Tetraplegia Research Articles

Calcification du ligament jaune du rachis cervical: À propos d’un cas et revue de la littérature

Calcification of the cervical ligamentum flavum is a rare entity observed exclusively in Japanese people. We report a new case in a 65-year-old man from Tunisia who presented with symptoms of cervical myelopathy with mild tetra paresis, sensory abnormalities and dysuria. Magnetic resonance imaging (MRI) showed a posterior compression of the spinal cord at C3-C4. CT-scan showed a calcification of the ligamentum flavum at level C3-C4, compressing the left postero-lateral aspect of the spinal cord. C3-C4 laminectomy was performed with removal of abnormal ligamentum flavum tissue. The postoperative course was uneventful and all symptoms resolved. Calcification of the cervical ligamentum flavum is a rare entity; the diagnosis is easy but the pathogenesis remains unclear. Literature regarding this pathology is reviewed.

Cardiorespiratory responses during passive walking-like exercise in quadriplegics

Cross-sectional and comparative investigation using quadriplegics (QP) and nondisabled subjects (ND). To evaluate cardiorespiratory responses during passive walking-like exercise (PWE) in QP. National Rehabilitation Center for Persons with Disabilities in Japan. The subjects were seven male QP with complete lesion (age: 27.0 +/- 5.4, injured level: C6-C7) and six male ND (age: 26.3 +/- 4.5). Cardiorespiratory responses were measured until voluntary fatigue during PWE, the rhythmical activity of paralyzed lower limbs synchronized with arm movements. There were no significant differences in oxygen consumption (VO(2)), pulmonary ventilation (VE), heart rate (HR) and oxygen pulse (O(2) pulse) between QP and ND during PWE. ND showed increased ventilatory equivalent for oxygen (VE/VO(2) ratio) during exercise, while QP showed a significantly greater respiratory rate (RR) during exercise than ND (P < 0.05). PWE elicited an increase in VO(2) with workload increment in QP similar to ND. However, higher RR suggested the intrinsic dysfunction of RR control during submaximal exercise in QP. From these results, it was thought that respiratory response would be the restriction factor of efficient oxygen transportation during PWE in QP.

Upper extremity musculoskeletal pain during and after rehabilitation in wheelchair-using persons with a spinal cord injury

Prospective cohort study. To study upper extremity musculoskeletal pain during and after rehabilitation in wheelchair-using subjects with a spinal cord injury (SCI) and its relation with lesion characteristics, muscle strength and functional outcome. Eight rehabilitation centers with an SCI unit in the Netherlands. Using a questionnaire, number, frequency and seriousness of musculoskeletal pain complaints of the upper extremity were measured. A pain score for the wrist, elbow and shoulder joints was calculated by multiplying the seriousness by the frequency of pain complaints. An overall score was obtained by adding the scores of the three joints of both upper extremities. Muscle strength was determined by manual muscle testing. The motor score of the functional independence measure provided a functional outcome. All outcomes were obtained at four test occasions during and 1 year after rehabilitation. Upper extremity pain and shoulder pain decreased over time (30%) during the latter part of in-patient rehabilitation (P<0.001). Subjects with tetraplegia (TP) showed more musculoskeletal pain than subjects with paraplegia (PP) (P<0.001). Upper extremity pain and shoulder pain were significantly inversely related to functional outcome (P<0.001). Muscle strength was significantly inversely related to shoulder pain (P<0.001). Musculoskeletal pain at the beginning of rehabilitation and BMI were strong predictors for pain 1 year after in-patient rehabilitation (P<0.001). Subjects with TP are at a higher risk for upper extremity musculoskeletal pain and for shoulder pain than subjects with PP. Higher muscle strength and higher functional outcome are related to fewer upper extremity complaints.

30 Influence of the effective size of the functional subunit (FSU) on rat spinal cord paralysis

30 Influence of the effective size of the functional subunit (FSU) on rat spinal cord paralysis

Application of Ventilatory Strategies to Enhance Functional Activities for an Individual with Spinal Cord Injury

This case report describes the benefits of teaching an individual with C6 tetraplegia how to use ventilatory movement strategies during functional activities and to thereby improve her level of independence. The client was a 25-year-old woman with C6 tetraplegia. Her goal was to become independent in 3 functional tasks: leaning forward in her wheelchair, repositioning her feet on her footplates of the wheelchair, and performing a lateral lean pressure relief. She was evaluated performing each task with her own ventilatory strategy, which was a valsalva maneuver. Then, she was taught specific ventilatory strategies for each activity and was re-evaluated to determine if the new strategy increased her ability to perform the task. This client was unable to perform each activity while using a valsalva maneuver as her self-selected ventilatory strategy. After learning the appropriate ventilatory strategy to use while performing each task, she became independent with each activity. Clinicians are encouraged to incorporate teaching appropriate ventilatory strategies to a client while the client is performing functional tasks to improve outcomes. Less than 30 seconds is needed to instruct a client in the appropriate ventilatory strategy. Many clients are able to learn ventilatory strategies in a short period of time and therefore improve their ability to perform tasks. This training can be a valuable asset to the current functional training that is needed for a client with tetraplegia.

