The disuse-related bone loss that results from immobilisation following injury shares characteris... more The disuse-related bone loss that results from immobilisation following injury shares characteristics with osteoporosis in post-menopausal women and the aged, with decreases in bone mineral density leading to weakening of the bone and increased risk of fracture. The aim of this study was to use the finite element method to: (i) calculate the mechanical response of the tibia under mechanical load and (ii) estimate of the risk of fracture; comparing between two groups, an able-bodied group and spinal cord injury patients group suffering from varying degrees of bone loss. The tibiae of eight male subjects with chronic spinal cord injury and those of four able-bodied age-matched controls were scanned using multi-slice peripheral quantitative computed tomography. Images were used to develop full three-dimensional models of the tibiae in Mimics (Materialise) and exported into Abaqus (Simulia) for calculation of stress distribution and fracture risk in response to specified loading conditi...
Journal of musculoskeletal & neuronal interactions
We describe the use of peripheral Quantitative Computed Tomography (pQCT) to identify musculoskel... more We describe the use of peripheral Quantitative Computed Tomography (pQCT) to identify musculoskeletal responses to partial body-weight supported treadmill training (BWSTT) in incomplete spinal cord injury (SCI). Long-term health consequences of SCI include extensive muscle atrophy, severe bone loss and an increased fracture risk in the affected limbs, mostly at both tibial epiphyses and the distal femoral epiphysis. Regular treadmill training may slow or reverse bone loss by recruiting available lower-limb musculature and loading the leg bones dynamically. The potential for detailed analysis of musculoskeletal changes using pQCT is illustrated with a single case study (14.5 years post-SCI), who completed seven months of partial BWSTT. Pre- and post-training lower-limb pQCT scans were taken to quantify changes in trabecular bone, cortical bone, and soft-tissue. Trabecular bone mineral density increased by 5% (right) and 20% (left) in the distal tibia. Changes in proximal tibia and di...
Objective: One of the brain signatures of the central neuropathic pain (CNP) is the theta band ov... more Objective: One of the brain signatures of the central neuropathic pain (CNP) is the theta band overactivity of wider cortical structures, during imagination of movement. The objective of the study was to investigate whether this over-activity is reversible following the neurofeedback treatment of CNP. Methods: Five paraplegic patients with pain in their legs underwent from twenty to forty neurofeedback sessions that significantly reduced their pain. In order to assess their dynamic cortical activity they were asked to imagine movements of all limbs a week before the first and a week after the last neurofeedback session. Using time–frequency analysis we compared EEG activity during imagination of movement before and after the therapy and further compared it with EEG signals of ten paraplegic patients with no pain and a control group of ten able-bodied people. Results: Neurofeedback treatment resulted in reduced CNP and a wide spread reduction of cortical activity during imagination o...
Background: Disuse osteoporosis occurs in response to long-term immobilisation. Spinal cord injur... more Background: Disuse osteoporosis occurs in response to long-term immobilisation. Spinal cord injury (SCI) leads to a form of disuse osteoporosis that only affects the paralysed limbs. High rates of bone resorption after injury are evident from decreases in bone mineral content (BMC), which in the past have been attributed in the main to loss of trabecular bone in the epiphyses and cortical thinning in the shaft through endocortical resorption. Methods: Patients with motor-complete SCI recruited from the Queen Elizabeth National Spinal Injuries Unit (Glasgow, UK) were scanned within 5 weeks of injury (Baseline) using peripheral Quantitative Computed Tomography (pQCT). Unilateral scans of the tibia, femur and radius provided separate estimates of trabecular and cortical bone parameters in the epiphyses and diaphyses, respectively. Using repeat pQCT scans at 4, 8 and 12 months post-injury, changes in bone mineral content (BMC), bone mineral density (BMD) and cross-sectional area (CSA) o...
Objective.—To identify the frequency and pattern of spinal injury sustained in mountaineering acc... more Objective.—To identify the frequency and pattern of spinal injury sustained in mountaineering accidents. Methods.—All patients with spinal injuries sustained while mountaineering who were treated at the Queen Elizabeth National Spinal Injuries Unit from 1992 to 2001 were studied. Information was obtained from hospital notes, and each patient completed a questionnaire. Results.—Twenty-one patients with spinal injuries sustained in mountaineering accidents were identified. Fourteen patients (67.7%) were experienced mountaineers. Four (19.0%) were rock climbing, 6 (28.6%) were winter climbing, 6 (28.6%) were hill walking, and 5 (23.8%) were winter walking. Ten patients (47.6%) sustained cervical injuries, 5 (23.8%) sustained thoracic injuries, 5 (23.8%) sustained lumbar injuries, and 1 (4.8%) sustained cervical and lumbar injuries. Nineteen patients (90.5%) sustained fractures, 1 (4.8%) sustained a dislocation, and 1 (4.8%) sustained a fracture dislocation. Seventeen patients (81.0%) w...
