We are grateful for the assistance from Martina Lienert and Fabienne Schaufelberger during exercise testing, as well as from P. D. Claudio Perret, PhD for his scientific advice.

The study was approved by the local ethical committee (Ethikkommission Nordwest- und Zentralschweiz, Basel, Switzerland), and written informed consent was obtained from the participants before starting the study.
1. Test Preparation and Participant Instruction
<ol>
	<li>Arm crank ergometer
	<ol>
		<li>Turn the power on the rotation speed-dependent arm crank ergometer before opening the software.</li>
		<li>Choose the test protocol for the 3 min, all-out ergometer test.
		<ol>
			<li>Insert a new protocol with a 120 s warmup, 180 s of test duration, and a 720 s cooldown period. Choose this test protocol and open a new participant sheet.</li>
		</ol>
		</li>
		<li>For every new test, determine the participant&#39;s body mass beforehand.</li>
		<li>Set the relative torque factor to 0.2 for able-bodied and paraplegic individuals (e.g., for a 100-kg participant with a relative torque factor of 0.2, a torque of 20 Nm results)12.
		<ol>
			<li>Apply a lower torque factor for tetraplegic participants depending on the lesion level of the spinal cord injury; two or more familiarization trials are needed to determine the optimal relative torque factor for the relevant participant.</li>
			<li>Perform a familiarization trial in the same manner as described in section 2. If no peak appears after printing the data from the familiarization trial, or if the participant was not able to crank for the whole 3 min, perform a second familiarization trial with a lower torque factor. Give participants a rest of at least two days between each trial.</li>
		</ol>
		</li>
	</ol>
	</li>
	<li>Exercise test settings
	<ol>
		<li>Adjust the height of the arm crank and record it to replicate identical test settings in the next test session. Adjust and record the distance between the arm crank ergometer and the participant.
		<ol>
			<li>To determine the height, measure the distance between the floor and the fixation of the crank. To record the distance between the crank and the participant, measure and record the distance between the wall and the chair fixation. Adjust the arm crank axis to a height horizontal to the shoulder joint.</li>
		</ol>
		</li>
		<li>Record either the distance between the wall fixation and the chair or the distance between the ergometer and the chair fixation. Adjust the chair settings according to whether the participant is a) able-bodied, b) paraplegic ,or c) tetraplegic.
		<ol>
			<li>If the participant is able-bodied, have the participant sit in the chair provided by the distributor.</li>
			<li>If the participant is paraplegic and needs to sit in their own wheelchair, use a fixation set to fix the wheelchair to the arm crank ergometer. If the participant does not need their own wheelchair, have the participant sit in the chair provided by the distributor.</li>
			<li>If the participant is tetraplegic, fix their upper body to the chair provided by the distributor or to their own wheelchair and possibly fix their hands to the pedals. To fix the upper body, use a strap with hook-and-loop fastener. For hand fixation, use a wristband in tetraplegic patients.</li>
		</ol>
		</li>
	</ol>
	</li>
	<li>Additional measurements
	<ol>
		<li>Make sure that the lactate system solution is refilled before using the lactate analyzer. Insert a new chip sensor every six months. Use the quality control solution (12 mM) every day and the 3 mM quality control solution every two weeks.
		<ol>
			<li>Put the 12 mM quality control solution into the &#34;STD 1&#34; slot every morning.</li>
			<li>To further enhance the quality, add 3 mM quality control solutions into gap &#34;1&#34; and &#34;2&#34; and run a measurement by pressing &#34;start&#34; every two weeks. The measurement should result in a range between 2.96 and 3.10 mM.</li>
		</ol>
		</li>
		<li>To determine the whole-blood lactate concentration before and after the 3 min, all-out arm crank ergometer test, obtain a baseline lactate concentration. Disinfect the earlobe with a disinfectant before drawing a blood sample from the earlobe using a 10 &#181;L capillary. Use a lancet to get the whole blood sample.
		<ol>
			<li>When the capillary is completely full of blood, put it into the hemolysis cup. 
			NOTE: These cups are commercially available and prefilled with a hemolyzing solution. Shake the solution until the blood is completely mixed before putting it into the tray of the lactate analyzer.</li>
			<li>Run a calibration before analyzing the lactate concentration. Place the quality control cup into the lactate analyzer (see step 1.3.1.1.). Ensure that the calibration results in a 12-mM lactate concentration; otherwise, replace the chip sensor.</li>
			<li>Place the samples into the numbered slots, starting with &#34;1&#34; for the sample that was taken first. 
			NOTE: After the calibration is completed, the samples are measured automatically by the chip sensor system.</li>
		</ol>
		</li>
		<li>To determine the heartrate, place a heartrate belt around the chest of the participant and fix the heartrate monitor to the arm crank ergometer. Start the measurement by pressing on the red start button on the monitor. If no heartrate is displayed on the watch, wet the heartrate belt with water to ensure a good recording of the heartrate.</li>
		<li>To determine oxygen consumption during warmup and during the 3 min all-out test, calibrate the metabolic cart before the test. Run automatic volume and gas calibration immediately before the test and before putting the mask on.
		<ol>
			<li>Open the automatic volume calibration in the software and press the start button. Store the results if the error is below 3% on the screen.</li>
			<li>Open the gas calibration in the software, as well as the calibration gas, and start with the automatic calibration. 
			NOTE: The calibration gas consists of 5% CO2, 16% O2, and 79% N2. When 8 green buttons are displayed on the screen at the end of the calibration, the calibration is successful and the results can be stored. Close the gas bottle to ensure no leakage of gas.</li>
			<li>Ensure that the participant&#39;s actual body mass is inserted into the computer program. After the participant is chosen by the search engine on the computer, choose &#34;ergospirometry&#34; in the software and start with the measurement of room air concentration by pressing the start button.</li>
			<li>To run this calibration, take the sensor out of the spirometer and press the start button. Calibration is finished when &#34;ok&#34; is displayed on the computer.</li>
			<li>Meanwhile, during the calibration, put the oxygen mask on the participant.</li>
			<li>When the measurement of room air concentration is finished and the program is ready to measure, put the sensor back into the spirometer. Then, put the whole spirometer into the cavity of the mask; the device is now ready to measure oxygen consumption.</li>
			<li>In addition, fix the hose of the spirometer somewhere (e.g., on the shoulder with an adhesive tape) so that it does not interfere during the arm crank exercise.</li>