12.11 CT-guided injection of botulinum toxin a in iliopsoasmuscles improves gait in hereditary spastic spinal paralysis

12.11 CT-guided injection of botulinum toxin a in iliopsoasmuscles improves gait in hereditary spastic spinal paralysis

Quantifying the passive extensibility of the flexor pollicis longus muscle in people with tetraplegia

Repeat measures design. The purpose of this study was firstly, to describe a simple clinical tool that can be used to measure the extensibility of the flexor pollicis longus (FPL) muscle; secondly, to test its reliability; and thirdly, to attain some 'normative' data of the extensibility of the FPL muscle in a representative sample of people with tetraplegia. A spinal cord injury unit in Sydney. A total of 37 people (62 hands) with C4-C7 tetraplegia. Angle of the carpometacarpal (CMC) joint of the thumb was measured in all subjects with the application of a series of thumb extensor torques. A device specifically designed for this purpose was used to standardize the torque and objectively quantify the CMC joint angle. In addition, repeat measurements were taken 3-5 days later in one subgroup of 13 subjects (one hand per subject) and 3 months later in another subgroup of 13 subjects (one hand per subject). Intraclass correlation coefficients and percent close agreement scores were derived to quantify the 3-5 days and 3-month reliability between repeat measurements. The median CMC angle of the thumb with the application of a 0.044 Nm torque was 63 degrees (range, 20-93 degrees). The intraclass correlation coefficients with the application of a 0.044 Nm torque were 0.88 (95% CI, 0.65-0.96) for measurements taken 3-5 days apart, and 0.90 (95% CI, 0.67-0.97) for measurements taken 3 months apart. This study describes a simple and reliable way of measuring the extensibility of the FPL muscle in people with tetraplegia. This assessment tool and the 'normative' data provided in this study can be used to further investigate the contribution of the passive mechanical properties of the FPL muscle to hand function of people with C6 and C7 tetraplegia.

Pulmonary vest therapy in pediatric long-term care.

Pulmonary infections are common in children with quadriplegic cerebral palsy. High frequency chest wall oscillation with the vest therapy (VT) is used to promote pulmonary clearance and to prevent pneumonias in cystic fibrosis patients. The purpose of this study was to ascertain the effectiveness of VT in patients with quadriplegic cerebral palsy who reside in pediatric skilled nursing facilities. Seven individuals with quadriplegic cerebral palsy, who had frequent pulmonary infections were identified (age range: 7-28 years; median 19 years; 2 females and 5 males). Five had a tracheostomy and three an active seizure disorder. Clinical data was collected for 12 months before starting VT and during 12 months of VT. The total number of pneumonias that required antibiotics decreased from 36 per year before VT, to 18 during the year of VT (P < 0.05). The number of hospitalizations due to pneumonia decreased from 9 to 3. With VT, the frequency of effective suctioning of pulmonary secretions was significantly increased (P < 0.01). In the patients with epilepsy, with VT, the average monthly frequency of seizures decreased from 4 to 1, from 9 to 2, and from 9 to 1. VT resulted in more effective suctioning of pulmonary secretions, reduced incidence of pneumonia, and reduced number of hospitalizations for pneumonia. In patients with epilepsy, VT resulted in reduced seizure frequency. VT was tolerated well, without complications or side effects. Further clinical investigations of the use of VT in cerebral palsy are indicated.

