The relationship between basal metabolic rate and femur bone mineral density in men with traumatic spinal cord injury

OBJECTIVES: To investigate the relationship between basal metabolic rate (BMR) and hip bone mineral density (BMD) in people with spinal cord injury (SCI) and to determine whether neurologic factors contribute to this relationship. DESIGN: Cross-sectional study. SETTING: Inpatient SCI unit in a rehabilitation hospital. PARTICIPANTS: Thirty men with chronic (time since injury, >1 y) traumatic SCI with an American Spinal Injury Association Impairment Scale grade A or B. Subjects' mean age was 32 years (range, 20-45 y). INTERVENTIONS: All participants were evaluated with neurologic examination to define the level and severity of injury. BMR was determined by indirect calorimetry, and BMD was determined by dual-energy x-ray absorptiometry (DXA). Patients were allocated to osteoporotic, osteopenic, and normal bone density groups according to World Health Organization criteria. DXA was used also to estimate lean- and fat-tissue mass (in kilograms) by standard methods. DXA measurements were performed on the same day as BMR analysis. MAIN OUTCOME MEASURES: DXA and indirect calorimetry. RESULTS: BMR correlated significantly with BMD of the total femur, femur neck, trochanter, and shaft. However, there was no correlation between BMR and femur Ward's triangle. These correlations were stronger in patients with tetraplegia. There was a moderate correlation between BMR and lean tissue mass (r = .66, P < .001), although femur BMD values did not correlate with lean tissue mass in our study group (P > .05). CONCLUSIONS: BMR is closely associated with BMD in men with SCI.     

Fracture threshold in the femur and tibia of people with spinal cord injury as determined by peripheral quantitative computed tomography

OBJECTIVE: To determine bone traits of the femur and tibia with peripheral quantitative computed tomography (pQCT) that best distinguish between spinal cord injury (SCI) subjects with and without fractures. DESIGN: Cross-sectional study. SETTING: In- and outpatient paraplegic center in Switzerland. PARTICIPANTS: Ninety-nine motor complete SCI subjects (duration of paralysis, 2 mo-49 y), 21 of whom had sustained fractures of the femur or tibia. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Subjects with SCI were questioned about the occurrence, location, and approximate date of fractures to their lower extremities. Trabecular and cortical bone mineral density (BMD), as well as bone geometric properties of distal epiphyses and midshafts of the femur and tibia, were measured by pQCT. RESULTS: Trabecular BMD of the femur and tibia distal epiphyses was found to distinguish best subjects with fractures from those without. Fractures occurred in subjects with trabecular BMD of less than 114 mg/cm 3 and less than 72 mg/cm 3 for the femoral and tibial distal epiphysis, respectively (corresponding to 46% and 29% of mean values of an able-bodied reference group). Approximately 50% of the subjects with chronic SCI (defined as time postinjury >5 y for femur data and >7 y for tibia data) had trabecular BMD values above the fracture threshold in the femur and about one third above the fracture threshold in the tibia. CONCLUSIONS: By using pQCT, it may be possible to identify subjects with SCI who are at risk of sustaining fractures of the femur and tibia through minor trauma.     

The relationship between sitting stability and functional performance in patients with paraplegia

OBJECTIVES: To compare sitting stability between patients with high and low thoracic spinal cord injury (SCI), to determine the factors that can predict sitting stability, and to examine the relationship between sitting stability and functional performance. DESIGN: Cross-sectional assessment was performed on subjects with paraplegia. SETTING: Rehabilitation hospital affiliated with a medical university. PARTICIPANTS: Convenience sample of 30 adults with complete chronic thoracic SCI. INTERVENTIONS: Not applicable. Main Outcome Measures: (1) Postural sway during quiet sitting over 30 seconds was recorded as static sitting stability, and composite maximal weight-shift during leaning tasks over 30 seconds was measured as dynamic sitting stability; (2) age, body weight, trunk length, trunk strength, postonset duration, injury level, and presence of spasticity were examined as predictive variables for sitting stability; and (3) the time for completion of upper- and lower-body dressing and undressing and transfer was measured as functional performance. RESULTS: A significant difference in composite maximal weight-shift was found between high and low thoracic SCI subjects (t=2.90, P<.01). Injury level and trunk length were 2 important predictive factors for dynamic sitting stability, and they explained 43.5% of the variance. Only the completion time of upper-body dressing and undressing correlated significantly with static (r=.465, P=.01) and dynamic (r=-.377, P<.05) sitting stability. CONCLUSIONS: The subjects with low thoracic SCI showed better dynamic sitting stability than those with high thoracic SCI. Injury level and trunk length, not trunk flexion or extension strength, predicted the outcome of dynamic sitting stability. Measures were not precise enough to predict functional performance from the viewpoint of injury level and sitting stability. The underlying premise that a reduction or increase in trunk strength is indicative of poorer or better sitting stability in SCI individuals is questioned, and implications for problem identification and treatment planning are discussed.     

