1
|
Wiles MD, Benson I, Edwards L, Miller R, Tait F, Wynn-Hebden A. Management of acute cervical spinal cord injury in the non-specialist intensive care unit: a narrative review of current evidence. Anaesthesia 2024; 79:193-202. [PMID: 38088443 DOI: 10.1111/anae.16198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2023] [Indexed: 01/11/2024]
Abstract
Each year approximately one million people suffer spinal cord injury, which has significant physical, psychosocial and economic impacts on patients and their families. Spinal cord rehabilitation centres are a well-established part of the care pathway for patients with spinal cord injury and facilitate improvements in functional independence and reductions in healthcare costs. Within the UK, however, there are a limited number of spinal cord injury centres, which delays admission. Patients and their families often perceive that they are not receiving specialist care while being treated in non-specialist units. This review aimed to provide clinicians who work in non-specialist spinal injury centres with a summary of contemporary studies relevant to the critical care management of patients with cervical spinal cord injury. We undertook a targeted literature review including guidelines, systematic reviews, meta-analyses, clinical trials and randomised controlled trials published in English between 1 June 2017 and 1 June 2023. Studies involving key clinical management strategies published before this time, but which have not been updated or repeated, were also included. We then summarised the key management themes: acute critical care management approaches (including ventilation strategies, blood pressure management and tracheostomy insertion); respiratory weaning techniques; management of pain and autonomic dysreflexia; and rehabilitation.
Collapse
Affiliation(s)
- M D Wiles
- Academic Department of Anaesthesia and Peri-operative Medicine, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
- Centre for Applied Health and Social Care Research, Sheffield Hallam University, Sheffield, UK
| | - I Benson
- National Spinal Injuries Centre, Buckinghamshire Hospitals NHS Trust, Stoke Mandeville, UK
| | - L Edwards
- University of Nottingham, Nottingham, UK
| | - R Miller
- Critical Care Department, Northampton General Hospital, Northampton, UK
| | - F Tait
- Critical Care Department, Northampton General Hospital, Northampton, UK
| | - A Wynn-Hebden
- Department of Anaesthesia and Critical Care, University Hospitals of Leicester NHS Trust, Leicester, UK
| |
Collapse
|
2
|
Gordon RE, Scrooby B, Havemann-Nel L. Physiological and nutrition-related challenges as perceived by spinal cord-injured endurance hand cyclists. Appl Physiol Nutr Metab 2024; 49:22-29. [PMID: 37793190 DOI: 10.1139/apnm-2023-0036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
This study explored the perceptions of spinal cord-injured (SCI) endurance hand cyclists regarding their physiological and nutrition-related challenges and the perceived impact of these challenges on nutritional intake and exercise capacity. This was an interpretive qualitative descriptive study in which semi-structured interviews were conducted with 12 adult South African national-level SCI endurance hand cyclists. Thematic analysis was used to explore perceptions regarding physiological and nutrition-related challenges and the impact thereof on nutritional practices and exercise capacity. Four themes emerged from the interviews: (i) physiological challenges experienced, (ii) nutrition-related challenges experienced, (iii) changes in nutritional practices, and (iv) compromised exercise capacity. The SCI endurance hand cyclists reported a number of physiological and nutrition-related challenges. Bowel and bladder challenges, limited hand function, muscle spasms, thermoregulatory challenges, pressure sores, menstrual periods, and low iron levels/anaemia were perceived to predominantly impact food and fluid intake (restrict intake) and compromise exercise capacity. This information can assist to devise tailored guidelines aimed to optimise fluid intake, overcome bladder challenges and ensure adequate nutritional intake in light of limited hand function.