Triceps denervation as a predictor of elbow flexion contractures in C5 and C6 tetraplegia

Bryden AM, Kilgore KL, Lind BB, Yu DT. Triceps denervation as a predictor of elbow flexion contractures in C5 and C6 tetraplegia. Arch Phys Med Rehabil 2004; 85:1880-5. Objective To determine whether the existence of elbow flexion contractures in persons with C5 or C6 tetraplegia is related to a lack of residual voluntary triceps function and triceps denervation (ie, lower motoneuron damage). Design A retrospective study of impairment data from 74 arms to identify the incidence of elbow flexion contractures and the contributing factors toward this deformity. Setting Five spinal cord injury (SCI) rehabilitation centers in the United States, 1 in England, and 1 in Australia. Participants Forty-three subjects with motor complete C5 or C6 traumatic SCI. Interventions Not applicable. Main outcome measures Active and passive elbow extension, triceps voluntary muscle strength, and triceps response to electric stimulation. Results Subjects with weak voluntary triceps had significantly fewer and less severe elbow flexion contractures than those with paralyzed triceps ( P=.024). Subjects with completely denervated triceps (ie, no response to electric stimulation) had significantly more elbow flexion contractures than subjects with even a weak response to electric stimulation ( P=.003). Overall, 51% of the arms could not be passively extended to zero. Forty-six percent of the arms classified as C5 lacked full passive elbow extension, compared with 63% of the arms classified as C6 ( P=.302). Conclusions A relationship has been found between elbow flexion contractures and lack of residual voluntary triceps and triceps denervation in subjects with C5 or C6 tetraplegia. There should be a greater awareness of the elbow flexion contractures that may develop as a result of this relationship. A better understanding of this deformity and its characteristics can lead to more effective clinical treatment and prevention strategies.

Die akuten hepatischen Porphyrien in der Notfall- und Intensivmedizin

Die akuten Porphyrien umfassen eine Gruppe von vier seltenen Stoffwechselerkrankungen mit einem angeborenen Defekt innerhalb der achtstufigen Hambiosynthese. In Europa ist der haufigste Subtyp die Akute Intermittierende Porphyrie. Die Porphyria Variegata und die Hereditare Koproporphyrie sind weitaus seltener. Zur 5-Aminolavulinsaure-Dehyratase-Defizienz-Porphyrie existieren weltweit weniger als zehn Fallberichte. In der Regel bleiben die akuten Porphyrien zeitlebens klinisch inapparent. Nur unter bestimmten Umstanden (z. B. Medikamente, endokrine Faktoren, Mangelernahrung oder Nikotinabusus) treten sie in Form sogenannter Attacken mit dann schwersten Bauchschmerzen und/oder neurologischen bzw. psychiatrischen Symptomen in Erscheinung. Das klinische Bild der porphyrischen Attacke ist variabel; gefurchtete Komplikationen sind Tetraparese unter Einbeziehung der Atemmuskulatur, SIADH mit Hyponatriamie und Krampfanfalle oder kardiale Arrhythmien. Eine porphyrische Attacke lasst sich anhand einer Urinanalyse auf Porphobilinogen und 5-Aminolavulinsaure diagnostisch bestatigen oder ausschliesen; dies setzt jedoch einen aktiven klinischen Anfangsverdacht voraus. Die umgehende Einleitung einer kausalen Therapie tragt zur fruhzeitigen Remission einer Attacke bei, sie ist jedoch keine Garantie dafur. Therapiemasnahmen umfassen neben dem sofortigen Absetzen jeglicher potenziell porphyrinogener Faktoren die Gabe von Hamarginat mit ggf. zusatzlich hochdosierter Glukose, wodurch die fehlregulierte hepatische Hambiosynthese durchbrochen wird.

Effects of spinal cord injury level on the activity of shoulder muscles during wheelchair propulsion: an electromyographic study

Mulroy SJ, Farrokhi S, Newsam CJ, Perry J. Effects of spinal cord injury level on the activity of shoulder muscles during wheelchair propulsion: an electromyographic study. Arch Phys Med Rehabil 2004;85:925–34. Objective To determine the influence of spinal cord injury (SCI) level on shoulder muscle function during wheelchair propulsion. Design Fine-wire electromyographic activity of 11 muscles was recorded during wheelchair propulsion. Setting Biomechanics research laboratory. Participants Convenience sample of 69 men, in 4 groups by SCI level (low paraplegia, n=17; high paraplegia, n=19; C7–8 tetraplegia, n=16; C6 tetraplegia, n=17). Interventions Not applicable. Main outcome measures Timing of muscle activity onset, cessation, and duration, and time of peak intensity for each functional group were compared with 1-way analysis of variance. Median electromyographic intensity was also compared. Results Two functional synergies were observed: push (anterior deltoid, pectoralis major, supraspinatus, infraspinatus, serratus anterior, biceps) and recovery (middle and posterior deltoid, supraspinatus, subscapularis, middle trapezius, triceps). Push phase activity began in late recovery and ceased in early to late push. Recovery phase muscles functioned from late push to late recovery. Recruitment patterns for the groups with paraplegia were remarkably similar. For subjects with tetraplegia, pectoralis major activity was significantly prolonged compared with subjects with paraplegia ( P<.05). Subscapularis activity shifted from a recovery pattern in subjects with paraplegia to a push pattern in persons with tetraplegia. Conclusions Level of SCI significantly affected the shoulder muscle recruitment patterns during wheelchair propulsion. Differences in rotator cuff and pectoralis major function require specific considerations in rehabilitation program design.

