This second issue of Spinal Cord 2016 starts with a challenging question, as written in the title of this page. Panisset et al. reviewed literature evaluating exercise interventions initiated within 12 weeks after SCI on muscle and bone loss in paralysed limbs, and compared it to standard care or immobilization. Five randomized controlled trials (RCTs), 4 cohort studies and 2 within-subject control studies, provided all level II positive evidence with a moderate risk of bias. But the early exercise and the method to evaluate effect differed between studies: high load Functional Electrical Stimulation (FES) resisted stance on physiological measures of muscle, 3 months of FES on muscle size, 6 months body-weight supported treadmill training or FES on trabecular bone using peripheral quantitative computed tomography. This finding is encouraging and though more standardisation would benefit clinical practice, it incites thinking about applying exercise early after SCI. What also needs to be resolved is the best way to keep these good effects in the long run.
Locomotor function: Dose et al. showed that epidural stimulation recruits spinal networks that generate locomotor programs when pulses are delivered to multiple sites at low frequency. This finding may help devise new protocols to optimize the increasingly more common use of epidural implantable arrays to treat spinal dysfunctions. Koyama et al. categorized unexpected postural changes during gait training in paraplegic patients with wearable gait-assist robots. Posterior breakdowns might be the result of near collisions between the trunk of the user and the walker, requiring training focused upon well-timed forward movements of the walker. Learmonth et al. provide cut-points based on the linear association between energy expenditure and accelerometer counts for estimating time spent in moderate-to-vigorous physical activity during wheelchair propulsion using wrist-worn accelerometers. Butler Forslund et al. validated the Swedish version of the Spinal Cord Injury Falls Concern Scale.
