我们非常感谢Martina Lienert和Fabienne Schaufelberger在运动测试期间的帮助，以及PD Claudio Perret博士的科学建议。

该研究得到当地伦理委员会（Ethikkommission Nordwest- und Zentralschweiz，Basel，Switzerland）的批准，并在开始研究之前获得了与会者的书面知情同意书。 测试准备和参与者指导<ol><li> 手臂曲柄测力计 <ol><li>在打开软件之前，打开旋转速度相关的手臂曲柄测力计的电源。 </li><li>选择测试方案3分钟，全能测力计测试。 <ol><li>插入一个新的协议，120秒的预热，180秒的测试时间和720秒的冷却时间。选择此测试协议并打开一个新的参与表。 </li></ol></li><li>对于每次新的测试，事先确定参与者的身体质量。 </li><li>对于身体健康和截瘫个体，将相对扭矩因子设为0.2（ 例如，对于100 kg参与者，相对扭矩因子为0.2，扭矩为20 Nm结果） 12 。 <ol><li>根据脊髓损伤的病变级别对四肢参与者应用较低的扭矩因子;需要两个或更多的熟悉试验来确定相关参与者的最佳相对扭矩因子。 </li><li>以与第2部分所述相同的方式进行熟悉试验。如果在熟悉试验中打印数据后没有出现峰值，或者如果参与者在整个3分钟内无法起动，则进行第二次熟悉试验扭矩因数。每次试验之间至少两天内给予参加者休息。 </li></ol></li></ol></li><li> 运动测试设置 <ol><li>调整手臂曲柄的高度并记录下来在下一个测试会话中复制相同的测试设置。调整并记录手臂曲柄测力计与参与者之间的距离。 <ol><li>要确定高度，测量距离在地板和曲柄的固定之间。记录曲柄和参与者之间的距离，测量和记录墙壁和椅子固定之间的距离。将手臂曲柄轴调整到与肩关节水平的高度。 </li></ol></li><li>记录墙壁固定件和椅子之间的距离或者测力计与椅子固定件之间的距离。根据参加者是否健康，b）截瘫或c）四肢麻醉调整椅子设置。 <ol><li>如果参与者身体健壮，请让参与者坐在经销商提供的椅子上。 </li><li>如果参与者截瘫，需要坐在自己的轮椅上，使用固定装置将轮椅固定在手臂曲柄测力计上。如果参与者不需要自己的轮椅，请让参与者坐在经销商提供的椅子上。 </li><li>如果参与者是四肢的，将其上身固定在身上由经销商或自己轮椅提供的椅子，并可能将手固定在踏板上。要固定上身，请使用带有钩环紧固件的皮带。手腕固定时，请在四肢手术患者中使用腕带。 </li></ol></li></ol></li><li> 附加测量 <ol><li>在使用乳酸盐分析仪之前，确保乳酸盐系统溶液被重新填充。每六个月插一个新的芯片传感器。每天使用质量控制溶液（12 mM），每两周使用3 mM质控对照溶液。 <ol><li>每天早上将12 mM质量控制解决方案放入"STD 1"插槽。 </li><li>为了进一步提高质量，将3 mM质量控制解决方案添加到间隙"1"和"2"中，并通过每两周按一次"开始"进行测量。测量值应该在2.96和3.10 mM之间。 </li></ol></li><li>确定之前和之前的全血乳酸浓度3分钟，全功能臂曲柄测力计测试，获得基线乳酸浓度。在使用10μL毛细管从耳垂抽取血液样品前，用消毒剂消毒耳垂。使用刺血针获得全血样本。 <ol><li>当毛细管充满血液时，将其放入溶血杯中。 注意:这些杯子是可商购的，并预先用溶血溶液。摇动溶液直到血液完全混合，然后将其放入乳酸盐分析仪的托盘中。 </li><li>在分析乳酸浓度前进行校准。将质量控制杯放入乳酸分析仪（参见步骤1.3.1.1。）。确保校准结果为12mM乳酸浓度;否则，更换芯片传感器。 </li><li>将样品放入编号的插槽中，首先从"1"开始。 注意:校准完成后，样品进行测量由芯片传感器系统自动完成。 </li></ol></li><li>要确定心率，请将心脏带放在参与者的胸部周围，并将心率监视器固定到手臂曲柄测力计上。按下显示器上的红色启动按钮开始测量。如果手表上没有显示心率，请用水润湿心率腰带，以确保良好的心率记录。 </li><li>为了确定在加热期间和3分钟全过程测试期间的氧消耗，在测试前校准代谢车。在测试前立即运行自动音量和气体校准，然后放置面罩。 <ol><li>在软件中打开自动音量校准，然后按开始按钮。存储结果如果错误在屏幕上低于3％。 </li><li>打开软件中的气体校准以及校准气体，并开始自动校准。 注意:校准气体由5％CO 2组成 ，16％O 2和79％N 2 。在校准结束时，屏幕上显示8个绿色按钮，校准成功并可以存储结果。关闭气瓶，确保气体不泄漏。 </li><li>确保参与者的实际身体质量插入到计算机程序中。在计算机上的搜索引擎选择参与者后，在软件中选择"自我测量"，然后按开始按钮开始测量室内空气浓度。 </li><li>要运行此校准，请将传感器从肺活量计中取出，然后按开始按钮。计算机上显示"ok"时，校准完成。 </li><li>同时，在校准期间，将氧气面罩放在参加者身上。 </li><li>当室内空气浓度的测量结束并且程序准备好测量时，将传感器放回肺活量计。然后，将整个肺活量计放入腔内面具;该设备现在可以测量氧气消耗。 </li><li>另外，在某处（ 例如，用胶带在肩膀上）固定肺活量计的软管，使其在手臂曲柄运动期间不会干扰。 </li></ol></li></ol></li></ol> 2.执行运动协议<ol><li> 暖身 <ol><li>开始预热前1分钟，开始测量休息时的氧气消耗量，当参与者坐在手臂曲柄测力计上，无需移动或说话。按软件程序中的开始按钮。 </li><li>同时，按红色按钮开始测量心率。在预热期间以及测试期间和之后测量心率。 </li><li>在测试开始之前，在20 W下进行2分钟的标准化预热。在暖身的最后30秒，保持节奏恒定在60转/分。倒数30秒的暖身的最后10秒。 </li></OL&gt; </li><li> 3分钟全程运动测试 <ol><li>倒计时结束时，一定要通过喊"走"来给出明确的启动信号。给出启动信号后，允许参与者加速。 </li><li>指导参与者在测试开始时尽可能加快手臂曲柄测力计的最大速度。在整个测试过程中尽可能保持速度。为了标准化的原因，不要鼓励参与者在测试期间。 </li><li>每30秒提供一次持续时间的信息。在3分钟的时间内完成测试。 </li></ol></li><li> 冷却和后分析 <ol><li>完成3分钟全部测试后，如果需要，测量乳酸浓度，然后在接下来的10分钟内每2分钟测量一次。重复使用与测试前使用的血液采样相同的穿刺部位。 </li><li>完成这些3后，停止测量耗氧量<html>最后按停止按钮。取下氧气面罩。通过按退出按钮并在软件要求进行数据存储时点击"是"，可以节省计算机上的耗氧量。 注意:数据存储在软件程序中，可以很容易地转换成csv文件。 </li><li>要导出数据，请按"导出"按钮将文件转换为csv文件供以后分析。所有血液样本从耳垂中抽出后，按心率监视器左侧的停止按钮，停止心率测量。 </li></ol></li></ol> 3.结果数据分析与解释<ol><li> 性能参数 <ol><li>完成此性能测试后分析几个不同的参数。 首先，保存测试并将其导出到电子表格。 </li><li>计算平均功率（P mean =_upload / 55485 / 55485eq1.jpg"/&gt; <img alt="方程" src="/files/ftp_upload/55485/55485eq2.jpg" />超过3分钟，峰值功率和最小功率在这3分钟之间12 。 注意:峰值功率（P 峰值 ）是整个3分钟内的最大功率。功率以0.2s的间隔测量。峰值功率最高，最小功率（P min ）是最低单功率测量。 </li><li>从峰值功率到最终功率（P 峰 [W] -Pmin [W]）/（t min [s] -t 峰 [s]）计算每秒功率衰减的疲劳指数。 </li><li>通过加入每秒完成的工作（工作[J] =电阻[kg] *每分钟转数*飞轮距离[m] *时间[min]）计算整个3分钟的总工作量。 </li><li>计算从开始到峰值功率（时间到峰值功率= t 峰值 [s]）的时间。此外，计算相对峰值（相对P peak = P 峰 / kg体重）和平均功率（相对P 平均值 = P 平均 / kg体重）除以参与者的身体质量的绝对值。 </li><li>将3分钟全出测试划分为30段，以便在3分钟内检查起搏策略和疲劳。计算每30秒段的平均功率（P mean = <img alt="方程" src="/files/ftp_upload/55485/55485eq3.jpg" /><img alt="方程" src="/files/ftp_upload/55485/55485eq4.jpg" /> 。 </li></ol></li><li> 其他测量 <ol><li>将所有血液样品放入血乳酸分析仪的编号槽中，并按"分析"自动运行测量。打印血乳酸浓度以供以后分析打开打印机。 </li><li>使用制造商的红外线设备将心率测量传输到计算机。打开心率监视器的软件，并从心脏导入数据te监控软件。将数据存储在本地，如果需要，将其导出到电子表格以供以后分析（ 例如，段分析） 13 。 </li><li>在3分钟的开始位置和3分钟结束时设置一个标记，允许为此段自动计算平均值，最大和最小心率。 注意:软件每隔5秒自动平均心率。 </li><li>将耗氧量的数据导出到csv文件（步骤2.3），并在电子表格中打开它进行分析14 。计算休息时的平均耗氧量（VO 2_rest = <img alt="方程" src="/files/ftp_upload/55485/55485eq5.jpg" /><img alt="方程" src="/files/ftp_upload/55485/55485eq6.jpg" />在3分钟内（VO 2_180s = <img alt="方程" src="/files/ftp_upload/55485/55485eq1.jpg" /><img alt="方程" src="/files/ftp_upload/55485/55485eq7.jpg" /> ，以及高峰30秒段氧耗和耗氧量（VO 2_30s = <img alt="方程" src="/files/ftp_upload/55485/55485eq3.jpg" /><img alt="方程" src="/files/ftp_upload/55485/55485eq8.jpg" /> 。 注意:氧气消耗的数据是经呼吸测量，然后在每段15秒的持续时间内自动平均。在3分钟运动试验中，峰值耗氧量是15秒间隔的最高值。 </li></ol></li><li> 统计 <ol><li>使用Shapiro-Wilk测试，QQ图和Kolmogorov Smirnov测试来检查数据的正常分布。如果数据是正态分布的，则将其作为平均值和标准偏差（SD）。 </li><li>使用类内相关系数（ICC; 3,1模型） 15分析测试重测信度。 </li><li>使用测量的标准误差（SEM），系数计算绝对和相对可靠性变异（CV），最小实际差异（SRD）和ICC 16的 95％置信区间。 注意:ICC应根据Munro分类17 :0.26至0.49进行解释反映低相关性; 0.50至0.69反映中度相关; 0.70〜0.89反映高度相关; 0.90〜1.0表示非常高的相关性。绝对可靠性应以SRD，CV和SEM表示，相对可靠性应为ICC 16,18的形式。 </li><li>使用配对t检验分析两次测试之间的重大变化。为了显示两个测试会话数据集的一致性，请使用Bland-Altman 19个图。使用统计软件进行数据分析;整体统计显着性水平为0.05。 </li></ol></li></ol>