Implantation of the Freehand System during initial rehabilitation using minimally invasive techniques.

Series of four single subjects with and without intervention design. To describe a minimally invasive surgical technique used to implant the Freehand System during initial spinal cord injury (SCI) rehabilitation and to report rehabilitation outcomes of four recently injured adolescents using the Freehand System. Nonprofit children's hospital specializing in orthopedic and SCI care. Four subjects with C5 tetraplegia between 13 and 16 years of age and between 9 and 16 weeks following traumatic SCI underwent implantation of the Freehand System using minimally invasive surgical techniques. Outcomes on muscle strength, pinch force, hand function, performance of activities of daily living and satisfaction with and without the Freehand System were collected. Each subject was successfully implanted with the Freehand System without perioperative complications and employed the Freehand System during therapy services and ad lib on the rehabilitation floor. At the last follow-up, every subject remained a motor candidate for the Freehand System. With the Freehand System, average lateral and palmar pinch force was 1.8 and 1.6 kg respectively; average pinch force without functional electrical stimulation (FES) was 0.29 kg. With the Freehand System, three subjects improved their rate of performance on The Upper Extremity Capabilities Questionnaire. All subjects increased their level of independence on The Quadriplegia Index of Function. On the Canadian Occupational Performance Measure (COPM) with the Freehand System, average performance and satisfaction scores improved for every patient. Three of the four subjects continued to use the system at home. This case series demonstrates that the Freehand System can vastly improve hand function and performance of rehabilitation activities within days after a minimally invasive implant procedure during initial SCI rehabilitation. Satisfaction with the Freehand System beyond initial rehabilitation is evidenced by continued use at home.

Book Review: History of the Treatment of Spinal Injuries

Dr Silver's title indicates a very wide canvas, and the book ranges back into fragments from antiquity in Egypt, Greece and the Arab countries, then to the more substantial contributions from military surgeons such as Pare, since war was of course the great provider of spinal injuries; in peacetime there is a lesser supply from traffic, work and sports accidents. Spinal paralysis was almost always lethal until well into the twentieth century, when scientific foundations for more hopeful management began to emerge. For this Silver rightly credits Theodor Kocher in Switzerland, Wilhelm Wagner and Otfried Foerster in Germany, and especially Donald Munro in Boston who laid down the right rules for treatment in the 1930s.

Simulated neuroprosthesis state activation and hand-position control using myoelectric signals from wrist muscles

This paper reports on the initial phase of feasibility testing of a control strategy that uses myoelectric signals (MES) from wrist flexor and extensor muscles to control a hand-grasp neuroprosthesis for C7 tetraplegia. The control strategy was customized to the MES patterns produced during wrist flexion, extension, and relaxation for five able-bodied subjects and two individuals with C7 spinal cord injury. We evaluated the reliability with which the subjects could deliberately activate target neuroprosthesis states and control the degree of opening and closing of a computer-simulated hand using the myoelectric control strategy. Every subject was able to activate at least 99% of the target states for at least 1 continuous second, enough time to prove the activation was deliberate and to achieve significant hand opening or closing. Additionally, every subject was able to control the opening and closing of the simulated hand with enough proficiency to match greater than 87% of the target hand positions for at least 2 continuous seconds. Most of the inadvertent disturbances in simulated hand position were of a magnitude less than 10% of full range of motion for every subject. Future studies will incorporate the control strategy into an electrical stimulation system that opens and closes the hand of an individual with C7 tetraplegia.

Abstract 10: Standing induced via segmental reflex pathways of persons with spinal paralysis: a case series.

