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This is a retrospective longitudinal study.The Standing and Walking Assessment Tool (SWAT) combines stages of standing and walking recovery (SWAT stages) with established measures (Berg Balance Scale (BBS), 10-m walk test (10MWT), 6-min walk test (6MWT), and modified Timed Up-and-Go (mTUG)). We evaluated the SWAT's validity (known-groups and convergent) and responsiveness among inpatients with sub-acute, traumatic spinal cord injury (SCI).Ten Canadian rehabilitation hospitals.Upon admission, SWAT stage and core measures (BBS, 10MWT, 6MWT, and mTUG), International Standards for Neurological Classification of SCI sensory and motor scores, and Spinal Cord Independence Measure III (SCIM) were collected from 618 adults with SCI. Known-groups validity was evaluated by comparing SWAT stage distributions across American Spinal Injury Association Impairment Scale (AIS) classification. Convergent validity was evaluated by correlating SWAT stages with scores on other measures using Spearman's rho. The SWAT (stage and core measures) was re-administered at discharge. To evaluate responsiveness, SWAT stages at admission and discharge were compared. The standardized response mean (SRM) was used to evaluate the responsiveness of core SWAT measures.The SWAT stage distribution of participants with AIS D injuries differed from those of participants with AIS A-C injuries (p ≤ 0.002). SWAT stages correlated strongly with BBS and motor scores (ρ = 0.778-0.836), and moderately with SCIM, mTUG, 10MWT, 6MWT, and sensory scores (ρ = 0.409-0.692). Discharge SWAT stage was greater than the admission stage (p 0.0001). The BBS was the most responsive core SWAT measure (SRM = 1.26).The SWAT is a valid and responsive approach to the measurement of standing and walking ability during sub-acute SCI.

Study Design This is a focused review article. Objectives To identify important concepts in lower extremity (LE) assessment with a focus on locomotor outcomes and provide guidance on how existing outcome measurement tools may be best used to assess experimental therapies in spinal cord injury (SCI). The emphasis lies on LE outcomes in individuals with complete and incomplete SCI in Phase II-III trials. Methods This review includes a summary of topics discussed during a workshop focusing on LE function in SCI, conceptual discussion of corresponding outcome measures and additional focused literature review. Results There are a number of sensitive, accurate, and responsive outcome tools measuring both quantitative and qualitative aspects of LE function. However, in trials with individuals with very acute injuries, a baseline assessment of the primary (or secondary) LE outcome measure is often not feasible. Conclusion There is no single outcome measure to assess all individuals with SCI that can be used to monitor changes in LE function regardless of severity and level of injury. Surrogate markers have to be used to assess LE function in individuals with severe SCI. However, it is generally agreed that a direct measurement of the performance for an appropriate functional activity supersedes any surrogate marker. LE assessments have to be refined so they can be used across all time points after SCI, regardless of the level or severity of spinal injury. Sponsors Craig H. Neilsen Foundation, Spinal Cord Outcomes Partnership Endeavor.

Study design: Repeated cross-sectional study. Objectives: To compare the effects of rolling resistances (RRs) on handrim kinetic intensity at the non-dominant upper limb and on handrim kinetic symmetry during wheelies performed by manual wheelchair users (MWUs) with spinal cord injury (SCI). Setting: Pathokinesiology Laboratory. Methods: Sixteen individuals with SCI who were able to perform wheelies participated in this study. During a laboratory assessment, participants randomly performed wheelies on four RRs: natural high-grade composite board, 5-cm thick soft foam, 5-cm thick memory foam, and with the rear wheels blocked by wooden blocks. Four trials were conducted for each of the RRs. Participant’s wheelchair was equipped with instrumented wheels to record handrim kinetics, whereas the movements of the wheelchair were recorded with a motion analysis system. Results: The net mean and peak total forces, including its tangential and mediolateral components, were greater during take-off compared with the other phases of the wheelie, independently of RR. During take-off, the greatest net mean and peak total and tangential forces were reached with the wheels blocked. Symmetrical tangential and mediolateral force intensities were applied at the dominant and non-dominant handrims. Conclusion: Wheelies performed on low or moderate density foam generate similar forces at the handrim than on a natural surface and significantly less forces than with the wheels blocked. Hence, when teaching individuals with an SCI to perform a stationary wheelie, the use of low or moderate density foam represents a valuable alternative for minimizing upper limb effort and may also optimize quasi-static postural steadiness. Spinal Cord (2013) 51, 245–251; doi:10.1038/sc.2012.140; published online 27 November 2012

