Sensitivity to change of the Systemic Therapy Inventory of Change (STIC) intersession scales.

Objective: The Systemic Therapy Inventory of Change (STIC) is a systemic measurement feedback system that provides therapists with feedback regarding the multidimensional clinical change in individual, couple, and family therapy. The STIC Intersession scales include Individual Problems and Strengths (IPS), Relationship with Partner (RWP), Family/Household (FH), and Child Problems and Strengths (CPS). They are administered to clients before each therapy session. The purpose of the current study is to investigate the STIC Intersession scales' sensitivity to change, the ability to detect reliable and valid changes that occur after an intervention. Method: Participants (N = 583) who voluntarily received individual, couple, or family therapy services in a randomized clinical trial attended the study. Results: By comparing the changes in pre-therapy and post-therapy scores of the STIC Intersession scales with those of the corresponding reference measures, the external sensitivity to change of the STIC Intersession scales was supported. The IPS Intersession scale showed greater change than the Beck Anxiety Inventory. However, no evidence supported the discriminant validity of CPS's change scores. Conclusion: Thus, the STIC Intersession IPS, RWP, and FH can be validly used to assess multi-systemic changes in both research and clinical work.

Does the STIC measurement and feedback system improve multisystemic outcomes in individual, couple and family therapy? A randomized clinical trial.

OBJECTIVE: In a randomized clinical trial, we evaluated whether the STIC (Systemic Therapy Inventory of Change) measurement and feedback system (MFS), the first MFS to explicitly integrate the family systems perspective, improved outcomes in individual, couple and family therapy. METHOD: Nine hundred and seventy clients seeking individual, couple or family therapy, entered therapy with 93 therapists at four sites in the Chicago metropolitan area. All therapists were trained with the STIC and participated in both Treatment as Usual (TAU) and TAU with the STIC (STIC). After agreeing to participate, clients were randomly assigned to TAU or STIC. Therapists did not know the condition to which a case was assigned, until just prior to the first session. Therapy was not time-limited or constrained, except for the use of the STIC in the STIC condition. All clients were evaluated on a non-STIC multi-systemic battery of widely used outcome measures pre-and-post therapy. RESULTS: STIC clients improved more than TAU clients regardless of treatment modality or outcome measure. Clinically significant change was also greater for STIC than TAU clients across outcome measures. CONCLUSION: The STIC MFS holds promise for improving outcomes beyond TAU in individual, couple, and family therapy.

Trends in measuring BMR and RMR after spinal cord injury: a comprehensive review.

Studying factors that contribute to our understanding of maintaining normal energy balance are of paramount significance following spinal cord injury (SCI). Accurate determination of energy needs is crucial for providing nutritional guidance and managing the increasing prevalence of malnutrition or obesity after SCI. BMR represents 75-80 % of the total energy expenditure in persons with SCI. Accurately measuring BMR is an important component for calculating total energetic needs in this population. Indirect calorimetry is considered the gold-standard technique for measuring BMR. However, technical challenges may limit its applications in large cohort studies and alternatively rely on prediction equations. Previous work has shown that BMR changes in response to disuse and exercise in the range of 15-120 %. Factors including sex, level of injury and type of assistive devices may influence BMR after SCI. RMR is erroneously used interchangeably for BMR, which may result in overestimation of energetic intake when developing nutritional plans. To address this concern, we comprehensively reviewed studies that conducted BMR (n=15) and RMR (n=22) in persons with SCI. The results indicated that RMR is 9 % greater than BMR in persons with SCI. Furthermore, the SCI-specific prediction equations that incorporated measures of fat-free mass appeared to accurately predict BMR. Overall, the current findings highlighted the significance of measuring BMR as well as encouraging the research and clinical community to effectively establish countermeasures to combat obesity after SCI.

Predictors of muscle hypertrophy responsiveness to electrically evoked resistance training after spinal cord injury.

