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Study design: Randomized dual center controlled clinical trial. Objective: To determine and compare the cardiorespiratory impact of 3 months of aquatic and robotic therapy for individuals with chronic motor incomplete spinal cord injury (CMISCI). Settings: Two rehabilitation specialty hospitals. Methods: Thirty-one individuals with CMISCI with neurological level between C2-T12 at least 1 year post injury were randomized to either aquatic or robotic treadmill therapy for 36 sessions. Customized sessions lasted 40-45 min at 65-75% heart rate reserve intensity with peak oxygen consumption (peak VO 2) measured during arm ergometry at baseline and post intervention. Additional peak robotic treadmill VO 2 assessments were obtained before and after training for participants randomized to robotic intervention. Results: Peak VO 2 measured with arm ergometry was not significantly different with either aquatic intervention (8.1%, p = 0.14, n = 15) or robotic intervention (−0.7%, p = 0.31, n = 17). Peak VO 2 measured with robotic treadmill ergometry demonstrated a statistical improvement (14.7%, p = 0.03, n = 17, two-tailed t-test) across the robotic intervention. Comparison between the two interventions demonstrated a trend favoring aquatic therapy for improving arm ergometry peak VO 2 (ANOVA, p = 0.063). Conclusions: Neither 3-month exercise interventions statistically improved arm cycle ergometry peak VO 2 , our cardiorespiratory surrogate marker, although percent improvement was greater in the aquatic exercise condition. Robotic ergometry peak VO 2 did improve for the robotic intervention, confirming previous work. These results suggest that either intervention may hold utility in improving cardiorespiratory fitness in CMISCI, but peak VO 2 measurement technique appears critical in detecting effects. Sponsorship: DOD CDMRP SCI Research Program Clinical Trial Award SC090147, FY 2009. This study is registered under ClinicalTrials.gov Identifier: NCT01407354.

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Objective: The routine clinical use of supported standing in hospitals, schools and homes currently exists. Questions arise as to the nature of the evidence used to justify this practice. This systematic review investigated the available evidence underlying supported standing use based on the Center for Evidence-Based Medicine (CEBM) Levels of Evidence framework. Design: The database search included MEDLINE, CINAHL, GoogleScholar, HighWire Press, PEDro, Cochrane Library databases, and APTAs Hooked on Evidence from January 1980 to October 2009 for studies that included supported standing devices for individuals of all ages, with a neuromuscular diagnosis. We identified 112 unique studies from which 39 met the inclusion criteria, 29 with adult and 10 with pediatric participants. In each group of studies were user and therapist survey responses in addition to results of clinical interventions. Results:The results are organized and reported by The International Classification of Function (ICF) framework in the following categories: b4: Functions of the cardiovascular, haematological, immunological, and respiratory systems; b5: Functions of the digestive, metabolic, and endocrine systems; b7: Neuromusculoskeletal and movement related functions; Combination of d4: Mobility, d8: Major life areas and Other activity and participation. The peer review journal studies mainly explored using supported standers for improving bone mineral density (BMD), cardiopulmonary function, muscle strength/function, and range of motion (ROM). The data were moderately strong for the use of supported standing for BMD increase, showed some support for decreasing hypertonicity (including spasticity) and improving ROM, and were inconclusive for other benefits of using supported standers for children and adults with neuromuscular disorders. The addition of whole body vibration (WBV) to supported standing activities appeared a promising trend but empirical data were inconclusive. The survey data from physical therapists (PTs) and participant users attributed numerous improved outcomes to supported standing: ROM, bowel/bladder, psychological, hypertonicity and pressure relief/bedsores. BMD was not a reported benefit according to the user group. Conclusion: There exists a need for empirical mechanistic evidence to guide clinical supported standing programs across practice settings and with various-aged participants, particularly when considering a life-span approach to practice.