PURPOSE The extent to which cardiorespiratory fitness and cycling power can be improved in indivi... more PURPOSE The extent to which cardiorespiratory fitness and cycling power can be improved in individuals with paraplegia by progressive, high-volume, home-based, electrically stimulated (ES) cycle training was investigated using a novel, sensitive method and protocol that allowed high-resolution power output analyses to be performed for the first time in ES cycling. METHODS Nine male and two female individuals with paraplegia trained progressively at home for up to five 60-min sessions x wk(-1) for 12 months. Peak power and cardiorespiratory parameters were estimated during quarterly feedback-controlled incremental work rate tests in the laboratory. RESULTS Cycle training endurance increased from 10 to 60 min of continuous pedaling for all subjects. Peak power output (POpeak) increased by 132% (P = 0.001), peak oxygen uptake (VO2peak) increased by 56% (P < 0.001), and oxygen pulse increased by 34% (P = 0.002). All significant adaptations occurred during the first 6 months of traini...
Large number of chronic Spinal Cord Injured (SCI) patients suffer from Central Neuropathic (CNP) ... more Large number of chronic Spinal Cord Injured (SCI) patients suffer from Central Neuropathic (CNP) pain that modifies both spontaneous EEG and Event related EEG responses. The aim of this paper was to analyze on a group level, using clustering approach, differences in EEG signatures between two Groups: the able-bodied persons and SCI patients with CNP during a motor imagination task. Results of this study showed that compared to the able-bodied, SCI patients with pain have lower ERS/ERD in the central and the centro/parietal areas of the motor cortex, which correspond to the paralyzed part of the body and higher event-related synchronization/desynchronisation (ERS/ERD) in the rest of the cortex, including frontal areas, remaining areas of the sensory-motor cortex and the occipital area. Significant differences in Power Spectral Density (PSD) between two Groups were found in 20-30 Hz range, possibly related to the baseline EEG rather then to the mental task.
Subsequent co-factors such as low blood pressure and muscle atrophy lead to a decrease in cardiop... more Subsequent co-factors such as low blood pressure and muscle atrophy lead to a decrease in cardiopulmonary fitness. It is proposed here that the introduction of an appropriate training program during the early stage of injury may attenuate this loss of fitness. This work examined the cardiopulmonary responses of three motor complete and three motor incomplete spinal cord injured subjects to a number of robotics-assisted stepping exercises. Subjects participated in periods of passive, active and electrically stimulated stepping. Increases in a number of cardiopulmonary parameters were observed with some subjects, in response to these exercises. These results show that those with an incomplete SCI may benefit from this form training during the acute phase of injury.
Clinical neurophysiology : official journal of the International Federation of Clinical Neurophysiology, Sep 1, 2016
One of the brain signatures of the central neuropathic pain (CNP) is the theta band over-activity... more One of the brain signatures of the central neuropathic pain (CNP) is the theta band over-activity of wider cortical structures, during imagination of movement. The objective of the study was to investigate whether this over-activity is reversible following the neurofeedback treatment of CNP. Five paraplegic patients with pain in their legs underwent from twenty to forty neurofeedback sessions that significantly reduced their pain. In order to assess their dynamic cortical activity they were asked to imagine movements of all limbs a week before the first and a week after the last neurofeedback session. Using time-frequency analysis we compared EEG activity during imagination of movement before and after the therapy and further compared it with EEG signals of ten paraplegic patients with no pain and a control group of ten able-bodied people. Neurofeedback treatment resulted in reduced CNP and a wide spread reduction of cortical activity during imagination of movement. The reduction wa...