		</ol>
		</li>
	</ol>
	</li>
</ol>
2. Execution of the Exercise Protocol
<ol>
	<li>Warmup
	<ol>
		<li>1 min before starting the warmup, start measuring the oxygen consumption at rest when the participant sits at the arm crank ergometer without moving or talking. Press the start button in the software program.</li>
		<li>At the same time, start the measurement of the heartrate by pressing the red button. Measure the heartrate during the warmup, as well as during and after the test.</li>
		<li>Perform a standardized warmup over 2 min at 20 W before the start of the test. During the last 30 s of the warmup, keep the cadence constant at 60 rpm. Count down the last 10 s of the 30-s warmup.</li>
	</ol>
	</li>
	<li>3 min all-out exercise test
	<ol>
		<li>At the end of the countdown, make sure to give a clear starting signal by shouting &#34;go.&#34; After the start signal is given, allow the participant to accelerate.</li>
		<li>Instruct the participant to accelerate the arm crank ergometer to the maximum possible speed right at the beginning of the test. Keep the cadence at the maximum possible speed during the whole test. For standardization reasons, do not encourage the participants during the tests.</li>
		<li>Give information on duration every 30 s. Finish the test after a duration of 3 min.</li>
	</ol>
	</li>
	<li>Cooldown and post analysis
	<ol>
		<li>After finishing the 3 min all-out test, measure the end lactate concentration, if desired, and thereafter every 2 min for the next 10 min. Re-use the same puncture site for blood sampling as was used before the test.</li>
		<li>Stop the measurement of oxygen consumption after finishing these 3 min by pressing the stop button. Remove the oxygen mask. Save the measurement of oxygen consumption on the computer by pressing the exit button and by clicking &#34;yes&#34; when the software asks for data storage. 
		NOTE: The data is stored in the software program and can easily be converted to a csv document later.</li>
		<li>To export the data, press the &#34;Export&#34; button to convert the file to a csv document for later analysis. Stop the heartrate measurement by pressing the stop button on the left side of the heartrate monitor after all blood samples have been drawn from the earlobe.</li>
	</ol>
	</li>
</ol>
3. Data Analysis and Interpretation of the Results
<ol>
	<li>Performance parameters
	<ol>
		<li>Analyze several different parameters after finishing this performance test. 
		First, save the test and export it to a spreadsheet.</li>
		<li>Calculate the mean power (Pmean = <img alt="Equation" src="/files/ftp_upload/55485/55485eq1.jpg" /><img alt="Equation" src="/files/ftp_upload/55485/55485eq2.jpg" /> over 3 min, the peak power, and the minimal power in between these 3-min12. 
		NOTE: the peak power (Ppeak) is the maximal power during the whole 3 min. The power is measured in 0.2-s intervals. The peak power is the highest and the minimal power (Pmin) the lowest single-power measurement.</li>
		<li>Calculate the fatigue index as the power decline per second from the peak power to the end power ((Ppeak [W] &#8211; Pmin [W])/(tmin [s] &#8211; tpeak [s])).</li>
		<li>Calculate the total work over the whole 3 min by adding the work done every second (Work [J]= resistance [kg] * revolutions per min * flywheel distance [m] * time [min]).</li>
		<li>Calculate the time from the start to the peak power (time to peak power = tpeak [s]). Furthermore, calculate the relative peak (relative Ppeak = Ppeak/kg body mass) and the mean power (relative Pmean = Pmean/kg body mass) by dividing the absolute values by the body mass of the participant.</li>
		<li>Divide the 3-min all-out test into 30-s segments to check the pacing strategy and fatigue over these 3 min. Calculate the mean power for every 30-s segment (Pmean = <img alt="Equation" src="/files/ftp_upload/55485/55485eq3.jpg" /><img alt="Equation" src="/files/ftp_upload/55485/55485eq4.jpg" />.</li>
	</ol>
	</li>
	<li>Other measurements
	<ol>
		<li>Place all blood samples into the numbered slots of the blood lactate analyzer and run the measurements automatically by pressing &#34;analyze.&#34; Print blood lactate concentrations for later analysis by turning on the printer.</li>
		<li>Transmit the heartrate measurements to the computer using an infrared device from the manufacturer. Open the software of the heartrate monitor and import the data from the heartrate monitor to the software. Store the data locally and, if desired, export it to a spreadsheet for later analysis (e.g., segment analysis)13.</li>
		<li>Set a marker right at the beginning of the 3 min and at the end of the 3 min, allowing the average, maximal, and minimal heartrate to be calculated automatically for this segment. 
		NOTE: The heartrate is averaged automatically by the software over 5 s intervals.</li>
		<li>Export the data for oxygen consumption to a csv file (step 2.3) and open it in a spreadsheet for analysis14. Calculate the average oxygen consumption at rest: (VO2_rest = <img alt="Equation" src="/files/ftp_upload/55485/55485eq5.jpg" /><img alt="Equation" src="/files/ftp_upload/55485/55485eq6.jpg" /> and during the 3 min (VO2_180s = <img alt="Equation" src="/files/ftp_upload/55485/55485eq1.jpg" /><img alt="Equation" src="/files/ftp_upload/55485/55485eq7.jpg" />, as well as the peak oxygen consumption and oxygen consumption during the 30-s segments: (VO2_30s = <img alt="Equation" src="/files/ftp_upload/55485/55485eq3.jpg" /><img alt="Equation" src="/files/ftp_upload/55485/55485eq8.jpg" />. 
		NOTE: The data for oxygen consumption are measured breath-by-breath and then averaged automatically over a duration of 15 s per segment. The peak oxygen consumption is the highest value over a 15-s interval during the 3-min exercise test.</li>
	</ol>
	</li>
	<li>Statistics
	<ol>
		<li>Use the Shapiro-Wilk test, the Q-Q-plot, and the Kolmogorov Smirnov tests to check the normal distribution of the data. If the data is normally distributed, present it as the mean and the standard deviation (SD).</li>
		<li>Analyze the test-retest reliability using the intra-class correlation coefficient (ICC; 3,1 model)15.</li>
		<li>Calculate the absolute and relative reliability using the standard error of the measurement (SEM), coefficient of variation (CV), smallest real difference (SRD), and 95% confidence interval of the ICC16. 
		NOTE: The ICC should be interpreted according to Munro`s classification17: 0.26 to 0.49 reflects a low correlation; 0.50 to 0.69 reflects a moderate correlation; 0.70 to 0.89 reflects a high correlation; and 0.90 to 1.0 indicates a very high correlation. The absolute reliability should be presented as the SRD, CV, and SEM, and the relative reliability should be in the form of the ICC16,18.</li>
		<li>Analyze significant changes between the two test sessions using a paired t-test. To show the agreement of the data sets of both test sessions, use Bland-Altman19 plots. Use statistical software to perform data analysis; set a statistical significance level of 0.05 throughout.</li>
	</ol>
	</li>
</ol>

