Multimodal Exercises to Improve Leg Function After Spinal Cord Injury

Exclusion Criteria

• •Unsuitable cognitive capacity as judged by the study physician;
• •Diagnosis of neurological injury other than SCI, such as stroke, traumatic brain injury, or other neurological condition that the study physician considers to be exclusionary;
• •Multiple spinal cord lesions;
• •History of frequent autonomic dysreflexia;
• •History of seizures;
• •Use of medications that significantly lower seizure threshold, such as anti-psychotics, tricyclic antidepressants, amphetamines, and bupropion;
• •History of implanted brain/spine/nerve stimulators, aneurysm clips, or cardiac pacemaker/defibrillator;
• •Deep vein thrombosis in lower extremities of less than 6 months duration;
• •Pregnancy;
• •(Interventional phase only): Lack of detectable tibialis anterior motor evoked potential (MEP) at baseline even with active facilitation;
• •(Interventional phase only): Pressure ulcers greater than stage 1 severity on the foot, ankle, knee and/or pelvic girdle;
• •(Interventional phase only): Bone mineral density of the hip (proximal femur) T-score \<3.5 standard deviations from age- and gender-matched normative data;
• •(Interventional phase only): Any spasticity, contractures, or heterotopic ossification that result in inadequate range of motion of the shoulder, elbow, wrist, fingers, hip, knee, or ankle joints in the judgment of the study physician;
• •(Interventional phase only): Inability to cooperate with instructions or unwilling to commit to daily training sessions for 3-4 days per week over 12-16 weeks;
• •(Interventional phase only): A diagnosis of coronary artery disease that precludes moderate to intense exercise.