Fasting serum levels of adiponectin, ghrelin, and leptin in men with spinal cord injury

OBJECTIVES: To measure serum levels of adiponectin, ghrelin, and leptin in men with spinal cord injury (SCI) and to investigate possible correlations between these serum levels and various factors, such as body mass index (BMI), age, injury level, and duration of injury. DESIGN: Cross-sectional. SETTING: A university hospital that is a tertiary referral center. PARTICIPANTS: Eighty-nine men with traumatic neurologically complete SCI (30 with tetraplegia, 59 with paraplegia) and 37 age- and BMI-matched male controls. Subjects with SCI were injured at the mean age +/- standard error of 28.5+/-1.0 years (range, 14.7-59.1 y) and the mean injury duration was 10.8+/-0.7 years (range, 1.1-27.7 y). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Serum levels of adiponectin, ghrelin, and leptin and BMI. RESULTS: Serum leptin levels in subjects with SCI (mean, 7.0+/-0.5 mg/mL) [corrected] were significantly higher than those in able-bodied controls (mean, 4.7+/-0.6 mg/mL) [corrected] (P<.01). The group with tetraplegia had higher serum leptin levels than the group with paraplegia, but this did not reach a statistically significant level (8.2+/-1.1 ng/mL vs 6.4+/-0.5 mg/mL [corrected] P=.097). There were significant differences in serum leptin levels among the 3 groups by 1-way analysis of variance (P=.008). Serum adiponectin levels in subjects with SCI (7.1+/-0.5 mg/mL) [corrected] were higher than those in able-bodied controls (5.6+/-0.5 mg/mL) [corrected] but this was not statistically significant (P=.08). In contrast, serum levels of ghrelin in subjects with SCI (302.0+/-17.5 pg/mL) were similar to those in the controls (264.0+/-27.0 pg/mL) (P=.24). Serum leptin levels correlated positively with BMI (SCI, r=.698, P<.001; controls, r=.782, P<.001), whereas serum adiponectin (SCI, r=-.527, P<.001; controls, r=-.315, P=.057) and ghrelin (SCI, r=-.368, P<.001; controls, r=-.447, P=.006) levels correlated negatively with the BMI in both subjects with SCI and controls. CONCLUSIONS: Men with SCI have significantly higher serum leptin levels than able-bodied controls, and serum leptin levels correlated with the degree of neurologic deficit. Men with SCI had a tendency toward higher serum adiponectin level than able-bodied controls. Serum levels of ghrelin in men with SCI were similar to those of controls.     

Chronologic age, time since injury, and time of measurement: effect on adjustment after spinal cord injury

People are now living longer after spinal cord injury (SCI), yet only limited research has addressed the issue of aging and adjustment after SCI. The purpose of this study was to use a time-sequential design to identify the relationship between adjustment after SCI and three facets of aging; chronologic age, time since injury, and time of measurement. Life Situation Questionnaires were obtained from one sample of participants with SCI in 1974 (n = 256) and from a second sample in 1985 (n = 193). Participants were grouped into five cohorts based on chronologic age, five cohorts based on time since injury, and two groups based on time of measurement (1974, 1985). Two two-way MANOVA's were performed, one between chronologic age and time of measurement, and the other between time since injury and time of measurement. Results indicated that chronologic age and time since injury often worked in opposing directions; as some aspects of adjustment declined with greater chronologic age, but other aspects improved with increasing time since injury. Activity was strongly related to chronologic age, but medical stability was more strongly related to time since injury. Both chronologic age and time since injury were correlated with some aspects of life satisfaction. Comparisons between the two times of measurement (1974, 1985) indicated some limited positive changes in adjustment with time. The results point to the complexity of the relationship between aging and adjustment and the need for rehabilitation professionals to consider multiple aging factors.     

