Clinical evaluation of computerized functional electrical stimulation after spinal cord injury: a multicenter pilot study

This study investigated the safety and effects of computerized functional electrical stimulation (FES) on spinal cord injured individuals. Nineteen subjects two to ten years postinjury, with clinically complete motor and sensory lesions between C4 and T10, participated. All subjects met the specific selection criteria. None had received lower extremity electrical stimulation before. In phase I, subjects received surface electrical stimulation to the quadriceps muscle bilaterally for resistive knee extension 3 times a week for four weeks. The resistance and number of completed lifts was recorded daily. In phase II, 36 sessions provided sequential surface electrical stimulation to the quadriceps, hamstrings, and gluteus muscles bilaterally in order for subjects to pedal a lower extremity ergometer with resistance varied depending on completed run time. For each session, heart rate, blood pressure, temperature, and work performance were recorded. Tests done before and after the training program included fasting blood chemistries, 24-hour urinalysis, arm-crank ergometer stress testing, and midthigh girth measurement. Results indicate that this form of FES is safe, that quadriceps strength and endurance is increased, that endurance for ergometer pedaling is increased, and that there may be a training effect as more work is done at a similar heart rate and systolic blood pressure and as muscle bulk is increased. The FES effect on cardiovascular conditioning and general health requires further research to precisely determine its benefits.     

Skeletal muscle morphology and exercise response in congenital generalized lipodystrophy

OBJECTIVE: Congenital generalized lipodystrophy (CGL) is an autosomal recessive genetic disorder characterized by almost complete absence of adipose tissue, muscular appearance, and severe insulin resistance since birth. We investigated whether insulin resistance in CGL patients is associated with abnormal muscle morphology and whether increased muscularity imparts increased muscle strength and exercise capacity RESEARCH DESIGN AND METHODS: We obtained quadriceps muscle biopsies to study muscle fiber types and capillary density in three African-American women (aged 17-20 years) with CGL. We also assessed quadriceps muscle strength, muscle metabolism, and maximal O2 consumption in the patients. RESULTS: Quadriceps muscle biopsies revealed a markedly higher percentage of type II (fast-twitch glycolytic) muscle fibers in patients with CGL versus sedentary young women (75-78 vs. 47-57%, respectively). The capillary-to-fiber ratio (2.7-3.0), however, was normal. Cross-sectional areas of type I (slow-twitch oxidative) (1,262-2,685 microm2) and type II (2,304-3,594 microm2) fibers were far below the normal values (3,811-4,310 and 3,115-4,193 microm2, respectively), suggesting muscle hyperplasia but not hypertrophy The quadriceps muscle strength, as measured by Cybex, was below average; the maximal O2 consumption (23-32 ml x kg(-1) x min(-1)) was also below average. 31P nuclear magnetic resonance spectroscopy of the forearm muscles revealed normal pH and metabolic responses to static and dynamic exercises. CONCLUSIONS: We conclude that insulin resistance in patients with CGL is associated with an increased proportion of type II muscle fibers but not reduced capillary density. Increased muscularity in CGL is due to muscle hyperplasia and is not associated with increased muscle strength.     

Increasing muscle mass in spinal cord injured persons with a functional electrical stimulation exercise program

OBJECTIVE: To determine the magnitude of changes in muscle mass and lower extremity body composition that could be induced with a regular regimen of functional electrical stimulation (FES)-induced lower-extremity cycling, as well as the distribution of changes in muscle mass among the thigh muscles in persons with spinal cord injury (SCI). STUDY DESIGN: Thirteen men with neurologically complete motor sensory SCI underwent a 3-phase, FES-induced, ergometry exercise program: phase 1, quadriceps strengthening: phase 2, progressive sequential stimulation to achieve a rhythmic pedaling motion (surface electrodes placed over the quadriceps, hamstrings, and gluteal muscles); phase 3, FES-induced cycling for 30 minutes. Participants moved from one phase to the next when they met the objectives for the current phase. MEASURES: Computed tomography of legs to assess muscle cross-sectional area and proportion of muscle and adipose tissue. Scans were done at baseline (before subjects started the program), at first follow-up, typically after 65.4+/-5.6 (SD) weekly sessions, and at second follow-up, typically after 98.1+/-9.1 sessions. RESULTS: Increases in cross-sectional areas were found in the following muscles: rectus femoris (31%, p<.001). sartorius (22%, p<.025), adductor magnus-hamstrings (26%, p<.001), vastus lateralis (39%, p = .001), vastus medialis-intermedius (31%, p = .025). Cross-sectional area of adductor longus and gracilis muscles did not change. The ratio of muscle to adipose tissue increased significantly in thighs and calves. There was no correlation among the total number of exercise sessions and the magnitude of muscle hypertrophy. CONCLUSIONS: Muscle cross-sectional area and the muscle to adipose tissue ratio of the lower extremities increased during a regular regimen of 2.3 FES-induced lower extremity cycling sessions weekly. The distribution of changes was related to the proximity of muscles to the stimulating electrodes.     

