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Neural Regeneration Research 2021年第8期16卷 1544-1545页

作者： Raymond E.Lai ash.af s.gorgey spinal Cord Injury and Disorders Hunter Holmes McGuire VA Medical CenterPhysical Medicine and RehabilitationVirginia Commonwealth UniversityRichmondVIUSA

The current perspective is aimed to highlight the significance of adding low-dose testosterone replacement therapy(TRT) to electrically evoked resistance training(RT).Evoked RT is primarily designed to load the paralyzed lower extremity muscles to elicit muscle hypertrophy in persons with spinal cord injury(sCI)(Ryan et al.,2013;gorgey et al.,2019).The rationale was based on previous work that indicated that highdose TRT is likely to enhance muscle quality。

关键词： TRT rational likely

Novel rehabilitation paradigm for restoration of hand functions after tetraplegia

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Neural Regeneration Research 2016年第7期11卷 1058-1059页

作者： ash.af s.gorgey Mina P.Ghatas spinal Cord Injury service and Disorders Hunter Holmes McGuire VA Medical Center Richmond VA USA Department of Physical Medicine and Rehabilitation Virginia Commonwealth University Richmond VA USA McConnell Brain Imaging Center Montreal Neurological Institute McGill University Montreal QC Canada

The letter by Bouton et al.（2016）“Restoring cortical control of functional movement in a human with quadriplegia”presents a case report of a 24 year old male with tetraplegia（C5–6）.The goal of the work was to bypass the spinal cord injury（sCI）lesion to stimulate the right forearm muscles to perform six movements and daily functional tasks.

关键词： restoration rehabilitation paradigm bypass muscles letter cortical capture challenging stimulate

Quantification of intermuscular and intramuscular adipose tissue using magnetic resonance imaging after neurodegenerative disorders

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Neural Regeneration Research 2017年第12期12卷 2100-2105页

作者： Madoka Ogawa Robert Lester Hiroshi Akima ash.af s.gorgey Graduate school of Education & Human Development Nagoya University Nagoya Japan Japan society for Promotion of science Tokyo Japan spinal Cord Injury and Disorders Center Hunter Holmes McGuire VAMC Richmond VA USA Research Center of Health Physical Fitness and Sports Nagoya University Nagoya Japan Department of Physical Medicine and Rehabilitation Virginia Commonwealth University Richmond VA USA

Ectopic adiposity has gained considerable attention because of its tight association with metabolic and cardiovascular health in persons with spinal cord injury（sCI）. Ectopic adiposity is characterized by the storage of adipose tissue in non-subcutaneous sites. Magnetic resonance imaging（MRI） has proven to be an effective tool in quantifying ectopic adiposity and provides the opportunity to measure different adipose depots including intermuscular adipose tissue（IMAT） and intramuscular adipose tissue（Intra MAT） or intramuscular fat（IMF）. It is highly important to distinguish and clearly define these compartments, because controversy still exists on how to accurately quantify these adipose depots. Investigators have relied on separating muscle from fat pixels based on their characteristic signal intensities. A common technique is plotting a threshold histogram that clearly separates between muscle and fat peaks. The cut-offs to separate between muscle and fat peaks are still not clearly defined and different cut-offs have been identified. This review will outline and compare the Midpoint and Otsu techniques, two methods used to determine the threshold between muscle and fat pixels on T1 weighted MRI. The process of water/fat segmentation using the Dixon method will also be outlined. We are hopeful that this review will trigger more research towards accurately quantifying ectopic adiposity due to its high relevance to cardiometabolic health after sCI.

