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Zoghi et al. Neuroimmunol Neuroinflammation 2019;6:14 I http://dx.doi.org/10.20517/2347-8659.2019.03 Page 5 of 14

tendon hammer was used to record ten tendon responses quadriceps and triceps surae bilaterally with
[21]
similar strike (consistent energy and independent of orientation and relative position) . Tonic vibratory
responses (TVR) of quadriceps and triceps surae muscles on both sides were also assessed by applying 30-s
vibration over the tendon. The vibrator was custom-constructed from a pneumatic hand-grinder fitted
with an offset weight and protective barrel (frequency of 115 Hz and a motion amplitude of 0.8 mm peak to
peak). All assessments were completed by an assessor blinded to group allocation.

ISNCSCI
[19]
The motor scores were derived from part of the ISNCSCI assessment . It involved testing the strength
of ten key muscles on each side of the body in the supine position (elbow flexors, wrist extensors, elbow
extensors, finger flexors, finger abductors, hip flexors, knee extensors, ankle dorsiflexors, long toe extensors
and ankle plantar flexors) on a scale from 0 = no contraction to 5 = normal resistance through full range
of motion. Scores were summed to give a total possible score of 50 for the upper extremities and 50 for the
lower extremities.

Data reduction
A prototype response vector for each phase of each voluntary task in the protocol was generated from 12
neurologically intact participants (24 limbs) [20,21] . The muscles selected for hip and knee tasks in prototype
calculations were quadriceps, hip adductors, hamstrings, lumbar paraspinal muscles and rectus abdominis
from both sides. Those selected for ankle tasks in prototype calculations were quadriceps, hamstrings,
tibialis anterior and gastrocnemius from both sides.

These values were used to calculate the SI, which compares the relative distribution of sEMG activity
[21]
across the above chosen muscles for each voluntary tasks and to evaluate the progression of participants
with SCI during the trial. If SCI participants were able to recruit the prime movers for a specific task and
decrease unnecessary muscle activity in the other muscles, their SI scores approximated neurologically
intact participants’ values, indicating better control of their movements. A value of 1.0 for the SI means
that the test participant had an identical distribution of sEMG activity across muscles to the neurologically
intact group for that task.

Generalised linear model (GLM) analysis was used to assess the main effects of Group: whole body training
vs. upper body training; Side: right vs. left; Tasks: four unilateral tasks on both sides; and Assessment
timepoint (Ax): first Ax (baseline), second Ax (after 12 weeks training), third Ax (6 months post-
randomisation) and fourth Ax (12 months post-randomisation), on SI. GLM analysis was also conducted to
assess the main effects of Group (whole body training vs. upper body training) and Ax [first Ax (baseline),
second Ax (after 12 weeks training), third Ax (6 months post-randomisation) and fourth Ax (12 months
post-randomisation)] on ISNCSCI motor score for right upper and lower limbs, left upper and lower limbs
and total ISNCSCI motor score for upper and lower limbs. A significance level of P < 0.05 was adopted for
all comparisons. This analysis was conducted using SPSS 22 software.

RESULTS
The main effect of Group, Side or Assessment time point on SI was not significant. GLM analysis only
showed a significant main effect of Task (P < 0.001) on SI. There were no significant interactions between the
factors (P > 0.05). The individual SI changes over time for two tasks in both groups are shown in Figure 1.

GLM analysis showed a significant main effect of Group (P < 0.05) on ISNCSCI motor scores of right, left
and total ISNCSCI motor score for the upper limb [Figure 2]. However, the main effect of Assessment
time point, the interaction between Group and Assessment time point and the analyses of ISNCSCI motor
scores from lower limb were not significant (P > 0.05). The strength of the key lower limb muscles in 12