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The authors have nothing to disclose.

Exercise testing in spinal-cord injured athletes is crucial to tracking exercise performance over several months or years of training. Only a few exercise tests exist to check short-term, high-intensity exercise performance on the arm crank ergometer. This method describes in detail how an exercise test that was already examined for its reliability in cycling5 and rowing7 might be applied to the arm crank ergometer. To collect reliable and meaningful results, two factors are very important: first, the preparation of the participant for this exercise test and second, the standardization of the test. Thus, the participant is instructed to enter the lab in a rested state, meaning no intense training during the two days prior to the test. Food intake (e.g., carbohydrate-rich nutrition 24 h prior testing) and sleep (e.g., at least 7 h of sleep during the two nights prior to testing) also need to be taken into account. Additionally, before performing the first &#34;real&#34; exercise test, a familiarization trial should be performed to ensure that the participant understands the test protocol. The second condition concerns the standardization of the test protocol, which includes the warmup, the start of the test, and the fixation strategies for the wheelchair and hands (step 1.2). These settings need to be kept identical for each test with the same person. Also, the height of the crank may influence the power output and oxygen consumption20. Additionally, the handgrip position might be clinically relevant in terms of shoulder pain following the exercise21. Furthermore, abdominal binding might influence respiratory function and oxygen transport22, but it seems to augment trunk stability and exercise performance23. Thus, it is best to record adjustments and fixations in detail to reproduce equivalent conditions in the following test.
The results in Figures 1 and 2 indicated that this 3 min, all-out arm crank test is reliable in able-bodied participants and can be used for research or exercise testing12. When comparing able-bodied, paraplegic, and tetraplegic participants with each other, differences between these three groups were found. Able-bodied and paraplegic participants showed very similar results for maximal and mean power, whereas tetraplegic participants performed with a significantly lower power output. Similar findings were shown when comparing the 30 s Wingate test for paraplegic participants11 with the one for tetraplegic participants10. Due to the different lesion levels of these spinal-cord injured participants, various muscles are affected by the impairment. Thus, with a higher lesion level (e.g., in tetraplegic participants), a less active muscle mass results in a lower power output (Table 2). To diminish the variability of the lesion, only individuals with a lesion level between cervical 5 (C5) and 7 (C7) and with a motor and sensory complete spinal cord injury were included to represent tetraplegic participants. Nevertheless, even between such participants, a high inter-individual variability can occur. Individuals with an injury below C5 only have Musculus (M.) biceps activated in the arms, whereas individuals with an injury below C7 show activity in M. biceps brachii, M. extensor radialis, and M. triceps arm muscles24. Therefore, even with very narrow inclusion criteria like the ones mentioned here, the group of participants was very inhomogeneous in terms of muscle function. Concerning paraplegic and able-bodied participants, one would expect a higher power output in able-bodied participants due to full trunk stability and unaffected respiratory muscle function. Our results did not show any significant differences in power output between these two groups, although able-bodied participants performed slightly better. This may have been because our able-bodied study participants were less trained compared to the paraplegic participants. It is possible that, even with lower trunk stability and lower respiratory function, the paraplegic participants were more adapted to arm cranking, which might have compensated for their disadvantages.
Even though this test protocol seems to be reliable in able-bodied individuals, test-retest reliability might be limited in tetraplegic individuals. The power output in tetraplegic participants showed a very high inter-individual variability, which might be explained by differences in muscle function and power (e.g., active muscle dependent on lesion level). Nevertheless, Jacobs, Johnson, Somarriba, and Carter showed a very high reliability in the shorter version of this test (30 s Wingate test) in tetraplegic athletes10. We assumed that the reliability might be good enough over a longer duration (i.e., 3 min in this protocol) but did not test it. The lack of a test-retest reliability investigation in individuals with a tetraplegia is a limitation. Thus, before using this test protocol in a group of individuals with tetraplegia, we recommend checking the reliability of the protocol first. Another limitation of the study involves the standardization of the fixation strategies in participants with a very low core stability (e.g., individuals with a high lesion level, such as in tetraplegia). To fix them to the chair, a strap must be bound around the chair and the participant. Thus, it can be be difficult to record the height of the strap and how tightly it was pulled. In a future study, it would be beneficial to test whether the tightness of such a strap influences the power output in the test protocol.
Nevertheless, this test is a good tool to test athletes from different sport disciplines involving upper-body exercise. Additionally, as the pacing strategy of going all-out right at the beginning of the test is predefined, no individual pacing strategy is present.
To conclude, this test seems to be a reliable tool to test exercise performance over a duration of 3 min and is similar to short-term, high-intensity exercise performance. A familiarization trial is needed before its application in athletes or in research investigations in order to minimize learning effects from test 1 to test 2. In addition, further research is needed to check test-retest reliability in participants or athletes with a tetraplegia.

There are several exercise tests that accurately determine the increase in exercise performance in elite athletes over the course of a training period1,2,3,4,5. One of these tests is the reliable 3-min all-out exercise test on a braked cycling ergometer3,4,5,6. This test was used to determine critical power, but it was also applied to exercise testing with athletes, as well as to research7,8,9. As this test was mainly used for lower-extremity performance, such as in rowing7 and cycling3,5, a similar testing protocol for upper-body exercise was needed. Sport disciplines that mainly use the upper body might be possible beneficiaries for such a new test protocol, in addition to athletes or individuals with an impairment of lower body muscles (e.g., an amputation or an impairment of limbs due to a spinal cord injury). Hence, a test protocol on the arm crank ergometer is a good tool to easily test upper-body exercise performance in a variety of athletes from different sport disciplines.
The existence of a very similar 30 s Wingate arm crank ergometer test10,11 helped with the development of a protocol for a 3 min, all-out arm crank ergometer test. Its duration is very similar to that of a 1,500 m wheelchair race. Therefore, this new test protocol of the 3 min, all-out arm crank ergometer test was tested for its test-retest reliability12. Overall, the reliability of this test protocol was excellent, so it could be a future testing tool in the field of upper-body exercise testing. Nevertheless, the use of this exercise test requires attention, especially when testing individuals with a spinal cord injury. Therefore, the aim of this experimental article is to demonstrate a detailed protocol that describes not only the test settings and analysis of the test results, but that also indicates the differences between testing able-bodied individuals and athletes with a spinal cord injury.

