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Study Design Prospective cohort study Objective This study was designed to neurophysiologically characterize motor control recovery after spinal cord injury (SCI). Setting University of Louisville, Louisville, Kentucky, USA. Material Eleven acute SCI admissions and five non-injured subjects were recruited for this study. Methods The American Spinal Injury Association Impairment Scale (AIS) was used to categorize injury level and severity at onset. Multi-muscle surface EMG (sEMG) recording protocol of reflex and volitional motor tasks was initially performed between the day of injury and 11 days post onset (6.4 ± 3.6, mean ± SD days). Follow-up recordings were performed for up to 17 months after injury. Initial AIS distribution was: 4 AIS-A; 2 AIS-C; 5 AIS-D. Multi-muscle activation patterns were quantified from the sEMG amplitudes of selected muscles using a vector-based calculation that produces values for Magnitude and Similarity of SCI test-subject patterns to those produced by non-injured subjects. Results In SCI subjects, overall sEMG amplitudes were lower after SCI. Prime mover muscle voluntary recruitment was slower and multi-muscle patterns were disrupted by SCI. Recovery occurred in 9 of the 11 showing an increase in sEMG amplitudes, more rapid prime mover muscle recruitment rates and the progressive normalization of the multi-muscle activation patterns. The rate of increase was highly individualized, differing over time by limb and proximal or distal joint within each subject and across the SCI group. Conclusions Recovery of voluntary motor function can be quantitatively tracked using neurophysiological methods in the domains of time and multi-muscle motor unit activation. Sponsorship NIH NINDS funded project #NS049954-01

This prospective case-controlled clinical study was undertaken to investigate to what extent the manually assisted treadmill stepping Locomotor Training with body weight support (LT) can change respiratory function in individuals with chronic Spinal Cord Injury (SCI). Pulmonary function outcomes (Forced Vital Capacity /FVC/, Forced Expiratory Volume one second /FEV1/, Maximum Inspiratory Pressure /PImax/, Maximum Expiratory Pressure /PEmax/) and surface electromyographic (sEMG) measures of respiratory muscles activity during respiratory taskswere obtained from eight individuals with chronic C3-T12 SCI before and after 62±10 (Mean ± SD) sessions of the LT. FVC, FEV1, PImax, PEmax, amount of overall sEMG activity and rate of motor unit recruitment were significantly increased after LT (p<0.05) These results suggest that these improvements induced by the LT are likely the result of neuroplastic changes in spinal neural circuitry responsible for the activation of respiratory muscles preserved after injury.

Treatment for breast cancer patients includes surgical removal of the tumor followed by chemotherapy. Chemotherapy frequently results in difficult to manage symptoms that threaten compliance with the therapy. Symptoms include fatigue, declines in functional ability, muscle wasting, and a decreased quality of life. Preparing the body to tolerate a stressful event such as chemotherapy has been termed "prehabilitation". This case study determined the efficacy of introducing aerobic training 1 week prior to and continuing through 8 weeks of chemotherapy on fatigue and functional ability in a 42-year-old newly diagnosed breast cancer patient. The patient participated in a supervised and home-based walking program. Fatigue during daily activities and functional ability (12-minute walk, ascending and descending stairs, sit to stand, getting to and rising from the floor, 30-second bicep curl) were measured before and after exercise training. Results indicate that 5 of 7 functional measures demonstrated improvement, ranging from 23.4- 54.5%. In addition, fatigue while performing activities of daily living, as well as following the performance of the functional tasks, was reduced. The findings of this case study indicate that fatigue can be decreased and functional ability can be improved as a result of aerobic training initiated 1 week before and continued throughout chemotherapy. This case study presents a novel approach to introducing exercise prior to and continued during 8 weeks of chemotherapy in a way that may reduce the cumulative effects of this stressor.

Pulmonary complications associated with persistent respiratory muscle weakness, paralysis, and spasticity are among the most important problems faced by patients with spinal cord injury when lack of muscle strength and disorganization of reciprocal respiratory muscle control lead to breathing insufficiency. This review describes the mechanisms of the respiratory motor control and its change in individuals with spinal cord injury, methods by which respiratory function is measured, and rehabilitative treatment used to restore respiratory function in those who have experienced such injury.

Study Design Prospective cohort study Objective This study was designed to neurophysiologically characterize spinal motor activity during recovery from spinal cord injury (SCI). Setting University of Louisville, Louisville, Kentucky, USA. Material Twenty five consecutive acute SCI admissions were recruited for this study. Methods The American Spinal Injury Association Impairment Scale (AIS) was used to categorize injury level and severity at onset. Surface EMG recording, was carried out initially between the day of admission and 17 days post onset (6.0 ± 4.3, mean ± SD days). Follow-up recordings were performed for up to 9 months after injury. Initial AIS distribution was: 7 AIS-A; 3 AIS-B; 2 AIS-C; 13 AIS-D. Results Twelve subjects (48%) showed long-duration involuntary motor unit activation during relaxation. This activity was seen on initial examination in nine and on follow-up by three months post-injury in three others. It was seen in muscles innervated from the injury zone in 11 and caudal to the lesion in 9 subjects. This activity was independent of the presence or absence of tendon reflexes and the ability to volitionally suppress plantar stimulation elicited reflex withdrawal. Conclusions The form of involuntary activity described here is the likely result of the altered balance of excitation and inhibition reaching spinal motor neurons due to the loss of inhibitory interneurons or their reduced activation by damaged supraspinal drive and the synaptic reorganization that follows SCI. As such, this activity may be useful for monitoring the effects of neuroprotective and restorative intervention strategies in persons with SCI.

Task specific training combined with epidural stimulation has the potential to show improvements in cardiovascular fitness and body composition in individuals with cervical or upper thoracic motor complete SCI.

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