Can functional electric stimulation-assisted rowing reproduce a race-winning rowing stroke?

OBJECTIVE: To compare the ergometer rowing technique of a person with spinal cord injury (SCI), using functional electric stimulation (FES) of his leg muscles, with that of a well-defined group of able-bodied rowers. DESIGN: Whole-body kinematics and kinetics and electric activity of selected muscles were measured during ergometer rowing. SETTING: A hospital-based motion analysis laboratory. PARTICIPANTS: Five male university varsity-level rowers and 1 male rower with SCI. INTERVENTIONS: Eight rowing trials were collected on the university-level rowers, 2 trials each at 20, 24, 28, and 32 strokes/min. The rower with SCI had surface electrodes applied to his medial hamstrings and medial quadriceps muscle bellies. The electrodes were attached to a stimulator that was activated using a button in the ergometer handle. The subject with SCI rowed at a self-selected stroke rate. MAIN OUTCOME MEASURES: Forces at the ergometer handle and foot cradle, 3-dimensional whole-body kinematics, net joint moments, and phasic activity of muscles. RESULTS: Motion of the arms, ankles, and knees of the rower with SCI was similar to those of the university-level rowers; other joint motions and forces applied to the ergometer differed. CONCLUSIONS: FES-assisted rowing in its current implementation cannot reproduce a race-winning rowing stroke. Further development work is required.     

The combined effects of controlled breathing techniques and ventilatory and upper extremity muscle exercise on cardiopulmonary responses in patients with spinal cord injury

This study investigated the effects of controlled breathing techniques and ventilatory and upper extremity muscle exercise on cardiopulmonary and metabolic functions and exercise tolerance in patients with spinal cord injury (SCI). The design of the study was prospective and was a before-after trial. Twenty patients with SCI were included in the study. Resting pulmonary functions were assessed spirometrically. Cardiopulmonary and metabolic responses to maximum exercise were determined with an electronically braked arm crank ergometer. The expired gases during this exercise were collected and analysed using a computerized gas analysis system. Patients with SCI participated in a 6-week ventilatory and upper extremity muscle exercise program for 1 h, three times per week. At the end of the exercise program, we observed significant improvement in spirometric values, peak oxygen uptake, time to fatigue, peak power output and minute ventilation compared with pre-training values for the patients.     

Binding of digoxin to slow- and fast-twitch skeletal muscle fibres

Summary. We have found previously great interindividual variations in the binding of digoxin to skeletal muscle even after standardized rest. The present study was performed in order to find out if there is a difference in the binding of digoxin to slow-and fast-twitch fibres in man at rest and after moderate exercise. Seven healthy digitalized subjects (digoxin 0·50 mg/day) were investigated after 90 min of supine rest and after a 1 h moderate bicycle exercise. Muscle biopsy specimens were taken immediately before and 5 min after exercise and dissected under a microscope to single fibres. After histochemical typing of all fibres the digoxin content in slow-and fast-twitch fibres was measured separately. At rest, digoxin binding to slow-twitch fibres was 33% higher than to fast-twitch fibres (P<0·01). During exercise the digoxin binding increased by 28% in slow-twitch fibres but was unchanged in fast-twitch fibres. The difference in digoxin binding to the two fibre types may explain, at least partly, the interindividual variations in the binding of digoxin to skeletal muscle.     

Cardiorespiratory responses during arm ergometry,functional electrical stimulation cycling,and two hybrid exercise conditions in spinal cord injured

Purpose.?The purpose of this study was to compare peak functional aerobic power (VO₂ peak) across four different types of exercise: arm crank ergometry (ACE), functional electrical stimulation (FES) cycling, and two hybrid exercise conditions: FES cycling combined with ACE and FES rowing using a newly developed rowing device (ROWSTIM).