Cross-sectional study.To evaluate isokinetic shoulder flexor-extensor (F/E) and abductor-adductor (Ab/Ad) torque ratios in individuals with paraplegia using a new interpretative approach. We proposed to study torque ratios according to joint angle sections (15 degrees angle subgroups) over a selected range of motion.Pathokinesiology Laboratory, Montreal, Canada.Sixteen individuals with complete motor paraplegia, without shoulder pain or impairment, were included in this study. After a preloading period of 1 s, maximum isokinetic concentric contractions of all muscle groups were completed at 30, 60 and 120 degrees s(-1) over the entire tested ranges of motion (70 to -35 degrees for the flexion-extension and 15 to 60 degrees for the abduction-adduction). After the continuous torque curves were rebuilt, the mean F/E and Ab/Ad torque ratios were calculated and analyzed every 15 degrees.A significant modification of the F/E (F=66.3; P0.001) and Ab/Ad (F=100.6; P0.001) torque ratios was observed according to the 15 degrees angle subgroup evaluated. More precisely, a progressive decline of both the F/E and Ab/Ad ratios was noted as the shoulder flexion or abduction progressed. Angular velocity did not have any influence on torque ratio values.Angle subgroup torque ratio analysis leads to a better estimation of the balance between the agonist and antagonist muscle groups than does traditional peak torque ratio analysis. In individuals with paraplegia, this precise estimation of torque ratios may lead to the development of specific shoulder strengthening programs to prevent muscle imbalance and its consequences.

Three-dimensional kinematic analysis and surface electromyography (EMG) of 10 male adults with complete spinal cord injury (C7 to L2). To examine movement patterns and muscular demands in individuals with spinal cord injury (SCI) during posterior transfers. Pathokinesiology Laboratory at a Rehabilitation Centre, Montreal, Canada. Kinematic variables that described the positions and angular displacements of the head, trunk, shoulder and elbow were obtained by videotaping markers placed on the subject segments. EMG data were recorded for the biceps, triceps, anterior deltoid, pectoralis major, latissimus dorsi and trapezius muscles of the dominant upper extremity during posterior transfers using surface electrodes. To quantify the muscular demand, the EMG data recorded during the transfers were normalized to values obtained during maximal static contractions (EMGmax). The mean muscular demand was calculated for every muscle during the lift phase of the transfers. The lift phase was determined by pressure-sensitive contacts. All subjects were able to execute the posterior transfers on an even surface, whereas nine subjects completed at least one of the transfers to the elevated surface. A forward-flexion pattern at the head and trunk was observed when either one or two hands remained on the lower surface, whereas a lift strategy was seen when both hands were placed on the elevated surface. Transferring to the elevated surface with hands on the lower surface required inferior electromyographic muscular utilization ratio (EMUR) than the transfer on the even surface for all muscles. The lowest EMUR were calculated for the transfer to the elevated surface with hands on the lower surface (triceps (18%), pectoralis major (53.8%), trapezius (66%) and latissimus dorsi (24.5%)) while performing the same transfer with hands on the elevated surface generated the highest EMUR (triceps (40.2%), anterior deltoid (73.2%), trapezius (83.6%) and latissimus dorsi (55.3%)). Subjects presented different movement characteristics and muscular demands during the posterior transfers. It is suggested that the forward-flexion pattern improves the dynamic trunk stability and reduces the muscular demand required to transfer. High muscular demand developed when hands were positioned on the elevated surface might be due to increased postural control demands on the upper limb and reduced angular momentum.