Spinal Cord Injury caused by stab wounds (SCISW) results from a partial or complete transection o... more Spinal Cord Injury caused by stab wounds (SCISW) results from a partial or complete transection of the cord and presents opportunities for interventional research. It is recognised that there is low incidence but little is known about the natural history or the patient's suitability for long-term clinical outcome studies. This study aims to provide population based evidence of the demographics of SCISW and highlight the issues regarding the potential for future research. The database of the Queen Elizabeth National Spinal Injuries Unit (QENSIU), the sole centre for treating SCI in Scotland, was reviewed between 1994 and 2013 to ascertain the incidence, demographics, functional recovery, and mortality rates for new SCISW. During this 20-year period 35 cases of SCISW were admitted (97.1% male, mean age 30.0 years). 31.4% had a cervical injury, 60.0% thoracic, and 8.6% lumbar. All had neurology with 42.9% motor complete on admission and 77.1% discharged as motor incomplete. 70.4% o...
After spinal cord injury (SCI), bone loss in the paralysed limbs progresses at variable rates. De... more After spinal cord injury (SCI), bone loss in the paralysed limbs progresses at variable rates. Decreases in bone mineral density (BMD) in the first year range from 1% (slow) to 40% (rapid). In chronic SCI, fragility fractures commonly occur around the knee, with significant associated morbidity. Osteoporosis treatments await full evaluation in SCI, but should be initiated early and targeted towards patients exhibiting rapid bone loss. The potential to predict rapid bone loss from a single bone scan within weeks of a SCI was investigated using statistical shape modelling (SSM) of bone morphology, hypothesis: baseline bone shape predicts bone loss at 12-months post-injury at fracture-prone sites. In this retrospective cohort study 25 SCI patients (median age, 33years) were scanned at the distal femur and proximal tibia using peripheral Quantitative Computed Tomography at <5weeks (baseline), 4, 8 and 12months post-injury. An SSM was made for each bone. Links between the baseline sha...
Central neuropathic pain has a prevalence of 40 % in patients with spinal cord injury. Electroenc... more Central neuropathic pain has a prevalence of 40 % in patients with spinal cord injury. Electroencephalography (EEG) studies showed that this type of pain has identifiable signatures, that could potentially be targeted by a neuromodulation therapy. The aim of the study was to investigate the putative mechanism of neurofeedback training on central neuropathic pain and its underlying brain signatures in patients with chronic paraplegia. Patients' EEG activity was modulated from the sensory-motor cortex, electrode location C3/Cz/C4/P4 in up to 40 training sessions Results. Six out of seven patients reported immediate reduction of pain during neurofeedback training. Best results were achieved with suppressing Ɵ and higher β (20-30 Hz) power and reinforcing α power at C4. Four patients reported clinically significant long-term reduction of pain (>30 %) which lasted at least a month beyond the therapy. EEG during neurofeedback revealed a wide spread modulation of power in all three ...
Journal of neurologic physical therapy : JNPT, 2015
Impaired hand function decreases quality of life in persons with tetraplegia. We tested functiona... more Impaired hand function decreases quality of life in persons with tetraplegia. We tested functional electrical stimulation (FES) controlled by a hybrid brain-computer interface (BCI) for improving hand function in participants with tetraplegia. Two participants with subacute tetraplegia (participant 1: C5 Brown-Sequard syndrome, participant 2: complete C5 lesion) took part in this proof-of-concept study. The goal was to determine whether the BCI system could drive the FES device by accurately classifying participants' intent (open or close the hand). Participants 1 and 2 received 10 sessions and 4 sessions of BCI-FES, respectively. A novel time-switch BCI strategy based on motor imagery was used to activate the FES. In one session, we tested a hybrid BCI-FES based on 2 spontaneously generated brain rhythms: a sensory-motor rhythm during motor imagery to activate a stimulator and occipital alpha rhythms to deactivate the stimulator. Participants received BCI-FES therapy 2 to 3 tim...
Strength changes in lower limb muscles following robot assisted gait training (RAGT) in subjects ... more Strength changes in lower limb muscles following robot assisted gait training (RAGT) in subjects with incomplete spinal cord injury (ISCI) has not been quantified using objective outcome measures. To record changes in the force generating capacity of lower limb muscles (recorded as peak voluntary isometric torque at the knee and hip), before, during and after RAGT in both acute and subacute/chronic ISCI subjects using a repeated measures study design. Eighteen subjects with ISCI participated in this study (Age range: 26-63 years mean age = 49.3 ± 11 years). Each subject participated in the study for a total period of eight weeks, including 6 weeks of RAGT using the Lokomat system (Hocoma AG, Switzerland). Peak torques were recorded in hip flexors, extensors, knee flexors and extensors using torque sensors that are incorporated within the Lokomat. All the tested lower limb muscle groups showed statistically significant (p < 0.001) increases in peak torques in the acute subjects. C...