<ol>
	<li>Conconi, F., Ferrari, M., Ziglio, P. G., Droghetti, P., Codeca, L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Determination+of+the+anaerobic+threshold+by+a+noninvasive+field+test+in+runners.">Determination of the anaerobic threshold by a noninvasive field test in runners.</a> J Appl Physiol. 52 (4), 869-873 (1982).</li><li>Strupler, M., Mueller, G., Perret, C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Heart+rate-based+lactate+minimum+test:+a+reproducible+method.">Heart rate-based lactate minimum test: a reproducible method.</a> Br J Sports Med. 43 (6), 432-436 (2009).</li><li>Black, M. I., Durant, J., Jones, A. M., Vanhatalo, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Critical+power+derived+from+a+3-min+all-out+test+predicts+16.1-km+road+time-trial+performance.">Critical power derived from a 3-min all-out test predicts 16.1-km road time-trial performance.</a> Eur J Sport Sci. 14 (3), 217-223 (2014).</li><li>Burnley, M., Doust, J. H., Vanhatalo, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+3-min+all-out+test+to+determine+peak+oxygen+uptake+and+the+maximal+steady+state.">A 3-min all-out test to determine peak oxygen uptake and the maximal steady state.</a> Med Sci Sports Exerc. 38 (11), 1995-2003 (2006).</li><li>Vanhatalo, A., Doust, J. H., Burnley, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+3-min+all-out+cycling+test+is+sensitive+to+a+change+in+critical+power.">A 3-min all-out cycling test is sensitive to a change in critical power.</a> Med Sci Sports Exerc. 40 (9), 1693-1699 (2008).</li><li>Johnson, T. M., Sexton, P. J., Placek, A. M., Murray, S. R., Pettitt, R. W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Reliability+analysis+of+the+3-min+all-out+exercise+test+for+cycle+ergometry.">Reliability analysis of the 3-min all-out exercise test for cycle ergometry.</a> Med Sci Sports Exerc. 43 (12), 2375-2380 (2011).</li><li>Cheng, C. F., Yang, Y. S., Lin, H. M., Lee, C. L., Wang, C. Y. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Determination+of+critical+power+in+trained+rowers+using+a+three-minute+all-out+rowing+test.">Determination of critical power in trained rowers using a three-minute all-out rowing test.</a> Eur J Appl Physiol. 112 (4), 1251-1260 (2012).</li><li>Fukuda, D. H., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Characterization+of+the+work-time+relationship+during+cross-country+ski+ergometry.">Characterization of the work-time relationship during cross-country ski ergometry.</a> Physiol Meas. 35 (1), 31-43 (2014).</li><li>Vanhatalo, A., McNaughton, L. R., Siegler, J., Jones, A. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Effect+of+induced+alkalosis+on+the+power-duration+relationship+of+"all-out"+exercise.">Effect of induced alkalosis on the power-duration relationship of "all-out" exercise.</a> Med. Sci. Sports Exerc. 42 (3), 563-570 (2010).</li><li>Jacobs, P. L., Johnson, B., Somarriba, G. A., Carter, A. B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Reliability+of+upper+extremity+anaerobic+power+assessment+in+persons+with+tetraplegia.">Reliability of upper extremity anaerobic power assessment in persons with tetraplegia.</a> J Spinal Cord Med. 28 (2), 109-113 (2005).</li><li>Jacobs, P. L., Mahoney, E. T., Johnson, B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Reliability+of+arm+Wingate+Anaerobic+Testing+in+persons+with+complete+paraplegia.">Reliability of arm Wingate Anaerobic Testing in persons with complete paraplegia.</a> J Spinal Cord Med. 26 (2), 141-144 (2003).</li><li>Flueck, J. L., Lienert, M., Schaufelberger, F., Perret, C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Reliability+of+a+3-min+all-out+arm+crank+ergometer+exercise+test.">Reliability of a 3-min all-out arm crank ergometer exercise test.</a> Int J Sports Med. 36 (10), 809-813 (2015).</li><li>Erich Jaeger GmbH. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> User Manual Oxycon Pro. , (2016).</li><li>Shrout, P. E., Fleiss, J. L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Intraclass+correlations:+uses+in+assessing+rater+reliability.">Intraclass correlations: uses in assessing rater reliability.</a> Psychol Bull. 86 (2), 420-428 (1979).</li><li>Beckerman, H., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Smallest+real+difference,+a+link+between+reproducibility+and+responsiveness.">Smallest real difference, a link between reproducibility and responsiveness.</a> Qual Life Res. 10 (7), 571-578 (2001).</li><li>Plichta, S. B., Kelvin, E. A., Munro, B. H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> Munro's statistical methods for health care research. , (2011).</li><li>Atkinson, G., Nevill, A. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Statistical+methods+for+assessing+measurement+error+(reliability)+in+variables+relevant+to+sports+medicine.">Statistical methods for assessing measurement error (reliability) in variables relevant to sports medicine.</a> Sports Med. 26 (4), 217-238 (1998).</li><li>Bland, J. M., Altman, D. G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Measuring+agreement+in+method+comparison+studies.">Measuring agreement in method comparison studies.</a> Stat Methods Med Res. 8 (2), 135-160 (1999).</li><li>van Drongelen, S., Maas, J. C., Scheel-Sailer, A., Van Der Woude, L. H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Submaximal+arm+crank+ergometry:+Effects+of+crank+axis+positioning+on+mechanical+efficiency,+physiological+strain+and+perceived+discomfort.">Submaximal arm crank ergometry: Effects of crank axis positioning on mechanical efficiency, physiological strain and perceived discomfort.</a> J. Med. Eng. Technol. 33 (2), 151-157 (2009).</li><li>Bressel, E., Bressel, M., Marquez, M., Heise, G. D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+effect+of+handgrip+position+on+upper+extremity+neuromuscular+responses+to+arm+cranking+exercise.">The effect of handgrip position on upper extremity neuromuscular responses to arm cranking exercise.</a> J. Electromyogr. Kinesiol. 11 (4), 291-298 (2001).</li><li>West, C. R., Goosey-Tolfrey, V. L., Campbell, I. G., Romer, L. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Effect+of+abdominal+binding+on+respiratory+mechanics+during+exercise+in+athletes+with+cervical+spinal+cord+injury.">Effect of abdominal binding on respiratory mechanics during exercise in athletes with cervical spinal cord injury.</a> J Appl Physiol (1985). 117 (1), 36-45 (2014).</li><li>West, C. R., Campbell, I. G., Goosey-Tolfrey, V. L., Mason, B. S., Romer, L. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Effects+of+abdominal+binding+on+field-based+exercise+responses+in+Paralympic+athletes+with+cervical+spinal+cord+injury.">Effects of abdominal binding on field-based exercise responses in Paralympic athletes with cervical spinal cord injury.</a> J. Sci. Med. Sport. 17 (4), 351-355 (2014).</li><li>Kirshblum, S. C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=International+standards+for+neurological+classification+of+spinal+cord+injury.">International standards for neurological classification of spinal cord injury.</a> J Spinal Cord Med. 34 (6), 535-546 (2011).</li></ol>