关键词： intermuscular adipose tissue intramuscular adipose tissue intramuscular fat ectopic adiposity magnetic resonance imaging

skeletal muscle stiffness as measured by magnetic resonance elastography after chronic spinal cord injury:a cross-sectional pilot study

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Neural Regeneration Research 2021年第12期16卷 2486-2493页

作者： Mina P.Ghatas M.Rehan Khan ash.af s.gorgey Department of spinal Cord Injury and Disorders Hunter Holmes McGuire VA Medical CenterRichmondVAUSA Department of Radiology Hunter Holmes McGuire VA Medical CenterRichmondVAUSA Department of Physical Medicine and Rehabilitation Virginia Commonwealth UniversityRichmondVAUSA

skeletal muscle stiffness is altered after spinal cord injury(sCI).Assessing muscle stiffness is essential for rehabilitation and pharmaceutical interventions design after *** study used magnetic resonance elastography to assess the changes in stiffness after chronic sCI compared to matched able-bodied controls and determine its association with muscle size,spasticity,and peak torque in persons with *** studies examined the association between muscle stiffness and spasticity,however,we are unaware of other studies that examined the effects of muscle composition on stiffness after *** participants(one female)with chronic sCI and eight(one female)matched able-bodied controls participated in this cross-sectional *** resonance elastography was utilized to monitor stiffness derived from shear waves *** ashworth scale was used to evaluate spasticity scores in a blinded *** isometric and isokinetic torques were measured using a biodex *** values were non-significantly lower(12.5%;P=0.3)in the sCI group compared to able-bodied ***,stiffness was positively related to vastus lateralis whole muscle cross-sectional area(CsA)(r2=0.64,Pstus lateralis absolute muscle CsA after accounting for intramuscular fat(r2=0.78,Pstiffness was also positively correlated to both isometric(r2=0.55-0.57,Psokinetic peak(r2=0.46-0.48,Psults suggest that larger clinical trial is warranted to confirm the preliminary findings that muscle stiffness is altered after sCI compared to healthy *** appeared to be influenced by infiltration of intramuscular fat and modestly by the spasticity of the paralyzed *** preliminary data indicated that the relationship between muscle stiffness and peak torque is not altered with changing the frequency of pulses or angular *** study procedures were approved by the Institutional Review Board at the

关键词： chronic spinal cord injury isometric and isokinetic torques magnetic resonance elastography muscle size rehabilitation shear modulus spasticity stiffness

Electrical stimulation and denervated muscles after spinal cord injury

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Neural Regeneration Research 2020年第8期15卷 1397-1407页

作者： subhalakshmi Chandrasekaran John Davis Ines Bersch Gary Goldberg ash.af s.gorgey spinal Cord Injury and Disorders Hunter Holmes McGuire VA Medical CenterRichmondVAUSA swiss Paraplegic Centre NottwilSwitzerland Institute of Clinical sciences Department of Orthopedics at the University of GothenburgGothenburgSweden Department of Physical Medicine and Rehabilitation Virginia Commonwealth UniversityRichmondVAUSA Electrodiagnostic Center Hunter Holmes McGuire VA Medical CenterRichmondVAUSA

spinal cord injury(sCI)population with injury below T10 or injury to the cauda equina region is characterized by denervated muscles,extensive muscle atrophy,infiltration of intramuscular fat and formation of fibrous *** morphological changes may put individuals with sCI at higher risk for developing other diseases such as various cardiovascular diseases,diabetes,obesity and ***,there is no available rehabilitation intervention to rescue the muscles or restore muscle size in sCI individuals with lower motor neuron ***,hereby,performed a review of the available evidence that supports the use of electrical stimulation in restoration of denervated muscle following *** pulse width stimulation(LPWs)technique is an upcoming method of stimulating denervated *** primary objective is to explore the best stimulation paradigms(stimulation parameters,stimulation technique and stimulation wave)to achieve restoration of the denervated *** parameters,such as the pulse duration,need to be 100–1000 times longer than in innervated muscles to achieve desirable excitability and *** use of electrical stimulation in animal and human models induces muscle *** in animal models indicate that electrical stimulation,with a combination of exercise and pharmacological interventions,have proven to be effective in improving various aspects like relative muscle weight,muscle cross sectional area,number of myelinated regenerated fibers,and restoring some level of muscle *** studies have shown similar outcomes,identifying the use of LPWs as an effective strategy in increasing muscle cross sectional area,the size of muscle fibers,and improving muscle ***,displaying promise is an effective future stimulation *** summary,LPWs is a novel stimulation technique for denervated muscles in humans with *** studies on LPWs of denervated muscles will help in translating

