Complete spinal cord lesion leads to profound metabolic abnormalities and striking changes in muscle morphology. Here we assess the effects of electrically stimulated leg cycling (ESLC) on whole body insulin sensitivity, skeletal muscle glucose metabolism, and muscle fiber morphology in five tetraplegic subjects with complete C5-C7 lesions. Physical training (seven ESLC sessions/wk for 8 wk) increased whole body insulin-stimulated glucose uptake by 33+/-13%, concomitant with a 2.1-fold increase in insulin-stimulated (100 microU/ml) 3-O-methylglucose transport in isolated vastus lateralis muscle. Physical training led to a marked increase in protein expression of GLUT4 (378+/-85%), glycogen synthase (526+/-146%), and hexokinase II (204+/-47%) in vastus lateralis muscle, whereas phosphofructokinase expression (282+/-97%) was not significantly changed. Hexokinase II activity was significantly increased, whereas activity of phosphofructokinase, glycogen synthase, and citrate synthase was not changed after training. Muscle fiber type distribution and fiber area were markedly altered compared to able-bodied subjects before ESLC training, with no change noted in either parameter after ECSL training. In conclusion, muscle contraction improves insulin action on whole body and cellular glucose uptake in cervical cord-injured persons through a major increase in protein expression of key genes involved in the regulation of glucose metabolism. Furthermore, improvements in insulin action on glucose metabolism are independent of changes in muscle fiber type distribution.

The practical aspects of utilizing electrically stimulated leg cycling (ESLC) to counteract alterations in body composition were investigated in five tetraplegic subjects with long-standing complete spinal cord injuries (C5-C7). After a 2-wk adaptation period, the subjects performed seven ESLC sessions per week for 8 wk. No adverse reactions were noted in response to the ESLC program. The ESLC sessions were accompanied by higher lactate concentrations compared with arm exercise. Heart rate and blood pressure response revealed clear, but not serious, signs of autonomic dysreflexia in the beginning of the ESLC sessions. Body temperature increased moderately during the ESLC sessions. Peak oxygen uptake (Vo2) during an ESLC session increased by 70% (P < 0.05) after 8 wk of training. Body composition, evaluated by dual-energy X-ray absorptiometry (DEXA), demonstrated an increase in lean body mass (LBM) from 66.2 +/- 2.6 to 68.2 +/- 2.1% (P < 0.05), with a concomitant decrease in whole body fat (BF) content from 29.7 +/- 2.6 to 27.8 +/- 2.1% (P < 0.05) after training. The cross-sectional area of quadriceps, hamstrings, gluteus maximus, and gluteus medius muscles, measured by computer tomographic scans, increased from 267 +/- 27 to 324 +/- 27 cm2 (P < 0.05) after the training. In conclusion, daily ESLC sessions during a 2-mo period resulted in increased LBM, decreased BF content, and increased muscular endurance in tetraplegic subjects without any noticeable adverse effects.

This randomized clinical trial assesses the effects of robot-assisted treadmill training in persons with chronic incomplete spinal cord injury acquired > 2 years earlier. Due to recruitment challenges, it was possible to recruit only 63% of the planned number of participants. The intervention group received gait training 3 days per week for a period of 6 months and the control group received usual care with their local physical therapist. The intervention group showed improvements in lower extremity strength and balance, but no change in walking function. Significant between-group difference was found only in postural control, favouring the control group. Because the target number of study participants was not reached, the study was underpowered and nonsignificant, and thus the findings are inconclusive. This training method may have benefits, but the robotic device is expensive and training effects are limited when the person's baseline function is poor and the training starts late in incomplete spinal cord injury. Objective: To assess the effects of robot-assisted locomotor training in patients with chronic incomplete spinal cord injury. Design: Randomized single-blind controlled clinical trial. Setting: The intervention site was an outpatient clinic, and pre-and post-evaluations were performed in a rehabilitation hospital. Patients: A total of 24 subjects with American Spinal Injury Association Impairment Scale grades C or D, > 2 years post-injury. Interventions: Subjects were randomized to 60 days of robot-assisted locomotor training, or to usual care. Methods: Walking function, lower extremity muscle strength and balance were assessed single-blinded pre-and post-intervention. Results: After a 9-year recruitment period, only 24 of the planned 30 subjects had been enrolled (mean time since injury 17 (standard deviation (SD) 20) years for all subjects). Walking function, lower extremity muscle strength and balance improved modestly in both groups, with no statistically significant group difference in walking function or muscle strength, whereas postural control declined significantly in the intervention group, compared with controls (p = 0.03). Conclusion: Late-onset robot-assisted locomotor training did not re-establish independent walking function. A modest, but non-significant, effect was seen on muscle strength and balance. However, significant between-group differences were found only in postural control in the control group.

Study design: Cross-sectional survey.Objective: This study investigates the role of physical exercise, perceived exercise mastery and fitness on life satisfaction of a sample of individuals with incomplete spinal cord injury (SCI). Setting: Sunnaas Rehabilitation Hospital and the Norwegian School of Sport Sciences, Norway. Methods: A questionnaire measuring life satisfaction, self-rated physical exercise and self-perceptions were mailed to persons with incomplete SCI. Results: In total, 100 questionnaires were sent out and 69 respondents were included in the study. Of those, 68% performed physical activity regularly once or more a week. Participants who were exercising regularly once a week or more scored significantly higher on the summed life satisfaction scale (P ¼ 0.002) and on perceived fitness (P ¼ 0.004), but significantly lower on perceived exercise mastery (P ¼ 0.012) than those who were non-exercisers. Conclusion: Participants in this study with incomplete SCI who exercised regularly experienced a significantly higher life satisfaction and perceived exercise fitness, but lower perceived exercise mastery than their inactive peers. Perceived exercise fitness was the psychological variable that contributed meaningfully to life satisfaction in this study.

Study design: Cross-sectional study. Objectives: To assess the interrater reliability and validity of the test-table-test (TTT) with which paralympic sports participants involved in Nordic sit-ski sports may be classified. Setting: Movement laboratory in a rehabilitation centre, The Netherlands. Methods: Thirty-three persons with a spinal cord injury caudally to Th2, a leg amputation, poliomyelitis affecting the trunk and/or lower extremities, or cerebral palsy participated. Subjects were classified according to a classification system for Nordic skiing (that is, five subclasses between LW10 and LW12) by two raters, involving, among others, a combination of four balance tests called TTT. The validity of the TTT was investigated using a gold standard, involving balance perturbation tests on a force plate and centre of pressure (CoP) displacement measurements. Results: As for the interrater reliability, Spearman's rank-correlation coefficient was 0.95 (Po0.001). As regards the validity of the TTT, correlation coefficients ranging from 0.61 to 0.74 (Po0.001) were found when comparing the data with the gold standard. Conclusion: Interrater reliability was high in both scoring and classification. With regard to TTT validity, strong positive correlations between CoP displacement and TTT classification were found. Overall, the results of this study show that the TTT is a reliable and valid test. However, the relations between TTT and CoP displacement in the LW10 and LW10.5 subclasses found in this study are somewhat vague, which could be due to the small number of participants in these subclasses. For the LW10 and LW10.5 subclasses further refinement of the four tests within the TTT is warranted.