<table><tbody><tr><td>Angio V2 arm crank ergometer</td><td>Lode BV, Groningen, NL</td><td>N/A</td><td>arm crank ergometer</td></tr><tr><td>Lode Ergometry Manager Software</td><td>Lode BV, Groningen, NL</td><td>N/A</td><td>Software</td></tr><tr><td>10 &amp;micro;l end-to-end capillary</td><td>EKF-diagnostics GmbH, Barleben, Germany</td><td>0209-0100-005</td><td>Capillaries</td></tr><tr><td>haemolysis cup</td><td>EKF-diagnostics GmbH, Barleben, Germany</td><td>0209-0100-006</td><td>hemolysis cup</td></tr><tr><td>lactate analyzer</td><td>Biosen C line, EKF-diagnostics GmbH</td><td>5213-0051-6200</td><td>lactate analyzer</td></tr><tr><td>Heart rate monitor, Polar 610i</td><td>Polar, Kempele, Finland</td><td>P610i</td><td>heart rate monitor</td></tr><tr><td>metabolic cart, Oxygen Pro</td><td>Jaeger GmbH</td><td>N/A</td><td>metabolic cart</td></tr><tr><td>oxygen mask, Hans Rudolph</td><td>Hans Rudolph Inc. , USA</td><td>113814</td><td>oxygen mask</td></tr><tr><td>statistical software, PSAW Software</td><td>SPSS Inc., Chicago USA</td><td>N/A</td><td>statistical software</td></tr><tr><td>desinfectant, Soft-Zellin</td><td>Hartmann GmbH, Austria</td><td>999979</td><td>desinfectant</td></tr><tr><td>Quality control cup, EasyCon Norm</td><td>EKF-diagnostics GmbH, Barleben, Germany</td><td>0201-005.012P6</td><td>quality control</td></tr><tr><td>Quality control cup 3mmol/L</td><td>EKF-diagnostics GmbH, Barleben, Germany</td><td>5130-6152</td><td>control cup</td></tr><tr><td>Chip sensor lactate analyzer</td><td>EKF-diagnostics GmbH, Barleben, Germany</td><td>5206-3029</td><td>chip sensor</td></tr><tr><td>Lactate system solution</td><td>EKF-diagnostics GmbH, Barleben, Germany</td><td>0201-0002-025</td><td>lactate system solution</td></tr><tr><td>lancet, Mediware Blutlanzetten</td><td>medilab</td><td>54041</td><td>lancet</td></tr><tr><td>Calibration gas,&amp;nbsp;</td><td>Jaeger GmbH</td><td>36-MC G020</td><td>calibration gas</td></tr><tr><td>chair provided by distributor (ergoselect)</td><td>ergoline GmbH, Germany</td><td>N/A</td><td>chair provided by distributor</td></tr></tbody></table>

experimental protocol of a three-minute, all-out arm crank exercise test in spinal-cord injured and able-bodied individuals

Reliable exercise protocols are required to test changes in exercise performance in elite athletes. Performance improvements in these athletes may be small; therefore, sensitive tools are fundamental to exercise physiology. There are currently many exercise tests that allow for the examination of exercise capacity in able-bodied athletes, with protocols mainly for lower-body or whole-body exercise. There is a trend to test athletes in a sport-specific setting that closely resembles the actions that the participants are used to performing. Only a few protocols test short-term, high-intensity exercise capacity in participants with an impairment of the lower body. Most of these protocols are very sport-specific and are not applicable to a wide range of athletes. One well-known test protocol is the 30 s Wingate test, which is well-established in cycling and in arm crank exercise testing. This test analyzes high-intensity exercise performance over a 30 s time duration. In order to monitor exercise performance over a longer duration, a different method was modified for application to the upper body. The 3 min, all-out arm crank ergometer test allows athletes to be tested in a manner specific to 1,500 m wheelchair racing (in terms of exercise duration), as well as to upper body exercises such as rowing or hand-cycling. In order to increase the reliability with identical test conditions, it is crucial to precisely replicate settings such as the resistance (i.e., torque factor) and the position of the participants (i.e., the height of the crank, the distance between the crank and the participant, and the fixation of the participant). Another important issue concerns the beginning of the exercise test. Fixed revolutions per minute are required to standardize the test conditions for the start of the exercise test. This exercise protocol shows the importance of accurate operations to reproduce identical test conditions and settings.