关键词： denervation DXA electrical stimulation LMN injury LPWs MRI spinal cord injury stimulation parameters

MRI analysis and clinical significance of lower extremity muscle cross-sectional area after spinal cord injury

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Neural Regeneration Research 2017年第5期12卷 714-722页

作者： Robert M.Lester Kori Johnson Refka E.Khalil Rehan Khan ash.af s.gorgey spinal Cord Injury and Disorders Center Hunter Holmes McGuire Veterans Administration Medical Center (VAMC) Richmond VA USA Department of Physical Medicine and Rehabilitation Virginia Commonwealth University Richmond VA USA Radiology service Hunter Holmes McGuire Veterans Administration Medical Center (VAMC) Richmond VA USA

shortly after spinal cord injury（sCI）, the musculoskeletal system undergoes detrimental changes in size and composition, predominantly below the level of injury. The loss of muscle size and strength, along with increased immobility, predisposes persons with sCI to rapid and severe loss in bone mineral density and other health related consequences. Previous studies have highlighted the significance of measuring thigh muscle cross-sectional area, however, measuring the size and composition of muscles of the lower leg may provide insights on how to decrease the risk of various comorbidities. The purpose of the current review was to summarize the methodological approach to manually trace and measure the muscles of the lower leg in individuals with sCI, using magnetic resonance imaging. We also intend to highlight the significance of analyzing lower leg muscle cross-sectional area and its relationship to musculoskeletal and vascular systems in persons with sCI.

关键词： spinal cord injury magnetic resonance imaging pressure ulcers venous thromboembolism cardiovascular disease bone health

semi-automated segmentation of magnetic resonance images for thigh skeletal muscle and fat using threshold technique after spinal cord injury

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Neural Regeneration Research 2018年第10期13卷 1787-1795页

作者： Mina P.Ghatas Robert M.Lester M.Rehan Khan ash.af s.gorgey Department of spinal Cord Injury and Disorders Hunter Holmes McGuire VA Medical Center Department of Radiology Hunter Holmes McGuire VA Medical Center Department of Physical Medicine and Rehabilitation Virginia Commonwealth University

Magnetic resonance imaging is considered the ＂gold standard＂ technique for quantifying thigh muscle and fat cross-sectional area. We have developed a semi-automated technique to segment seven thigh compartments in persons with spinal cord injury. Thigh magnetic resonance images from 18 men（18–50 years old） with traumatic motor-complete spinal cord injury were analyzed in a blinded fashion using the threshold technique. The cross-sectional area values acquired by thresholding were compared to the manual tracing technique. The percentage errors for thigh circumference were（threshold： 170.71 ± 38.67; manual： 169.45 ± 38.27 cm2） 0.74%, subcutaneous adipose tissue（threshold： 65.99±30.79; manual： 62.68 ± 30.22） 5.2%, whole muscle（threshold： 98.18 ± 20.19; manual： 98.20 ± 20.08 cm2） 0.13%, femoral bone（threshold： 6.53 ± 1.09; manual： 6.53 ± 1.09 cm2） 0.64%, bone marrow fat（threshold： 3.12 ± 1.12; manual： 3.1 ± 1.11 cm2） 0.36%, knee extensor（threshold： 43.98 ± 7.66; manual： 44.61 ± 7.81 cm2） 1.78% and % intramuscular fat（threshold： 10.45 ± 4.29; manual： 10.92 ± 8.35%） 0.47%. Collectively, these results suggest that the threshold technique provided a robust accuracy in measuring the seven main thigh compartments, while greatly reducing the analysis time.

