Diagnostic accuracy of common clinical tests for assessing abdominal muscle function after motor-complete spinal cord injury above T6.

STUDY DESIGN: Diagnostic study. OBJECTIVES: The objective of this study was to compare patterns of electromyography (EMG) recordings of abdominal muscle function in persons with motor-complete spinal cord injury (SCI) above T6 and in able-bodied controls, and to determine whether manual examination or ultrasound measures of muscle activation can be accurate alternatives to EMG. SETTING: Research center focused on SCI and University laboratory, Vancouver, Canada. METHODS: Thirteen people with SCI (11 with American Spinal Injury Association Impairment Scale (AIS) A and 2 AIS B; C4-T5), and 13 matched able-bodied participants volunteered for the study. Participants completed trunk tasks during manual examination of the abdominal muscles and then performed maximal voluntary isometric contractions, while EMG activity and muscle thickness changes were recorded. The frequency of muscle responses detected by manual examination and ultrasound were compared with detection by EMG (sensitivity and specificity). RESULTS: All individuals with SCI were able to elicit EMG activity above resting levels in at least one abdominal muscle during one task. In general, the activation pattern was task specific, confirming voluntary control of the muscles. Ultrasound, when compared with EMG, showed low sensitivity but was highly specific in its ability to detect preserved abdominal muscle function in persons with SCI. Conversely, manual examination was more sensitive than ultrasound but showed lower specificity. CONCLUSION: The results from this study confirm preserved voluntary abdominal muscle function in individuals classified with motor-complete SCI above T6 and highlight the need for further research in developing more accurate clinical measures to diagnose the level of trunk muscle preservation in individuals with SCI.

Seated double-poling ergometer performance of individuals with spinal cord injury - a new ergometer concept for standardized upper body exercise.

This study aimed to evaluate biomechanics during seated double-poling exercises in individuals with spinal cord injury (SCI) and to compare these with those of able-bodied persons (AB). 26 participants volunteered for the study; 13 with SCI (injury levels C7-T12), and 13 AB. A seated double-poling ergometer (SDPE) was developed. 3-dimensional kinematics was measured and piezoelectric force sensors were used to register force in both poles for calculation of power during incremental intensities. Significantly lower power outputs, (143.2 ± 51.1 vs. 198.3 ± 74.9 W) and pole forces (137.1 ± 43.1 vs. 238.2 ± 81.2 N) were observed during maximal effort in SCI compared to AB. Sagittal upper trunk range of motion increased with intensity and ranged from 6.1-34.8° for SCI, and 6.9-31.3° for AB, with larger peak amplitudes in flexion for AB (31.4 ± 12.9°) compared to SCI (10.0 ± 8.0°). All subjects with SCI were able to exercise on the SDPE. Upper body kinematics, power and force outputs increased with intensity in both groups, but were in general, lower in SCI. In conclusion, the SDPE could be successfully used at low to high work intensities enabling both endurance and strength training for individuals with SCI.

Effects of an exercise programme on musculoskeletal and neuropathic pain after spinal cord injury--results from a seated double-poling ergometer study.

OBJECTIVES: To assess pain relieving effects of an intensive exercise programme on a seated double-poling ergometer in individuals with spinal cord injury (SCI). SETTING: Stockholm, Sweden. METHODS: A total of 13 wheelchair-dependent individuals with a thoracic or lumbar SCI were recruited to a 10-week training period (three times weekly) assessing the effects of regular training on upper-body strength, aerobic and mechanical power, and crossover effects on functional performance, as well as cardiovascular risk factors. Eight of the participants reported pain and were included in this exploratory pain protocol and assessed using the International SCI Basic Pain Data set, the Wheelchair Users' Shoulder Pain Index and International SCI Quality of Life Basic Data set. RESULTS: For those with neuropathic pain, median pain intensity ratings decreased from 5 on a 0-10 numerical rating scale at base-line to 3 at the end of study, and four of seven participants reported an improvement on the Patient Global Impression of Change scale. For those with musculoskeletal pain (n = 5), median pain intensity ratings improved from 4 at baseline to 0 at the end of study. All but one rated no musculoskeletal pain at all at the end of study and number of days with pain per week decreased from 5.5 to 0.7. None of the participants developed pain, because of overuse during the training period and few reported unwanted side effects. CONCLUSION: Considering its promising effects and safety, an intensive exercise programme can be tried for treating musculoskeletal pain and also neuropathic pain following SCI.

Dynamic trunk stability is improved in paraplegics following kayak ergometer training.

The purpose of the study was to assess whether postural stability in persons with spinal cord injury (SCI) could be affected by training. Ten post-rehabilitated persons with thoracic SCI performed 30 sessions of kayak ergometer training during a 10-week period. The ergometer was modified with a balance module adjustable in the medio-lateral direction. Before and after the training period, horizontal support-surface translations were presented randomly, either in the forward or backward direction, or to the side, while subjects sat in their own wheelchairs. The platform perturbation consisted of an unpredictable initial acceleration, followed by a constant-velocity phase and a predictable deceleration. Markers were applied on the trunk and movement data were recorded in 3D. Four kinematic responses of trunk angular and linear displacement were investigated. In general, postural stability was improved after training with smaller rotational and linear displacements of the trunk observed during both predictable and unpredictable translations in all directions. Thus, the training was able to improve the ability of persons with long-standing SCI to maintain an upright sitting posture in response to externally generated balance perturbations, which should imply an increased capacity to master similar challenges to balance in everyday life.

Effects of kayak ergometer training on motor performance in paraplegics.

The purpose of this study was to assess the effects of kayak ergometer training on functional tests performed in wheelchair by persons with spinal cord injury. Ten post-rehabilitated persons with thoracic spinal cord injury volunteered for the study and performed 30 sessions of kayak ergometer training during a 10-week period. The ergometer was modified with an additional balance demand in the medio-lateral direction. Before and after the training period the subjects performed functional tests in the wheelchair: Sit-and-reach tests (distance), mounting a platform, transfer to a bench (height), propelling the wheelchair: 5 m on the rear wheels; in a figure-8; 15 m on a level surface and 50 m on a 3 degrees inclined surface (time). Test-retests were performed for all tests before the training began. A written questionnaire was distributed to evaluate the subjective experiences of the training. The test-retest resulted in coefficient of variation of 1.3 - 4.6 %. There were significant improvements in sit-and-reach (14 %), mounting a platform (7 %), transfer to a bench (10 %), propelling on level (3 %), and inclined surface (6 %). Furthermore, the training, did not cause any shoulder pain or other problems. This, and the positive subjective experience expressed by the subjects after the training indicate that this type of training is a suitable activity for persons with thoracic spinal cord injury.