個創新的機器人系統。大多數的病患在經過適當的訓練之後多能改善步行能力，本系統可應用於台灣脊髓損傷合併下半身癱瘓的病人。

Shoulder Pain Is Associated With Rate of Rise and Jerk of the Applied Forces During Wheelchair Propulsion in Individuals With Paraplegic Spinal Cord Injury

ObjectiveTo investigate the association between propulsion biomechanics, including variables that describe smoothness of the applied forces, and shoulder pain in individuals with spinal cord injury (SCI). DesignCross-sectional, observational study. SettingNon-university research institution. ParticipantsCommunity dwelling, wheelchair dependent participants (N=30) with chronic paraplegia between T2 and L1, with and without shoulder pain (age, 48.6±9.3y; 83% men). InterventionsNot applicable. Main Outcome MeasuresRate of rise and jerk of applied forces during wheelchair propulsion. Participants were stratified in groups with low, moderate, and high pain based on their Wheelchair User Shoulder Pain Index score on the day of measurement. ResultsA mixed-effect multilevel analysis showed that wheelchair users in the high pain group propelled with a significantly greater rate of rise and jerk, measures that describe smoothness of the applied forces, compared with individuals with less or no pain, when controlling for all covariables. ConclusionsIndividuals with severe shoulder pain propelled with less smooth strokes compared to individuals with less or no pain. This supports a possible association between shoulder pain and rate of rise and jerk of the applied forces during wheelchair propulsion.

Gains in aerobic capacity with whole-body functional electrical stimulation row training and generalization to arms-only exercise after spinal cord injury.

Study Design:Longitudinal study in adults (n=27; 19–40 years old) with tetraplegic or paraplegic spinal cord injury (SCI).Objectives:Determine physiological adaptations and generalizable fitness effects of six months of whole-body exercise training using volitional arm and functional electrical stimulation (FES) leg rowing.Setting:Outpatient hospital-based exercise facility and laboratoryMethods:Participants enrolled in hybrid FES row training (FESRT) and performed peak exercise tests with arms-only (AO; baseline and 6-Mo) and FES rowing (baseline, 3-Mo, 6-Mo).Results:Participants demonstrated increased aerobic capacity (VO2peak) after FESRT (p<0.001, np2=0.56) that tended to be higher when assessed with FES than AO rowing tests (0.15 ± 0.20 vs. 0.04 ± 0.22 L/min; p=0.10). Changes in FES and AO VO2peak were significantly correlated (r=0.55; p<0.01), and 11 individuals demonstrated improvements (>6%) on both test formats. Younger age was the only difference between those who showed generalization of training effects and those who did not (mean age 26.6 ± 5.6 vs. 32.0 ± 5.7 years; p<0.05) but changes in FES VO2peak correlated to time since injury in individuals <2 years post-SCI (r=−0.51, p<0.01, n=24). Lastly, VO2peak improvements were greater during the first three months vs. months 4–6 (+7.0% vs. +3.9%; p<0.01) which suggests early training adaptations during FESRT.Conclusions:Gains in aerobic capacity after whole-body FESRT are better reflected during FES row testing format. They relate to high-intensity exercise and appear early during training, but they may not generalize to equivalent increases in AO exercise in all individuals with SCI.

Ultrasound-guided versus blind subacromial bursa corticosteroid injection for paraplegic spinal cord injury patients with rotator cuff tendinopathy: a randomized, single-blind clinical trial

Introduction Shoulder pain is one of the common musculoskeletal complaints of the patients with spinal cord injury. Corticosteroid injection to the subacromial bursa is one of the confirmed therapies which can be guided by anatomic landmarks or ultrasound. This study is aimed to compare these two methods to find the one with the highest therapeutic impact. Materials and methods In this study, 30 patients with paraplegic SCI suffering from shoulder pain were enrolled. They were divided into 2 groups based on 4-block randomization sampling. The first group received subacromial corticosteroid injection through anatomic landmarks; while in the second group, the injection was guided by ultrasound. VAS criterion was employed for investigation of pain severity; while the constant score was used to study the shoulder pain and function. BREF questionnaire was also applied to examine the quality of life. Findings The mean scores of VAS and Constant in both groups showed a significant improvement two months after intervention when compared with their condition before the intervention. This improvement was significantly higher in the ultrasound group. The physical, physiological and environmental health scores of BREF questionnaire as well as their total score showed a significant improvement in both groups two months after intervention. But this improvement was not significantly different between the two groups in terms of any of the items. Discussion Hence, although ultrasound-guided injection is more costly and requires higher skills in comparison with blind injection, it is significantly more effective in controlling the pain and improving the shoulder function.

Prevalence of Shoulder Pain in Spinal Cord Injury Patients Referring to the Brain and Spinal Cord Injury Research Center of Tehran University of Medical Sciences

BackgroundSpinal cord injury (SCI) is a catastrophic event that influences all aspects of the life of the patients and their families. It may have many acute or chronic complications. One of the most common complications is shoulder pain, which particularly occurs in wheelchair users.ObjectivesThis study aimed to estimate the prevalence of shoulder pain in paraplegic spinal cord injury patients who were referred to our clinic.MethodsWe included 70 spinal cord injury patients in our study according to inclusion criteria. Demographic data and SCI-related factors were recorded. The disabilities of the arm, shoulder, and hand (DASH) questionnaire was used to assess shoulder pain in our patients.ResultsMean score of pain was 51 in cervical, 23 in thoracic and 12 in lumbar spinal cord injury according to the DASH questionnaire. The pain was more prevalent and severe in the cervical group.ConclusionsAccording to our study, it seems that shoulder pain has a relatively high prevalence and is more severe in cervical quadriplegic SCI patients that may be due to muscle imbalance around the shoulder. Therefore, this problem should be noted in the course of managing these patients.