Twenty patients with chronic supra sacral spinal cord injury presenting with detrusor hyperreflexia were examined. In a preliminary study in ten patients we investigated the reproducibility of bladder capacity through the repetition of three cystometries. The effect of electrical stimulation (ES) on detrusor hyperreflexia was then investigated in ten patients during three consecutive cystometries, the first one without ES (baseline) and the other two with continuous ES of the dorsal penile or clitoris nerve via surface electrodes. Parameters of stimulation were 5 Hz frequency, 0.50 msec pulse duration, and stimulation strength of I and 2 times the bulbocavernosus reflex threshold.No significant differences in bladder capacity were found between the three consecutive cystometries without ES (respectively 97.0 ml, 101.5 ml and 105.6 ml). A current at the bulbocavernosus threshold (mean 24.4 rnA) failed to induce a significant increase in bladder capacity compared to baseline (173.0 ml vs 155.5 ml, P = 0. 17) whereas a current of twice the bulbocavernosus threshold (mean 48.9 rnA) was highly significant (318.5 ml vs 155.5 ml, P< 0.007). ES of twice the threshold resulted in perineal contraction in all of the patients, the threshold ES never did.Our results emphasise the decisive roles of perineal contraction and of current strength for achieving short-term bladder inhibition in spinal cord injury patients. The carry-over effect may also be dependent on the current strength. If so, maximal pudendal ES could represent an alternative procedure in the treatment of detrusor hyperreflexia in these patients.

Evaluation of cardiorespiratory fitness by using the valid leg seems to be feasible in hemiplegic patients 1 month post-stroke. Early post-stroke physical training appears to be needed to limit the negative effects of functional hypoactivity.

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Plantar flexors (PF) of sixty-two patients were tested on the Cybex II Dynamometer about three weeks after anterior cruciate ligament (ACL) surgery. Compared to the non-injured extremity, the deficit is in the range of 30-40%.The authors emphasize the important role of the PF in the stability of the knee and thus the need to reinforce them in a comprehensive program of rehabilitation after ACL surgery.

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