Effect of electrical stimulation-induced cycling on bone mineral density in spinal cord-injured patients

BACKGROUND: Bone atrophy in spinal cord-injured people (SCI) is, among other factors, caused by immobilization and is initiated shortly after the injury. The present study measured the effect of an functional electrical stimulation (FES)-cycling intervention on bone mineral density (BMD) of the tibia in recently injured SCI people. METHODS: As soon as possible after the injury (mean 4.5 weeks), para- and tetraplegic patients were recruited into an intervention and control group comparable with regard to gender, age, and lesion level. The intervention consisted of 30-min functional electrical stimulation-cycling three times a week for the duration of their primary rehabilitation (mean = 6 months). Computed tomography (CT) scans of the right tibia diaphysis were taken at the beginning and at the end of the intervention. Bone mineral density of cortical bone was calculated from the CT scans. RESULTS: A total of 38 subjects (19 in each group) were included in the study. Both groups showed a reduction in tibial cortical BMD of 0-10% of initial values within 3-10 months. The mean decrease in BMD was 0.3% (+/- 0.6) per month in the intervention group and 0.7% (+/- 0.8) in the control group. This difference did not reach statistical significance. Decrease of BMD was linearly correlated to initial BMD and age in the pooled data of both groups; subjects who had a high initial BMD and/or were older lost more bone. In neither group was bone loss associated with duration of immobilization nor lesion level. CONCLUSIONS: Functional electrical stimulation-cycling applied shortly after SCI did not significantly attenuate bone loss.     

Serum creatinine as an indicator of renal function after spinal cord injury

This study was conducted to determine (1) if serum creatinine levels (SCL) in spinal cord injury (SCI) patients are influenced by neurologic level of lesion, sex, age, or time since injury, and (2) if SC values are a sensitive indicator of renal function (as reflected by renal plasma flow [RPF]) in these patients. The overall SC mean and SD were 0.9 +/- 0.2mg/dl (n = 141). There was no difference in SC values between patients with higher injuries (T-6 or above) and patients with lower injuries (T-7 or below), nor was there any difference between patients with lesions less than 3 months, 10-14, 22-26, 34-38, 46-50, or 58-62 months in duration. Age and gender each accounted for less than 5% of the variation in SC. There was no significant correlation between RPF and SC (unless the patient also had moderate or severe pyelocaliectasis) nor between change in serum RPF (from the previous examination, usually 12 months earlier) and change in SC, suggesting that SCL does not reflect the functional status of the kidney in these patients.     

Bone mineral density after spinal cord injury: a reliable method for knee measurement

OBJECTIVES: To test the interrater reliability of a standardized method to analyze knee bone mineral density (BMD) using dual-energy x-ray absorptiometry (DXA); to compare spine, hip, and knee BMD of people with spinal cord injury (SCI) with able-bodied controls; and to determine the relation between hip BMD and knee BMD in SCI and able-bodied subjects. DESIGN: Criterion standard and masked comparison. SETTING: Primary care university hospital. PARTICIPANTS: A convenience sample of 11 subjects with complete SCI was age and sex matched with 11 able-bodied control subjects. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Four raters analyzed regions of interest according to operational definitions recently developed to standardize the analysis of BMD of the knee. Subjects with chronic SCI and matched controls underwent conventional DXA scans of the spine and hips and "less conventional" scans of the distal femurs and proximal tibias. The relation between hip and knee BMD was analyzed. RESULTS: The knee measurements were highly reliable (femur intraclass correlation coefficient model 2,1 [ICC(2,1)]=.98; tibia ICC(2,1)=.89). Subjects with SCI had lower BMD values than controls at all hip and knee sites (P<.05). Lumbar spine BMD did not differ between groups. Hip BMD was moderately predictive of distal femur BMD (R2=.67), but less correlated with the proximal tibia (R2=.38). CONCLUSIONS: Knee BMD can be reliably analyzed using DXA with this protocol. Subjects with SCI have diminished knee and hip BMD. Low hip BMD is associated with low distal femur BMD.     