Collapse
Affiliation(s)
- Reno Eron Gordon
- Department of Human Nutrition & DieteticsSchool of Health Care Sciences, Sefako Makgatho Health Sciences University, Ga-Rankuwa 0204, South Africa
- Centre of Excellence for Nutrition (CEN), North-West University, Potchefstroom 2520, South Africa
| | - Belinda Scrooby
- School of Nursing Science, North-West University, Potchefstroom 2520, South Africa
| | - Lize Havemann-Nel
- Centre of Excellence for Nutrition (CEN), North-West University, Potchefstroom 2520, South Africa
| |
Collapse
|
3
|
Angeli C, Wagers S, Harkema S, Rejc E. Sensory Information Modulates Voluntary Movement in an Individual with a Clinically Motor- and Sensory-Complete Spinal Cord Injury: A Case Report. J Clin Med 2023; 12:6875. [PMID: 37959340 PMCID: PMC10647542 DOI: 10.3390/jcm12216875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 10/26/2023] [Accepted: 10/27/2023] [Indexed: 11/15/2023] Open
Abstract
Motor recovery following a complete spinal cord injury is not likely. This is partially due to insurance limitations. Rehabilitation strategies for individuals with this type of severe injury focus on the compensation for the activities of daily living in the home and community and not on the restoration of function. With limited time in therapies, the initial goals must focus on getting the patient home safely without the expectation of recovery of voluntary movement below the level of injury. In this study, we report a case of an individual with a chronic, cervical (C3)-level clinically motor- and sensory-complete injury who was able to perform voluntary movements with both upper and lower extremities when positioned in a sensory-rich environment conducive to the specific motor task. We show how he is able to intentionally perform push-ups, trunk extensions and leg presses only when appropriate sensory information is available to the spinal circuitry. These data show that the human spinal circuitry, even in the absence of clinically detectable supraspinal input, can generate motor patterns effective for the execution of various upper and lower extremity tasks, only when appropriate sensory information is present. Neurorehabilitation in the right sensory-motor environment that can promote partial recovery of voluntary movements below the level of injury, even in individuals diagnosed with a clinically motor-complete spinal cord injury.
Collapse
Affiliation(s)
- Claudia Angeli
- Tim and Caroline Reynolds Center for Spinal Stimulation, Kessler Foundation, West Orange, NJ 07052, USA;
- Department of Bioengineering, University of Louisville, Louisville, KY 40292, USA
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY 40202, USA; (S.W.); (S.H.)
| | - Sarah Wagers
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY 40202, USA; (S.W.); (S.H.)
- Division of Physical Medicine and Rehabilitation, University of Louisville, Louisville, KY 40292, USA
| | - Susan Harkema
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY 40202, USA; (S.W.); (S.H.)
| | - Enrico Rejc
- Tim and Caroline Reynolds Center for Spinal Stimulation, Kessler Foundation, West Orange, NJ 07052, USA;
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY 40202, USA; (S.W.); (S.H.)
- Department of Medicine, University of Udine, 33100 Udine, Italy
| |
Collapse
|
4
|
A New Approach to the Study of Two-Joint Upper Limb Movements in Humans: Independent Programming of the Positioning and Force. NEUROPHYSIOLOGY+ 2021. [DOI: 10.1007/s11062-021-09896-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
|
5
|
Mohammed R, Opara K, Lall R, Ojha U, Xiang J. Evaluating the effectiveness of anti-Nogo treatment in spinal cord injuries. Neural Dev 2020; 15:1. [PMID: 31918754 PMCID: PMC6953157 DOI: 10.1186/s13064-020-0138-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 01/05/2020] [Indexed: 02/08/2023] Open
Abstract
As humans, we cannot regenerate axons within the central nervous system (CNS), therefore, making any damage to it permanent. This leads to the loss of sensory and motor function below the site of injury and can be crippling to a person’s health. Spontaneous recovery can occur from plastic changes, but it is minimal. The absence of regeneration is due to the inhibitory environment of the CNS as well as the inherent inability of CNS axons to form growth cones. Amongst many factors, one of the major inhibitory signals of the CNS environment is the myelin-associated Nogo pathway. Nogo-A, Nogo-B and Nogo-C (Nogo), stimulate the Nogo receptor, inhibiting neurite outgrowth by causing growth cones to collapse through activation of Rho Kinase (ROCK). Antibodies can be used to target this signalling pathway by binding to Nogo and thus promote the outgrowth of neuronal axons in the CNS. This use of anti-Nogo antibodies has been shown to upregulate CNS regeneration as well as drastically improve sensory and motor function in both rats and primates when coupled with adequate training. Here, we evaluate whether the experimental success of anti-Nogo at improving CNS regeneration can be carried over into the clinical setting to treat spinal cord injuries (SCI) and their symptoms successfully. Furthermore, we also discuss potential methods to improve the current treatment and any developmental obstacles.