Methods.?Five participants (C7 – T12), four male paraplegics with neurologically complete spinal cord injury (SCI), and one male with neurologically incomplete SCI, underwent a progressive maximal peak oxygen exercise test to ascertain peak physical work capacity during arm cranking, FES cycling, FES cycling combined with arm cranking and FES rowing.

Results.?Metabolic variables were significantly lower for FES cycling versus ACE, FES cycling combined with ACE and FES rowing measures (P < 0.05). However there were no significant differences between ACE, FES cycling combined with ACE and FES rowing.

Conclusions.?Preliminary results suggest that the ROWSTIM is as effective an exercise device or training tool for persons with SCI as ACE or combined FES-cycling and ACE, and more effective than FES-cycling. A larger sample size and further technological developments of the ROWSTIM are needed to demonstrate the efficacy of rowing over other hybrid exercise modalities and ACE.     

Resting Membrane Potential and Ionic Distribution in Fast- and Slow-Twitch Mammalian Muscle

The resting membrane potential and intracellular potassium and sodium concentration of three guinea pig hind limb muscles were studied. These properties are related to the gross color, the speed of contraction, and the biochemically defined fiber type composing the muscle. The resting membrane potential and intracellular content were: white vastus (grossly white, fast-twitch glycolytic) -85.3 mV. potassium 171.9 meq/liter; soleus (grossly red, slow-twitch oxidative) -69.7 mV, potassium 137.5 meq/liter; and red vastus lateralis (grossly red, fast-twitch oxidative glycolytic) -71.7 mV, potassium 139.6 meq/liter. In soleus and red vastus lateralis, the relative permeability of sodium to potassium was 0.041 and 0.036, while in white vastus it was 0.015. These results give us the first exception to the hypothesis that fast-twitch fibers have higher intracellular potassium and higher resting membrane potential than slow-twitch fibers.     

Effects of Open and Closed Kinetic Chains of Sling Exercise Therapy on the Muscle Activity of the Vastus Medialis Oblique and Vastus Lateralis

[Purpose] The muscle strength of the quadriceps muscle is critical in patellofemoral pain syndrome. The quadriceps muscle supplies the power for dynamic patellar movement, and the vastus medialis oblique (VMO) and vastus lateralis (VL) enable the patella to stabilize during tracking. We followed the theories about open and closed kinetic chain exercises to design two exercises, sling open chain knee extension (SOCKE) exercise and sling closed chain knee extension (SCCKE) exercise. The purpose of our study was to research the changes in quadriceps muscle activity during both exercises. [Methods] Electromyographic analysis was used to explore the different effects of the two exercises. The MVC% was calculated for the VMO and VL during exercise for analysis. [Results] We found that the mean MVC% values of the VMO and VL during the SOCKE exercise were higher than those during the SCCKE exercise. The ratio of the VMO to VL was 1.0 ± 0.19 during the SOCKE exercise and 1.11 ± 0.15 during the SCCKE exercise. [Conclusions] The SOCKE exercise is targeted at quadriceps muscle training and has a recruitment effect on the VMO. The beneficial effect of the SOCKE exercise is better than that of the SCCKE exercise.Key words: Patellofemoral pain syndrome, Sling exercise therapy, Electromyography     

Changes in spastic muscle tone increase in patients with spinal cord injury using functional electrical stimulation and passive leg movements

OBJECTIVE: Comparison of cycling interventions to reduce spastic muscle tone increase in patients with spinal cord injury. SETTING: Neuroprosthetic outpatient clinic in a university hospital. METHODS: Five patients with spinal cord injury took part in a crossover study in which the lower limbs (1) were stimulated by functional neuromuscular electrical stimulation (FES) to induce leg cycling movements and (2) were passively moved by an ergometer machine. Patients sat in a comfortable chair fastened to the ergometer while FES was done to induce leg cycling (active session). During the passive leg movement session the ergometer moved their legs for the same period of time at the same velocity and frequency. MAIN OUTCOME MEASURES: The change in spastic muscle tone increase before and after each training session was tested with the modified Ashworth Scale and the pendulum test of spasticity (relaxation index and peak velocity). RESULTS: The averaged data of the relaxation index increased after FES by about 68%. Compared with the slight increase after the passive movement training of 12%, this is statistically significant (P = 0.01). Peak velocity increased after FES by around 50%, while it was nearly unchanged after the passive intervention (1%); this is also significant (P = 0.01). This was similar with the peak velocity and the modified Ashworth Scale. CONCLUSION: The study presents further interesting aspects of the usefulness of FES in patients with spinal cord injury to reduce spastic muscle tone.     

