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Zoghi et al. Neuroimmunol Neuroinflammation 2019;6:14 I http://dx.doi.org/10.20517/2347-8659.2019.03 Page 7 of 14

Figure 2. Total ISNCSCI motor score for upper and lower limbs in experimental and control group. WBT: whole-body training; UBT: upper
body training; LL: lower limb; UL: upper limb; ISNCSCI: international standard for neurological classification of spinal cord injury

patterns of muscle activation during left hip-knee flexion in Participant 6 throughout the trial are very
similar to each other and very different from the normal pattern of muscle activation [Figure 3A]. It can
be seen that left quadriceps is more active than left hamstring and right hamstring does not show enough
activity. The other example is during right hip-knee flexion: Participant 3 showed significant co-contraction
of right hip adductors and left quadriceps even though they needed to be quiet during this task [Figure 3A].

In this study, 10 participants were assessed as having clinically complete SCI. Of these, nine participants
showed tendon tap responses in 1-4 of the assessed muscles (Participants 4, 8, 10, 11, 12, 13, 16, 17 and 18)
[Table 3]. Participants 4 and 11 did not show any TVR in any of the four assessed muscles. However,
Participants 8, 10, 12, 13, 16, 17 and 18 showed TVR in 1-4 targeted muscles [Table 4].

Tendon tap responses are markers that can be used to indicate the existence of supraspinal influences over
the motor circuitry of the examined muscle. Multi-level tendon-tap responses can be seen in some patients
in both groups over time.

Vibration responses are markers that can be used to indicate the existence of supraspinal influences
over the motor circuitry of the examined muscle. These responses were seen in some patients who were
categorised as clinically complete SCI.

DISCUSSION
Eighteen participants with different levels of SCI (C6-T12) from one site who were participating in a multi-
centre randomised controlled trial were assessed up to four times with the BMCA protocol. Twelve of these
participants received whole body training while the other six participants received an upper body strength
and fitness program three times per week for 12 weeks. Five of the six participants in upper body training
group had the maximum total ISNCSCI motor scores of 50 throughout the study as their injury levels
were at the thoracic level or at C8 level (incomplete). The training provided to the whole-body group had
no effect on lower limb ISNCSCI motor scores. Twelve of the 18 participants in this group were classified
as AIS A-complete (10 participants) or AIS B (2 participants) with the strength of the assessed lower limb
muscles recorded as 0 throughout the trial.