作者没有什么可以披露的。

脊髓损伤运动员的运动测试对于追踪几个月或几年训练中的运动表现至关重要。只有几个运动测试存在，以检查手臂曲柄测力计的短期，高强度运动表现。该方法详细描述了已经检查其在骑自行车5和划艇7中的可靠性的运动测试可以应用于手臂曲柄测力计。为了收集可靠而有意义的成果，有两个因素非常重要:一是为参与者准备本次运动测试，二是进行标准化测试。因此，参与者被指示进入休息状态的实验室，这意味着在测试前两天没有进行强烈的训练。食物摄入量（ 例如，测试前24小时富含碳水化合物的营养）和睡眠（ 例如，在测试前两个晚上至少7小时的睡眠）也需要tak考虑到。此外，在执行第一次"真实"运动测试之前，应进行熟悉试验以确保参与者了解测试协议。第二个条件涉及测试协议的标准化，包括预热，测试开始和轮椅和手的固定策略（步骤1.2）。这些设置需要与同一个人保持相同的每个测试。此外，曲柄的高度可能会影响功率输出和耗氧量20 。另外，在练习21之后，手柄位置可能在临床上与肩部疼痛有关。此外，腹部结合可能影响呼吸功能和氧气运输22 ，但似乎增强了躯干的稳定性和运动性能23 。因此，最好记录调整和修改细节以重现e以下试验中的等价条件。 图1和图 2中的结果表明，这种3分钟的全功能曲柄试验在健全的参与者中是可靠的，可用于研究或运动测试12 。比较健康，截瘫和四肢的参与者，发现这三组之间的差异。健康和截瘫参与者对最大和平均功率显示非常相似的结果，而四肢参与者以显着较低的功率输出进行。比较截瘫患者30例30天的Wingate检查结果与四肢手术者10例相似。由于这些脊髓损伤参与者的不同病变水平，各种肌肉受到损伤的影响。因此，具有较高的病变水平（ 例如，在四肢麻痹中呕吐物），较少活动的肌肉质量导致较低的功率输出（ 表2 ）。为了减少病变的变异性，仅包括在子宫颈5（C5）和7（C7）之间以及运动和感觉完全脊髓损伤的病变水平的个体代表四肢参与者。然而，即使在这些参与者之间，也可能发生高的个体间变异性。受伤低于C5的个体只有手臂中的肌肉（M）二头肌激活，而受伤低于C7的个体显示肱二头肌，伸肌桡侧肌和肱三头肌手臂肌肉的活动。因此，即使是非常狭窄的入选标准，如这里提到的，参与者组在肌肉功能方面非常不均匀。关于截瘫和健全的参与者，由于全身躯干的稳定性和不受影响的呼吸音聪明功能。虽然身体健康的参与者表现稍好一点，但我们的结果并没有显示这两组之间功率输出的显着差异。这可能是因为我们健康的研究参与者与截瘫患者相比训练较少。可能的是，即使具有较低的躯干稳定性和较低的呼吸功能，截瘫参与者更适应于手臂起搏，这可能补偿了其缺点。 尽管这个测试方案似乎在健壮的个体中是可靠的，但在四肢个体中，测试重新测试的可靠性可能会受到限制。四肢参与者的功率输出显示出非常高的个体间变异性，这可能由肌肉功能和功能的差异（ 例如，主动肌肉依赖于病变水平）来解释。尽管如此，Jacobs，Johnson，Somarriba和Carter在较短的版本中表现出非常高的可靠性这个测试（30秒的Wingate测试）在四肢运动员10 。我们假设在更长的持续时间内（ 即在该协议中为 3分钟）的可靠性可能足够好，但没有测试。缺乏对四肢麻痹患者进行测试重新测试的可靠性调查是一个限制。因此，在将这种测试方案用于一组患有瘫痪的个体之前，我们建议先检查协议的可靠性。该研究的另一个限制涉及到具有非常低的核心稳定性的参与者（ 例如具有高病变水平的个体，例如四肢麻痹）的固定策略的标准化。要将它们固定在椅子上，必须将绑带绑在椅子和参与者身上。因此，可能难以记录带子的高度以及拉紧的程度。在未来的研究中，测试这种带的紧密度是否影响测试协议中的功率输出将是有益的。 然而，这项测试是测试来自不同运动学科的运动员参与上肢运动的好工具。另外，由于在测试开始时全面开放的起搏策略是预先定义的，因此不存在单独的起搏策略。 总而言之，这个测试似乎是在3分钟内测试运动表现的可靠工具，并且类似于短期，高强度运动表现。在应用于运动员或研究调查之前，需要进行熟悉试验，以尽量减少从测试1到测试2的学习效果。此外，需要进一步的研究来检查具有四肢麻痹症的参与者或运动员的测试重测信度。