The purpose of the study was to identify potential predictors of muscle hypertrophy responsiveness following neuromuscular electrical stimulation resistance training (NMES-RT) in persons with chronic spinal cord injury (SCI). Data for twenty individuals with motor complete SCI who completed twice weekly NMES-RT lasting 12-16 weeks as part of their participation in one of two separate clinical trials were pooled and retrospectively analyzed. Magnetic resonance imaging (MRI) was used to measure muscle cross-sectional area (CSA) of the whole thigh and knee extensor muscle before and after NMES-RT. Muscle biopsies and fasting biomarkers were also measured. Following the completion of the respective NMES-RT trials, participants were classified into either high-responders (n = 8; muscle CSA > 20%) or low-responders (n = 12; muscle CSA < 20%) based on whole thigh muscle CSA hypertrophy. Whole thigh muscle and knee extensors CSAs were significantly greater (P < 0.0001) in high-responders (29 ± 7% and 47 ± 15%, respectively) compared to low-responders (12 ± 3% and 19 ± 6%, respectively). There were no differences in total caloric intake or macronutrient intake between groups. Extensor spasticity was lower in the high-responders compared to the low-responders as was the dosage of baclofen. Prior to the intervention, the high-responders had greater body mass compared to the low-responders with SCI (87.8 ± 13.7 vs. 70.4 ± 15.8 kg; P = 0.012), body mass index (BMI: 27.6 ± 2.7 vs. 22.9 ± 6.0 kg/m2; P = 0.04), as well as greater percentage in whole body and regional fat mass (P < 0.05). Furthermore, high-responders had a 69% greater increase (P = 0.086) in total Akt protein expression than low-responders. High-responders also exhibited reduced circulating IGF-1 with a concomitant increase in IGFBP-3. Exploratory analyses revealed upregulation of mRNAs for muscle hypertrophy markers [IRS-1, Akt, mTOR] and downregulation of protein degradation markers [myostatin, MurF-1, and PDK4] in the high-responders compared to low-responders. The findings indicate that body composition, spasticity, baclofen usage, and multiple signaling pathways (anabolic and catabolic) are involved in the differential muscle hypertrophy response to NMES-RT in persons with chronic SCI.

Denervation impacts muscle quality and knee bone mineral density after spinal cord injury.

STUDY DESIGN: Cross-sectional study. OBJECTIVES: To compare muscle size, body composition, bone mineral density (BMD), and metabolic profiles in denervated versus innervated individuals with spinal cord injury (SCI). SETTING: Hunter Holmes McGuire Veterans Affairs (VA) Medical Center. METHODS: Body composition, bone mineral density (BMD), muscle size, and metabolic parameters were collected in 16 persons with chronic SCI (n = 8 denervated, n = 8 innervated) using dual-energy x-ray absorptiometry (DXA), magnetic resonance imaging (MRI), and fasting blood samples. BMR was measured by indirect calorimetry. RESULTS: Percent differences of the whole thigh muscle cross-sectional area (CSA; 38%), knee extensor CSA (49%), vasti CSA (49%), and rectus femoris CSA (61%) were smaller in the denervated group (p < 0.05). Leg lean mass was also lower (28%) in the denervated group (p < 0.05). Whole muscle intramuscular fat (IMF%; 15.5%), knee extensor IMF% (22%), and % fat mass (10.9%) were significantly greater in the denervated group (p < 0.05). Knee distal femur and proximal tibia BMD were lower in the denervated group, 18-22% and 17-23%; p < 0.05. Certain indices of metabolic profile were more favorable in the denervated group though were not significant. CONCLUSIONS: SCI results in skeletal muscle atrophy and dramatic changes in body composition. Lower motor neuron (LMN) injury results in denervation of the lower extremity muscles which exacerbates atrophy. Denervated participants exhibited lower leg lean mass and muscle CSA, greater muscle IMF, and reduced knee BMD compared to innervated participants. Future research is needed to explore therapeutic treatments for the denervated muscles after SCI.

The interaction of macronutrients and body composition among individuals with chronic spinal cord injury.

