Body composition assessment in spinal cord injury clinical trials

Body weight and composition impact almost every aspect of rehabilitation and community reintegration for the person with spinal cord injury (SCI), but they have received fairly little attention from the rehabilitation community. In particular, sarcopenia (muscle wasting) and fat accumulation due to paralysis significantly impair activities of daily living, community mobility, cardiopulmonary health, bowel and bladder function, skin integrity, and spasticity and can contribute to morbidities associated with obesity including atherosclerosis, diabetes, dyslipidemia, hypertension, chronic pain, depression, and societal isolation. Usual methods of body composition assessment typically underestimate body fat in SCI and are relatively insensitive to changes that may occur from exercise and nutritional interventions. Current body composition assessment techniques are reviewed for their appropriateness in use with the SCI population, and limitations of those techniques are discussed. Recommendations are made for future investigations to validate clinical assessment tools with the 4-compartment (gold standard) model of body composition assessment and for minimal standards of reporting body weight and composition in clinical trials.