Improvement in weight loss and ambulation outcomes after gastric sleeve surgery for a person with chronic motor-incomplete tetraplegia: clinical case report.

OBJECTIVE: To measure body mass index (BMI) and ambulation changes for a morbidly obese, 47-year-old man with chronic motor-incomplete tetraplegia after gastric sleeve surgery. DESIGN/METHOD: A morbidly obese man, BMI=44 kg m(-)(2), with chronic C5 AIS D tetraplegia underwent elective gastric sleeve surgery. Assessment of BMI and function via the 6-minute walk test (6MWT), 10-meter walk test (10MWT) and ambulation parameters (CIR Systems/GAITRite, Franklin, NJ, USA) was performed preoperatively and at 12, 24, 36 and 52 weeks postoperatively, and additionally after 3 weeks of both a prescribed coached (3 × /week facility based) and a non-coached (3 × /week home based) walking program initiated at 52 weeks. A step activity monitor assessed daily ambulation preoperatively, prior to and during the third and sixth week of the walking program. RESULTS: Results included a 34.3% peak BMI decrease at 52 weeks post surgery and a peak increase in 6MWT distance of 58% at 52 weeks post surgery, 10MWT preferred speed of 56% at 55 weeks and step activity monitor of 82% at 58 weeks post surgery. At 58 weeks, gait data demonstrated a decrease in double limb stance of 38% and decrease in base of support of 72%. CONCLUSION/CLINICAL RELEVANCE: This empirical case assessment of BMI and functional mobility before and after gastric sleeve surgery may encourage further investigation into mobility and general health effects post gastric procedures for people with chronic motor-incomplete spinal cord injury.

Reliability and relatedness of peak VO2 assessments during body weight supported treadmill training and arm cycle ergometry in individuals with chronic motor incomplete spinal cord injury.

STUDY DESIGN: Prospective assessment as part of initial evaluations for randomized-controlled trial participation. OBJECTIVES: To determine the test-retest reliability of peak VO2 testing during both robotically assisted body weight supported treadmill training (RABWSTT) and arm cycle ergometry and to assess whether a relationship exists between these two measurements in individuals with chronic motor incomplete spinal cord injury (CMISCI). METHODS: Twenty-one participants with CMISCI enrolled in a 3- month, RABWSTT randomized-controlled trial. As part of their baseline assessments, individuals underwent VO2 peak assessments twice on separate days during both RABWSTT and arm cycle ergometry using a metabolic cart. RESULTS: Peak oxygen consumption measured at baseline correlated significantly between repeated tests in the RABWSTT (r=0.96, P<0.01) and the arm ergometer (r=0.95, P<0.01). A Pearson correlation (r=0.87, P<0.01) existed between the peak VO2 measurements obtained using RABWSTT and arm ergometry, although Bland-Altman analysis suggested a more limited relationship with a bias of 1.1 favoring arm ergometry. This relationship was stronger for individuals with tetraplegia than for people with paraplegia. CONCLUSION/CLINICAL RELEVANCE: Determination of VO2 peak during both RABWSTT and arm ergometry in individuals with CMISCI is highly reproducible. Furthermore, a moderate correlation exists between peak VO2 measured during RABWSTT and arm cycle ergometry in this population for individuals with tetraplegia. This correlation offers implications for future cardiovascular testing of individuals with CMISCI, as two reliable peak VO2 measurement techniques are possible.