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Background/Objective: To determine the body composition of adolescents with spinal cord injury (SCI) and to assess whether established cutoff values for obesity determined by body mass index (BMI) are valid for this population.Methods: Sixty patients, aged 10-21 years, with traumatic SCI (50 with paraplegia and 10 with tetraplegia) were compared with 60 gender-, age-, and BMI-matched controls (CTRL). Dual-energy x-ray absorptiometry was used to estimate regional and total bone mineral content, lean tissue mass, fat tissue mass, and body fat percentage. BMI was calculated from measured weight and stature (kg/m 2 ).Results: Total percent body fat was significantly higher in the paraplegia group (31.4% 6 1.2%; mean 6 SE) than in the tetraplegia and CTRL groups (25.7% 6 2.7% and 22.9% 6 1.1%, respectively). This change in percent total body fat was associated with a reduction of lean tissue mass in the paraplegia (37.6 6 1.1 kg; mean 6 SE) and tetraplegia (32.8 6 2.5 kg) subjects as compared to the CTRL group (46.2 6 1.0 kg; P , 0.001). Total fat mass was significantly greater in the paraplegia group (19.3 6 1.3 kg) than the CTRL and tetraplegia groups (14.9 6 1.2 kg and 11.7 6 3.0 kg, respectively). Regional measurements revealed that the greatest reduction of lean tissue mass in the SCI subjects occurred in the lower extremities, followed by the trunk. As a result of these changes in body composition, the optimal BMI for classifying obesity (trunk fat percent .30 in males and .35 in females) in subjects with SCI was 19 kg/m 2 as compared to 25 kg/m 2 in able-bodied subjects.Conclusions: Patients aged 10 to 21 years with SCI have significantly decreased lean tissue mass and bone mineral content, and increased fat mass. As a result, traditional BMI cutoff criteria significantly underestimate obesity in this population. New clinically applicable criteria to define obesity should be established for SCI children and adolescents with SCI.J Spinal Cord Med. 2007;30:S97-S104

Background/Objective: To determine whether a new upper extremity exercise device integrated with a video game (GameCycle) requires sufficient metabolic demand and effort to induce an aerobic training effect and to explore the feasibility of using this system as an exercise modality in an exercise intervention.Design: Pre-post intervention.Setting: University-based research facility.Subject Population: A referred sample of 8 adolescent subjects with spina bifida (4 girls, 15.5 6 0.6 years; 4 boys, 17.5 6 0.9 years) was recruited to participate in the project. All subjects had some level of mobility impairment that did not allow them to participate in mainstream sports available to their nondisabled peers. Five subjects used a wheelchair full time, one used a wheelchair occasionally, but walked with forearm crutches, and 2 were fully ambulatory, but had impaired gait.Main Outcome Measures: Peak oxygen uptake, maximum work output, aerobic endurance, peak heart rate, rating of perceived exertion, and user satisfaction.Results: Six of the 8 subjects were able to reach a VO 2 of at least 50% of their VO 2 reserve while using the GameCycle. Seven of the 8 subjects reached a heart rate of at least 50% of their heart rate reserve. One subject did not reach either 50% of VO 2 reserve or 50% of heart rate reserve. Seven of the 8 subjects increased their maximum work capability after training with the GameCycle at least 3 times per week for 16 weeks. Conclusions:The data suggest that the GameCycle seems to be adequate as an exercise device to improve oxygen uptake and maximum work capability in adolescents with lower extremity disability caused by spinal cord dysfunction. The subjects in this study reported that the video game component was enjoyable and provided a motivation to exercise.

Objectives: The objectives of this study were: (1) to compare the health-related quality of life (HRQOL) of children and adolescents with mobility impairments due to spinal cord injury (SCI) and spina bifida (SB) to the HRQOL of children and adolescent controls without mobility impairments (CTRL); and (2) to examine the impact of of obesity on the HRQOL of these subjects.Methods: The Pediatric Quality of Life Inventory (PedsQL) was administered to 42 SB, 71 SCI and 60 ablebodied subjects who were 8-20 years of age. Subjects were categorized as obese if their BMI exceeded the 95th percentile for age. Twenty-one CTRL, 26 SB and 26 SCI subjects were obese.Results: The SCI and SB subjects had significantly lower subscores than the control subjects on the physical (p , 0.001), emotional (p , .01), social (p , .001), and school (p , .001) domains of the PedsQL. The obese (CTRL) group had lower subscores on the physical (p , 0.001), social (p , 0.001), and psychosocial (p , 0.001) domains of the PedsQL as compared to the non-obese CTRL group, while there were no significant differences in subscores from the emotional and school domains. In contrast to the subjects without mobility impairment, there were no significant differences between the sub-scores of the obese and non-obese subjects with spinal cord dysfunction secondary to SCI or SB. The mean total PedsQL score of the non-obese control group (87.7 6 2.1) was significantly higher than the obese control group (75.2 6 3.4, p , 0.02), which in turn was significantly higher than the SCI group (63.7 6 2.2, p , 0.02), and the SB group (63.0 6 2.2, p , 0.02). Conclusion:Patients with SCI and SB have significantly lower HRQOL than children and adolescents without mobility impairments. Whereas obesity significantly reduces the quality of life scores of adolescents without mobility impairments, it has no significant incremental effect on subjects with SCI or SB.