The effects of ankle joint muscle strengthening and proprioceptive exercise programs accompanied by functional electrical stimulation on stroke patients’ balance

[Purpose] The purpose of the present study was to examine the effects of ankle joint muscle strengthening and proprioceptive exercises accompanied by functional electrical stimulation on stroke patients’ balance ability. [Methods] For six weeks beginning in April 2015, 22 stroke patients receiving physical therapy at K Hospital located in Gyeonggi-do were divided into a functional electrical stimulation (FES), ankle proprioceptive exercise and ankle joint muscle strengthening exercise group (FPS group) of 11 patients and an FES and stretching exercise group (FS group) of 11 patients. The stimulation and exercises were conducted for 30 min per day, five days per week for six weeks. Balance ability was measured using a BioRescue and the Berg balance scale, functional reach test, and the timed up-and-go test were also used as clinical evaluation indices. Repeated measures ANOVA was conducted to examine differences between before the exercises and at three and six weeks after beginning the exercises within each group, and the amounts of change between the two groups were compared. [Results] In the comparison within each group, both groups showed significant differences between before and after the experiment in all the tests and comparison between the groups showed that greater improvement was seen in all values in the FPS group. [Conclusion] In the present study, implementing FES and stretching exercises plus ankle joint muscle strengthening and proprioceptive exercises was more effective at improving stroke patients balance ability than implementing only FES and stretching exercises.Key words: Proprioceptive, Strengthening, Stroke     

Functional electric stimulation to enhance systemic fibrinolytic activity in spinal cord injury patients

Functional electric stimulation (FES) of muscle has been used to decrease the incidence of postoperative deep vein thrombosis (DVT) in neurologically intact individuals. This study was undertaken in order to determine whether a large-scale trial should be initiated using FES to prevent DVT in spinal cord injury (SCI) patients. The goals of this pilot study were to demonstrate the value of FES of calf musculature in (1) increasing plasma fibrinolytic activity and (2) promoting venous blood flow in the lower extremities. Plasma fibrinolytic activity was monitored in ten SCI patients before, immediately after, and 100 minutes after 60 minutes of calf FES. A significant increase in plasma fibrinolytic activity was noted using whole blood and platelet-rich plasma clot lysis assays. Continuous photoplethysmographic and Doppler ultrasound monitoring of venous flow was attempted during FES in four spinal cord patients, and a mild to moderate increase in flow was achieved. FES was not as successful as manual compression in promoting venous emptying of the lower extremity. FES may be a useful tool in the prevention of DVT in SCI patients due to a significant increase in fibrinolytic activity and a mild to moderate increase in venous blood flow. FES merits full-scale clinical evaluation for this purpose.     

Immediate effects of short period lower limb ergometer exercise in adolescent and young adult patients with cerebral palsy and spastic diplegia

[Purpose] To determine the effects of lower limb ergometer exercise on the spasticity and joint range of motion of the lower extremity and gait function in patients with cerebral palsy and spastic paralysis. [Participants and Methods] This study included 8 participants with cerebral palsy and spastic paralysis (GMFCS levels I to IV) who received care at the outpatient clinic. After a 5-min rest, the lower limb ergometer exercises were performed for 10 min. We measured the participants’ arterial blood pressure, pulse rate, passive range of knee joint extension, muscle tone using the Modified Ashworth scale (MAS) and Modified Tardieu scale (MTS), and 10-m walk test (10MWT). Measurements were collected three times (at baseline before exercise, immediately at the end of exercise, and 5 min after exercise during recovery). [Results] The 10-min lower limb ergometer exercise significantly improved the knee joint extension, MAS and MTS scores, and reduced lower extremity spasticity. Furthermore, it significantly increased the range of knee joint extension and decreased the 10MWT score. [Conclusion] The results showed that the 10-minute lower limb ergometer exercise is beneficial in reducing the spasticity of the lower limb muscles and in increasing the range of motion of knee extension in paraplegic patients with cerebral palsy, suggesting that its implementation in young children could prevent spasticity and enhance motor function.Key words: Spasticity, Rehabilitation, Muscle tone     

