Paralytic and nonparalytic muscle adaptations to exercise training versus high-protein diet in individuals with long-standing spinal cord injury.

This study compares the effects of an 8-wk isocaloric high-protein (HP) diet versus a combination exercise (Comb-Ex) regimen on paralytic vastus lateralis (VL) and nonparalytic deltoid muscle in individuals with long-standing spinal cord injury (SCI). Fiber-type distribution, cross-sectional area (CSA), levels of translation initiation signaling proteins (Erk-1/2, Akt, p70S6K1, 4EBP1, RPS6, and FAK), and lean thigh mass were analyzed at baseline and after the 8-wk interventions. A total of 11 participants (C5-T12 levels, 21.8 ± 6.3 yr postinjury; 6 Comb-Ex and 5 HP diet) completed the study. Comb-Ex training occurred 3 days/wk and consisted of upper body resistance training (RT) in addition to neuromuscular electrical stimulation (NMES)-induced-RT for paralytic VL muscle. Strength training was combined with high-intensity arm-cranking exercises (1-min intervals at 85-90%, V̇o2peak) for improving cardiovascular endurance. For the HP diet intervention, protein and fat each comprised 30%, and carbohydrate comprised 40% of total energy. Clinical tests and muscle biopsies were performed 24 h before and after the last exercise or diet session. The Comb-Ex intervention increased Type IIa myofiber distribution and CSA in VL muscle and Type I and IIa myofiber CSA in deltoid muscle. In addition, Comb-Ex increased lean thigh mass, V̇o2peak, and upper body strength ( P < 0.05). These results suggest that exercise training is required to promote favorable changes in paralytic and nonparalytic muscles in individuals with long-standing SCI, and adequate dietary protein consumption alone may not be sufficient to ameliorate debilitating effects of paralysis. NEW & NOTEWORTHY This study is the first to directly compare the effects of an isocaloric high-protein diet and combination exercise training on clinical and molecular changes in paralytic and nonparalytic muscles of individuals with long-standing spinal cord injury. Our results demonstrated that muscle growth and fiber-type alterations can best be achieved when the paralyzed muscle is sufficiently loaded via neuromuscular electrical stimulation-induced resistance training.

Reliability and Validity of the Adapted Turkish Version of the Early-onset Scoliosis-24-Item Questionnaire (EOSQ-24).

INTRODUCTION: Early-onset scoliosis (EOS) can have negative effects on the developing thorax, lungs, and quality of life in general. Children with EOS can face various health problems and require recurring hospitalization and surgeries. Radiographic parameters are insufficient to evaluate the severity and efficacy of treatment in EOS. Early-onset Scoliosis Questionnaire (EOSQ)-24 questionnaire is a new instrument developed for this specific age group. To date, reliability of this questionnaire has not yet been interrogated in wide patient groups from different cultures. The aim of this study was to evaluate the validity and reliability of culturally adapted Turkish version of the EOSQ-24. METHODS: Forward translation and back translation of the English version of the EOSQ-24 was done, and all steps for cross-cultural adaptation process were performed properly by an expert committee. Turkish version of the EOSQ-24 and Child Health Questionnaire-Parent Form-50 (CHQ-PF-50) were applied to 61 (24 male, 37 female) EOS patients. The average age of these patients was 9.1 ± 3.1 years (0.4 to 14.3 y), and 50 of them had undergone surgical treatment. Data quality was assessed by mean, median, percentage of missing data, and extent of ceiling and floor effects. Reliability was assessed by internal consistency using Cronbach's α and item-total correlations. The construct validity was evaluated by comparing the results of the EOSQ-24 with the Turkish version of the CHQ-PF-50. Subgroup analyses were applied for sex, diagnosis, treated/untreated, mobilization ability, and complications. RESULTS: The item response to the EOSQ-24 was high with a small number of missing answers (1.6% to 3.3%). Of the 24 items, 22 were evenly distributed. This resulted in a floor effect in 0% to 21.7% of patients, and a ceiling effect in 1.6% to 68.3%. The calculated Cronbach's α for the 24-item scale was 0.909, indicating excellent reliability. Construct validity showed that high correlations between the EOSQ and the CHQ by means of similar domains. Correlation coefficient was between 0.348 and 0.688 (P=0.0001). Subgroup analyses also showed significant difference in treated/untreated patients (P=0.032) and mobilization ability (P=0.001). DISCUSSION: The Turkish adaptation of the EOSQ-24 exhibits favorable psychometric properties and excellent reliability, validating its use in this population.