Spasticity in spinal cord injury: self- and clinically rated intrinsic fluctuations and intervention-induced changes

OBJECTIVES: (1) To determine patterns of intrinsic fluctuations in spasticity, using repeated self-ratings, in subjects with spinal cord injury (SCI); and (2) To determine the relation between self-ratings of spasticity using a visual analogue scale (VAS) and clinical ratings of spasticity using the Modified Ashworth Scale (MAS) before and after spasticity-reducing treatment. DESIGN: Part I: observational, prospective cross-sectional study; part II: experimental, prospective longitudinal study. SETTING: Outpatient clinic of the Karolinska Hospital, Stockholm, Sweden. PATIENTS: Forty-five persons with SCI (39 men, 6 women); mean age at injury, 26 yrs; mean time since injury, 11 yrs. INTERVENTION: Repetitive passive movements of standardized range of motion in three different body positions, performed by two motorized tables. MAIN OUTCOME MEASURES: VAS ratings of spasticity, every other hour when awake, and of movement-provoked spasticity, rated before and after each treatment session, and MAS ratings of movement-provoked spasticity, before and after each treatment session. RESULTS: The spasticity of cervical SCI subjects fluctuated significantly (p < .05) during the day, unlike the spasticity of thoracic SCI subjects. Immediately after intervention with passive movements, spasticity ratings in thoracic motor complete SCI patients decreased by 11 to 14 mm (90%, p < .001) as self-rated on VAS and by 1 to 2 grades (50%, p < .001) as measured with MAS. A 30% (p < .018) decrease in VAS values of intrinsic pattern of spasticity was maintained over time when treatment was given regularly and was maintained for at least 1 week after discontinuation of treatment. VAS ratings correlated significantly with MAS ratings (r = .44 to .62, p < .001). CONCLUSION: Repetitive passive movement intervention decreased spasticity when performed regularly, as assessed by VAS and MAS ratings. VAS and MAS ratings were significantly correlated. It is recommended that SCI patients repeatedly rate their spasticity to establish a baseline before and to track changes after interventions aimed at reducing spasticity. The time of day when spasticity is measured seems more important in cervically injured individuals, because of their more pronounced intrinsic fluctuations.     

阿法骨化醇及二膦酸盐类药物对脊髓损伤患者骨密度的影响

目的探讨阿法骨化醇及二膦酸盐类药物对脊髓损伤患者骨密度的影响。方法分别比较 3 1例口服阿法骨化醇与42例未口服该药的脊髓损伤患者 ,以及 2 2例口服二膦酸盐类药物与 2 4例未口服该药的脊髓损伤患者第 4腰椎和股骨近端及其分区骨密度变化的差异。结果是否口服阿法骨化醇对脊髓损伤患者骨密度的保持无显著影响 ;但口服二膦酸盐类药物患者的股骨近端 (total)骨密度较未口服该药物患者下降少 ,两者的差异具有显著性意义 (P <0 .0 5 )。结论口服二膦酸盐类药物对股骨近端的骨密度变化有保护作用。     

Testosterone replacement therapy and motor function in men with spinal cord injury: a retrospective analysis

OBJECTIVE: To evaluate motor function in men with spinal cord injury (SCI) given testosterone replacement therapy (TRT). DESIGN: American Spinal Injury Association (ASIA) rehabilitation discharge motor index scores were compared between men with SCI given TRT (testosterone cypionate, 200 mg, monthly; n = 50) and a comparison group (n = 480) in a retrospective study. Covariates included admission motor and FIM scores, level of injury (paraplegia/tetraplegia), days since injury, and age. RESULTS: ASIA discharge motor scores for ASIA impairment scale grades C and D were significantly different (P < 0.05) in men with incomplete SCI given TRT, relative to the comparison group. The covariate-adjusted mean discharge score for the TRT group was higher than for the comparison group. There were no significant differences in discharge FIM scores (P = 0.34) for men with incomplete injuries and no differences in the adjusted discharge ASIA motor scores (P = 0.92) or adjusted discharge FIM scores (P = 0.16) for men with complete injuries. CONCLUSION: The data support a relationship between TRT and strength gains in men with residual motor function after SCI. Prospective studies are necessary to validate these findings.     