有几项运动测试可准确地确定精英运动员在训练期间1,2,3,4,5的运动表现的增加。这些测试中的一个是在制动的自行车测力计3,4,5,6上可靠的3分钟全程运动测试。该测试用于确定临界功率，但也适用于运动员的运动测试，以及研究7,8,9 。由于该测试主要用于下肢性能，如在划艇7和骑自行车3，5 ，类似t需要用于上身运动的估计方案。主要使用上身的运动学科除了体育运动员或体力较弱的个体（ 例如截肢或由于脊髓损伤引起的肢体损伤）之外，也可能是这样一种新的测试方案的受益者。因此，手臂曲柄测力计上的测试方案是一个很好的工具，可轻松测试来自不同体育学科的各种运动员的上身运动表现。 存在一个非常相似的30年代Wingate手臂曲柄测力计测试10,11帮助制定了一个3分钟，全面的手臂曲柄测力计测试。其持续时间与1500米轮椅比赛非常相似。因此，这种新的测试方案为3分钟，全功能臂曲柄测力计测试测试其重测信度12 。总体而言，thi的可靠性s测试协议非常好，因此它可能是上身运动测试领域的未来测试工具。然而，使用这种运动测试需要注意，特别是在测试患有脊髓损伤的个体时。因此，本实验文章的目的是展示一个详细的方案，不仅描述了测试设置和测试结果的分析，而且还显示了测试能力强的人员和脊髓损伤运动员之间的差异。

<table><tbody><tr><td>Angio V2 arm crank ergometer</td><td>Lode BV, Groningen, NL</td><td>N/A</td><td>arm crank ergometer</td></tr><tr><td>Lode Ergometry Manager Software</td><td>Lode BV, Groningen, NL</td><td>N/A</td><td>Software</td></tr><tr><td>10 &amp;micro;l end-to-end capillary</td><td>EKF-diagnostics GmbH, Barleben, Germany</td><td>0209-0100-005</td><td>Capillaries</td></tr><tr><td>haemolysis cup</td><td>EKF-diagnostics GmbH, Barleben, Germany</td><td>0209-0100-006</td><td>hemolysis cup</td></tr><tr><td>lactate analyzer</td><td>Biosen C line, EKF-diagnostics GmbH</td><td>5213-0051-6200</td><td>lactate analyzer</td></tr><tr><td>Heart rate monitor, Polar 610i</td><td>Polar, Kempele, Finland</td><td>P610i</td><td>heart rate monitor</td></tr><tr><td>metabolic cart, Oxygen Pro</td><td>Jaeger GmbH</td><td>N/A</td><td>metabolic cart</td></tr><tr><td>oxygen mask, Hans Rudolph</td><td>Hans Rudolph Inc. , USA</td><td>113814</td><td>oxygen mask</td></tr><tr><td>statistical software, PSAW Software</td><td>SPSS Inc., Chicago USA</td><td>N/A</td><td>statistical software</td></tr><tr><td>desinfectant, Soft-Zellin</td><td>Hartmann GmbH, Austria</td><td>999979</td><td>desinfectant</td></tr><tr><td>Quality control cup, EasyCon Norm</td><td>EKF-diagnostics GmbH, Barleben, Germany</td><td>0201-005.012P6</td><td>quality control</td></tr><tr><td>Quality control cup 3mmol/L</td><td>EKF-diagnostics GmbH, Barleben, Germany</td><td>5130-6152</td><td>control cup</td></tr><tr><td>Chip sensor lactate analyzer</td><td>EKF-diagnostics GmbH, Barleben, Germany</td><td>5206-3029</td><td>chip sensor</td></tr><tr><td>Lactate system solution</td><td>EKF-diagnostics GmbH, Barleben, Germany</td><td>0201-0002-025</td><td>lactate system solution</td></tr><tr><td>lancet, Mediware Blutlanzetten</td><td>medilab</td><td>54041</td><td>lancet</td></tr><tr><td>Calibration gas,&amp;nbsp;</td><td>Jaeger GmbH</td><td>36-MC G020</td><td>calibration gas</td></tr><tr><td>chair provided by distributor (ergoselect)</td><td>ergoline GmbH, Germany</td><td>N/A</td><td>chair provided by distributor</td></tr></tbody></table>

experimental protocol of a three-minute, all-out arm crank exercise test in spinal-cord injured and able-bodied individuals

需要可靠的运动方案来测试精英运动员运动表现的变化。这些运动员的表现改善可能很小;因此，敏感工具是锻炼生理的基础。目前，有许多运动测试可以检测运动能力强壮的运动员，主要用于下肢或全身运动。有一种趋势是测试运动员在体育特定的环境中非常类似于参与者习惯执行的动作。只有少数协议测试参与者的短期，高强度运动能力，对身体有损害。大多数这些协议是非常体育专用的，不适用于广泛的运动员。一个众所周知的测试方案是30秒的Wingate测试，它在骑自行车和手臂曲柄运动测试中已经建立起来。该测试在30秒内分析高强度运动表现ñ。为了在更长的时间内监测运动表现，修改了适用于上身的不同方法。 3分钟，全面的手臂曲柄测力计测试允许运动员以特定的1500米轮椅赛跑（运动时间）的方式进行测试，以及上身锻炼，如划船或手动循环。为了在相同的测试条件下提高可靠性，重要的是精确地复制设置，例如电阻（ 即扭矩因子）和参与者的位置（ 即曲柄的高度，曲柄和曲柄之间的距离参与者和参与者的固定）。另一个重要的问题是运动测试的开始。需要固定每分钟的转数来标准运动测试开始时的测试条件。此运动协议显示准确操作重现相同测试条件和设置的重要性。

