Objective: To assess the effectiveness of robotically assisted body weight supported treadmill training (RABWSTT) for improving cardiovascular fitness in chronic motor incomplete spinal cord injury (CMISCI). Design: Pilot prospective randomized, controlled clinical trial. Setting: Outpatient rehabilitation specialty hospital. Participants: Eighteen individuals with CMISCI with American Spinal Injury Association (ASIA) level between C4 and L2 and at least one-year post injury. Interventions: CMISCI participants were randomized to RABWSTT or a home stretching program (HSP) three times per week for three months. Those in the home stretching group were crossed over to three months of RABWSTT following completion of the initial three month phase. Outcome measures: Peak oxygen consumption (peak VO 2 ) was measured during both robotic treadmill walking and arm cycle ergometry: twice at baseline, once at six weeks (mid-training) and twice at three months (posttraining). Peak VO 2 values were normalized for body mass. Results: The RABWSTT group improved peak VO 2 by 12.3% during robotic treadmill walking (20.2 ± 7.4 to 22.7 ± 7.5 ml/kg/min, P = 0.018), compared to a non-significant 3.9% within group change observed in HSP controls (P = 0.37). Neither group displayed a significant change in peak VO 2 during arm cycle ergometry (RABWSTT, 8.5% (P = 0.25); HSP, 1.76% (P = 0.72)). A repeated measures analysis showed statistically significant differences between treatments for peak VO 2 during both robotic treadmill walking (P = 0.002) and arm cycle ergometry (P = 0.001). Conclusion: RABWSTT is an effective intervention model for improving peak fitness levels assessed during robotic treadmill walking in persons with CMISCI.

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Objective: Functional passive range of motion (PROM) requirements for individuals with cervical spinal cord injury (SCI) are clinically accepted despite limited evidence defining the specific PROM needed to perform functional tasks. The objective of this investigation was to better define the minimum PROM needed for individuals with cervical SCI to achieve optimal functional ability, and as a secondary outcome gather selfreported standardized functional data via the Spinal Cord Independence Measure-III (SCIM-III), and the Spinal Cord Injury Functional Index (SCI-FI). Design: Observational cohort. Setting: 128-bed rehabilitation hospital with inpatient and outpatient spinal cord injury rehabilitation programs. Participants: A convenience sample of 29 community-dwelling individuals with chronic (greater than one year) tetraplegic SCI (C5-8) who use a wheelchair for mobility. Interventions: None. Outcome measures: Therapist goniometric measurement of upper and lower extremity PROM, and participant completion of a demographic questionnaire and two functional self-report measures (SCIM-III and SCI-FI) were completed. Results: Compared to the general population, differences observed in our study participants included limitations in forearm pronation and elbow extension and increased shoulder extension and wrist extension (likely related to prop sitting). Elbow hyperextension was noted in one-third of the participants. Limitations in straight leg raise, hip flexion, abduction, and internal rotation, in combination with increased hip external rotation suggested these individuals with cervical SCI potentially completed activities of daily living (ADLs) in frog-sitting, rather than long-sitting. Ankle plantarflexion contractures were found in many participants. Shoulder horizontal adduction, elbow extension, hip flexion, knee flexion, ankle plantarflexion, and forefoot eversion ROM were associated with functional performance. Conclusion: Based on our results healthcare providers should work with individuals with cervical SCI to develop long term PROM plans to optimize functional abilities.

Study design: Prospective assessment as part of initial evaluations for randomized-controlled trial participation. Objectives: To determine the test-retest reliability of peak VO 2 testing during both robotically assisted body weight supported treadmill training (RABWSTT) and arm cycle ergometry and to assess whether a relationship exists between these two measurements in individuals with chronic motor incomplete spinal cord injury (CMISCI). Methods: Twenty-one participants with CMISCI enrolled in a 3-month, RABWSTT randomized-controlled trial. As part of their baseline assessments, individuals underwent VO 2 peak assessments twice on separate days during both RABWSTT and arm cycle ergometry using a metabolic cart. Results: Peak oxygen consumption measured at baseline correlated significantly between repeated tests in the RABWSTT (r ¼ 0.96, Po0.01) and the arm ergometer (r ¼ 0.95, Po0.01). A Pearson correlation (r ¼ 0.87, Po0.01) existed between the peak VO 2 measurements obtained using RABWSTT and arm ergometry, although Bland-Altman analysis suggested a more limited relationship with a bias of 1.1 favoring arm ergometry. This relationship was stronger for individuals with tetraplegia than for people with paraplegia. Conclusion/clinical relevance: Determination of VO 2 peak during both RABWSTT and arm ergometry in individuals with CMISCI is highly reproducible. Furthermore, a moderate correlation exists between peak VO 2 measured during RABWSTT and arm cycle ergometry in this population for individuals with tetraplegia. This correlation offers implications for future cardiovascular testing of individuals with CMISCI, as two reliable peak VO 2 measurement techniques are possible. Spinal Cord (2014) 52, 287-291; doi:10.1038/sc.2014.6; published online 18 February 2014Keywords: robotically assisted body weight supported treadmill training; chronic motor incomplete spinal cord injury; peak VO 2 ; reproducibility; validity INTRODUCTION Individuals with spinal cord injury (SCI) experience decreased lean muscle mass and increased total body and abdominal fat, predisposing them to a higher incidence of diabetes, hypertension and dyslipidemia than able-bodied people. 1-4 These problems, in part, are caused by neuromuscular limitations following injury and the subsequent associated sedentary lifestyle. Physical activity is recommended to combat these health-related problems. Unfortunately, the person with SCI holds limited activity options. Several evidence-based guidelines exist for the able-bodied population, including the Adult Treatment Panel III, which recommends aerobic exercise to achieve cholesterol modification and weight reduction. 5 However, specific available exercise guidelines are limited for individuals with SCI, and the associated restricted muscle activation, secondary metabolic derangements and barriers to accessing exercise opportunities may limit activity engagement. [6][7][8] This lack of optimal aerobic exercise recommendation for individuals with SCI partially stems from limited information

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