The disuse-related bone loss that results from immobilisation following injury shares characteris... more The disuse-related bone loss that results from immobilisation following injury shares characteristics with osteoporosis in post-menopausal women and the aged, with decreases in bone mineral density leading to weakening of the bone and increased risk of fracture. The aim of this study was to use the finite element method to: (i) calculate the mechanical response of the tibia under mechanical load and (ii) estimate of the risk of fracture; comparing between two groups, an able-bodied group and spinal cord injury patients group suffering from varying degrees of bone loss. The tibiae of eight male subjects with chronic spinal cord injury and those of four able-bodied age-matched controls were scanned using multi-slice peripheral quantitative computed tomography. Images were used to develop full three-dimensional models of the tibiae in Mimics (Materialise) and exported into Abaqus (Simulia) for calculation of stress distribution and fracture risk in response to specified loading conditi...
Journal of musculoskeletal & neuronal interactions
We describe the use of peripheral Quantitative Computed Tomography (pQCT) to identify musculoskel... more We describe the use of peripheral Quantitative Computed Tomography (pQCT) to identify musculoskeletal responses to partial body-weight supported treadmill training (BWSTT) in incomplete spinal cord injury (SCI). Long-term health consequences of SCI include extensive muscle atrophy, severe bone loss and an increased fracture risk in the affected limbs, mostly at both tibial epiphyses and the distal femoral epiphysis. Regular treadmill training may slow or reverse bone loss by recruiting available lower-limb musculature and loading the leg bones dynamically. The potential for detailed analysis of musculoskeletal changes using pQCT is illustrated with a single case study (14.5 years post-SCI), who completed seven months of partial BWSTT. Pre- and post-training lower-limb pQCT scans were taken to quantify changes in trabecular bone, cortical bone, and soft-tissue. Trabecular bone mineral density increased by 5% (right) and 20% (left) in the distal tibia. Changes in proximal tibia and di...
Objective: One of the brain signatures of the central neuropathic pain (CNP) is the theta band ov... more Objective: One of the brain signatures of the central neuropathic pain (CNP) is the theta band overactivity of wider cortical structures, during imagination of movement. The objective of the study was to investigate whether this over-activity is reversible following the neurofeedback treatment of CNP. Methods: Five paraplegic patients with pain in their legs underwent from twenty to forty neurofeedback sessions that significantly reduced their pain. In order to assess their dynamic cortical activity they were asked to imagine movements of all limbs a week before the first and a week after the last neurofeedback session. Using time–frequency analysis we compared EEG activity during imagination of movement before and after the therapy and further compared it with EEG signals of ten paraplegic patients with no pain and a control group of ten able-bodied people. Results: Neurofeedback treatment resulted in reduced CNP and a wide spread reduction of cortical activity during imagination o...
Background: Disuse osteoporosis occurs in response to long-term immobilisation. Spinal cord injur... more Background: Disuse osteoporosis occurs in response to long-term immobilisation. Spinal cord injury (SCI) leads to a form of disuse osteoporosis that only affects the paralysed limbs. High rates of bone resorption after injury are evident from decreases in bone mineral content (BMC), which in the past have been attributed in the main to loss of trabecular bone in the epiphyses and cortical thinning in the shaft through endocortical resorption. Methods: Patients with motor-complete SCI recruited from the Queen Elizabeth National Spinal Injuries Unit (Glasgow, UK) were scanned within 5 weeks of injury (Baseline) using peripheral Quantitative Computed Tomography (pQCT). Unilateral scans of the tibia, femur and radius provided separate estimates of trabecular and cortical bone parameters in the epiphyses and diaphyses, respectively. Using repeat pQCT scans at 4, 8 and 12 months post-injury, changes in bone mineral content (BMC), bone mineral density (BMD) and cross-sectional area (CSA) o...
Objective.—To identify the frequency and pattern of spinal injury sustained in mountaineering acc... more Objective.—To identify the frequency and pattern of spinal injury sustained in mountaineering accidents. Methods.—All patients with spinal injuries sustained while mountaineering who were treated at the Queen Elizabeth National Spinal Injuries Unit from 1992 to 2001 were studied. Information was obtained from hospital notes, and each patient completed a questionnaire. Results.—Twenty-one patients with spinal injuries sustained in mountaineering accidents were identified. Fourteen patients (67.7%) were experienced mountaineers. Four (19.0%) were rock climbing, 6 (28.6%) were winter climbing, 6 (28.6%) were hill walking, and 5 (23.8%) were winter walking. Ten patients (47.6%) sustained cervical injuries, 5 (23.8%) sustained thoracic injuries, 5 (23.8%) sustained lumbar injuries, and 1 (4.8%) sustained cervical and lumbar injuries. Nineteen patients (90.5%) sustained fractures, 1 (4.8%) sustained a dislocation, and 1 (4.8%) sustained a fracture dislocation. Seventeen patients (81.0%) w...