在21名休闲训练（但不具体为上身训练），非吸烟个体（男9例，女12例，年龄34±11岁，体重69.6±11.1 kg，身高: 175.5±6.9厘米）。 表1显示了相对和绝对测试重新测试可靠性的结果12 。测试和重新测试之间的峰值功率如图 12所示 。 图2 12给出了该测试重新测试的Bland Altman图。然后，将3分钟的全功能臂曲柄测力计测试用于17个健壮（年龄:38±7岁，高度:183±13厘米，体重:79±6公斤），截瘫患者10例7名四肢参与者（ 表2 ）。呈现代表身体健康和四肢参与者的个人数据n 图3 。健康参与者的峰值功率为483±94 W，而截瘫和四肢参与者的峰值功率分别为375±101 W和98±49 W。平均功率分别为172±20W，157±28W，40±14W，分别为健康，截瘫和四肢参与者。在健康和四肢参与者之间（p &lt;0.001）以及截瘫和四肢参与者之间发现平均和峰值功率的显着差异（p &lt;0.001）。健康参与者的乳酸浓度为8.9±2.4mM，截瘫患者为10​​.6±2.9mM，四肢参与者为4.0±0.8mM。在3分钟全程测试中，平均心率为155±9.2 bpm，健康体重为163±6.2 bpm，截瘫患者为113±15.9 bpm。再次，四肢参与者的心跳是重要的<html>与截瘫患者相比（p &lt;0.001）和健康参与者（p &lt;0.001）明显降低。在3分钟全出测试中测得的耗氧量如图4所示 。 <img alt="图1" src="/files/ftp_upload/55485/55485fig1.jpg" /> 图1:平均功率比较在两个3分钟全程运动测试在一个手臂曲柄测功计12 。实线表示最佳拟合，虚线表示身份线。 <a href="http://ecsource.jove.com/files/ftp_upload/55485/55485fig1large.jpg" target="_blank">请点击此处查看此图的较大版本。</a> <img alt="图2" src="/files/ftp_upload/55485/55485fig2.jpg" /> 图2:Bland-Altman图峰值功率12 。 SD =标准差。ve.com/files/ftp_upload/55485/55485fig2large.jpg"target ="_ blank"&gt;请点击此处查看此图的较大版本。 <img alt="图3" src="/files/ftp_upload/55485/55485fig3.jpg" /> 图3:身体健康和四肢参与者的3分钟全功能曲柄测力计测试的个人数据。左=身体健壮的参与者右=四肢参与者蓝线=功率输出;绿线=节奏<a href="http://ecsource.jove.com/files/ftp_upload/55485/55485fig3large.jpg" target="_blank">请点击此处查看此图的较大版本。</a> <img alt="图4" src="/files/ftp_upload/55485/55485fig4.jpg" /> 图4:健康参与者在3分钟全程臂式测力计测试中耗氧量。时间点零表示3分钟测试的开始。数据a作为口气测量的原始数据呈现。 <table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always"><tbody><tr><td></td><td> ICC </td><td> 95％CI </td><td> SEM％ </td><td> SRD％ </td><td>简历</td></tr><tr><td>峰值功率[W] </td><td> 0.961 </td><td> [0.907; 0.984] </td><td> 2 </td><td> 5.6 </td><td> 6.66 </td></tr><tr><td>平均功率[W] </td><td> 0.984 </td><td> [0.960; 0.993] </td><td> 0.6 </td><td> 1.6 </td><td> 3.13 </td></tr><tr><td>最小功率[W] </td><td> 0.964 </td><td> [0.914; 0.985] </td><td> 1.4 </td><td> 4 </td><td> 6.05 </td></tr><tr><td>时间到了</td><td> 0.379 </td><td> [-0.052; 0.691] </td><td> 22.5 </td><td> 62.4 </td><td> 11.37 </td></tr><tr><td>疲劳指数</td><td> 0.940 </td><td> [0.858; 0.975] </td><td> 3.6 </td><td> 9.9 </td><td> 9.43 </td></tr><tr><td>相对。峰值功率[W /公斤] </td><td> 0.922 </td><td> [0.818; 0.968] </td><td> 2.8 </td><td> 7.8 </td><td> 6.45 </td></tr><tr><td>相对。平均功率[W / kg] </td><td> 0.950 </td><td> [0.882; 0.979] </td><td> 1.1 </td><td> 3.2 </td><td> 3.46 </td></tr><tr><td>总工作量[J] </td><td> 0.984 </td><td> [0.960; 0.993] </td><td> 0.6 </td><td> 1.6 </td><td> 3.13 </td></tr></tbody></table> 表1:所有参数的测试重测信度12 。 ICC =班内相关系数; CI =可信区间; SEM =测量的标准误差; SRD =最小实数差; CV =变异系数;相对。 =相对。 <table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always"><tbody><tr><td> 截瘫参与者 </td><td colspan="2"> 损伤程度 </td><td> AIS </td&gt; <td colspan="2"> 年龄（y） </td><td> 体重（kg） </td><td> 身高（cm） </td></tr><tr><td> P01 </td><td colspan="2"> TH12 </td><td>一个</td><td colspan="2"> 47 </td><td> 80 </td><td> 184 </td></tr><tr><td> P02 </td><td colspan="2"> TH10 </td><td>一个</td><td colspan="2"> 43 </td><td> 73 </td><td> 183 </td></tr><tr><td> P03 </td><td colspan="2"> TH11 </td><td>一个</td><td colspan="2"> 55 </td><td> 72 </td><td> 174 </td></tr><tr><td> P04 </td><td colspan="2"> L1 </td><td>一个</td><td colspan="2"> 26 </td><td> 64 </td><td> 150 </td></tr><tr><td> P05 </td><td colspan="2"> TH12 </td><td>一个</td><td colspan="2"> 22 </td><td> 63 </td><td> 185 </td></tr><tr><td> P06 </td><td colspan="2"> L1 </td><td>一个</td><td colspan="2"> 32 </td><td> 76 </td><td> 175 </td></tr><tr><td> P07 </td><td colspan="2"> TH11 </td><td>一个</td><td colspan="2"> 59 </td><td> 80 </td><td> 178 </td></tr><tr><td> P08 </td><td colspan="2"> L1 </td><td>一个</td><td colspan="2"> 35 </td><td> 63 </td><td> 165 </td></tr><tr><td> P09 </td><td colspan="2"> L4 </td><td>一个</td><td colspan="2"> 44 </td><td> 78 </td><td> 176 </td></tr><tr><td> P10 </td><td colspan="2"> L1 </td><td>一个</td><td colspan="2"> 48 </td><td> 80 </td><td> 185 </td></tr><tr><td> 意思 </td><td colspan="2"></td><td></td><td colspan="2"> 41 </td><td> 73 </td><td> 176 </td></tr><tr><td> SD </td><td colspan="2"></td><td></td><td colspan="2"> 12.1 </td><td> 6.8 </td><td> 10.4 </td></tr><tr><td> 四肢参与者 </td><td> 损伤程度 </td><td colspan="2"> AIS </td><td> 年龄（y） </td><td colspan="2"> 身体质量（公斤） </td><td> 身高（cm） </td></tr><tr><td> T01 </td><td> C5 </td><td colspan="2">一个</td><td> 24 </td><td colspan="2"> 85 </td><td> 188 </td></tr><tr><td> T02 </td><td> C7 </td><td colspan="2">一个</td><td> 31 </td><td colspan="2"> 60 </td><td> 180 </td></tr><tr><td> T03 </td><td> C7 </td><td colspan="2">一个</td><td> 40 </td><td colspan="2"> 60 </td><td> 168 </td></tr><tr><td> T04 </td><td> C7 </td><td colspan="2">一个</td><td> 31 </td><td colspan="2"> 80 </td><td> 190 </td></tr><tr><td> T05 </td><td> C5 </td><td colspan="2">一个</td><td> 43 </td><td colspan="2"> 80 </td><td> 176 </td></tr><tr><td> T06 </td><td> C6 </td><td colspan="2">一个</td><td> 56 </td><td colspan="2"> 74 </td><td> 170 </td></tr><tr><td> T07 </td><td> C5 </td><td colspan="2">一个</td><td> 65 </td><td colspan="2"> 75 </td><td> 190 </td></tr><tr><td><strong&gt;平均</td><td></td><td colspan="2"></td><td> 41 </td><td colspan="2"> 73 </td><td> 180 </td></tr><tr><td> SD </td><td></td><td colspan="2"></td><td> 13.6 </td><td colspan="2"> 9.9 </td><td> 9.3 </td></tr></tbody></table> 表2:截瘫和四肢参与者的人体测量数据。 AIS =美国脊髓损伤协会减损量表，Th =胸椎，L =腰椎，C =子宫颈，SD =标准偏差。