Functional electric stimulation-assisted rowing: Increasing cardiovascular fitness through functional electric stimulation rowing training in persons with spinal cord injury

OBJECTIVES: To assess changes in peak functional aerobic power after a 36-session, progressive functional electric stimulation (FES) rowing hybrid training program for persons with spinal cord injury (SCI) and to examine the safety and acceptability of the ROWSTIM II device as well as the integrity of technical modifications to it. DESIGN: Repeated-measures training study, quasi-experimental design, within-person data comparison. SETTING: A university-based recreational physical activity facility for persons with physical disabilities. PARTICIPANTS: Six persons with level C7-T12 SCI (American Spinal Injury Association classes A-C). INTERVENTION: Progressive rowing training program, 30 minutes per session, 3 times a week for 12 weeks at 70% to 75% of pretest peak functional aerobic power during FES rowing on an open loop control, FES-assisted rowing machine. MAIN OUTCOME MEASURES: Total rowing distance, peak functional oxygen consumption, and peak oxygen pulse. RESULTS: Subjects completed between 22 to 36 sessions. After 3 months of training, rowing distance increased by 25% (P<.02), peak oxygen consumption by 11.2% (P<.001), and peak oxygen pulse by 11.4% (P<.01). Heart rate response to hybrid training did not change at the end of training, although peak heart rate with FES lower-extremity exercise increased significantly from pre- to posttraining (P<.01). CONCLUSIONS: Pre- and posttraining peak aerobic power values for ROWSTIM II training were comparable to previously reported values for hybrid cycle and upper-extremity exercise. We conclude that FES-assisted rowing is an effective, safe, and well-tolerated training system for persons with SCI.     

The effects of aerobic and resistance exercises in obese women

OBJECTIVE: To compare the effects of aerobic and resistance exercise on weight, muscle strength, cardiovascular fitness, blood pressure and mood in obese women who were not on an energy-restricted diet. DESIGN: Randomized, prospective, controlled trial. SETTING: Department of Physical Medicine and Rehabilitation, University Hospital. SUBJECTS: Sixty obese women were assigned to one of three groups: aerobic exercise (n = 20), resistance exercise (n = 20) and control group (n = 20). INTERVENTIONS: The aerobic exercise group performed both walking and leg cycle exercise with increasing duration and frequency. The resistance exercise group performed progressive weight-resistance exercises for the upper and lower body. MAIN OUTCOME MEASURES: Before and after a 12-week period, all subjects were evaluated by anthropometric measurement, rating of mood, cardiorespiratory capacity and maximum strength of trained muscles. RESULTS: After a 12-week training period, subjects in the resistance group showed significant improvement in one-repetition maximum test of hip abductors (7.95+/-3.58 kg), quadriceps (14+/-7.18 kg), biceps (3.37+/- 2.84 kg) and pectorals (8.75+/-5.09 kg) compared with those in the control group (P < 0.001). VO2 max increased (0.51+/-0.40) and Beck Depression Scale scores decreased (-5.40+/-4.27) in the aerobic exercise group compared with the control group, significantly (P < 0.001). Only in hip abductor muscle strength was there a significant increase in the resistance exercise group compared with the aerobic exercise group (P < 0.05). CONCLUSION: Both aerobic exercise and resistance exercise resulted in improved performance and exercise capacity in obese women. While aerobic exercise appeared to be beneficial with regard to improving depressive symptoms and maximum oxygen consumption, resistance exercise was beneficial in increasing muscle strength.     

Electrical stimulation: can it increase muscle strength and reverse osteopenia in spinal cord injured individuals?

OBJECTIVE: To study the extent to which atrophy of muscle and progressive weakening of the long bones after spinal cord injury (SCI) can be reversed by functional electrical stimulation (FES) and resistance training. DESIGN: A within-subject, contralateral limb, and matching design. SETTING: Research laboratories in university settings. PARTICIPANTS: Fourteen patients with SCI (C5 to T5) and 14 control subjects volunteered for this study. INTERVENTIONS: The left quadriceps were stimulated to contract against an isokinetic load (resisted) while the right quadriceps contracted against gravity (unresisted) for 1 hour a day, 5 days a week, for 24 weeks. MAIN OUTCOME MEASURES: Bone mineral density (BMD) of the distal femur, proximal tibia, and mid-tibia obtained by dual energy x-ray absorptiometry, and torque (strength). RESULTS: Initially, the BMD of SCI subjects was lower than that of controls. After training, the distal femur and proximal tibia had recovered nearly 30% of the bone lost, compared with the controls. There was no difference in the mid-tibia or between the sides at any level. There was a large strength gain, with the rate of increase being substantially greater on the resisted side. CONCLUSION: Osteopenia of the distal femur and proximal tibia and the loss of strength of the quadriceps can be partly reversed by regular FES-assisted training.     