Collapse
Affiliation(s)
- Raihan Mohammed
- Department of Medicine, School of Clinical Medicine, University of Cambridge, Hills Rd, Cambridge, CB2 0SP, UK.
| | - Kaesi Opara
- Department of Medicine, School of Clinical Medicine, University of Cambridge, Hills Rd, Cambridge, CB2 0SP, UK
| | - Rahul Lall
- Department of Medicine, School of Clinical Medicine, University of Cambridge, Hills Rd, Cambridge, CB2 0SP, UK
| | - Utkarsh Ojha
- Faculty of Medicine, Imperial College London, London, UK
| | - Jinpo Xiang
- Faculty of Medicine, Imperial College London, London, UK
| |
Collapse
|
6
|
Chisholm AE, Malik RN, Blouin JS, Borisoff J, Forwell S, Lam T. Feasibility of sensory tongue stimulation combined with task-specific therapy in people with spinal cord injury: a case study. J Neuroeng Rehabil 2014; 11:96. [PMID: 24906679 PMCID: PMC4057581 DOI: 10.1186/1743-0003-11-96] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Accepted: 06/02/2014] [Indexed: 11/30/2022] Open
Abstract
Background Previous evidence suggests the effects of task-specific therapy can be further enhanced when sensory stimulation is combined with motor practice. Sensory tongue stimulation is thought to facilitate activation of regions in the brain that are important for balance and gait. Improvements in balance and gait have significant implications for functional mobility for people with incomplete spinal cord injury (iSCI). The aim of this case study was to evaluate the feasibility of a lab- and home-based program combining sensory tongue stimulation with balance and gait training on functional outcomes in people with iSCI. Methods Two male participants (S1 and S2) with chronic motor iSCI completed 12 weeks of balance and gait training (3 lab and 2 home based sessions per week) combined with sensory tongue stimulation using the Portable Neuromodulation Stimulator (PoNS). Laboratory based training involved 20 minutes of standing balance with eyes closed and 30 minutes of body-weight support treadmill walking. Home based sessions consisted of balancing with eyes open and walking with parallel bars or a walker for up to 20 minutes each. Subjects continued daily at-home training for an additional 12 weeks as follow-up. Results Both subjects were able to complete a minimum of 83% of the training sessions. Standing balance with eyes closed increased from 0.2 to 4.0 minutes and 0.0 to 0.2 minutes for S1 and S2, respectively. Balance confidence also improved at follow-up after the home-based program. Over ground walking speed improved by 0.14 m/s for S1 and 0.07 m/s for S2, and skilled walking function improved by 60% and 21% for S1 and S2, respectively. Conclusions Sensory tongue stimulation combined with task-specific training may be a feasible method for improving balance and gait in people with iSCI. Our findings warrant further controlled studies to determine the added benefits of sensory tongue stimulation to rehabilitation training.
Collapse
Affiliation(s)
- Amanda E Chisholm
- School of Kinesiology, University of British Columbia, Vancouver, Canada.
| | | | | | | | | | | |
Collapse
|
7
|
Fawcett JW, Schwab ME, Montani L, Brazda N, Müller HW. Defeating inhibition of regeneration by scar and myelin components. HANDBOOK OF CLINICAL NEUROLOGY 2012; 109:503-22. [PMID: 23098733 DOI: 10.1016/b978-0-444-52137-8.00031-0] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Axon regeneration and the sprouting processes that underlie plasticity are blocked by inhibitory factors in the central nervous system (CNS) environment, several of which are upregulated after injury. The major inhibitory molecules are those associated with myelin and those associated with the glial scar. In myelin, NogoA, MAG, and OMgp are present on normal oligodendrocytes and on myelin debris. They act partly via the Nogo receptor, partly via an unidentified amino-Nogo receptor. In the glial scar, chondroitin sulphate proteoglycans, semaphorins, and the formation of a collagen-based membrane are all inhibitory. Methods to counteract these forms of inhibition have been identified, and these treatments promote axon regeneration in the damaged spinal cord, and in some cases recovery of function through enhanced plasticity.
Collapse
Affiliation(s)
- James W Fawcett
- Cambridge University Centre for Brain Repair, Cambridge, UK.