The test-retest reliability was checked in 21 recreationally trained (but not specifically upper-body trained), non-smoking individuals (9 males, 12 females; age: 34 &#177; 11 years; body mass: 69.6 &#177; 11.1 kg; and height: 175.5 &#177; 6.9 cm). Table 1 shows the results for the relative and absolute test-retest reliabilities12. The peak power compared between the test and retest is presented in Figure 112. A Bland Altman plot for this test-retest is presented in Figure 212. Afterwards, this 3-min, all-out arm crank ergometer test was used in 17 able-bodied (age: 38 &#177; 7 years, height: 183 &#177; 13 cm, and body mass: 79 &#177; 6 kg), 10 paraplegic, and 7 tetraplegic participants (Table 2). Individual data representing an able-bodied as well as a tetraplegic participant are presented in Figure 3. Able-bodied participants showed a peak power of 483 &#177; 94 W, whereas paraplegic and tetraplegic participants were found to have a peak power of 375 &#177; 101 W and 98 &#177; 49 W, respectively. The mean power was found to be 172 &#177; 20 W, 157 &#177; 28 W, and 40 &#177; 14 W for able-bodied, paraplegic, and tetraplegic participants, respectively. Significant differences in mean and peak power were found between able-bodied and tetraplegic participants (p &#60; 0.001), as well as between paraplegic and tetraplegic participants (p &#60; 0.001). The end lactate concentration was 8.9 &#177; 2.4 mM in able-bodied participants, 10.6 &#177; 2.9 mM in paraplegic participants, and 4.0 &#177; 0.8 mM in tetraplegic participants. The average heartrate during the 3-min all-out test was 155 &#177; 9.2 bpm in able-bodied, 163 &#177; 6.2 bpm in paraplegic, and 113 &#177; 15.9 bpm in tetraplegic participants. Again, the heartrate of tetraplegic participants was significantly lower compared to paraplegic (p &#60;0.001) as well as to able-bodied participants (p &#60;0.001). The oxygen consumption measured during a 3-min all-out test is presented in Figure 4.
<img alt="Figure 1" src="/files/ftp_upload/55485/55485fig1.jpg" /> 
Figure 1: Mean power compared between the two 3-min all-out exercise tests on an arm crank ergometer12. The solid line represents the best fit and the dashed line the line of identity. <a href="https://cloudflare-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/55485/55485fig1large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
<img alt="Figure 2" src="/files/ftp_upload/55485/55485fig2.jpg" /> 
Figure 2: Bland-Altman plot for peak power12. SD = standard deviation. <a href="https://cloudflare-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/55485/55485fig2large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
<img alt="Figure 3" src="/files/ftp_upload/55485/55485fig3.jpg" /> 
Figure 3: Individual data of the 3-min all-out arm crank ergometer test for an able-bodied as well as a tetraplegic participant. Left = able-bodied participant; right = tetraplegic participant; blue line = power output; green line = cadence. <a href="https://cloudflare-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/55485/55485fig3large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
<img alt="Figure 4" src="/files/ftp_upload/55485/55485fig4.jpg" /> 
Figure 4: Oxygen consumption during a 3 min all-out arm crank ergometer test in an able-bodied participant. Time point zero represents the start of the 3 min test. The data are presented as the raw data measured breath-by-breath.
<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td></td>
			<td>ICC</td>
			<td>95% CI</td>
			<td>SEM %</td>
			<td>SRD %</td>
			<td>CV</td>
		</tr>
		<tr>
			<td>Peak power [W]</td>
			<td>0.961</td>
			<td>[0.907; 0.984]</td>
			<td>2</td>
			<td>5.6</td>
			<td>6.66</td>
		</tr>
		<tr>
			<td>Mean power [W]</td>
			<td>0.984</td>
			<td>[0.960; 0.993]</td>
			<td>0.6</td>
			<td>1.6</td>
			<td>3.13</td>
		</tr>
		<tr>
			<td>Minimal power [W]</td>
			<td>0.964</td>
			<td>[0.914; 0.985]</td>
			<td>1.4</td>
			<td>4</td>
			<td>6.05</td>
		</tr>
		<tr>
			<td>Time to peak [s]</td>
			<td>0.379</td>
			<td>[-0.052; 0.691]</td>
			<td>22.5</td>
			<td>62.4</td>
			<td>11.37</td>
		</tr>
		<tr>
			<td>Fatigue index&#160;</td>
			<td>0.940</td>
			<td>[0.858; 0.975]</td>
			<td>3.6</td>
			<td>9.9</td>
			<td>9.43</td>
		</tr>
		<tr>
			<td>Rel. peak power [W/kg]</td>
			<td>0.922</td>
			<td>[0.818; 0.968]</td>
			<td>2.8</td>
			<td>7.8</td>
			<td>6.45</td>
		</tr>
		<tr>
			<td>Rel. mean power [W/kg]</td>
			<td>0.950</td>
			<td>[0.882; 0.979]</td>
			<td>1.1</td>
			<td>3.2</td>
			<td>3.46</td>
		</tr>
		<tr>
			<td>Total work [J]</td>
			<td>0.984</td>
			<td>[0.960; 0.993]</td>
			<td>0.6</td>
			<td>1.6</td>
			<td>3.13</td>
		</tr>
	</tbody>
</table>
Table 1: Test-retest reliability for all parameters12. ICC = intra-class correlation coefficient; CI = confident interval; SEM = standard error of the measurement; SRD = smallest real difference; CV = coefficient of variation; rel. = relative.
<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>Paraplegic participant</td>
			<td colspan="2">Lesion level</td>
			<td>AIS</td>
			<td colspan="2">Age (y)</td>
			<td>Body mass (kg)</td>
			<td>Height (cm)</td>
		</tr>
		<tr>
			<td>P01</td>
			<td colspan="2">Th12</td>
			<td>A</td>
			<td colspan="2">47</td>
			<td>80</td>
			<td>184</td>
		</tr>
		<tr>
			<td>P02</td>
			<td colspan="2">Th10</td>
			<td>A</td>
			<td colspan="2">43</td>
			<td>73</td>
			<td>183</td>
		</tr>
		<tr>
			<td>P03</td>
			<td colspan="2">Th11</td>
			<td>A</td>
			<td colspan="2">55</td>
			<td>72</td>
			<td>174</td>
		</tr>
		<tr>
			<td>P04</td>
			<td colspan="2">L1</td>
			<td>A</td>
			<td colspan="2">26</td>
			<td>64</td>
			<td>150</td>
		</tr>
		<tr>
			<td>P05</td>
			<td colspan="2">Th12</td>
			<td>A</td>
			<td colspan="2">22</td>
			<td>63</td>
			<td>185</td>
		</tr>
		<tr>
			<td>P06</td>
			<td colspan="2">L1</td>
			<td>A</td>
			<td colspan="2">32</td>
			<td>76</td>
			<td>175</td>
		</tr>
		<tr>
			<td>P07</td>
			<td colspan="2">Th11</td>
			<td>A</td>
			<td colspan="2">59</td>
			<td>80</td>
			<td>178</td>
		</tr>
		<tr>
			<td>P08</td>
			<td colspan="2">L1</td>
			<td>A</td>
			<td colspan="2">35</td>
			<td>63</td>
			<td>165</td>
		</tr>
		<tr>
			<td>P09</td>
			<td colspan="2">L4</td>
			<td>A</td>
			<td colspan="2">44</td>
			<td>78</td>
			<td>176</td>
		</tr>
		<tr>
			<td>P10</td>
			<td colspan="2">L1</td>
			<td>A</td>
			<td colspan="2">48</td>
			<td>80</td>
			<td>185</td>
		</tr>
		<tr>
			<td>Mean</td>
			<td colspan="2"></td>
			<td></td>
			<td colspan="2">41</td>
			<td>73</td>
			<td>176</td>
		</tr>
		<tr>
			<td>SD</td>
			<td colspan="2"></td>
			<td></td>
			<td colspan="2">12.1</td>
			<td>6.8</td>
			<td>10.4</td>
		</tr>
		<tr>
			<td>Tetraplegic participant</td>
			<td>Lesion level</td>
			<td colspan="2">AIS</td>
			<td>Age (y)</td>
			<td colspan="2">Body mass (kg)</td>
			<td>Height (cm)</td>
		</tr>
		<tr>
			<td>T01</td>
			<td>C5</td>
			<td colspan="2">A</td>
			<td>24</td>
			<td colspan="2">85</td>
			<td>188</td>
		</tr>
		<tr>
			<td>T02</td>
			<td>C7</td>
			<td colspan="2">A</td>
			<td>31</td>
			<td colspan="2">60</td>
			<td>180</td>
		</tr>
		<tr>
			<td>T03</td>
			<td>C7</td>
			<td colspan="2">A</td>
			<td>40</td>
			<td colspan="2">60</td>
			<td>168</td>
		</tr>
		<tr>
			<td>T04</td>
			<td>C7</td>
			<td colspan="2">A</td>
			<td>31</td>
			<td colspan="2">80</td>
			<td>190</td>
		</tr>
		<tr>
			<td>T05</td>
			<td>C5</td>
			<td colspan="2">A</td>
			<td>43</td>
			<td colspan="2">80</td>
			<td>176</td>
		</tr>
		<tr>
			<td>T06</td>
			<td>C6</td>
			<td colspan="2">A</td>
			<td>56</td>
			<td colspan="2">74</td>
			<td>170</td>
		</tr>
		<tr>
			<td>T07</td>
			<td>C5</td>
			<td colspan="2">A</td>
			<td>65</td>
			<td colspan="2">75</td>
			<td>190</td>
		</tr>
		<tr>
			<td>Mean</td>
			<td></td>
			<td colspan="2"></td>
			<td>41</td>
			<td colspan="2">73</td>
			<td>180</td>
		</tr>
		<tr>
			<td>SD</td>
			<td></td>
			<td colspan="2"></td>
			<td>13.6</td>
			<td colspan="2">9.9</td>
			<td>9.3</td>
		</tr>
	</tbody>
</table>
Table 2: Anthropometric data of paraplegic and tetraplegic participants. AIS = American Spinal Injury Association Impairment Scale, Th = thoracic, L = lumbar, C = cervical, SD = standard deviation.