PURPOSE The extent to which cardiorespiratory fitness and cycling power can be improved in indivi... more PURPOSE The extent to which cardiorespiratory fitness and cycling power can be improved in individuals with paraplegia by progressive, high-volume, home-based, electrically stimulated (ES) cycle training was investigated using a novel, sensitive method and protocol that allowed high-resolution power output analyses to be performed for the first time in ES cycling. METHODS Nine male and two female individuals with paraplegia trained progressively at home for up to five 60-min sessions x wk(-1) for 12 months. Peak power and cardiorespiratory parameters were estimated during quarterly feedback-controlled incremental work rate tests in the laboratory. RESULTS Cycle training endurance increased from 10 to 60 min of continuous pedaling for all subjects. Peak power output (POpeak) increased by 132% (P = 0.001), peak oxygen uptake (VO2peak) increased by 56% (P < 0.001), and oxygen pulse increased by 34% (P = 0.002). All significant adaptations occurred during the first 6 months of traini...
Large number of chronic Spinal Cord Injured (SCI) patients suffer from Central Neuropathic (CNP) ... more Large number of chronic Spinal Cord Injured (SCI) patients suffer from Central Neuropathic (CNP) pain that modifies both spontaneous EEG and Event related EEG responses. The aim of this paper was to analyze on a group level, using clustering approach, differences in EEG signatures between two Groups: the able-bodied persons and SCI patients with CNP during a motor imagination task. Results of this study showed that compared to the able-bodied, SCI patients with pain have lower ERS/ERD in the central and the centro/parietal areas of the motor cortex, which correspond to the paralyzed part of the body and higher event-related synchronization/desynchronisation (ERS/ERD) in the rest of the cortex, including frontal areas, remaining areas of the sensory-motor cortex and the occipital area. Significant differences in Power Spectral Density (PSD) between two Groups were found in 20-30 Hz range, possibly related to the baseline EEG rather then to the mental task.
Subsequent co-factors such as low blood pressure and muscle atrophy lead to a decrease in cardiop... more Subsequent co-factors such as low blood pressure and muscle atrophy lead to a decrease in cardiopulmonary fitness. It is proposed here that the introduction of an appropriate training program during the early stage of injury may attenuate this loss of fitness. This work examined the cardiopulmonary responses of three motor complete and three motor incomplete spinal cord injured subjects to a number of robotics-assisted stepping exercises. Subjects participated in periods of passive, active and electrically stimulated stepping. Increases in a number of cardiopulmonary parameters were observed with some subjects, in response to these exercises. These results show that those with an incomplete SCI may benefit from this form training during the acute phase of injury.
Clinical neurophysiology : official journal of the International Federation of Clinical Neurophysiology, Sep 1, 2016
One of the brain signatures of the central neuropathic pain (CNP) is the theta band over-activity... more One of the brain signatures of the central neuropathic pain (CNP) is the theta band over-activity of wider cortical structures, during imagination of movement. The objective of the study was to investigate whether this over-activity is reversible following the neurofeedback treatment of CNP. Five paraplegic patients with pain in their legs underwent from twenty to forty neurofeedback sessions that significantly reduced their pain. In order to assess their dynamic cortical activity they were asked to imagine movements of all limbs a week before the first and a week after the last neurofeedback session. Using time-frequency analysis we compared EEG activity during imagination of movement before and after the therapy and further compared it with EEG signals of ten paraplegic patients with no pain and a control group of ten able-bodied people. Neurofeedback treatment resulted in reduced CNP and a wide spread reduction of cortical activity during imagination of movement. The reduction wa...