Watch this Scientific Journal Video about Experimental Protocol of a Three-minute, All-out Arm Crank Exercise Test in Spinal-cord Injured and Able-bodied Individuals at JoVE.com

Experimental Protocol of a Three-minute, All-out Arm Crank Exercise Test in Spinal-cord Injured and Able-bodied Individuals

我们提出一个方案，测试上肢肌肉的有氧和无氧能力，持续时间为3分钟，身体健康，截瘫和四肢个体。该方案在具有或不具有残疾的个体中对其适用于上肢运动的具体修改。

脊髓损伤和健康人员三分钟全能臂曲柄运动试验实验方案

Reliable exercise protocols are required to test changes in exercise performance in elite athletes. Performance improvements in these athletes may be ...

experimental-protocol-three-minute-all-out-arm-crank-exercise-test

Nanyang Technological University

Research

JoVE Journal

Medicine

9.6K 次观看.  Swiss Paraplegic Center Nottwil. 我们提出一个方案，测试上肢肌肉的有氧和无氧能力，持续时间为3分钟，身体健康，截瘫和四肢个体。该方案在具有或不具有残疾的个体中对其适用于上肢运动的具体修改。 

视频: Experimental Protocol of a Three-minute, All-out Arm Crank Exercise Test in Spinal-cord Injured and Able-bodied Individuals

Methods to Quantify Pharmacologically Induced Alterations in Motor Function in Human Incomplete SCI

Spinal cord injury (SCI) is a debilitating disorder, which produces profound deficits in volitional motor control. Following medical stabilization, recovery from SCI typically involves long term rehabilitation. While recovery of walking ability is a primary goal in many patients early after injury, those with a motor incomplete SCI, indicating partial preservation of volitional control, may have the sufficient residual descending pathways necessary to attain this goal. However, despite physical interventions, motor impairments including weakness, and the manifestation of abnormal involuntary reflex activity, called spasticity or spasms, are thought to contribute to reduced walking recovery. Doctrinaire thought suggests that remediation of this abnormal motor reflexes associated with SCI will produce functional benefits to the patient. For example, physicians and therapists will provide specific pharmacological or physical interventions directed towards reducing spasticity or spasms, although there continues to be little empirical data suggesting that these strategies improve walking ability.
In the past few decades, accumulating data has suggested that specific neuromodulatory agents, including agents which mimic or facilitate the actions of the monoamines, including serotonin (5HT) and norepinephrine (NE), can initiate or augment walking behaviors in animal models of SCI. Interestingly, many of these agents, particularly 5HTergic agonists, can markedly increase spinal excitability, which in turn also increases reflex activity in these animals. Counterintuitive to traditional theories of recovery following human SCI, the empirical evidence from basic science experiments suggest that this reflex hyper excitability and generation of locomotor behaviors are driven in parallel by neuromodulatory inputs (5HT) and may be necessary for functional recovery following SCI. 
The application of this novel concept derived from basic scientific studies to promote recovery following human SCI would appear to be seamless, although the direct translation of the findings can be extremely challenging. Specifically, in the animal models, an implanted catheter facilitates delivery of very specific 5HT agonist compounds directly onto the spinal circuitry. The translation of this technique to humans is hindered by the lack of specific surgical techniques or available pharmacological agents directed towards 5HT receptor subtypes that are safe and effective for human clinical trials. However, oral administration of commonly available 5HTergic agents, such as selective serotonin reuptake inhibitors (SSRIs), may be a viable option to increase central 5HT concentrations in order to facilitate walking recovery in humans. Systematic quantification of how these SSRIs modulate human motor behaviors following SCI, with a specific focus on strength, reflexes, and the recovery of walking ability, are missing.
This video demonstration is a progressive attempt to systematically and quantitatively assess the modulation of reflex activity, volitional strength and ambulation following the acute oral administration of an SSRI in human SCI. Agents are applied on single days to assess the immediate effects on motor function in this patient population, with long-term studies involving repeated drug administration combined with intensive physical interventions.

This video demonstrates modulation of reflex activity, volitional strength and ambulation through clinical and quantitative assessments in individuals with motor incomplete SCI as a result of acute oral administration of a serotonin reuptake inhibitor (SSRI).

量化人类不完全脊髓损伤运动功能的药理学诱导改建的方法

Spinal cord injury (SCI) is a debilitating disorder, which produces profound deficits in volitional motor control. Following medical stabilization, ...

科研

医学

Assessing Forelimb Function after Unilateral Cervical SCI using Novel Tasks: Limb Step-alternation, Postural Instability and Pasta Handling

Cervical spinal cord injury (cSCI) can cause devastating neurological deficits, including impairment or loss of upper limb and hand function. A majority of the spinal cord injuries in humans occur at the cervical levels. Therefore, developing cervical injury models and developing relevant and sensitive behavioral tests is of great importance. Here we describe the use of a newly developed forelimb step-alternation test after cervical spinal cord injury in rats. In addition, we describe two behavioral tests that have not been used after spinal cord injury: a postural instability test (PIT), and a pasta-handling test. All three behavioral tests are highly sensitive to injury and are easy to use. Therefore, we feel that these behavioral tests can be instrumental in investigating therapeutic strategies after cSCI.

Three new behavioral tests (forelimb step-alternation, postural instability test, pasta handling test) for evaluating forelimb function after cervical spinal cord injury in rodents are described.

采用新型任务评估前肢功能单侧颈脊髓损伤后：肢体步交替，姿势不稳和面食处理

Cervical spinal cord injury (cSCI) can cause devastating neurological deficits, including impairment or loss of upper limb and hand function. A majority ...