Changes in body composition and dietary intake occur following spinal cord injury (SCI). The Geometric Framework for Nutrition (GFN) is a tool that allows the examination of the complex relationships between multiple nutrition factors and health parameters within a single model. This study aimed to utilize the GFN to examine the associations between self-reported macronutrient intakes and body composition in persons with chronic SCI. Forty-eight individuals with chronic SCI were recruited. Participants completed and returned 3- or 5-day self-reported dietary recall sheets. Dietary intake of macronutrients (fats, proteins, and carbohydrates) were analysed. Anthropometric measures (circumferences), dual-energy x-ray absorptiometry (DXA), and magnetic resonance imaging (MRI) were used to assess whlole-body composition. Associations between all circumference measures and carbohydrates were observed. Among MRI measures, only significant associations between subcutaneous adipose tissue and protein x carbohydrate as well as carbohydrates alone were identified. Carbohydrates were negatively associated with several measures of fat mass as measured by DXA. Overall, carbohydrates appear to play an important role in body composition among individuals with SCI. Higher carbohydrate intake was associated with lower fat mass. Additional research is needed to determine how carbohydrate intake influences body composition and cardiometabolic health after SCI.

Role of exercise on visceral adiposity after spinal cord injury: a cardiometabolic risk factor.

PURPOSE: Visceral adipose tissue (VAT) is associated with cardiometabolic disease risk in able-bodied (AB) populations. However, the underlying mechanisms of VAT-induced disease risk are unknown in persons with spinal cord injury (SCI). Potential mechanisms of VAT-induced cardiometabolic dysfunction in persons with SCI include systemic inflammation, liver adiposity, mitochondrial dysfunction, and anabolic deficiency. Moreover, how exercise interventions impact these mechanisms associated with VAT-induced cardiometabolic dysfunction are still being explored. METHODS: A search for relevant scientific literature about the effects of exercise on VAT and cardiometabolic health was conducted on the PubMed database. Literature from reference lists was also included when appropriate. RESULTS: Both aerobic and resistance exercise training beneficially impact health and VAT mass via improving mitochondrial function, glucose effectiveness, and inflammatory signaling in SCI and AB populations. Specifically, aerobic exercise appears to also modulate cellular senescence in AB populations and animal models, while resistance exercise seems to augment anabolic signaling in persons with SCI. CONCLUSIONS: The current evidence supports regular engagement in exercise to reduce VAT mass and the adverse effects on cardiometabolic health in persons with SCI. Future research is needed to further elucidate the precise mechanisms by which VAT negatively impacts health following SCI. This will likely facilitate the development of rehabilitation protocols that target VAT reduction in persons with SCI.

Proximity to Failure and Total Repetitions Performed in a Set Influences Accuracy of Intraset Repetitions in Reserve-Based Rating of Perceived Exertion.

ABSTRACT: Zourdos, MC, Goldsmith, JA, Helms, ER, Trepeck, C, Halle, JL, Mendez, KM, Cooke, DM, Haischer, MH, Sousa, CA, Klemp, A, and Byrnes, RK. Proximity to failure and total repetitions performed in a set influences accuracy of intraset repetitions in reserve-based rating of perceived exertion. J Strength Cond Res 35(2S): S158-S165, 2021-The aim of this study was to assess the accuracy of predicting repetitions in reserve (RIR) intraset using the RIR-based rating of perceived exertion (RPE) scale. Twenty-five men (age: 25.3 ± 3.3 years, body mass: 89.0 ± 14.7 kg, height: 174.69 ± 6.7 cm, and training age: 4.7 ± 3.2 years) reported to the laboratory. Subjects performed a 1 repetition maximum (1RM) squat followed by one set to failure at 70% of 1RM. During the 70% set, subjects verbally indicated when they believed they were at a 5RPE (5RIR), 7RPE (3RIR), or 9RPE (1RIR), and then continued to failure. The difference between actual repetitions performed and participant-predicted repetitions was calculated as the RIR difference (RIRDIFF). The average load used for the 70% set was 123.10 ± 24.25 kg and the average repetitions performed were 16 ± 4. The RIRDIFF was lower (RPEs were more accurate) closer to failure (RIRDIFF at 9RPE = 2.05 ± 1.73; RIRDIFF at 7RPE = 3.65 ± 2.46; and RIRDIFF at 5RPE = 5.15 ± 2.92 repetitions). There were significant relationships between total repetitions performed and RIRDIFF at 5RPE (r = 0.65, p = 0.001) and 7RPE (r = 0.56, p = 0.004), but not at 9RPE (r = 0.01, p = 0.97). Thus, being farther from failure and performing more repetitions in a set were associated with more inaccurate predictions. Furthermore, a multiple linear regression revealed that more repetitions performed per set was a significant predictor of RIR prediction inaccuracy at the called 5 (p = 0.003) and 7 (p = 0.011) RPEs, while training age (p > 0.05) was not predictive of rating accuracy. These data indicate RIR predictions are improved during low to moderate repetition sets and when there is close proximity to failure.