Peripheral quantitative computed tomography: measurement sensitivity in persons with and without spinal cord injury

OBJECTIVES: To determine (1) the error attributable to external tibia-length measurements by using peripheral quantitative computed tomography (pQCT) and (2) the effect these errors have on scan location and tibia trabecular bone mineral density (BMD) after spinal cord injury (SCI). DESIGN: Blinded comparison and criterion standard in matched cohorts. SETTING: Primary care university hospital. PARTICIPANTS: Eight able-bodied subjects underwent tibia length measurement. A separate cohort of 7 men with SCI and 7 able-bodied age-matched male controls underwent pQCT analysis. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The projected worst-case tibia-length-measurement error translated into a pQCT slice placement error of +/-3 mm. We collected pQCT slices at the distal 4% tibia site, 3 mm proximal and 3 mm distal to that site, and then quantified BMD error attributable to slice placement. RESULTS: Absolute BMD error was greater for able-bodied than for SCI subjects (5.87 mg/cm(3) vs 4.5 mg/cm(3)). However, the percentage error in BMD was larger for SCI than able-bodied subjects (4.56% vs 2.23%). CONCLUSIONS: During cross-sectional studies of various populations, BMD differences up to 5% may be attributable to variation in limb-length-measurement error.     

脊髓损伤后大鼠骨代谢和骨密度变化

目的:了解脊髓损伤后不同时期大鼠骨代谢和骨密度的变化。方法:60只SD大鼠按体重随机分为6组,对20只大鼠采用脊髓横断法在第10胸椎段横断脊髓制作完全性脊髓损伤模型,分为脊髓损伤6周和12周组;20只在同水平处切断棘突、椎板制作假手术对照组,分为假手术6周和12周组;另20只分为正常6周和12周对照组。分别在脊髓损伤后6周和12周时处死动物。结果:脊髓损伤6周、12周时,脊髓损伤组血Ca较对照组明显升高(P<0.05),碱性磷酸酶和骨钙素则较对照组无明显变化(P>0.05)。脊髓损伤6周时,股骨近端、远端骨密度(BMD)均较对照组显著降低(P<0.001),损伤12周时,除股骨近端、远端外,中段BM D也明显降低(P<0.05)。L5BMD在SCI6周和SCI12周与对照组比较差异无显著性意义(P>0.05)。结论:脊髓损伤6周时,大鼠骨代谢已发生明显改变,骨量出现明显丢失,12周时骨代谢稍有改善,但股骨骨量丢失持续存在。     

Sleep apnea syndrome in chronic spinal cord injury: associated factors and treatment

OBJECTIVE: To determine the prevalence of sleep apnea in a sample of persons with chronic spinal cord injury (SCI) of varying injury levels and degrees of impairment. DESIGN: Cross-sectional study. SETTING: Inpatient SCI rehabilitation unit. PARTICIPANTS: Twenty men with SCI (motor complete and incomplete; American Spinal Injury Association classes A-D) of at least 1 year's duration, randomly selected from patients with SCI undergoing elective hospitalization. MAIN OUTCOME MEASURES: Apnea index, determined by sleep study (including chest wall movement, airflow, oxygen saturation), and daytime sleepiness, determined by Epworth sleepiness score. RESULTS: Eight subjects (40%) had sleep apnea, manifested by elevated apnea index (mean +/- SD, 17.1 +/- 6.9) and excessive daytime sleepiness. Sleep apnea was commonly diagnosed in motor-incomplete injuries. A trend (p = .07) existed toward a greater prevalence of sleep apnea with tetraplegia. Age and body mass index were not associated with sleep apnea. CONCLUSION: The prevalence of sleep apnea in men with chronic SCI admitted for nonrespiratory elective hospitalization is high relative to the general population.     

Effects of lateral trunk support on scoliotic spinal alignment in persons with spinal cord injury: a radiographic study

