The 200-Rep Trial: 200 repetitions of isolated muscle contractions for partially-paralysed muscles

INTERVENTION: One target muscle group will be selected on one side of the body from the following muscles: the elbow flexors, elbow extensors, wrist flexors, wrist extensors, knee flexors, knee extensors, ankle dorsiflexors or ankle plantarflexors. This will be chosen by the physiotherapist in consultation with the participant. A target muscle group in participants allocated to the Treatment group will be trained once a day, six times a week for 8 weeks. The sessions will be supervised in the hospital or rehabilitation centre at which the participant is an inpatient. Training on five of the days will be supervised by a qualified therapist, while the other day will be supervised by a family member/carer where possible or a qualified therapist if they are available. Participants will aim to perform 200 repeat contractions of the target muscle group during each session, and this will be completed within a 30‐minute time frame. The strength training will be progressed as possible. Initially, participants who are very weak and unable to move through a full range of motion (ROM) with gravity eliminated will be encouraged to focus on increasing their ROM during the 200 contractions. Once a participant can readily move 200 times through a full ROM with gravity eliminated, they will be required to move against gravity. Again, initially they will focus on attaining full ROM against gravity during all 200 contractions. Once participants can move 200 times through full ROM against gravity then resistance will be slowly introduced. In addition, participants will also continue to receive usual care (see Control group). The details of the training provided to participants will be recorded by the therapist in a training diary. CONDITION: Partial Paralysis Spinal cord injury PRIMARY OUTCOME: Muscle strength: Muscle strength will be measured using the Manual Muscle Test on a 13‐point scale. This scale is adapted from the traditional 0 to 5‐point Manual Muscle Test but utilises pluses and minuses. INCLUSION CRITERIA: A person will be eligible to participate if they: * have a recent complete or incomplete SCI (as defined by the International Standards for Neurological classification of SCI) that was sustained less than six months prior * have partial paralysis in a major muscle group on one side of the body (i.e., elbow flexors or extensors, wrist flexors or extensors, knee flexors or extensors, ankle dorsiflexors or plantarflexors) * have less than grade 3 strength in the target muscle as measured by a manual muscle test (MMT). * are an inpatient of one of the participating SCI units and are likely to remain there for the duration of their involvement in the trial (i.e., approximately 9 weeks, or are being discharged home to the local area surrounding the hospital) * are aged 16 years or over at the time of consent * are willing to participate in the trial SECONDARY OUTCOME: Participants’ perceptions of function: At the completion of the trial participants will be asked to rate their impressions of change in their ability to use the target muscle group for functional activities on a 15‐point scale where ‐7 indicates “a very great deal worse”, 0 indicates “no change” and +7 indicates “a very great deal better” for each muscle group. Participants’ perceptions of strength: At the completion of the trial participants will be asked to rate their impressions of change in strength of the target muscle group on a 15‐point scale where ‐7 indicates “a very great deal worse”, 0 indicates “no change” and +7 indicates “a very great deal better”. Therapist’s expectation of final strength: Prior to the baseline assessment, the treating therapist will be asked to estimate how much the target muscle will improve in strength over the study period. Specifically, the therapist will be asked to estimate the grade that they expect the target muscle to be at the end of the 8‐week study period (on a 13‐point manual muscle test). This prediction will be used to calculate the difference between predicted and actual muscle strength at 8‐weeks.