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Background and purposeSpared fibers after spinal cord injury (SCI) tend to consist predominantly of subcortical circuits that are not under volitional (cortical) control. We aim to improve function after SCI by using targeted physical exercises designed to simultaneously stimulate cortical and spared subcortical neural circuits.MethodsParticipants with chronic motor-incomplete SCI enrolled in a single-center, prospective interventional crossover study. Participants underwent 48 sessions each of weight-supported robotic-assisted treadmill training and a novel combination of balance and fine hand exercises, in randomized order, with a 6-week washout period. Change post-intervention was measured for lower extremity motor score, soleus H-reflex facilitation; seated balance function; ambulation; spasticity; and pain.ResultsOnly 9 of 21 enrolled participants completed both interventions. Thirteen participants completed at least one intervention. Although there were no statistically significant differences, multimodal training tended to increase short-interval H-reflex facilitation, whereas treadmill training tended to improve dynamic seated balance.DiscussionThe low number of participants who completed both phases of the crossover intervention limited the power of this study to detect significant effects. Other potential explanations for the lack of significant differences with multimodal training could include insufficient engagement of lower extremity motor cortex using skilled upper extremity exercises; and lack of skill transfer from upright postural stability during multimodal training to seated dynamic balance during testing. To our knowledge, this is the first published study to report seated posturography outcomes after rehabilitation interventions in individuals with SCI.ConclusionIn participants with chronic incomplete SCI, a novel mix of multimodal exercises incorporating balance exercises with skilled upper extremity exercises showed no benefit compared to an active control program of body weight-supported treadmill training. To improve participant retention in long-term rehabilitation studies, subsequent trials would benefit from a parallel group rather than crossover study design.

Objective: To describe the impact of an education program to prevent falls in full-time manual wheelchair users (MWU) living with Spinal Cord Injury (SCI). Design: Pre/post. At baseline, participants reported the frequency of falls over the past six months and completed the Community Participation Indicators(CPI) and the World Health Organization Quality of Life (short version -WHO-QOL BREF) assessment. Transfer quality to and from a mat table was assessed using the Transfer Assessment Instrument (TAI) and boundaries of seated stability were evaluated using standardized procedures. After baseline testing, a structured education program designed to decrease fall frequency was implemented. After the intervention, participants were asked to prospectively track fall frequency for 12 weeks. After 12 weeks, the assessment, as described above, was repeated. Participant/methods: 18 fulltime MWUs with SCI participated in the study. Participants were an average of 35.78 ± 13.89 y.o. and lived with their SCI for an average of 17 ± 15 years. The majority of participants were female (n = 11, 61.1%). Level of injury ranged from C4-L3, AIS A-C. To examine the differences in outcomes pre and post exposure to the education program, seated stability was evaluated using a paired t-test. Nonparametric Wilcoxon tests were used to evaluate all other variables due to the ordinal or non-normally distributed nature of the data. Results: After exposure to the intervention, fall frequency significantly decreased, (Pre: 1.37 ± 1.62 falls per month, Post: 0.67 ± 0.82, p = 0.047). A trend in the data indicated improvements in seated stability (Pre:

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