表面肌电结合等速测试仪评价功能性电刺激对脑卒中患者下肢痉挛及其功能影响的临床研究

目的:运用表面肌电结合等速测试仪探讨基于正常行走模式的功能性电刺激(FES)对脑卒中患者下肢痉挛及功能的影响.方法:54例脑卒中患者随机分为2组,FES组及安慰刺激组(对照组).2组患者均接受常规的临床及康复治疗.FES组在此基础上接受基于正常行走模式的FES治疗,安慰刺激组给予无电流输出的电刺激.治疗前及治疗4周后,...     

Angina and ST-segment depression during treadmill and arm ergometer testing in patients with coronary artery disease

The clinical use of exercise rehabilitation programs has increased for patients with coronary artery disease. Exercise testing in these programs typically is conducted on a treadmill or cycle ergometer, although many patients' vocations require upper extremity activities and some patients cannot perform lower extremity exercises. To compare the hemodynamic responses and the incidence of angina and ST-segment depression during upper and lower extremity exercise in patients with coronary artery disease, we administered symptom-limited arm ergometer and submaximal or maximal symptom-limited treadmill tests to 95 cardiac rehabilitation patients who had completed an eight-week exercise training program. Treadmill testing resulted in significantly higher heart rates, systolic blood pressures, and double products than arm ergometer testing. The incidence of ST-segment depression was significantly greater with treadmill testing than with arm ergometer testing, but the incidence of angina was not different between tests. Ten patients had ST-segment depression during both arm ergometer and treadmill testing, and the double products at the onset of ST-segment depression were not different. Our data suggest that arm ergometer testing is less likely to result in ST-segment depression than treadmill testing in patients with coronary artery disease, possibly because of the lower hemodynamic responses during arm ergometer testing.     

The effect of complex rehabilitation training for 12 weeks on trunk muscle function and spine deformation of patients with SCI

[Purpose] It is important for patients with incomplete spinal cord injury (SCI) to strengthen their muscle strength and return to the work force one of the ultimate objectives of rehabilitation. This study reports how a single patient with SCI became stabilized in terms of abdominal muscles and back extension muscles, as well as returning the back to the neutral position from spinal deformation, as result of complex exercises performed for 12 weeks. [Subjects] The degree of damage of the subject was rated as C grade. The subject of this study had unstable posture due to paralysis in the lower extremities of the left side after removal of a malignant tumor by surgical operation, and tilting and torsion in the pelvis increased followed by increase of kyphosis in the thoracolumbar spine. The subject was more than two years since diagnosis of incomplete SCI after surgery. [Methods] Using isokinetic lumbar muscle strength measurement equipment, peak torque/weight, total work and average power in flexion and extension of the lumbar region were measured. A trunk measurement system (Formetric 4D, DIERS, Germany), which is a 3D image processing apparatus with high resolution for vertebrae, was used in order to measure 3D vertebrae and pelvis deformation as well as static balance abilities. As an exercise method, a foam roller was used to conduct fascia relaxation massage for warming-up, and postural kyphosis was changed into postural lordosis by lat pull-down using equipment, performed in 5 sets of 15 times preset at 60% intensity of 1RM 4 set of 10 crunch exercises per set using Togu’s were done while sitting at the end of Balance pad, and 4 sets of 15 bridge exercises. [Results] All angular speed tests showed a gradual increase in muscle strength. Flexion and extension showed 10% and 3% improvements, respectively. The spine deformation test showed that isokinetic exercise and lat pull-down exercise for 12 weeks resulted in improved spinal shape. [Conclusion] In this study, core stability exercise for deep muscle training and lat pull-down exercise had positive effects on lower extremity muscle strength and the spinal shape of a patient with SCI.Key words: Spinal Cord Injury (SCI), Stability, Lat pull down