Musculoskeletal Changes After Spinal Cord Injury: Effects of Body Weight Supported Treadmill Training

The overall focus of this thesis was musculoskeletal changes after individuals with spinal cord injury. The bulk of the thesis investigated the impact of a rehabilitation intervention, namely body weight supported treadmill training (BWSTT), on skeletal health and muscle atrophy in individuals with acute and chronic spinal cord injury (SCI). The first two studies in this thesis were methodological in nature. The first revealed that the presence of metal in a dual-energy x-ray absorptiometry scan results in reproducible errors in estimations of bone mineral content and body composition. The second study demonstrated that mid-tibia speed of sound measurements obtained with quantitative ultrasound might not reveal the changes that occur in the skeleton after SCI. These studies impart an important contribution to the area of osteoporosis diagnosis in individuals with SCI. The two longitudinal prospective studies presented here add to the growing body of literature that BWSTT can improve ambulation in individuals with chronic and acute incomplete SCI. Individuals participating in regular BWSTT improved their walking abilities on the treadmill, and some individuals improved their over ground walking abilities. The studies in this thesis are the first to investigate the impact of BWSTT on bone and muscle together in individuals with acute and chronic SCI. BWSTT had a positive impact on muscle, in that significant increases in lean mass and muscle cross-sectional area were observed after training in both acute and chronic SCI. BWSTT did not appear to have an impact on the skeleton, but further research is required to confirm these findings. Ultimately, it appears that individuals with SCI stand to benefit from BWSTT and the benefits are not limited to improved ambulation.

Year	Entry
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1998	Zerwekh JE, Ruml LA, Gottschalk F, Pak CYC. The effects of twelve weeks of bed rest on bone histology, biochemical markers of bone turnover, and calcium homeostasis in eleven normal subjects. J Bone Miner Res. October 1998;13(10):1594-1601.
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Year

Entry

1994

Kanis JA; WHO Study Group. Assessment of fracture risk and its application to screening for postmenopausal osteoporosis: synopsis of a WHO report. Osteoporos Int. November 1994;4(6):368-381.

1998

Zerwekh JE, Ruml LA, Gottschalk F, Pak CYC. The effects of twelve weeks of bed rest on bone histology, biochemical markers of bone turnover, and calcium homeostasis in eleven normal subjects. J Bone Miner Res. October 1998;13(10):1594-1601.

1979

Goodship AE, Lanyon LE, McFie H. Functional adaptation of bone to increased stress: an experimental study. J Bone Joint Surg. June 1979;61A(4):539-546.

1994

Nelson ME, Fiatarone MA, Morganti CM, Trice I, Greenberg RA, Evans WJ. Effects of high-intensity strength training on multiple risk factors for osteoporotic fractures: a randomized controlled trial. JAMA. December 28, 1994;271(24):1909-1914.

1995

Kannus P, Haapasalo H, Sankelo M, Sievanen H, Pasanen M, Heinonen A, Oja P, Vuori I. Effect of starting age of physical activity on bone mass in the dominant arm of tennis and squash players. Ann Intern Med. July 1995;123(1):27-31.