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Page 8 of 14 Zoghi et al. Neuroimmunol Neuroinflammation 2019;6:14 I http://dx.doi.org/10.20517/2347-8659.2019.03

Figure 3. Pattern of muscle activation during right and left hip-knee flexion and extension in a neurologically intact participant (A)
and 2 SCI participants (B and C). The lower limb muscle strength changes during the trial for these two SCI participants (C). RQ: right
quadriceps; RAd: right hip adductors; RH: right hamstring; LQ: left quadriceps; LAd: left hip adductors; LH: left hamstring; Ax: assessment;
SCI: spinal cord injury

BMCA can provide objective information regarding the pattern of muscular activation during lower limb
tasks in patients with SCI during rehabilitation and how the treatment strategies can shift this pattern
towards the normal pattern of movements in lower limbs. This assessment can be even more valuable when
other functional clinical assessments, e.g., gait assessment (10-m walk test, timed up and go, 6-min walk
test, etc.), cannot be completed due to the level of injuries, e.g., for patients with complete lesion at cervical
or thoracic levels. Available data post BMCA are very limited, which makes it very difficult to compare
these data with those of previous studies.

As shown in Figure 3, both Participants 3 and 6 (both in experimental group, incomplete D) showed some
improvements in lower limb muscle strength throughout the trial at each assessment sessions; however,
the increased strength of these muscles did not have any effect on the pattern of muscle activation during
the assessed tasks (right and left hip-knee flexion and extension). For instance, the 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 the left
quadriceps are more active than the left hamstrings, and the right hamstrings do not show sufficient
activity. Furthermore, during right hip-knee flexion, Participant 3 showed significant co-contraction of the
right hip adductors and left quadriceps even though these muscles should have been quiet during this task