Changes in Commitment and Sexual Satisfaction: Trajectories in Couple Therapy.

The purpose of this study was to examine the covarying relationship between commitment and sexual satisfaction in committed relationships throughout the course of couple therapy. A sample of 366 heterosexual couples completed questionnaires regarding sexual satisfaction and commitment at each of the first five sessions of couple therapy. Cross-lagged panel analyses revealed that, between the first and second therapy sessions, there was a bidirectional relationship between commitment and sexual satisfaction, with each variable at the first session predicting the other at the second session. In addition, sexual satisfaction at the second session predicted commitment at the third session.

Testing the convergent and discriminant validity of the Systemic Therapy Inventory of Change Initial scales.

OBJECTIVE: The Systemic Therapy Inventory of Change (STIC®) is the first multi-systemic and multi-dimensional measurement and feedback system designed for assessment in family, couple, and individual functioning. Patients fill out the STIC Initial before the first session to identify treatment targets and provide starting values for subsequent assessments of trajectories of change. This study tested the construct validity of five of the six STIC Initial scales. METHODS: We administered both the STIC Initial and a set of validity measures to a relatively large sample of patients. Convergent and discriminant validity were tested using both an examination of observed correlations and confirmatory factor analysis (CFA). RESULTS: The correlations among the observed measures showed that the convergent validity coefficients were generally large, whereas the discriminant validity coefficients were moderate to small. Similarly, CFAs suggested that the STIC total scales and subscales are good indicators of the factors they were intended to measure and that the STIC total scales and subscales are weakly related to the factors they were intended to not measure. CONCLUSION: The results supported the convergent and discriminant validity of the five scales of the STIC Initial. Clinical or methodological significance of this article: The clinical significance of this article is that it demonstrates that the STIC Initial should be useful for identifying treatment targets including both which systems, in addition to the facets within each system, that require targeting. The methodological significance is twofold. First, the use of CFA for testing convergent and discriminant validity is still relatively rare. Second, we demonstrated how to use CFA for a more stringent test of discriminant validity compared with the original approach described by Cole ( 1987 ).

Factors underlying the perception of effort during constant heart rate running above and below the critical heart rate.

PURPOSE: This study examined: (1) the sustainability of the critical heart rate (CHR) minus 5 b min(-1) (CHR - 5) and CHR plus 5 b min(-1) (CHR + 5); (2) the ratings of perceived exertion (RPE), velocity, [Formula: see text], minute ventilation ([Formula: see text]), breathing frequency (f b ), and electromyographic amplitude (EMG AMP) and EMG mean power frequency (MPF) responses during treadmill running at CHR - 5 and CHR + 5 to determine what factors underlie the perception of effort when heart rate (HR) is held constant; and (3) the relationships among RPE, [Formula: see text], and HR, to determine which variable(s) reflect exhaustion during exercise performed at a constant HR. METHODS: The CHR was determined in eight runners (mean ± SD; age = 24 ± 3 years) from a series of four exhaustive, constant velocity runs. The RPE, velocity, [Formula: see text], [Formula: see text], f b , EMG AMP, and EMG MPF responses were recorded during runs at the CHR - 5 and CHR + 5. RESULTS: At CHR - 5, RPE, f b, and EMG MPF increased, while velocity, [Formula: see text], [Formula: see text], and EMG AMP decreased. At CHR + 5, RPE and f b increased, velocity, [Formula: see text], [Formula: see text], and EMG AMP decreased, and EMG MPF remained constant. CONCLUSIONS: The close association between f b and RPE throughout the run at CHR - 5 and during the last 50 % of the run at CHR + 5 indicated that muscle afferents may have provided feedback from metabolic and mechanical stimuli that contributed to the perceptual responses. In addition, only RPE consistently indicated exhaustion and the current findings supported its use to monitor exercise performed at a constant HR.

