(1)Objectives: Bone unloading due to muscle paralysis and immobility is one of the most important factors in the decline of bone mass in patients with spinal cord injury. Bones of the lower extremities in patients not receiving compressive forces caused by the weight bearing and not tensile forces caused by the contraction of muscle; So this mechanical loading by weight bearing exercises and functional electrical stimulation may be limited or improve reduce of bone density.
(2)Design: Randomize control trial
(3)Setting and conduct: 30 volunteers divided into 3 groups (exercise, exercise with electrical stimulation and control). Exercise group and exercise with electrical stimulation group undergo interventions for 24 weeks. Quantitative compute tomography will be taken from the distal femur and proximal tibia in both legs for all patients before and after the 24 weeks.
(4)Participants including major eligibility criteria: Patients with chronic paraplegic spinal cord injury (between T2 up T12, grade A or B)
(5)Intervention: Advanced weight-bearing exercises including trunk twisting and raising, quadruped, tall-kneeling with Weight shifting to different directions, alternative isometric and rhythmic stabilization contractions, and forward reaching along with functional electrical stimulation of quadriceps and soleus muscles.
(6)main outcome measures (variables): Total bone mineral density, trabecular bone mineral density, cortical bone mineral density, cortical thickness, cortical cross section area and total cross section area will be measured. Also in order to assess the level of independence in daily activities and the patient’s general health survey, the Persian version of the Barthel index and the SF-36 questionnaire is used. Functional and stability performance be evaluated with the number of practice of trunk twisting and raising exercise, and time exposure of quadruped, forward reaching and tall-knelling positions.