Watch this Scientific Journal Video about Experimental Protocol of a Three-minute, All-out Arm Crank Exercise Test in Spinal-cord Injured and Able-bodied Individuals at JoVE.com

Experimental Protocol of a Three-minute, All-out Arm Crank Exercise Test in Spinal-cord Injured and Able-bodied Individuals

We present a protocol to test the aerobic and anaerobic power of the upper body muscles over a duration of 3 min in able-bodied as well as in paraplegic and tetraplegic individuals. The protocol presents specific modifications in its application for upper-body exercise in individuals with or without disability.

Reliable exercise protocols are required to test changes in exercise performance in elite athletes. Performance improvements in these athletes may be ...

experimental-protocol-three-minute-all-out-arm-crank-exercise-test

Nanyang Technological University

Research

JoVE Journal

Medicine

9.6K Views.  Swiss Paraplegic Center Nottwil. We present a protocol to test the aerobic and anaerobic power of the upper body muscles over a duration of 3 min in able-bodied as well as in paraplegic and tetraplegic individuals. The protocol presents specific modifications in its application for upper-body exercise in individuals with or without disability. 

Video: Experimental Protocol of a Three-minute, All-out Arm Crank Exercise Test in Spinal-cord Injured and Able-bodied Individuals

Methods to Quantify Pharmacologically Induced Alterations in Motor Function in Human Incomplete SCI

Spinal cord injury (SCI) is a debilitating disorder, which produces profound deficits in volitional motor control. Following medical stabilization, recovery from SCI typically involves long term rehabilitation. While recovery of walking ability is a primary goal in many patients early after injury, those with a motor incomplete SCI, indicating partial preservation of volitional control, may have the sufficient residual descending pathways necessary to attain this goal. However, despite physical interventions, motor impairments including weakness, and the manifestation of abnormal involuntary reflex activity, called spasticity or spasms, are thought to contribute to reduced walking recovery. Doctrinaire thought suggests that remediation of this abnormal motor reflexes associated with SCI will produce functional benefits to the patient. For example, physicians and therapists will provide specific pharmacological or physical interventions directed towards reducing spasticity or spasms, although there continues to be little empirical data suggesting that these strategies improve walking ability.
In the past few decades, accumulating data has suggested that specific neuromodulatory agents, including agents which mimic or facilitate the actions of the monoamines, including serotonin (5HT) and norepinephrine (NE), can initiate or augment walking behaviors in animal models of SCI. Interestingly, many of these agents, particularly 5HTergic agonists, can markedly increase spinal excitability, which in turn also increases reflex activity in these animals. Counterintuitive to traditional theories of recovery following human SCI, the empirical evidence from basic science experiments suggest that this reflex hyper excitability and generation of locomotor behaviors are driven in parallel by neuromodulatory inputs (5HT) and may be necessary for functional recovery following SCI. 
The application of this novel concept derived from basic scientific studies to promote recovery following human SCI would appear to be seamless, although the direct translation of the findings can be extremely challenging. Specifically, in the animal models, an implanted catheter facilitates delivery of very specific 5HT agonist compounds directly onto the spinal circuitry. The translation of this technique to humans is hindered by the lack of specific surgical techniques or available pharmacological agents directed towards 5HT receptor subtypes that are safe and effective for human clinical trials. However, oral administration of commonly available 5HTergic agents, such as selective serotonin reuptake inhibitors (SSRIs), may be a viable option to increase central 5HT concentrations in order to facilitate walking recovery in humans. Systematic quantification of how these SSRIs modulate human motor behaviors following SCI, with a specific focus on strength, reflexes, and the recovery of walking ability, are missing.
This video demonstration is a progressive attempt to systematically and quantitatively assess the modulation of reflex activity, volitional strength and ambulation following the acute oral administration of an SSRI in human SCI. Agents are applied on single days to assess the immediate effects on motor function in this patient population, with long-term studies involving repeated drug administration combined with intensive physical interventions.

This video demonstrates modulation of reflex activity, volitional strength and ambulation through clinical and quantitative assessments in individuals with motor incomplete SCI as a result of acute oral administration of a serotonin reuptake inhibitor (SSRI).

Spinal cord injury (SCI) is a debilitating disorder, which produces profound deficits in volitional motor control. Following medical stabilization, ...

Assessing Forelimb Function after Unilateral Cervical SCI using Novel Tasks: Limb Step-alternation, Postural Instability and Pasta Handling

Cervical spinal cord injury (cSCI) can cause devastating neurological deficits, including impairment or loss of upper limb and hand function. A majority of the spinal cord injuries in humans occur at the cervical levels. Therefore, developing cervical injury models and developing relevant and sensitive behavioral tests is of great importance. Here we describe the use of a newly developed forelimb step-alternation test after cervical spinal cord injury in rats. In addition, we describe two behavioral tests that have not been used after spinal cord injury: a postural instability test (PIT), and a pasta-handling test. All three behavioral tests are highly sensitive to injury and are easy to use. Therefore, we feel that these behavioral tests can be instrumental in investigating therapeutic strategies after cSCI.

Three new behavioral tests (forelimb step-alternation, postural instability test, pasta handling test) for evaluating forelimb function after cervical spinal cord injury in rodents are described.

Cervical spinal cord injury (cSCI) can cause devastating neurological deficits, including impairment or loss of upper limb and hand function. A majority ...

Behavior

Paradigms of Lower Extremity Electrical Stimulation Training After Spinal Cord Injury

Skeletal muscle atrophy, increased adiposity and reduced physical activity are key changes observed after spinal cord injury (SCI) and are associated with numerous cardiometabolic health consequences. These changes are likely to increase the risk of developing chronic secondary conditions and impact the quality of life in persons with SCI. Surface neuromuscular electrical stimulation evoked resistance training (NMES-RT) was developed as a strategy to attenuate the process of skeletal muscle atrophy, decrease ectopic adiposity, improve insulin sensitivity and enhance mitochondrial capacity. However, NMES-RT is limited to only a single muscle group. Involving multiple muscle groups of the lower extremities may maximize the health benefits of training. Functional electrical stimulation-lower extremity cycling (FES-LEC) allows for the activation of 6 muscle groups, which is likely to evoke greater metabolic and cardiovascular adaptation. Appropriate knowledge of the stimulation parameters is key to maximizing the outcomes of electrical stimulation training in persons with SCI. Adopting strategies for long-term use of NMES-RT and FES-LEC during rehabilitation may maintain the integrity of the musculoskeletal system, a pre-requisite for clinical trials aiming to restore walking after injury. The current manuscript presents a combined protocol using NMES-RT prior to FES-LEC. We hypothesize that muscles conditioned for 12 weeks prior to cycling will be capable of generating greater power, cycle against higher resistance and result in greater adaptation in persons with SCI.