Confirming, Validating, and Norming the Factor Structure of Systemic Therapy Inventory of Change Initial and Intersession.

UNLABELLED: Progress or feedback research tracks and feeds back client progress data throughout the course of psychotherapy. In the effort to empirically ground psychotherapeutic practice, feedback research is both a complement and alternative to empirically supported manualized treatments. Evidence suggests that tracking and feeding back progress data with individual or nonsystemic feedback systems improves outcomes in individual and couple therapy. The research reported in this article pertains to the STIC(®) (Systemic Therapy Inventory of Change)-the first client-report feedback system designed to empirically assess and track change within client systems from multisystemic and multidimensional perspectives in individual, couple, and family therapy. Clients complete the STIC Initial before the first session and the shorter STIC Intersession before every subsequent session. This study tested and its results supported the hypothesized factor structure of the six scales that comprise both STIC forms in a clinical outpatient sample and in a normal, random representative sample of the U.S. POPULATION: This study also tested the STIC's concurrent validity and found that its 6 scales and 40 of its 41 subscales differentiated the clinical and normal samples. Lastly, the study derived clinical cut-offs for each scale and subscale to determine whether and how much a client's score falls in the normal or clinical range. Beyond supporting the factorial and concurrent validity of both STIC forms, this research supported the reliabilities of the six scales (Omegahierarchical ) as well as the reliabilities of most subscales (alpha and rate-rerate). This article delineates clinical implications and directions for future research.

Application of the Critical Heart Model to Treadmill Running.

The mathematical model used to estimate critical power has been applied to heart rate (HR) measurements during cycle ergometry to derive a fatigue threshold called the critical heart rate (CHR). This study had 2 purposes: (a) determine if the CHR model for cycle ergometry could be applied to treadmill running and (b) examine the times to exhaustion (Tlim) and the VO2 responses during constant HR runs at the CHR. Thirteen runners (mean ± SD; age = 23 ± 3 years) performed an incremental treadmill test to exhaustion. On separate days, 4 constant velocity runs to exhaustion were performed. The total number of heart beats (HBlim) for each velocity was calculated as the product of the average 5-second HR and Tlim. The CHR was the slope coefficient of the HBlim vs. Tlim relationship. The Tlim and VO2 responses were recorded during a constant HR run at the CHR. Polynomial regression analyses were used to examine the patterns of responses for VO2 and velocity. The HBlim vs. Tlim relationship (r = 0.995-1.000) was described by the linear equation: HBlim = a + CHR (Tlim). The CHR (176 ± 7 b·min, 91 ± 3% HRpeak) was maintained for 47.84 ± 11.04 minutes. There was no change in HR but quadratic decreases in velocity and VO2. These findings indicated that the CHR model for cycle ergometry was applicable to treadmill running and represented a sustainable (30-60 minutes) intensity but cannot be used to demarcate exercise intensity domains.

The Effect of Time-Equated Concurrent Training Programs in Resistance-Trained Men.

