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Objective To examine the effect on body composition and bone mineral density of locomotor training using a robotic exoskeleton in individuals with spinal cord injury. Study design Interventional study. Subjects/methods Five adults with a non-progressive traumatic complete sensorimotor spinal cord injury who were using a wheelchair as a primary mode of mobility. Participants performed a personalized 6-week progressive locomotor training programme using a robotic exoskeleton 3 times/week for up to 60 min. Body composition measures were determined using dual energy X-ray absorptiometry and peripheral quantitative computed tomography. Results A significant increase in leg and appendicular lean body mass and a decrease in total, leg and appendicular fat mass was observed after the intervention. Furthermore, the calf muscle cross-sectional area increased significantly after the intervention. Finally, although not statistically significant, there was an increase of 14.5% in bone mineral density of the tibia, which may be clinically significant. A decrease of > 5 % was also noted for subcutaneous adipose tissue and intramuscular adipose tissue. Conclusion Locomotor training using a robotic exoskeleton appears to be associated with improvements in body composition and, potentially, bone health.

To quantify the reaction forces exerted under the hands, feet and buttocks when individuals with spinal cord injury performed sitting pivot transfers.Twelve men with paraplegia completed 3 transfers between seats of the same height (0.5 m high) and 3 transfers to a high target seat (0.6 m high).Greater mean and peak vertical reaction forces were always recorded under the hands compared with the feet (p0.001) during the transfers. Mean vertical reaction forces were similar between the leading and trailing hands (p0.088) for the 2 transfers studied. However, the mean vertical reaction force underneath the leading hand was greater when transferring between a seat of the same height compared with one of a higher height (p=0.021) and vice-versa for the trailing hand (p=0.0001). The peak vertical reaction force always occurred earlier (p0.0001) and was greater underneath the trailing hand compared with the leading one (p0.02), and reached its highest value when transferring to the high target seat (p=0.003). Peak and mean horizontal reaction forces were always higher underneath the trailing hand compared with the leading hand (p0.001).These results provide evidence-based data to better understand transfers and strengthen clinical practice guidelines targeting the preservation of upper extremity integrity.

Objectives: To compare multidirectional seated postural stability between individuals with spinal cord injury and able-bodied individuals and to evaluate the impact of abdominal and low back muscle paralysis on multidirectional seated stability. Design: Case-control study. Participants: Fifteen individuals with complete or incomplete spinal cord injury affecting various vertebral levels participated in this study and were gender-matched with 15 able-bodied individuals. Methods: Participants were instructed to lean as far as possible in 8 directions, set apart by 45° intervals, while seated on an instrumented chair with their feet placed on force plates. Eight direction-specific stability indices and a global stability index were calculated. Results: The global stability index and all direction-specific indices, except in the anterior and posterior directions, were lower in individuals with spinal cord injury than in ablebodied individuals. However, the individuals with spinal cord injury who had partial or full control of their abdominal and lower trunk muscles obtained a similar global stability index and similar direction-specific indices compared to the able-bodied individuals. Conclusion: Multidirectional seated postural stability is reduced in individuals with SCI who have paralysis of the abdominal and lower back muscles in comparison to ablebodied individuals.

OBJECTIVES To determine efficiency and efficacy of publicly-funded inpatient stroke rehabilitation based on a Case-Mix Group Classification Model, and to analyse the usefulness of this decisional aid in the refinement of rehabilitation services delivery needed to optimize accessibility to inpatient rehabilitation services for individuals with stroke in a publicly-funded healthcare system. DESIGN Individuals with stroke (n=422) who received inpatient rehabilitation through the Montreal Rehabilitation Hospital Network were included in this retrospective study. Clinical (total, motor and cognitive-Functional Independence Measure (FIM) scores, percentage of discharge to community) and administrative outcomes (onset to rehabilitation interval, length of inpatient rehabilitation stay, length of stay efficiency) were measured. RESULTS Across Case-Mix Groups, mean onset to rehabilitation days varied between 16.2 (5.7) and 32.0 (19.4) days whereas the mean length of stay fluctuated between 27.5 (13) and 77.0 (27) days. Best total (41.6 (21.4)) and motor-FIM (38.9 (19.0)) gains were observed in most severely disabled cases (114) whereas the Case-Mix Group 103 presented the best cognitive-FIM gain (5.8 (4.0)). Optimal mean total, motor and cognitive-FIM efficiency rates, found in moderately disabled stroke patients, were 0.668 (0.434), 0.634 (0.377) and 0.15 (0.136), respectively. Majority of patients returned home following rehabilitation in all Case-Mix Groups (63.6% to 96.4%) except for groups 112 and 108. CONCLUSION Moderate to good length of stay efficiencies are observed among all Case-Mix Group following stroke rehabilitation. In fact, individuals with moderate disability present the best rate of recovery. Variations in length of stay efficiency suggest that the use of a Case-Mix Group Classification Model in stroke rehabilitation could represent an innovative approach, especially for program evaluation in publicly-funded and universal-access rehabilitation hospitals.