Spinal cord injury is a traumatic medical condition that may result in elevated risks of chronic secondary metabolic disorders. Here, we presented a protocol using surface neuromuscular electrical stimulation-resistance training in conjunction with functional electrical stimulation-lower extremities cycling as a strategy to ameliorate several of these medical problems.

Skeletal muscle atrophy, increased adiposity and reduced physical activity are key changes observed after spinal cord injury (SCI) and are associated with ...

Training Persons with Spinal Cord Injury to Ambulate Using a Powered Exoskeleton

Powered exoskeletons have become available for overground ambulation in persons with paralyses due to spinal cord injury (SCI) who have intact upper extremity function and are able to maintain upright balance using forearm crutches. To ambulate in an exoskeleton, the user must acquire the ability to maintain balance while standing, sitting and appropriate weight shifting with each step. This can be a challenging task for those with deficits in sensation and proprioception in their lower extremities. This manuscript describes screening criteria and a training program developed at the James J. Peters VA Medical Center, Bronx, NY to teach users the skills needed to utilize these devices in institutional, home or community environments. Before training can begin, potential users are screened for appropriate range of motion of the hip, knee and ankle joints. Persons with SCI are at an increased risk of sustaining lower extremity fractures, even with minimal strain or trauma, therefore a bone mineral density assessment is performed to reduce the risk of fracture. Also, as part of screening, a physical examination is performed in order to identify additional health-related contraindications. 
Once the person has successfully passed all screening requirements, they are cleared to begin the training program. The device is properly adjusted to fit the user. A series of static and dynamic balance tasks are taught and performed by the user before learning to walk. The person is taught to ambulate in various environments ranging from indoor level surfaces to outdoors over uneven or changing surfaces. Once skilled enough to be a candidate for home use with the exoskeleton, the user is then required to designate a companion-walker who will train alongside them. Together, the pair must demonstrate the ability to perform various advanced tasks in order to be permitted to use the exoskeleton in their home/community environment.

Training a person with paralysis to ambulate using a powered exoskeleton may present challenges. The goals are to present the candidate selection criteria and the training procedures for exoskeletal-assisted walking and other mobility skills that can be progressed as the participant's skill level improves.

Powered exoskeletons have become available for overground ambulation in persons with paralyses due to spinal cord injury (SCI) who have intact upper ...

Bioengineering

Standing Neurophysiological Assessment of Lower Extremity Muscles Post-Stroke

Transcranial magnetic stimulation (TMS) is a common tool used to measure the behavior of motor circuits in healthy and neurologically impaired populations. TMS is used extensively to study motor control and the response to neurorehabilitation of the upper extremities. However, TMS has been less utilized in the study of lower extremity postural and walking-specific motor control. The limited use and the additional methodological challenges of lower extremity TMS assessments have contributed to the lack of consistency in lower extremity TMS procedures within the literature. Inspired by the decreased ability to record lower extremity TMS motor evoked potentials (MEP), this methodological report details steps to enable post-stroke TMS assessments in a standing posture. The standing posture allows for the activation of the neuromuscular system, reflecting a state more akin to the system's state during postural and walking tasks. Using dual-top force plates, we instructed participants to equally distribute their weight between their paretic and non-paretic legs. Visual feedback of the participants' weight distribution was provided. Using image guidance software, we delivered single TMS pulses via a double-cone coil to the participants' lesioned and non-lesioned hemispheres and measured the corticomotor response of the paretic and non-paretic tibialis anterior and soleus muscles. Performing assessments in the standing position increased the TMS response rate and allowed for the use of the lower stimulation intensities compared to the standard sitting/resting position. Utilization of this TMS protocol can provide a common approach to assess the lower extremity corticomotor response post-stroke when the neurorehabilitation of postural and gait impairments are of interest.

This protocol describes the process for performing a neurophysiological assessment of the lower extremity muscles, tibialis anterior and soleus, in a standing position using TMS in people post-stroke. This position provides a greater probability of eliciting a post-stroke TMS response and allows for the use of reduced stimulator power during neurophysiological assessments.

Transcranial magnetic stimulation (TMS) is a common tool used to measure the behavior of motor circuits in healthy and neurologically impaired ...

Quantifying Arms and Legs Contributions during Repetitive Electrically-Assisted Sit-To-Stand Exercise in Paraplegics: A Pilot Study

Execution of Sit-to-Stand (SitTS) in incomplete spinal cord injury (SCI) patients involves motor function in both upper and lower extremities. The use of arm support, in particular, is a significant assistive factor while executing SitTS movement in SCI population. In addition, the application of functional electrical stimulation (FES) onto quadriceps and gluteus maximus muscles is one of the prescribed management for incomplete SCI to improve muscle action for simple lower limb movements. However, the relative contribution of upper and lower extremities during SitTS has not been thoroughly investigated. Two motor incomplete SCI paraplegics performed repetitive SitTS to fatigue exercise challenge. Their performance was investigated as a mixed-method case-control study comparing SitTS with and without the assistance of FES. Three sets of SitTS tests were completed with 5-min resting period allocated in between sets, with mechanomyography (MMG) sensors attached over the rectus femoris muscles bilaterally. The exercise was separated into 2 sessions; Day 1 for voluntary SitTS and Day 2 for FES-assisted SitTS. Questionnaires were conducted after every session to gather the participants&#39; input about their repetitive SitTS experience. The analysis confirmed that a SitTS cycle could be divided into three phases; Phase 1 (Preparation to stand), Phase 2 (Seat-off), and Phase 3 (Initiation of hip extension), which contributed to 23% &#177; 7%, 16% &#177; 4% and 61% &#177; 6% of the SitTS cycle, respectively. The contribution of arms and legs during SitTS movement varied in different participants based on their legs&#39; Medical Research Council (MRC) muscle grade. In particular, the applied arm forces start to increase clearly when the leg forces start to decline during standing. This finding is supported by the significantly reduced MMG signal indicating leg muscle fatigue and their reported feeling of tiredness.

Arms contribution in Sit-To-Stand (SitTS) is determined by the legs' muscle condition. Several compensating strategies were discovered in efforts to achieve complete SitTS cycles. These findings triangulate the spinal cord injury (SCI) persons' biomechanical measures with their subjective feeling of load borne by both their limbs throughout the SitTS approaches.

Execution of Sit-to-Stand (SitTS) in incomplete spinal cord injury (SCI) patients involves motor function in both upper and lower extremities. The use of ...