The purpose of this investigation was to compare the effects of three different concurrent training (CT) programs and a resistance training (RT) program. Twenty-three resistance trained men (age: 24 ± 3 years) were randomized into four groups: concurrent RT and high intensity interval cycling (CTH, n = 6), concurrent RT and moderate intensity continuous cycling (CTM, n = 5), RT and barbell circuit training (RTC, n = 6), or RT only (RT, n = 6). Back squat and bench press strength, quadriceps, and pectoralis muscle thickness, VO2peak, and maximum workload (Wmax, Watts) were assessed. Squat strength gains were meaningful in all groups and comparable among CTH (16.88 kg [95% CrI: 11.15, 22.63]), CTM (25.54 kg [95% CrI: 19.24, 31.96]), RTC (17.5 kg [95% CrI: 11.66, 23.39]), and RT (20.36 kg [95% CrI: 15.29, 25.33]) groups. Bench press strength gains were meaningful in all groups and comparable among CTH (11.86 kg [95% CrI: 8.28, 15.47]), CTM (10.3 kg [95% CrI: 6.49, 14.13]), RTC (4.84 kg [95% CrI: 1.31, 8.47]), and RT (10.16 kg [95% CrI: 7.02, 13.22]) groups. Quadriceps hypertrophy was meaningful in all groups and comparable among CTH (2.29 mm [95% CrI: 0.84, 3.76]), CTM (3.41 mm [95% CrI: 1.88, 4.91]), RTC (2.6 mm [95% CrI: 1.17, 4.05]), and RT (2.83 mm [95% CrI: 1.55, 4.12]) groups. Pectoralis hypertrophy was meaningful in CTH (2.29 mm [95% CrI: -0.52, 5.1]), CTM (5.14 mm [95% CrI: 2.1, 8.15]), and RTC (7.19 mm [95% CrI: 4.26, 10.02]) groups, but not in the RT group (1 mm [95% CrI: -1.59, 3.59]); further, between-group contrasts indicated less pectoralis growth in the RT compared to the RTC group. Regarding cardiovascular outcomes, only the RTH and RTM groups experienced meaningful improvements in either measure (VO2peak or Wmax). These data suggest that the interference effect on maximal strength and hypertrophy can be avoided when the aerobic training is moderate intensity cycling, high intensity cycling, or a novel barbell circuit for ~one hour per week and on non-RT days. However, the barbell circuit failed to elicit meaningful cardiovascular adaptations.

Effects of percutaneously-implanted epidural stimulation on cardiovascular autonomic function and spasticity after complete spinal cord injury: A case report.

Importance: There is a revived interest to explore spinal cord epidural stimulation (SCES) to improve physical function after spinal cord injury (SCI). This case report highlights the potential of eliciting multiple functional improvements with a single SCES configuration, a strategy which could improve clinical translation. Objective: To determine whether SCES intended to facilitate walking also acutely yields benefits in cardiovascular autonomic regulation and spasticity. Design: Case report from data collected at two timepoints 15 weeks apart from March to June 2022 as part of a larger clinical trial. Setting: Research lab at Hunter Holmes McGuire VA Medical Center. Participant: 27-year-old male, 7 years post a C8 motor complete spinal cord injury. Intervention: A SCES configuration intended to enhance exoskeleton-assisted walking training applied for autonomic and spasticity management. Main outcomes and measures: The primary outcome was cardiovascular autonomic response to a 45-degree head-up-tilt test. Systolic blood pressure (SBP), heart rate (HR), and absolute power of the low-frequency (LF) and high-frequency (HF) components of a heart-rate variability analysis were collected in supine and tilt with and without the presence of SCES. Right knee flexor and knee extensor spasticity was assessed via isokinetic dynamometry with and without SCES. Results: At both assessments with SCES off, transitioning from supine to tilt decreased SBP (assessment one: 101.8 to 70 mmHg; assessment two: 98.9 to 66.4 mmHg). At assessment one, SCES on in supine (3 mA) increased SBP (average 117 mmHg); in tilt, 5 mA stabilized SBP near baseline values (average 111.5 mmHg). At assessment two, SCES on in supine (3 mA) increased SBP (average 140 mmHg in minute one); decreasing amplitude to 2 mA decreased SBP (average 119 mmHg in minute five). In tilt, 3 mA stabilized SBP near baseline values (average 93.2 mmHg). Torque-time integrals at the right knee were reduced at all angular velocities for knee flexors (range: -1.9 to -7.8%) and knee extensors (range: -1 to -11.4%). Conclusions and relevance: These results demonstrate that SCES intended to facilitate walking may also enhance cardiovascular autonomic control and attenuate spasticity. Using one configuration to enhance multiple functions after SCI may accelerate clinical translation. Clinical trial registration: https://clinicaltrials.gov/ct2/show/, identifier NCT04782947.

A case study of percutaneous epidural stimulation to enable motor control in two men after spinal cord injury.

