Development and assessment of novel methods of exercise testing during treadmill gait in incomplete spinal cord injury
The main study of this thesis monitors changes in cardiopulmonary fitness, peak voluntary force and CAR of the quadriceps and hamstring muscles, and lower limb BMD in two incomplete SCI subjects who participated in a 20-week BWS treadmill training (BWSTT) programme. The main outcomes of the BWSTT study were: a substantial improvement in performance parameters (training work rate, peak work rate (WRpeak) and the distance walked in 15 minutes), an overall increase in VO2peak and peak heart rate (HRpeak), a substantial decrease in ?VO2/?WR and a decrease in the VO2 and HR associated with a step increase in work rate. Accurate identification of an LT, tVO2, and the voluntary peak force and CAR was not established. An increase in lower limb BMD was not identified in the subject who was 2 years post injury. However, encouragingly an increase was shown in the trabecular BMD of the right and left tibia of the subject who was 14.5 years post injury. A novel non-robot-assisted treadmill IET which incorporated nonlinear, equally smooth increases in both speed and gradient was also developed and assessed. The benefits of BWSTT in those with an incomplete SCI have been highlighted in this thesis. It has also been shown that cardiopulmonary exercise testing can potentially be utilised in this population. Whether or not the IETs assessed throughout this thesis provide a true indication of the subjects’ actual cardiopulmonary capacity is debatable due to limitations in their gait pattern and lower limb muscle fatigue. Therefore, the accurate detection of an LT and tVO2 may be key to determining improvements in cardiopulmonary fitness in this population. It is therefore suggested that further study in a larger subject group be carried out to determine the repeatability and reliability of the outcome measures obtained.