行为学

Paradigms of Lower Extremity Electrical Stimulation Training After Spinal Cord Injury

Skeletal muscle atrophy, increased adiposity and reduced physical activity are key changes observed after spinal cord injury (SCI) and are associated with numerous cardiometabolic health consequences. These changes are likely to increase the risk of developing chronic secondary conditions and impact the quality of life in persons with SCI. Surface neuromuscular electrical stimulation evoked resistance training (NMES-RT) was developed as a strategy to attenuate the process of skeletal muscle atrophy, decrease ectopic adiposity, improve insulin sensitivity and enhance mitochondrial capacity. However, NMES-RT is limited to only a single muscle group. Involving multiple muscle groups of the lower extremities may maximize the health benefits of training. Functional electrical stimulation-lower extremity cycling (FES-LEC) allows for the activation of 6 muscle groups, which is likely to evoke greater metabolic and cardiovascular adaptation. Appropriate knowledge of the stimulation parameters is key to maximizing the outcomes of electrical stimulation training in persons with SCI. Adopting strategies for long-term use of NMES-RT and FES-LEC during rehabilitation may maintain the integrity of the musculoskeletal system, a pre-requisite for clinical trials aiming to restore walking after injury. The current manuscript presents a combined protocol using NMES-RT prior to FES-LEC. We hypothesize that muscles conditioned for 12 weeks prior to cycling will be capable of generating greater power, cycle against higher resistance and result in greater adaptation in persons with SCI.

Spinal cord injury is a traumatic medical condition that may result in elevated risks of chronic secondary metabolic disorders. Here, we presented a protocol using surface neuromuscular electrical stimulation-resistance training in conjunction with functional electrical stimulation-lower extremities cycling as a strategy to ameliorate several of these medical problems.

脊髓损伤后下肢电刺激训练的模式

Skeletal muscle atrophy, increased adiposity and reduced physical activity are key changes observed after spinal cord injury (SCI) and are associated with ...

Training Persons with Spinal Cord Injury to Ambulate Using a Powered Exoskeleton

Powered exoskeletons have become available for overground ambulation in persons with paralyses due to spinal cord injury (SCI) who have intact upper extremity function and are able to maintain upright balance using forearm crutches. To ambulate in an exoskeleton, the user must acquire the ability to maintain balance while standing, sitting and appropriate weight shifting with each step. This can be a challenging task for those with deficits in sensation and proprioception in their lower extremities. This manuscript describes screening criteria and a training program developed at the James J. Peters VA Medical Center, Bronx, NY to teach users the skills needed to utilize these devices in institutional, home or community environments. Before training can begin, potential users are screened for appropriate range of motion of the hip, knee and ankle joints. Persons with SCI are at an increased risk of sustaining lower extremity fractures, even with minimal strain or trauma, therefore a bone mineral density assessment is performed to reduce the risk of fracture. Also, as part of screening, a physical examination is performed in order to identify additional health-related contraindications. 
Once the person has successfully passed all screening requirements, they are cleared to begin the training program. The device is properly adjusted to fit the user. A series of static and dynamic balance tasks are taught and performed by the user before learning to walk. The person is taught to ambulate in various environments ranging from indoor level surfaces to outdoors over uneven or changing surfaces. Once skilled enough to be a candidate for home use with the exoskeleton, the user is then required to designate a companion-walker who will train alongside them. Together, the pair must demonstrate the ability to perform various advanced tasks in order to be permitted to use the exoskeleton in their home/community environment.

Training a person with paralysis to ambulate using a powered exoskeleton may present challenges. The goals are to present the candidate selection criteria and the training procedures for exoskeletal-assisted walking and other mobility skills that can be progressed as the participant's skill level improves.

训练脊髓损伤者走动使用动力服

Powered exoskeletons have become available for overground ambulation in persons with paralyses due to spinal cord injury (SCI) who have intact upper ...

生物工程

Standing Neurophysiological Assessment of Lower Extremity Muscles Post-Stroke

Transcranial magnetic stimulation (TMS) is a common tool used to measure the behavior of motor circuits in healthy and neurologically impaired populations. TMS is used extensively to study motor control and the response to neurorehabilitation of the upper extremities. However, TMS has been less utilized in the study of lower extremity postural and walking-specific motor control. The limited use and the additional methodological challenges of lower extremity TMS assessments have contributed to the lack of consistency in lower extremity TMS procedures within the literature. Inspired by the decreased ability to record lower extremity TMS motor evoked potentials (MEP), this methodological report details steps to enable post-stroke TMS assessments in a standing posture. The standing posture allows for the activation of the neuromuscular system, reflecting a state more akin to the system's state during postural and walking tasks. Using dual-top force plates, we instructed participants to equally distribute their weight between their paretic and non-paretic legs. Visual feedback of the participants' weight distribution was provided. Using image guidance software, we delivered single TMS pulses via a double-cone coil to the participants' lesioned and non-lesioned hemispheres and measured the corticomotor response of the paretic and non-paretic tibialis anterior and soleus muscles. Performing assessments in the standing position increased the TMS response rate and allowed for the use of the lower stimulation intensities compared to the standard sitting/resting position. Utilization of this TMS protocol can provide a common approach to assess the lower extremity corticomotor response post-stroke when the neurorehabilitation of postural and gait impairments are of interest.

This protocol describes the process for performing a neurophysiological assessment of the lower extremity muscles, tibialis anterior and soleus, in a standing position using TMS in people post-stroke. This position provides a greater probability of eliciting a post-stroke TMS response and allows for the use of reduced stimulator power during neurophysiological assessments.

中风后下肢肌肉的站立神经生理学评估

Transcranial magnetic stimulation (TMS) is a common tool used to measure the behavior of motor circuits in healthy and neurologically impaired ...

Quantifying Arms and Legs Contributions during Repetitive Electrically-Assisted Sit-To-Stand Exercise in Paraplegics: A Pilot Study

Execution of Sit-to-Stand (SitTS) in incomplete spinal cord injury (SCI) patients involves motor function in both upper and lower extremities. The use of arm support, in particular, is a significant assistive factor while executing SitTS movement in SCI population. In addition, the application of functional electrical stimulation (FES) onto quadriceps and gluteus maximus muscles is one of the prescribed management for incomplete SCI to improve muscle action for simple lower limb movements. However, the relative contribution of upper and lower extremities during SitTS has not been thoroughly investigated. Two motor incomplete SCI paraplegics performed repetitive SitTS to fatigue exercise challenge. Their performance was investigated as a mixed-method case-control study comparing SitTS with and without the assistance of FES. Three sets of SitTS tests were completed with 5-min resting period allocated in between sets, with mechanomyography (MMG) sensors attached over the rectus femoris muscles bilaterally. The exercise was separated into 2 sessions; Day 1 for voluntary SitTS and Day 2 for FES-assisted SitTS. Questionnaires were conducted after every session to gather the participants&#39; input about their repetitive SitTS experience. The analysis confirmed that a SitTS cycle could be divided into three phases; Phase 1 (Preparation to stand), Phase 2 (Seat-off), and Phase 3 (Initiation of hip extension), which contributed to 23% &#177; 7%, 16% &#177; 4% and 61% &#177; 6% of the SitTS cycle, respectively. The contribution of arms and legs during SitTS movement varied in different participants based on their legs&#39; Medical Research Council (MRC) muscle grade. In particular, the applied arm forces start to increase clearly when the leg forces start to decline during standing. This finding is supported by the significantly reduced MMG signal indicating leg muscle fatigue and their reported feeling of tiredness.

Arms contribution in Sit-To-Stand (SitTS) is determined by the legs' muscle condition. Several compensating strategies were discovered in efforts to achieve complete SitTS cycles. These findings triangulate the spinal cord injury (SCI) persons' biomechanical measures with their subjective feeling of load borne by both their limbs throughout the SitTS approaches.