Two persons with chronic motor complete spinal cord injury (SCI) were implanted with percutaneous spinal cord epidural stimulation (SCES) leads to enable motor control below the injury level (NCT04782947). Through a period of temporary followed by permanent SCES implantation, spinal mapping was conducted primarily to optimize configurations enabling volitional control of movement and training of standing and stepping as a secondary outcome. In both participants, SCES enabled voluntary increased muscle activation and movement below the injury and decreased assistance during exoskeleton-assisted walking. After permanent implantation, both participants voluntarily modulated induced torques but not always in the intended directions. In one participant, percutaneous SCES enabled motor control below the injury one-day following temporary implantation as confirmed by electromyography. The same participant achieved independent standing with minimal upper extremity self-balance assistance, independent stepping in parallel bars and overground ambulation with a walker. SCES via percutaneous leads holds promise for enhancing rehabilitation and enabling motor functions for people with SCI.

Employment of Neuromuscular Electrical Stimulation to Examine Muscle and Bone Qualities after Spinal Cord Injury.

(1) Background: Resource intensive imaging tools have been employed to examine muscle and bone qualities after spinal cord injury (SCI). We tested the hypothesis that surface neuromuscular electrical stimulation (NMES) amplitude can be used to examine knee extensor muscle quality, distal femur and proximal tibia bone mineral density (BMD) in persons with SCI. (2) Methods: Seventeen persons (2 women) with chronic SCI participated in three weeks of NMES-resistance training twice weekly of 4 sets of 10 repetitions. Participants were classified according to the current amplitude (>100 mA) and the number of repetitions (>70 reps) of leg extension into greater (n = 8; 1 woman; group A) and lower (n = 9; 1 woman; group B) musculoskeletal qualities. Magnetic resonance imaging, dual energy x-ray absorptiometry, isometric peak torque, Modified Ashworth and Penn spasm frequency scales were conducted. (3) Results: In between group comparisons, current amplitude was lower (38−46%) in group A. Whole (27−32%; p = 0.02), absolute (26−33%, p = 0.02) thigh muscle and absolute knee extensor muscle cross-sectional areas (22−33%, p = 0.04) were greater in group A. Right distal femur (24%; p = 0.08) and proximal tibia (29%; p = 0.03) BMDs were lower in group B, and peak isometric torque (p < 0.01), extensor spasticity scorers (p = 0.04) and muscle spasm scores (p = 0.002) were significantly higher in group A. Regression models revealed that amplitude of current, repetitions and body weight can accurately predict musculoskeletal qualities in persons with SCI. (4) Conclusions: Surface NMES amplitude and repetitions of leg extension differentiated between SCI survivors with greater versus lower musculoskeletal qualities. The study may shed the light on the interplay between muscle and bone in persons with SCI.

Visceral Adiposity, Inflammation, and Testosterone Predict Skeletal Muscle Mitochondrial Mass and Activity in Chronic Spinal Cord Injury.

BACKGROUND: Mitochondrial health is an important predictor of several health-related comorbidities including obesity, type 2 diabetes mellitus, and cardiovascular disease. In persons with spinal cord injury (SCI), mitochondrial health has been linked to several important body composition and metabolic parameters. However, the complex interplay of how mitochondrial health is affected has yet to be determined in this population. OBJECTIVE: In this study, we examined the contribution of visceral adiposity, inflammatory biomarkers, testosterone and circulating serum growth factors as predictors of mitochondrial health in persons with chronic SCI. PARTICIPANTS: Thirty-three individuals with chronic SCI (n = 27 Males, n = 6 Females, age: 40 ± 13.26 years, level of injury: C4-L1, BMI: 23 ± 5.57) participated in this cross-sectional study. METHODS: Visceral adipose tissue (VAT) was measured via magnetic resonance imaging (MRI). After an overnight fast, serum testosterone, inflammatory biomarkers [interleukin 6 (IL-6), tumor necrosis factor alpha (TNF-α), c-reactive protein (CRP)], and anabolic growth factors [insulin-like growth factor 1 (IGF-1), insulin-like growth factor binding protein 3 (IGFBP-3)] were measured. Skeletal muscle biopsies were obtained from the vastus lateralis muscle to measure citrate synthase (CS) and Complex III activity. Regression analyses were used to examine predictors of mitochondrial mass and activity. RESULTS: CS activity was negatively associated with VAT (r 2 = 0.360, p < 0.001), CRP (r 2 = 0.168, p = 0.047), and positively associated with testosterone (r 2 = 0.145, p = 0.042). Complex III activity was negatively associated with VAT relative to total lean mass (VAT:TLM) (r 2 = 0.169, p = 0.033), trended for CRP (r 2 = 0.142, p = 0.069), and positively associated with testosterone (r 2 = 0.224, p = 0.010). Multiple regression showed CS activity was significantly associated with VAT + CRP (r 2 = 0.412, p = 0.008) and VAT + Testosterone (r 2 = 0.433, p = 0.001). Complex III activity was significantly associated with VAT relative to total trunk cross-sectional area (CSA) + CRP (VAT:total trunk CSA + CRP; r 2 = 0.286, p = 0.048) and VAT + Testosterone (r 2 = 0.277, p = 0.024). CONCLUSION: Increased visceral adiposity and associated inflammatory signaling (CRP) along with reduced testosterone levels predict mitochondrial dysfunction following SCI. Specifically, lower VATCSA and higher testosterone levels or lower VATCSA and lower CRP levels positively predict mitochondrial mass and enzyme activity in persons with chronic SCI. Future research should investigate the efficacy of diet, exercise, and potentially testosterone replacement therapy on enhancing mitochondrial health in chronic SCI. CLINICAL TRIAL REGISTRATION: [www.ClinicalTrials.gov], identifier: [NCT02660073].

