A substantial number of fall risk assessment tools are readily available and assess similar patient characteristics. Although their diagnostic accuracy and overall usefulness showed wide variability, there are several scales that can be used with confidence as part of an effective falls prevention program. Consequently, there should be little need for facilities to develop their own scales. To continue to develop fall risk assessments unique to individual facilities may be counterproductive because scores will not be comparable across facilities.

Spinal cord-injured (SCI) patients are at increased risk for fractures secondary to neurogenic osteoporosis. Earlier research claimed physical conditioning resulted in a decreased incidence or reversal of neurogenic osteoporosis. This study evaluated the effects of functional electrical stimulation-induced lower extremity cycling (FESILEC) on the bone densities of SCI patients using dual-energy x/ray absorptiometry (DEXA). The study consisted of 12 healthy male SCI patients, aged 23 to 46 (x +/- SD, 34 +/- 6) yr. The patients were post-traumatic, complete, spastic SCI; time postinjury ranged from 2 to 19 (9.7 +/- 5.1) yr. Patients participated in a three-phase training program. Phase 1 consisted of quadriceps strengthening. Phase 2 consisted of progressive sequential stimulation of quadriceps, hamstrings, and gluteal muscles, achieving a rhythmical pedaling motion on the REGYS I ergometer. Phase 3a consisted of 30-min FESILEC sessions. DEXAs were done at baseline and at completion of Phase 3a and Phase 3b. Bone densities were done of the lumbar spine levels 2-4 (L2-4), bilateral trochanters (T), Ward's triangles (WT) and femoral necks (FN). Baseline bone density indicated no difference between L2-4 of ambulatory males and SCI males. Baseline values obtained for T, WT, and FN were, respectively, 71, 82, and 79% of ambulatory values. Results after completion of the Phase 3a training program indicated no statistically significant difference compared with baseline values. There was, however, a positive trend in the lumbar spine post-Phase 3a (L2-4, P=0.056). Eight patients continued the exercise program, using a combination of upper and lower extremity cycling (Phase 3b) for a longer period of time (25 +/- 9 wk). DEXAs done after Phase 3b indicated no change relative to baseline data or data post-Phase 3a. In conclusion, although FESILEC did not significantly increase bone density in the hip parameters of chronic SCI patients, a positive trend was observed in the lumbar spine. Further research with acute intervention, such as FESILEC during the first few months post-SCI, is warranted to further evaluate a treatment regimen to prevent or reduce neurogenic osteopenia.

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The torque generated during a passive movement of the knee joint was used to quantify muscle tone in normal able-bodied subjects and spastic and flaccid spinal cord injury (SCI) subjects using a computerized isokinetic dynamometer. Maximum peak (Tmax) and the sum of four consecutive peaks (Tsum) were calculated for each velocity (30, 60, 120° Is) and for each phase (flexing or extending) separately and compared statistically using a one-way ANOV A. Statistical significance between groups was found in T max FLEXION (FLX) at 60 and 1200/s. Scheffe's tests revealed that the spastic group was significantly less than both the flaccid and normal groups, although the flaccid and normal groups were not significantly different from each other. The slopes of the linear regression curve of the torque-velocity data were found and compared statistically using a t-test for parallelism. In all parameters, the data increased in a linear fashion with increasing velocity of knee motion. The slope of the regression curve for the spastic group was significantly lower than that of the normal group for T max and was significantly lower than that of the flaccid group for Tsum while the slopes for the flaccid and normal groups were not significantly different. The ability of the entire set of variables to classify subjects into three groups (normal, spastic, and flaccid) was tested using discriminant analysis. By taking into account 7 of the 12 original variables, this multivariate technique correctly classified 100% of the spastic, 90% of the normal, but only 67% of the flaccid subjects. Separation of observations was between spastic and normal subjects was good, except for only one case. This feature could be useful when dealing with assessment of individual responses to therapeutic interventions aimed at modification of spasticity.

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1. Hindlimb step-cycle kinetics of forward (FWD) and backward (BWD) walking in adult cats were assessed. The hindlimb was modeled as a linked system of rigid bodies and inverse-dynamics techniques were used to calculate hip, knee, and ankle joint kinetics. For swing, net torque at each joint was divided into three components: gravitational, motion dependent, and a generalized muscle torque. For stance, vertical and horizontal components of the ground-reaction force applied at a point on the paw (center of pressure) were added to the torque calculations. Muscle torque profiles were matched to electromyograms (EMGs) recorded from hindlimb muscles. 2. Torque profiles for BWD swing were the approximate time reversal of those for FWD swing. At each joint, the net torque during swing was small because the mean motion-dependent and muscle torque components counteracted each other. At the hip a flexor muscle torque persisted except for a brief extensor muscle torque late in FWD swing and at the onset of BWD swing. At the knee the muscle torque was relatively negligible except for a peak flexor muscle torque late in FWD swing and early in BWD swing. At the ankle there was a midswing transition from a flexor to an extensor muscle torque during FWD swing and the reverse was true for BWD swing. 3. The vertical ground-reaction force was greater for the forelimbs than the hindlimbs during FWD stance; the reverse was true for BWD stance. Thus the hindlimbs bore a greater percentage (66%) of body weight than the forelimbs during BWD stance, and the forelimbs bore a greater percentage (59%) during FWD stance. For most of FWD stance, the hindlimb exerted a small propulsive ground-reaction force, but for BWD stance the hindlimb first exerted a braking force and then a propulsive force, with the transition occurring after midstance (59% of stance). 4. At the hip the ground-reaction force vector was oriented anteriorly and then posteriorly to the estimated joint center with a midstance transition during FWD stance. The muscle torque and joint power patterns showed similar transitions, changing from extensor and power generation to flexor and power absorption, respectively. For most of BWD stance the ground-reaction force vector was oriented anteriorly to the joint center and was counter-balanced by a large extensor muscle torque; nonetheless, power was absorbed because the hip flexed.(ABSTRACT TRUNCATED AT 400 WORDS)