Spinal Cord Injury caused by stab wounds (SCISW) results from a partial or complete transection o... more Spinal Cord Injury caused by stab wounds (SCISW) results from a partial or complete transection of the cord and presents opportunities for interventional research. It is recognised that there is low incidence but little is known about the natural history or the patient's suitability for long-term clinical outcome studies. This study aims to provide population based evidence of the demographics of SCISW and highlight the issues regarding the potential for future research. The database of the Queen Elizabeth National Spinal Injuries Unit (QENSIU), the sole centre for treating SCI in Scotland, was reviewed between 1994 and 2013 to ascertain the incidence, demographics, functional recovery, and mortality rates for new SCISW. During this 20-year period 35 cases of SCISW were admitted (97.1% male, mean age 30.0 years). 31.4% had a cervical injury, 60.0% thoracic, and 8.6% lumbar. All had neurology with 42.9% motor complete on admission and 77.1% discharged as motor incomplete. 70.4% o...
After spinal cord injury (SCI), bone loss in the paralysed limbs progresses at variable rates. De... more After spinal cord injury (SCI), bone loss in the paralysed limbs progresses at variable rates. Decreases in bone mineral density (BMD) in the first year range from 1% (slow) to 40% (rapid). In chronic SCI, fragility fractures commonly occur around the knee, with significant associated morbidity. Osteoporosis treatments await full evaluation in SCI, but should be initiated early and targeted towards patients exhibiting rapid bone loss. The potential to predict rapid bone loss from a single bone scan within weeks of a SCI was investigated using statistical shape modelling (SSM) of bone morphology, hypothesis: baseline bone shape predicts bone loss at 12-months post-injury at fracture-prone sites. In this retrospective cohort study 25 SCI patients (median age, 33years) were scanned at the distal femur and proximal tibia using peripheral Quantitative Computed Tomography at <5weeks (baseline), 4, 8 and 12months post-injury. An SSM was made for each bone. Links between the baseline sha...
Central neuropathic pain has a prevalence of 40 % in patients with spinal cord injury. Electroenc... more Central neuropathic pain has a prevalence of 40 % in patients with spinal cord injury. Electroencephalography (EEG) studies showed that this type of pain has identifiable signatures, that could potentially be targeted by a neuromodulation therapy. The aim of the study was to investigate the putative mechanism of neurofeedback training on central neuropathic pain and its underlying brain signatures in patients with chronic paraplegia. Patients' EEG activity was modulated from the sensory-motor cortex, electrode location C3/Cz/C4/P4 in up to 40 training sessions Results. Six out of seven patients reported immediate reduction of pain during neurofeedback training. Best results were achieved with suppressing Ɵ and higher β (20-30 Hz) power and reinforcing α power at C4. Four patients reported clinically significant long-term reduction of pain (>30 %) which lasted at least a month beyond the therapy. EEG during neurofeedback revealed a wide spread modulation of power in all three ...
Journal of neurologic physical therapy : JNPT, 2015
Impaired hand function decreases quality of life in persons with tetraplegia. We tested functiona... more Impaired hand function decreases quality of life in persons with tetraplegia. We tested functional electrical stimulation (FES) controlled by a hybrid brain-computer interface (BCI) for improving hand function in participants with tetraplegia. Two participants with subacute tetraplegia (participant 1: C5 Brown-Sequard syndrome, participant 2: complete C5 lesion) took part in this proof-of-concept study. The goal was to determine whether the BCI system could drive the FES device by accurately classifying participants' intent (open or close the hand). Participants 1 and 2 received 10 sessions and 4 sessions of BCI-FES, respectively. A novel time-switch BCI strategy based on motor imagery was used to activate the FES. In one session, we tested a hybrid BCI-FES based on 2 spontaneously generated brain rhythms: a sensory-motor rhythm during motor imagery to activate a stimulator and occipital alpha rhythms to deactivate the stimulator. Participants received BCI-FES therapy 2 to 3 tim...
Strength changes in lower limb muscles following robot assisted gait training (RAGT) in subjects ... more Strength changes in lower limb muscles following robot assisted gait training (RAGT) in subjects with incomplete spinal cord injury (ISCI) has not been quantified using objective outcome measures. To record changes in the force generating capacity of lower limb muscles (recorded as peak voluntary isometric torque at the knee and hip), before, during and after RAGT in both acute and subacute/chronic ISCI subjects using a repeated measures study design. Eighteen subjects with ISCI participated in this study (Age range: 26-63 years mean age = 49.3 ± 11 years). Each subject participated in the study for a total period of eight weeks, including 6 weeks of RAGT using the Lokomat system (Hocoma AG, Switzerland). Peak torques were recorded in hip flexors, extensors, knee flexors and extensors using torque sensors that are incorporated within the Lokomat. All the tested lower limb muscle groups showed statistically significant (p < 0.001) increases in peak torques in the acute subjects. C...
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