Effects of Breathing and Walking Treatments on Recovery Post-Spinal Cord Injury
Effects of Breathing and Walking Treatments on Recovery Post-Spinal Cord Injury
Change to Reflect What Was Done and reason Changes Were Made.

 The purpose of this study is to determine (1) if a specific breathing treatment (intermittent
 hypoxia) can promote changes in breathing function and (2) if pairing breathing treatments
 (hypoxia) with locomotor training can enhance the benefits of walking recovery observed with
 locomotor training alone (without breathing treatments).
Spinal cord injury (SCI) is a very disabling health problem. Paralysis and paresis of limb
 and trunk muscles are major consequences of SCI and result in the inability to walk or
 difficulty walking. The most commonly stated goal by individuals with SCI during
 rehabilitation is the desire to walk again. Locomotor training (LT) that uses a body-weight
 support system and treadmill (BWST) is a task-specific rehabilitation intervention that
 allows practice of walking at normal speeds while loading the lower extremities, facilitating
 upright posture, and hip extension. Substantial improvement in ambulation can occur following
 locomotor training (LT) in individuals with motor incomplete spinal cord injury (iSCI).
 Despite these advances in activity-dependent rehabilitation, a need exists for defining
 complementary strategies that further amplify endogenous neuroplasticity. The proposed study
 will assess the therapeutic potential of (1) a respiratory training intervention (acute
 intermittent hypoxia, or AIH) on breathing function and (2) a combined locomotor (LT) and
 respiratory (AIH) training intervention for enhancing walking recovery.
Inclusion Criteria:

 -  Adults at least 18 years of age

 -  At least 12 months post-incomplete spinal cord injury (I-SCI), including but not
 limited to the following syndromes: Brown Sequard and Central Cord Syndromes

 -  Upper motor neuron lesion (with upper motor neuron signs (i.e. presence of clonus,
 spasms, and/or hyperreflexia))

 -  A diagnosis of first time SCI including etiology from trauma, vascular, or orthopedic
 pathology

 -  Resting oxygen saturation (SpO2) levels of 95-99%

 -  Individuals who ambulate independently, with an assistive device, or who can walk when
 provided manual assistance

 -  Persons using anti-spasticity medication must maintain stable medication dosage during
 the study

 -  Able to give informed consent.

 -  Medical approval by individual's physician

 Exclusion Criteria:

 -  Current participation in a rehabilitation program/research protocol that could
 interfere or influence the outcome measures of the current study

 -  History of congenital SCI (e.g. myelomeningocele, intraspinal neoplasm, Frederich's
 ataxia) or other degenerative spinal disorders (e.g. spinocerebellar degeneration,
 syringomyelia) that may complicate the protocol

 -  Inappropriate or unsafe fit of the harness due to the participant's body size and/or
 joint contractures or severe spasticity that would prohibit the safe provision of
 either training modality.

 -  Severe spasticity that would prohibit the safe provision of training.

 -  Pregnancy - all women of childbearing age will be required to undergo pregnancy
 testing prior to enrollment

 -  Unstable medical condition that could interfere with safety during participation in
 study (i.e. symptomatic cardiopulmonary complication, osteoporosis, contractures or
 other significant medical complications that would prohibit or interfere with testing
 of walking function and training or alter compliance with a training protocol)