Setting: Urban hospital. Patients: 12 persons with paralysis of spinal origin. Case Description: Reflex standing is induced by means of whole body vibration in persons with paralysis of spinal origin. A case series of persons who had paralysis due to spinal infection, paraplegia after traumatic injury at the thoracic and lumbar levels, or quadriplegia after cervical trauma. Subjects were 1 year postonset, had stable skeletal systems, and tone in the thighs. Subjects reflexively stood on a vibratory device as muscles contracted and relaxed in response to segmental reflex loops triggered by vibration delivered at amplitudes ranging from 0 to 5.1mm, and frequencies ranging from 0 to 28Hz. Assessment/Results: Standing time with and without vibratory stimulaton; degree of volitional movement in trunk and limbs; and carry-over to voluntary standing and walking. Subjects were able to stand for periods (up to 30min) with vibration and for brief periods (1–3min) after vibration ceased. Some patients recovered the ability to stand and to ambulate. Discussion: Long periods of immobility and loss of sensation can produce skin breakdown with fatal consequences if left untreated. A sedentary life style resulting from a loss of voluntary movement and sensation may aggravate existing dysfunction of the bowel and bladder and lead to constipation and urinary infection, as well as increased vulnerability to pneumonia and respiratory infection. Spinal cord injury increases the vulnerability to chronic conditions such as cardiovascular disease, diabetes, and osteoporosis. Fitness has been improved through treadmill-induced reflex walking in humans for 2 decades. Likewise, the act of standing, be it for brief periods, benefits patients physically and provides a source of emotional, psychologic, and social satisfaction. Conclusion: Vibratory-induced standing represents a promising modality for use in the rehabilitation of persons with motor dysfunction of spinal origin.

Effects of spinal cord lesion level upon thermoregulation during exercise in the heat.

This study examined the effects of the level of spinal cord injury upon the thermoregulatory responses of wheelchair athletes during prolonged wheelchair exercise in warm conditions. Eight tetraplegic (TP), 10 high-level paraplegic (HP), and 10 low-level paraplegic (LP) athletes exercised for 60 min at 60% [OV0312]O(2peak) in a warm environment (31.5 +/- 1.7 degrees C, 42.9 +/- 8.0% relative humidity). Skin temperature and aural temperature were monitored. Aural temperature increased gradually during the exercise period by 1.1 +/- 0.3 and 1.4 +/- 0.5 degrees C for the HP and LP groups, with a more marked increase observed for the TP group (2.1 +/- 0.5 degrees C; P < 0.05). Upper-arm skin temperature was higher for the TP when compared with the HP and LP between 30 and 60 min (P < 0.05). Back skin temperature was higher for the TP when compared with the HP and LP between 45 and 60 min (P < 0.05). No differences were noted between groups for the thigh or calf skin temperatures. During recovery, skin temperature remained elevated for the TP group when compared with the HP and LP groups (P < 0.05). Heat storage was greatest for the TP athletes at the end of exercise and remained elevated throughout recovery (P < 0.05). All athletes completed the exercise task even though the gradual increase in aural temperature observed for the HP and LP groups suggests a degree of thermal imbalance. However, this was much less than observed for TP athletes, who demonstrated a much greater imbalance in temperature regulation. Increasing the exercise or environmental strain may result in the thermoregulatory responses of athletes with a spinal cord injury being compromised.

Breathlessness associated with abdominal spastic contraction in a patient with C4 tetraplegia: a case report

Laffont I, Durand M-C, Rech C, Perez De La Sotta A, Hart N, Dizien O, Lofaso F. Breathlessness associated with abdominal spastic contraction in a patient with C4 tetraplegia: a case report. A tetraplegic patient with C4 cervical cord injury reported breathlessness during episodes of spastic contraction of the abdominal muscles. To determine the mechanism, we performed electrophysiologic testing of the phrenic nerves. We measured abdominal pressure, esophageal pressure, and transdiaphragmatic pressure (Pdi) during a maximal inspiratory effort (Pdi max), a maximal sniff maneuver (sniff Pdi) during resting breathing, and during the episodes of breathlessness. Electrophysiologic testing of the phrenic nerves showed axonal neuropathy on the left. Sniff Pdi and Pdi max were 38cmH 2O and 42cmH 2O, respectively. Transient spastic contractions of abdominal muscles were associated with an increase in abdominal pressure greater than 30cmH 2O, with a decrease in abdominal volume; this rise in abdominal pressure was transmitted to the esophageal pressure. Inspiration became effective only when esophageal pressure fell below the resting baseline value. Achieving this decrease required an increase in inspiratory effort, characterized by swings in esophageal pressure and Pdi of 30cmH 2O and 40cmH 2O (approximately 100% of Pdi max), respectively. During these periods, minute ventilation was markedly reduced. This is the first report that spastic abdominal muscle contractions can impose a significant load on the diaphragm, uncovering moderate diaphragmatic weakness. This has important clinical implications; abolition of the spastic abdominal muscle contraction in this patient completely resolved her intermittent respiratory symptoms.