OBJECTIVE: To develop a radiographic method for measuring the spinal alignment of a person in a seated position and with which to investigate the effects of lateral trunk supports (LTS) in special seating on the frontal and sagittal spinal alignment in persons with spinal cord injury (SCI). DESIGN: Before-after trial. SETTING: University-based research laboratory. PARTICIPANTS: Ten men and 7 women who had SCI with scoliosis (age, 35.4+/-9.4y; injury level, C5-T11) voluntarily participated. INTERVENTION: An adjustable seating system with LTS. MAIN OUTCOME MEASURES: Radiographs of the spine in the anteroposterior (AP) and lateral directions were taken while sitting on an adjustable seating system without and with LTS. The Cobb angles and scoliotic indices based on the AP radiographic images and the angles of the thoracic and lumbar spine based on lateral were calculated. The relative change in angle (RCA) with LTS in terms of the percentage reduction of the Cobb angles was also obtained. RESULTS: The Cobb angles and scoliotic indices while sitting with LTS were significantly smaller than those without, the mean difference of Cobb angles +/- standard error (SE) being 9.12 degrees +/-1.64 degrees (P<.001) and those for the scoliotic indices being .09+/-.04 (P=.027). The mean RCA +/- SE was 26.16%+/-4.23%. The RCA correlated weakly with the original Cobb angles (r=-.347, P=.172). The LTS caused a significant reduction in the lumbar angles (P<.001), but no significant effects on the thoracic angles were found. CONCLUSIONS: The radiographic findings demonstrate improved scoliotic spinal alignment in the frontal plane and reduced lumbar angles in the sagittal plane in persons with SCI when seated in a special seat and using LTS.     

Employment outcomes of adults who sustained spinal cord injuries as children or adolescents

OBJECTIVES: To determine employment outcomes of adults with pediatric-onset spinal cord injury (SCI) and factors associated with those outcomes. DESIGN: Structured interview, including standardized measures. SETTING: Community. PARTICIPANTS: Individuals who sustained an SCI at age 18 years or younger, were 24 years or older at follow-up, did not have a significant brain injury, and were living in the United States or Canada. A total of 195 subjects were interviewed. Mean age at injury was 14 years (0-18 y), mean age at interview was 29 years (24-37 y), and mean duration of injury was 15 years (7-28 y). All participants had been enrolled in SCI programs. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: A structured interview, the FIM instrument, the Craig Handicap Assessment and Recording Technique, the Medical Outcomes Study 12-Item Short-Form Health Survey, and the Satisfaction with Life Scale. RESULTS: Of the participants, 99 (51%) were employed, 78 (40%) were unemployed, 12 (6%) were students, and 6 (3%) were homemakers. A predictive model of employment identified 4 factors associated with employment: education, community mobility, functional independence, and decreased medical complications. Other variables significantly associated with employment included community integration, independent driving, independent living, higher income, and life satisfaction. CONCLUSIONS: Compared with the general population, the high rate of unemployment among adults with pediatric-onset SCI is a cause for concern. Risk factors associated with adult unemployment provide guidelines for targeting rehabilitation resources and strategies.     

Bone mineral density of metatarsus in hemiplegic subjects.

The cortical bone mineral density (BMD) of the first metatarsus was measured using computed x-ray densitometry in 84 hemiplegic subjects (35 men and 49 postmenopausal women) and 49 healthy age-matched controls (23 men and 26 postmenopausal women), and the determinants of paralysis-induced cortical osteopenia were investigated. In the hemiplegia group, ages were 63.9 +/- 9.8 yr (mean +/- standard deviation) for men and 66.6 +/- 11.0 yr for women. The duration of hemiplegia was 25.3 +/- 19.8 mo for men and 26.0 +/- 26.3 mo for women. The Brunnstrom stage (lower limb) was 4.0 +/- 1.1 for men and 3.8 +/- 1.4 for women. The walking ability, evaluated by walking score, was 3.6 +/- 1.3 (range, 1-5) for men and 3.2 +/- 1.5 (range, 1-5) for women. The time since menopause was 14.8 +/- 10.0 yr. The age and time since menopause were similar in the hemiplegia and control groups. On the paralyzed side, the BMD of men and women in the hemiplegia group was significantly lower than that of the control group on the nondominant side (by 6.1% and 11.6%, respectively). In hemiplegic men, Brunnstrom stage and walking score showed a significant positive correlation to the BMD (r = 0.418 and r = 0.349, respectively). In hemiplegic women, on the other hand, age, duration of hemiplegia, and years since menopause showed a significant negative correlation to the BMD (r = -0.260, r = -0.478, and r = -0.506, respectively), and Brunnstrom stage and walking score showed a significant positive correlation to the BMD (r = 0.526 and r = 0.406, respectively). These findings suggest that the determinant of metatarsal cortical BMD loss on the paralyzed side of the hemiplegic subject might be different according to gender. That is, although the degree of paralysis and walking ability could be a determinant of metatarsal cortical BMD loss on the paralyzed side of hemiplegic men, additional factors such as age, duration of hemiplegia, and years since menopause could play an important role in the determination of metatarsal cortical BMD loss in postmenopausal hemiplegic women.     