Leisure-time physical activity, anthropometrics, and body composition as predictors of quality of life domains after spinal cord injury: an exploratory cross-sectional study.

The objective of the current work was to examine the relationships between quality of life (QOL) domains in persons with spinal cord injury (SCI) and their levels of weekly leisure-time physical activity (LTPA), anthropometric variables, and body composition variables. This exploratory cross-sectional study consisted of baseline data collected as part of a randomized clinical trial at a VA Medical Center and SCI center. A convenience sample of 36 community-dwelling persons with SCI participated in the current study. Outcome measures included the World Health Organization Quality of Life Short Form (WHOQOL-BREF), Leisure-Time Physical Activity Questionnaire for People with Spinal Cord Injury (LTPAQ-SCI), anthropomorphic measures (waist, hip, and abdominal circumference), and dual-energy x-ray absorptiometry (DXA) to quantify regional and total body composition. Multiple regression models suggested that engagement in LTPA accounted for 35.7% of the variance in physical health QOL, 33.5% in psychological QOL, 14.2% in social relationships QOL, and 38.2% in environmental QOL. Anthropometric measures accounted for 11.3%, 3.1%, 12.0%, and 6.7% of the variance in these QOL indices, respectively, and DXA indices accounted for 18.7%, 17.5%, 27.4%, and 21.9%. Within these models, the number of minutes of heavy LTPA per day uniquely predicted physical health QOL, the number of mild LTPA days per week uniquely predicted psychological QOL, and the amount of mild LTPA per day uniquely predicted environmental QOL. Bivariate analyses also suggested that android and trunk fat, as well as supine waist and abdominal circumferences, were positively associated with social relationships QOL. Encouraging individuals with SCI to engage in LTPA may robustly enhance multiple aspects of QOL while reducing the risk for cardiovascular and metabolic morbidities associated with SCI. Moreover, this may lead to a further understanding of how QOL may impact longitudinal intervention trials. The study protocol and procedures were reviewed and approved by the McGuire VA Research Institutional Review Board (IRB# 02152, approval date August 9, 2015; IRB# 02375, approval date May 2, 2018).

Epidural stimulation with locomotor training ameliorates unstable blood pressure after tetraplegia. A case report.

A male with C7 complete tetraplegia participated in 14 weeks of body weight supported treadmill training (BWSTT) combined with spinal cord epidural stimulation (SCES), 4 weeks of no intervention, and two more weeks of BWSTT + SCES. The participant presented with unstable resting seated blood pressure (BP; 131/66 mmHg). After retrospective analysis, resting systolic BP decreased and diastolic BP increased, yielding a safe mean arterial BP. There was a fivefold increase in BWSTT bouts per session, and percentage of body weight support decreased to 69%. BWSTT + SCES safely and effectively regulated resting BP and mitigated symptoms of orthostatic intolerance. These effects were not maintained after 4 weeks without training.