EFFECT OF HAND CYCLE TRAINING ON PHYSICAL CAPACITY IN PERSONS WITH A TETRAPLEGIA

Synchronous hand cycling (HC) is a common form of wheeled ambulation for daily use, sports and recreation in persons with a spinal cord injury in the Netherlands. HC has been shown to be more efficient and less straining than wheelchair propulsion. Therefore HC seems to be a useful alternative for improving physical capacity (PC) in persons with a low physical ability level, like persons with tetraplegia (TP). However, little is known about training effects in HC. PURPOSE To determine the effects of an 8-week HC interval training program in TP and to gain insight in training principles of HC in TP. METHODS At this stage four trained subjects with TP (>2yrs post-injury) received a HC interval training intervention and were tested before and after the training period. The 8-week interval training consisted of 30 minute sessions, 3 times a week, at an intensity of 70–90% heart rate reserve. Peak VO2 and power output (POmax) were evaluated during a discontinuous maximal HC exercise test on a motor driven treadmill. Arm strength (hand-held dynamometry) and pulmonary function were determined as other parameters of PC. RESULTS Results in these four initially trained subjects showed a strong tendency for an increase in VO2 (pre:1.73 ± 0.32, post: 1.93± 0.14 1/min; p = 0.1) and POmax (pre: 65.6± 9.7, post: 75.1± 7.6W; p = 0.06). No tendencies for improvement of arm strength and pulmonary function were seen. CONCLUSIONS Even in this small and trained TP group (n=4) a strong tendency for improvement in PC was seen after an 8-week HC interval training. Future results will involve data of groups of untrained (n=10) and trained TP (n=10) and their controls.

Plasma processing of materials for medical applications

The thin and defect-free calcium phosphate coating layer deposited to a thickness of 1 μm by electron beam evaporation was characterized in vivo. Calcium phosphate film deposited implants made of commercially pure Ti were inserted in rabbit tibiae. The bone forming ability was compared with the as-machined and as-blasted implants. Eighteen white rabbits were ovariectomized 2 months before insertion for osteoporic condition. The calcium phosphate coated implants had the most bone-to-metal contact and required the highest removal torque force in ovariectomized rabbit. The removal torque force was increased to slightly more than 50% by calcium phosphate coating for the same surface finished condition. The sacral nerve, S3, stimulation of a 38-year-old male patient with C4 and C5 tetraplegia by iridium coated electrode increased the reservoir volume and decreased the bladder pressure at the same time.

Shoulder Emg During Depression Raise In Men With Spinal Cord Injury: The Influence Of Lesion Level

Background & Objective: The depression-style raise maneuver is commonly performed by persons with spinal cord injury (SCI) to relieve skin pressures and avoid skin ulceration. The demands of this critical activity, however, are not fully documented for individuals with higher spinal cord lesions. The purpose of this investigation was to determine the influence of SCI lesion level on shoulder muscle activity during a depression raise maneuver.Experimental Design: Sample of convenience, group comparison.Methods: Fine-wire intramuscular electrodes recorded electromyographic (EMG) activity from 1 2 shoulder muscles in 57 men with SCI while they performed depression raises (C6 tetraplegia, n = 1 0; C7 tetraplegia, n = 1 8; high paraplegia, n = 1 6; low paraplegia, n = 1 3). EMG intensity was normalized to a manual muscle test (MMT) effort.Results: For persons with paraplegia and C7 tetraplegia, dominant EMG activity was recorded from latissimus dorsi, sternal pectoralis major, and triceps muscles (31 %-69% MMT) . Tetraplegic groups had significantly greater anterior deltoid activity (C6 = 53%, C7 = 22% MMT) than that recorded in paraplegic groups (high paraplegia = 1 0%, low paraplegia = 3% MMT). Participants with tetraplegia also had increased infraspinatus activity (C6 = 50%, C7 = 32% MMT) compared with participants with low paraplegia (7% MMT). All other muscles had low or very low EMG activity during the depression raise.Conclusions: Persons with tetraplegia lack normal strength of the primary muscles used by participants with paraplegia for the depression raise (ie, latissimus dorsi, sternal pectoralis major, and triceps muscles) . Although increased anterior deltoid activation assisted with elbow extension, it potentially contributes to glenohumeral joint impingement. Alternate methods of pressure relief should be considered for persons with tetraplegia.J Spinal Cord Med. 2003;26:59-64