量化截瘫患者重复性电动辅助坐立锻炼期间手臂和腿部的贡献:一项试点研究

Execution of Sit-to-Stand (SitTS) in incomplete spinal cord injury (SCI) patients involves motor function in both upper and lower extremities. The use of ...

工程学

Induction and Assessment of Exertional Skeletal Muscle Damage in Humans

Contraction-induced muscle damage via voluntary eccentric (lengthening) contractions offers an excellent model for studying muscle adaptation and recovery in humans. Herein we discuss the design of an eccentric exercise protocol to induce damage in the quadriceps muscles, marked by changes in strength, soreness, and plasma creatine kinase levels. This method is simple, ethical, and widely applicable since it is performed in human participants and eliminates the interspecies translation of the results. Subjects perform 300 maximal eccentric contractions of the knee extensor muscles at a speed of 120&#176;/sec on an isokinetic dynamometer. The extent of the damage is measurable using relatively non-invasive isokinetic and isometric measures of strength loss, soreness, and plasma creatine kinase levels over several days following the exercise. Therefore, its application can be directed to specific populations in an attempt to identify mechanisms for muscle adaptation and regeneration.

This article describes a safe and reliable method to induce and quantify exertional skeletal muscle damage in human subjects.

诱导和人类劳力骨骼肌损伤评估

Contraction-induced muscle damage via voluntary eccentric (lengthening) contractions offers an excellent model for studying muscle adaptation and recovery ...

Activity-based Training on a Treadmill with Spinal Cord Injured Wistar Rats

Spinal cord injury (SCI) results in lasting deficits that include both mobility and a multitude of autonomic-related dysfunctions. Locomotor training (LT) on a treadmill is widely used as a rehabilitation tool in the SCI population with many benefits and improvements to daily life. We utilize this method of activity-based task-specific training (ABT) in rodents after SCI to both elucidate the mechanisms behind such improvements and to enhance and improve upon existing clinical rehabilitation protocols. Our current goal is to determine the mechanisms underlying ABT-induced improvements in urinary, bowel, and sexual function in SCI rats after a moderate to severe level of contusion. After securing each individual animal in a custom-made adjustable vest, they are secured to a versatile body weight support mechanism, lowered to a modified three-lane treadmill and assisted in step-training for 58 minutes, once a day for 10 weeks. This setup allows for the training of both quadrupedal and forelimb-only animals, alongside two different non-trained groups. Quadrupedal-trained animals with body weight support are aided by a technician present to assist in stepping with proper hind limb placement as necessary, while forelimb-only trained animals are raised at the caudal end to ensure no hind limb contact with the treadmill and no weight-bearing. One non-trained SCI group of animals is placed in a harness and rests next to the treadmill, while the other control SCI group remains in its home cage in the training room nearby. This paradigm allows for the training of multiple SCI animals at once, thus making it more time-efficient in addition to ensuring that our pre-clinical animal model mimics the clinical representation as close as possible, particularly with respect to the body weight support with manual assistance.

This protocol demonstrates our model of activity-based locomotor treadmill training for rats with spinal cord injury (SCI). Included is both quadrupedal and forelimb-only groups, in addition to two distinct types of non-trained control groups. Investigators are able to assess training effects on SCI rats using this protocol.

脊髓损伤 wistar 大鼠跑步机的作业训练

Spinal cord injury (SCI) results in lasting deficits that include both mobility and a multitude of autonomic-related dysfunctions. Locomotor training (LT) ...

神经科学

The Impact of Motor Task Conditions on Goal-Directed Arm Reaching Kinematics and Trunk Compensation in Chronic Stroke Survivors

Trunk compensation is the most common movement strategy to substitute for upper extremity (UE) motor deficits in chronic stroke survivors. There is a lack of evidence examining how task conditions impact trunk compensation and goal-directed arm reaching kinematics. This protocol aims to investigate the impact of task conditions, including task difficulty and complexity, on goal-directed arm reaching kinematics. Two non-disabled young adults and two chronic stroke survivors with mild UE motor impairment were recruited for testing the protocol. Each participant performed goal-directed arm reaches with four different task conditions (2 task difficulties [large vs. small targets] X 2 task complexities [pointing vs. picking up]). The task goal was to reach and point at a target or pick up an object located 20 cm in front of the home position as quickly as possible with a stylus or a pair of chopsticks, respectively, in response to an auditory cue. Participants performed ten reaches per task condition. A 3-dimensional motion capture camera system was used to record trunk and arm kinematics. Representative results showed that there was a significant increase in movement duration, movement jerkiness, and trunk compensation as a function of task complexity, but not task difficulty in all participants. Chronic stroke survivors showed significantly slower, jerkier, and more feedback-dependent arm reaches and significantly more compensatory trunk movements than non-disabled adults. Our representative results support that this protocol can be used to investigate the impact of task conditions on motor control strategies in chronic stroke survivors with mild UE motor impairment.

This protocol is intended to investigate the impact of task conditions on movement strategies in chronic stroke survivors. Further, this protocol can be used to examine if a restriction in elbow extension induced by neuromuscular electrical stimulation causes trunk compensation during goal-directed arm reaches in non-disabled adults.

运动任务条件对长期中风幸存者目标定向手臂达到运动学和树干补偿的影响

Trunk compensation is the most common movement strategy to substitute for upper extremity (UE) motor deficits in chronic stroke survivors. There is a lack ...

Development of a Novel Task-oriented Rehabilitation Program using a Bimanual Exoskeleton Robotic Hand

A robot-assisted hand is used for the rehabilitation of patients with impaired upper limb function, particularly for stroke patients with a loss of motor control. However, it is unclear how conventional occupational training strategies can be applied to the use of rehabilitation robots. Novel robotic technologies and occupational therapy concepts are used to develop a protocol that allows patients with impaired upper limb function to grasp objects using their affected hand through a variety of pinching and grasping functions. To conduct this appropriately, we used five types of objects: a peg, a rectangular cube, a cube, a ball, and a cylindrical bar. We also equipped the patients with a robotic hand, the Mirror Hand, an exoskeleton&#160;hand that is fitted to the subject&#8217;s affected hand and follows the movement of the sensor glove fitted to their unaffected hand (bimanual movement training (BMT)). This study had two stages. Three healthy subjects were first recruited to test the feasibility and acceptability of the training program. Three patients with hand dysfunction caused by stroke were then recruited to confirm the feasibility and acceptability of the training program, which was conducted on 3 consecutive days. On each day, the patient was monitored during 5 min of movement in a passive range of motion, 5 min of robot-assisted bimanual movement, and task-oriented training using the five objects. The results showed that both healthy subjects and subjects who had suffered a stroke in conjunction with the robotic hand could successfully grasp the objects. Both healthy subjects and those who had suffered a stroke performed well with the robot-assisted task-oriented training program in terms of feasibility and acceptability.

This study reports the development of a novel robot-assisted task-oriented program for hand rehabilitation. The developmental process consists of experiments using both healthy subjects and subjects who have had a stroke and suffered from subsequent motor control dysfunction.

使用双骨外骨骼机器人手开发面向任务的新康复计划

A robot-assisted hand is used for the rehabilitation of patients with impaired upper limb function, particularly for stroke patients with a loss of motor ...