of electrical muscle stimulation using MRI. J. Appl. Physiol. 74(2): 532-537, 1993.-The purpose of this study was to map the pattern of muscle contractile activity elicited by electromyostimulation (EMS). A secondary interest was to determine whether EMS evoked a different pattern of contractile activity than voluntary (VOL) efforts. These objectives were addressed by examining the pattern and extent of contrast shift in magnetic resonance (MR) images after isometric actions of the left m. quadriceps of seven subjects had been elicited by EMS (1-s train of 500-µs sine wave pulses at 50 Hz) or by VOL means. For both conditions, five sets of 10 muscle actions were executed at each of the three force levels equal to 25, 50, and 75% of maximal VOL isometric torque. There were 1-s, 1.5-min, and 30-min rests between muscle actions, sets, and torque levels, respectively. Transaxial proton MR images (TR/TE = 2,000/30, 60) of m. quadriceps femoris were obtained with a 1.5-T imager at rest and after completion of the five sets of isometric actions at each force level. MR image contrast shift, as indicated by T 2 values> 1 SD above the mean resting muscle T 2 , was calculated per pixel. Torque declined ~18% (P < 0.05) during each EMS set independent of the preset relative force level but recovered between sets. EMS increased T 2 values above rest (29 ± 0.2 to 36 ± 0.5,

Objective-To compare the efficacy of step training with body weight support on a treadmill (BWSTT) with over-ground practice to the efficacy of a defined over-ground mobility therapy (CONT) in patients with incomplete spinal cord injury (SCI) admitted for inpatient rehabilitation.Methods-A total of 146 subjects from six regional centers within 8 weeks of SCI were entered in a single-blinded, multicenter, randomized clinical trial (MRCT). Subjects were graded on the American Spinal Injury Association Impairment Scale (ASIA) as B, C, or D with levels from C5 to L3 and had a Functional Independence Measure for locomotion (FIM-L) score <4. They received 12 weeks of equal time of BWSTT or CONT. Primary outcomes were FIM-L for ASIA B and C subjects and walking speed for ASIA C and D subjects 6 months after SCI.Results-No significant differences were found at entry between treatment groups or at 6 months for FIM-L (n = 108) or walking speed and distance (n = 72). In the upper motor neuron (UMN) subjects, 35% of ASIA B, 92% of ASIA C, and all ASIA D subjects walked independently. Velocities for UMN ASIA C and D subjects were not significantly different for BWSTT (1.1 ± 0.6 m/s, n = 30) and CONT (1.1 ± 0.7, n = 25) groups.Conclusions-The physical therapy strategies of body weight support on a treadmill and defined overground mobility therapy did not produce different outcomes. This finding was partly due to the unexpectedly high percentage of American Spinal Injury Association C subjects who achieved functional walking speeds, irrespective of treatment. The results provide new insight into disability after incomplete spinal cord injury and affirm the importance of the multicenter, randomized clinical trial to test rehabilitation strategies.Annually, approximately 10,000 Americans have a traumatic spinal cord injury (SCI). For many patients, the most visible lingering disability is the inability to walk or a slow spastic- NIH Public Access Author ManuscriptNeurology. Author manuscript; available in PMC 2014 July 17. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript paretic gait with high energy cost. 1 A gait training strategy, using body weight support on a treadmill (BWSTT), 2,3 has evolved from physiologic studies of the effects of the level and timing of limb loading during stepping and of stance and swing phase kinematics in spinal transected quadrupeds [4][5][6][7] and in patients with complete SCI. [8][9][10] The experimental intervention received clinical support from nonrandomized studies of patients with incomplete SCI early and late after injury. 2,3,[11][12][13] No randomized trials with blinded outcomes, however, had compared different physical therapy strategies aimed at the recovery of walking during initial inpatient and outpatient rehabilitation. Further, no prospective trials in SCI had collected measures related to functional walking, such as walking speed, distance, and the need for assistive devices. 14,15The Spinal Cord Injury Locomotor Trial (SCILT) was a single-bli...

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