Engineering

Induction and Assessment of Exertional Skeletal Muscle Damage in Humans

Contraction-induced muscle damage via voluntary eccentric (lengthening) contractions offers an excellent model for studying muscle adaptation and recovery in humans. Herein we discuss the design of an eccentric exercise protocol to induce damage in the quadriceps muscles, marked by changes in strength, soreness, and plasma creatine kinase levels. This method is simple, ethical, and widely applicable since it is performed in human participants and eliminates the interspecies translation of the results. Subjects perform 300 maximal eccentric contractions of the knee extensor muscles at a speed of 120&#176;/sec on an isokinetic dynamometer. The extent of the damage is measurable using relatively non-invasive isokinetic and isometric measures of strength loss, soreness, and plasma creatine kinase levels over several days following the exercise. Therefore, its application can be directed to specific populations in an attempt to identify mechanisms for muscle adaptation and regeneration.

This article describes a safe and reliable method to induce and quantify exertional skeletal muscle damage in human subjects.

Contraction-induced muscle damage via voluntary eccentric (lengthening) contractions offers an excellent model for studying muscle adaptation and recovery ...

Activity-based Training on a Treadmill with Spinal Cord Injured Wistar Rats

Spinal cord injury (SCI) results in lasting deficits that include both mobility and a multitude of autonomic-related dysfunctions. Locomotor training (LT) on a treadmill is widely used as a rehabilitation tool in the SCI population with many benefits and improvements to daily life. We utilize this method of activity-based task-specific training (ABT) in rodents after SCI to both elucidate the mechanisms behind such improvements and to enhance and improve upon existing clinical rehabilitation protocols. Our current goal is to determine the mechanisms underlying ABT-induced improvements in urinary, bowel, and sexual function in SCI rats after a moderate to severe level of contusion. After securing each individual animal in a custom-made adjustable vest, they are secured to a versatile body weight support mechanism, lowered to a modified three-lane treadmill and assisted in step-training for 58 minutes, once a day for 10 weeks. This setup allows for the training of both quadrupedal and forelimb-only animals, alongside two different non-trained groups. Quadrupedal-trained animals with body weight support are aided by a technician present to assist in stepping with proper hind limb placement as necessary, while forelimb-only trained animals are raised at the caudal end to ensure no hind limb contact with the treadmill and no weight-bearing. One non-trained SCI group of animals is placed in a harness and rests next to the treadmill, while the other control SCI group remains in its home cage in the training room nearby. This paradigm allows for the training of multiple SCI animals at once, thus making it more time-efficient in addition to ensuring that our pre-clinical animal model mimics the clinical representation as close as possible, particularly with respect to the body weight support with manual assistance.

This protocol demonstrates our model of activity-based locomotor treadmill training for rats with spinal cord injury (SCI). Included is both quadrupedal and forelimb-only groups, in addition to two distinct types of non-trained control groups. Investigators are able to assess training effects on SCI rats using this protocol.

Spinal cord injury (SCI) results in lasting deficits that include both mobility and a multitude of autonomic-related dysfunctions. Locomotor training (LT) ...

Neuroscience

The Impact of Motor Task Conditions on Goal-Directed Arm Reaching Kinematics and Trunk Compensation in Chronic Stroke Survivors

Trunk compensation is the most common movement strategy to substitute for upper extremity (UE) motor deficits in chronic stroke survivors. There is a lack of evidence examining how task conditions impact trunk compensation and goal-directed arm reaching kinematics. This protocol aims to investigate the impact of task conditions, including task difficulty and complexity, on goal-directed arm reaching kinematics. Two non-disabled young adults and two chronic stroke survivors with mild UE motor impairment were recruited for testing the protocol. Each participant performed goal-directed arm reaches with four different task conditions (2 task difficulties [large vs. small targets] X 2 task complexities [pointing vs. picking up]). The task goal was to reach and point at a target or pick up an object located 20 cm in front of the home position as quickly as possible with a stylus or a pair of chopsticks, respectively, in response to an auditory cue. Participants performed ten reaches per task condition. A 3-dimensional motion capture camera system was used to record trunk and arm kinematics. Representative results showed that there was a significant increase in movement duration, movement jerkiness, and trunk compensation as a function of task complexity, but not task difficulty in all participants. Chronic stroke survivors showed significantly slower, jerkier, and more feedback-dependent arm reaches and significantly more compensatory trunk movements than non-disabled adults. Our representative results support that this protocol can be used to investigate the impact of task conditions on motor control strategies in chronic stroke survivors with mild UE motor impairment.

This protocol is intended to investigate the impact of task conditions on movement strategies in chronic stroke survivors. Further, this protocol can be used to examine if a restriction in elbow extension induced by neuromuscular electrical stimulation causes trunk compensation during goal-directed arm reaches in non-disabled adults.

Trunk compensation is the most common movement strategy to substitute for upper extremity (UE) motor deficits in chronic stroke survivors. There is a lack ...

Development of a Novel Task-oriented Rehabilitation Program using a Bimanual Exoskeleton Robotic Hand

A robot-assisted hand is used for the rehabilitation of patients with impaired upper limb function, particularly for stroke patients with a loss of motor control. However, it is unclear how conventional occupational training strategies can be applied to the use of rehabilitation robots. Novel robotic technologies and occupational therapy concepts are used to develop a protocol that allows patients with impaired upper limb function to grasp objects using their affected hand through a variety of pinching and grasping functions. To conduct this appropriately, we used five types of objects: a peg, a rectangular cube, a cube, a ball, and a cylindrical bar. We also equipped the patients with a robotic hand, the Mirror Hand, an exoskeleton&#160;hand that is fitted to the subject&#8217;s affected hand and follows the movement of the sensor glove fitted to their unaffected hand (bimanual movement training (BMT)). This study had two stages. Three healthy subjects were first recruited to test the feasibility and acceptability of the training program. Three patients with hand dysfunction caused by stroke were then recruited to confirm the feasibility and acceptability of the training program, which was conducted on 3 consecutive days. On each day, the patient was monitored during 5 min of movement in a passive range of motion, 5 min of robot-assisted bimanual movement, and task-oriented training using the five objects. The results showed that both healthy subjects and subjects who had suffered a stroke in conjunction with the robotic hand could successfully grasp the objects. Both healthy subjects and those who had suffered a stroke performed well with the robot-assisted task-oriented training program in terms of feasibility and acceptability.

This study reports the development of a novel robot-assisted task-oriented program for hand rehabilitation. The developmental process consists of experiments using both healthy subjects and subjects who have had a stroke and suffered from subsequent motor control dysfunction.

A robot-assisted hand is used for the rehabilitation of patients with impaired upper limb function, particularly for stroke patients with a loss of motor ...