Reliability and validity of the six-minute arm test for the evaluation of cardiovascular fitness in people with spinal cord injury

OBJECTIVES: To design a submaximal arm ergometry test (six-minute arm test [6-MAT]), for persons with spinal cord injury (SCI) and to determine the test-retest reliability and concurrent validity of this test. DESIGN: Prospective, exploratory, methodologic study. To determine test-retest reliability, subjects completed the 6-MAT on 2 days, separated by 1 week. Validity was determined by comparing 6-MAT results with peak oxygen consumption (VO2peak). SETTING: Tertiary rehabilitation center. PARTICIPANTS: Thirty subjects with SCI (mean age, 36.3y; 83% male). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Subjects were evaluated on the 6-MAT and a VO2peak test. RESULTS: All subjects were able to complete the 6-MAT. Test-retest reliability of steady-state oxygen consumption (VO2) and heart rate during the 6-MAT were excellent (intraclass correlation coefficient [ICC], .81; 95% confidence interval [CI], .58-.92; ICC=.90; 95% CI, .75-.96, respectively). The correlation between VO2peak and 6-MAT VO2 was excellent (r=.92) and the correlations between VO2peak and 6-MAT heart rate (r=.63) and VO2peak and 6-MAT power output (r=.73) were good. CONCLUSIONS: This study showed that the 6-MAT has acceptable values for test-retest reliability and validity. The 6-MAT should be further tested for responsiveness to enhance its use as a clinical tool.     

Sex hormone levels and functional outcomes: a controlled study of patients with spinal cord injury compared with healthy subjects

OBJECTIVES: To investigate testosterone and free testosterone levels in male patients after spinal cord injury (SCI) in comparison with healthy subjects, the effects of free testosterone on Functional Independence Measure (FIM) instrument, and their relationship between time since injury, spinal cord injury levels, and testosterone levels. DESIGN: Prospective case series during 2004-2005. Male patients with SCI (n = 44) and a control group (n = 42) from healthy volunteers with similar age and body mass index were included in the study. Plasma luteinizing hormone (LH) was measured along with testosterone and free testosterone in the same blood sample. The FIM instrument was administered at the admission to hospital and at discharge. RESULTS: Serum LH levels were significantly higher in both patient subgroups than in the control group (P < 0.01 and 0.03). Free testosterone levels were lower in the subgroup with time since injury 相似文献   

Impaired glucose tolerance and bone mineral content in overweight latino children with a family history of type 2 diabetes

OBJECTIVE: Research on the skeletal status of pre-diabetic (type 2 diabetic) children is warranted. We examined the hypothesis that bone mineral content (BMC) and bone mineral density (BMD) will be lower in children with impaired glucose tolerance (IGT) versus normal glucose tolerance (NGT). RESEARCH DESIGN AND METHODS: Total body BMC and BMD of 184 overweight Latino children (106 boys, 78 girls, 11.9 +/- 1.7 years) with a family history of type 2 diabetes were measured using dual-energy X-ray absorptiometry. Glucose tolerance was assessed by 2-h glucose after an oral glucose tolerance test. Area under the insulin curve (AUC) assessed the cumulative insulin response to oral glucose. Acute insulin response to glucose (AIR) was determined by an intravenous glucose tolerance test. RESULTS: Partial correlations revealed an inverse relationship between BMC and AIR (r = -0.29, P = 0.00), AUC (r = -0.28, P = 0.00), fasting insulin (r = -0.16, P = 0.04), and 2-h insulin (r = -0.16, P = 0.04). There was no significant difference in BMC or BMD between children with IGT (n = 46) or NGT (n = 138). Stepwise multiple linear regression revealed that 89% of the variance in BMC is attributed to lean mass (87%), age (1%), and AIR (1%). BMD was explained by lean mass (69%), Tanner stage (3%), and AUC (2%). CONCLUSIONS: The findings of this study suggest that in overweight children, lean mass is the primary predictor of BMC and BMD, whereas age, Tanner stage, and the acute and cumulative insulin responses to oral glucose make subtle independent contributions to the total variances. In addition, poor glycemic control does not seem to be detrimental to bone mass of pre-diabetic children.