{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T07:01:19Z","timestamp":1780556479833,"version":"3.54.1"},"reference-count":57,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/100000090","name":"Congressionally Directed Medical Research Programs","doi-asserted-by":"crossref","award":["DOD CDMRP HT94252410708"],"award-info":[{"award-number":["DOD CDMRP HT94252410708"]}],"id":[{"id":"10.13039\/100000090","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Neurotrauma Reports"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:p>\n                    Improving overground walking in people with chronic, incomplete spinal cord injury (iSCI) is especially important for older adults, who now represent more than 40% of the SCI population. Age and injury appear to interact to limit neuroplasticity in spared pathways, constraining gains from gait training. Brief episodes of low oxygen breathing (therapeutic acute intermittent hypoxia [tAIH]) may function as a plasticity-promoting primer to enhance the effects of transcutaneous spinal stimulation-augmented gait training (WALK\n                    <jats:sub>tSTIM<\/jats:sub>\n                    ), particularly in older individuals. This multicenter, age-stratified, placebo-controlled clinical trial will examine dose- and age-dependent effects of tAIH+WALK\n                    <jats:sub>tSTIM<\/jats:sub>\n                    on walking recovery in 60 adults with chronic (&gt;1 year) iSCI. After an eight-session WALK prewash phase, participants are randomized within age strata (18-49 and 50-80 years) to tAIH+WALK\n                    <jats:sub>tSTIM<\/jats:sub>\n                    or Placebo+WALK\n                    <jats:sub>tSTIM<\/jats:sub>\n                    . The active intervention delivers daily tAIH or Placebo immediately before a 45-min WALK\n                    <jats:sub>tSTIM<\/jats:sub>\n                    session, 4 days per week for 4 weeks. Primary outcomes are walking speed (10-Meter Walk Test), endurance (6-Minute Walk Test), and balance (Timed Up-and-Go), assessed at baseline, during intervention weeks, and 1, 4, and 8 weeks post intervention. Safety and mechanistic measures include lower extremity strength, spasticity, pain, cardiopulmonary function, cognition, autonomic events, and serum testosterone. Findings will determine whether tAIH priming augments WALK\n                    <jats:sub>tSTIM<\/jats:sub>\n                    relative to Placebo, whether extending pretreatment from 2 to 4 weeks (in pooled analyses with BO\n                    <jats:sub>2<\/jats:sub>\n                    ST-I) yields larger or more durable walking gains, and whether age and hormone levels modify responsiveness. These results will inform age-appropriate tAIH dosing strategies and support the development of personalized neuromodulatory rehabilitation for an aging SCI population.\n                  <\/jats:p>","DOI":"10.1177\/2689288x261452592","type":"journal-article","created":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T06:52:44Z","timestamp":1780296764000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["A Research Protocol to Study the Dose- and Age-Dependent Effects of Breathing Low Oxygen on Enhancing Transcutaneous Spinal Stimulation-Induced Walking Function for People with Spinal Cord Injury: The BO\n                    <sub>2<\/sub>\n                    ST-II Trial"],"prefix":"10.1177","volume":"7","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6285-9641","authenticated-orcid":false,"given":"Julia","family":"Wall","sequence":"first","affiliation":[{"name":"Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naama","family":"Nijk","sequence":"additional","affiliation":[{"name":"Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, USA."},{"name":"Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"Tuthill","sequence":"additional","affiliation":[{"name":"Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noah","family":"Piazza","sequence":"additional","affiliation":[{"name":"Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sachin","family":"Patel","sequence":"additional","affiliation":[{"name":"Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hannah","family":"Snyder","sequence":"additional","affiliation":[{"name":"Brooks Rehabilitation, Jacksonville, Florida, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathryn","family":"Cavka","sequence":"additional","affiliation":[{"name":"Brooks Rehabilitation, Jacksonville, Florida, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Parag","family":"Gad","sequence":"additional","affiliation":[{"name":"SpineX Inc., Northridge, California, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guogen","family":"Shan","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, University of Florida, Gainesville, Florida, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gordon S.","family":"Mitchell","sequence":"additional","affiliation":[{"name":"Department of Physical Therapy, University of Florida, Gainesville, Florida, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily J.","family":"Fox","sequence":"additional","affiliation":[{"name":"Brooks Rehabilitation, Jacksonville, Florida, USA."},{"name":"Department of Physical Therapy, University of Florida, Gainesville, Florida, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Randy D.","family":"Trumbower","sequence":"additional","affiliation":[{"name":"Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, USA."},{"name":"Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,5,31]]},"reference":[{"key":"e_1_3_3_2_1","volume-title":"Traumatic Spinal Cord Injury Facts and Figures at a Glance","author":"Center NSCIS","year":"2025","unstructured":"1.Center NSCIS. 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