关键词： spinal cord injury magnetic resonance imaging semi-automated segmentation subcutaneous adipose tissue intramuscular fat

Leisure-time physical activity,anthropometrics,and body composition as predictors of quality of life domains after spinal cord injury:an exploratory cross-sectional study

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Neural Regeneration Research 2022年第6期17卷 1369-1375页

作者： Melody N.Mickens Paul Perrin Jacob A.Goldsmith Refka E.Khalil William E.Carter III ash.af s.gorgey Division of Physical Medicine and Rehabilitation University of Utah School of MedicineSalt Lake CityUTUSA Department of Psychology Virginia Commonwealth UniversityRichmondVAUSA spinal Cord Injury&Disorders Hunter Holmes McGuire VA Medical CenterRichmondVAUSA Department of Physical Medicine and Rehabilitation Virginia Commonwealth University School of MedicineRichmondVAUSA

The objective of the current work was to examine the relationships between quality of life(QOL)domains in persons with spinal cord injury(sCI)and their levels of weekly leisure-time physical activity(LTPA),anthropometric variables,and body composition *** exploratory cross-sectional study consisted of baseline data collected as part of a randomized clinical trial at a VA Medical Center and sCI center.A convenience sample of 36 community-dwelling persons with sCI participated in the current *** measures included the World Health Organization Quality of Life short Form(WHOQOL-BREF),Leisure-Time Physical Activity Questionnaire for People with spinal Cord Injury(LTPAQ-sCI),anthropomorphic measures(waist,hip,and abdominal circumference),and dual-energy x-ray absorptiometry(DXA)to quantify regional and total body *** regression models suggested that engagement in LTPA accounted for 35.7%of the variance in physical health QOL,33.5%in psychological QOL,14.2%in social relationships QOL,and 38.2%in environmental *** measures accounted for 11.3%,3.1%,12.0%,and 6.7%of the variance in these QOL indices,respectively,and DXA indices accounted for 18.7%,17.5%,27.4%,and 21.9%.Within these models,the number of minutes of heavy LTPA per day uniquely predicted physical health QOL,the number of mild LTPA days per week uniquely predicted psychological QOL,and the amount of mild LTPA per day uniquely predicted environmental *** analyses also suggested that android and trunk fat,as well as supine waist and abdominal circumferences,were positively associated with social relationships *** individuals with sCI to engage in LTPA may robustly enhance multiple aspects of QOL while reducing the risk for cardiovascular and metabolic morbidities associated with ***,this may lead to a further understanding of how QOL may impact longitudinal intervention *** study protocol and procedures were reviewed and appro

关键词： anthropometrics body composition dual-energy-x-ray absorptiometry exercise physical activity quality of life spinal cord injury

skeletal muscle conditioning may be an effective rehabilitation intervention preceding functional electrical stimulation cycling

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Neural Regeneration Research 2016年第8期11卷 1232-1233页

作者： Rodney C.Wade ash.af s.gorgey spinal Cord Injury and Disorders service Hunter Holmes McGuire Department of Veterans Affairs Medical Center Department of Physical Medicine and Rehabilitation Virginia Commonwealth University

In our recent effort,we introduced a submaximal index that utilized ventilatory efficiency relative to CO2 production（VE/CO2）to evaluate the cardiovascular effectiveness to functional electrical stimulation lower-ex... 详细信息

关键词： cycling stimulation conditioning rehabilitation resting cardiovascular utilized extremity intramuscular prior

Robotic exoskeletons: The current pros and cons

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World Journal of Orthopedics 2018年第9期9卷 112-119页

作者： ash.af s.gorgey spinal Cord Injury and Disorders Center Hunter Holmes McGuire VAMC Department of Physical Medicine and Rehabilitation Virginia Commonwealth University

Robotic exoskeletons have emerged as rehabilitation tool that may ameliorate several of the existing healthrelated consequences after spinal cord injury(sCI).However,evidence to support its clinical application is still lacking considering their prohibitive *** current mini-review is written to highlight the main limitations and potential benefits of using exoskeletons in the rehabilitation of persons with *** have recognized two main areas relevant to the design of exoskeletons and to their applications on major health consequences after *** design prospective refers to safety concerns,fitting time and speed of *** health prospective refers to factors similar to body weight,physical activity,pressure injuries and bone *** trials are currently underway to address some of these limitations and to maximize the benefits in rehabilitation *** directions highlight the need to use exoskeletons in conjunction with other existing and emerging technologies similar to functional electrical stimulation and brain-computer interface to address major *** have the potential to revolutionize rehabilitation following sCI;however,it is still premature to make solid recommendations about their clinical use after sCI.

关键词： spinal cord injury Exoskeleton Robotics Rehabilitation Locomotion