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The selected Wii games were able to elicit upper extremity muscle activation and elevated heart rates for individuals with SCI that may be used to target therapeutic outcomes.

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cortical4-6 and spinal excitability 7 and to improve upper limb function. [4][5][6][7] However, it is not clear that all individuals with incomplete tetraplegia are necessarily good candidates for these types of programs. If the motoneuron pool of a particular muscle remains largely intact, then an activity-based therapy program that targets the re-establishment of neural connections to activate those motoneurons may increase strength and contribute to improved function. On the other hand, if there has been a major loss of lower motoneurons (gray matter), then the remaining ones may not be able to support an intense schedule of exercise. For these individuals, activitybased therapy might result in overuse weakness and fatigue, as it does in post-polio syndrome. 8,9The conventional clinical measures for assessing motor impairment after cSCI may not be adequate Background: Candidates for activity-based therapy after spinal cord injury (SCI) are often selected on the basis of manual muscle test scores and the classification of the injury as complete or incomplete. However, these scores may not adequately predict which individuals have sufficient residual motor resources for the therapy to be beneficial. Objective: We performed a preliminary study to see whether dynamometry and quantitative electromyography (EMG) can provide a more detailed assessment of residual motor resources. Methods: We measured elbow extension strength using a hand-held dynamometer and recorded fine-wire EMG from the triceps brachii muscles of 4 individuals with C5, C6, or C7 level SCI and 2 able-bodied controls. We used EMG decomposition to measure motor unit action potential (MUAP) amplitudes and motor unit (MU) recruitment and firing-rate profiles during constant and ramp contractions. Results: All 4 subjects with cervical SCI (cSCI) had increased MUAP amplitudes indicative of denervation. Two of the subjects with cSCI had very weak elbow extension strength (<4 kg), dramatically reduced recruitment, and excessive firing rates (>40 pps), suggesting profound loss of motoneurons. The other 2 subjects with cSCI had stronger elbow extension (>6 kg), more normal recruitment, and more normal firing rates, suggesting a substantial remaining motoneuron population. Conclusions: Dynamometry and quantitative EMG may provide information about the extent of gray matter loss in cSCI to help guide rehabilitation strategies.