| | | | | | | | | |
Collapse
|
8
|
Harkema S, Behrman A, Barbeau H. Evidence-based therapy for recovery of function after spinal cord injury. HANDBOOK OF CLINICAL NEUROLOGY 2012; 109:259-74. [PMID: 23098718 DOI: 10.1016/b978-0-444-52137-8.00016-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Physical rehabilitation for individuals coping with neurological deficits is evolving in response to a paradigm shift in thinking about the injured nervous system and using evidence as a basis for clinical decisions. Functional recovery from paralysis was generally believed to be nearly impossible, based on traditional expert opinion, and the priority was to develop compensation strategies to achieve functional goals in the home and community. Research, which began in animal models of neurological insult and is currently being translated to the clinic, has challenged these assumptions. The nervous system, whether intact or injured, has enormous potential for adaptation and modification, which can be harnessed to facilitate recovery. In this chapter we will briefly outline the history of physical rehabilitation as it concerns the development of strategies aimed at compensation, rather than functional recovery. Then we will discuss how new activity-based therapies are being developed, based on evidence from basic science and clinical evidence. One of these activity-based therapies is locomotor training, a program which relies on the intrinsic, automatic, control of locomotion by "lower" neural centers. A brief description of the program, including the four foundational principles, will be followed by an introduction to the use of robotics in these programs. Finally, we will discuss a second activity-based therapy, functional electrical stimulation (FES), and the future of physical rehabilitation for spinal cord injury and other neurological disorders.
Collapse
Affiliation(s)
- Susan Harkema
- Department of Neurological Surgery, University of Louisville, Louisville, KY, USA.
| | | | | |
Collapse
|
9
|
Onifer SM, Smith GM, Fouad K. Plasticity after spinal cord injury: relevance to recovery and approaches to facilitate it. Neurotherapeutics 2011; 8:283-93. [PMID: 21384221 PMCID: PMC3101826 DOI: 10.1007/s13311-011-0034-4] [Citation(s) in RCA: 103] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Motor, sensory, and autonomic functions can spontaneously return or recover to varying extents in both humans and animals, regardless of the traumatic spinal cord injury (SCI) level and whether it was complete or incomplete. In parallel, adverse and painful functions can appear. The underlying mechanisms for all of these diverse functional changes are summarized under the term plasticity. Our review will describe what is known regarding this phenomenon after traumatic SCI and focus on its relevance to motor and sensory recovery. Although it is still somewhat speculative, plasticity can be found throughout the neuraxis and includes various changes ranging from alterations in the properties of spared neuronal circuitries, intact or lesioned axon collateral sprouting, and synaptic rearrangements. Furthermore, we will discuss a selection of potential approaches for facilitating plasticity as possible SCI treatments. Because a mechanism underlying spontaneous plasticity and recovery might be motor activity and the related neuronal activity, activity-based therapies are being used and investigated both clinically and experimentally. Additional pharmacological and gene-delivery approaches, based on plasticity being dependent on the delicate balance between growth inhibition and promotion as well as the basic intrinsic growth ability of the neurons themselves, have been found to be effective alone and in combination with activity-based therapies. The positive results have to be tempered with the reality that not all plasticity is beneficial. Therefore, a tremendous number of questions still need to be addressed. Ultimately, answers to these questions will enhance plasticity's potential for improving the quality of life for persons with SCI.
Collapse
Affiliation(s)
- Stephen M. Onifer
- Spinal Cord and Brain Injury Research Center, University of Kentucky, College of Medicine, Lexington, Kentucky 40536-0509 USA
- Department of Anatomy and Neurobiology, University of Kentucky, College of Medicine, Lexington, Kentucky 40536-0098 USA
| | - George M. Smith
- Spinal Cord and Brain Injury Research Center, University of Kentucky, College of Medicine, Lexington, Kentucky 40536-0509 USA
- Department of Physiology, University of Kentucky, College of Medicine, Lexington, Kentucky 40536-0298 USA
| | - Karim Fouad
- Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, T6G 2G4 Canada
| |
Collapse
|
10
|
Gravano S, Ivanenko YP, Maccioni G, Macellari V, Poppele RE, Lacquaniti F. A novel approach to mechanical foot stimulation during human locomotion under body weight support. Hum Mov Sci 2010; 30:352-67. [PMID: 20417979 DOI: 10.1016/j.humov.2010.01.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2009] [Revised: 12/26/2009] [Accepted: 01/05/2010] [Indexed: 12/01/2022]
Abstract
Input from the foot plays an essential part in perceiving support surfaces and determining kinematic events in human walking. To simulate adequate tactile pressure inputs under body weight support (BWS) conditions that represent an effective form of locomotion training, we here developed a new method of phasic mechanical foot stimulation using light-weight pneumatic insoles placed inside the shoes (under the heel and metatarsus). To test the system, we asked healthy participants to walk on a treadmill with different levels of BWS. The pressure under the stimulated areas of the feet and subjective sensations were higher at high levels of BWS and when applied to the ball and toes rather than heels. Foot stimulation did not disturb significantly the normal motor pattern, and in all participants we evoked a reliable step-synchronized triggering of stimuli for each leg separately. This approach has been performed in a general framework looking for "afferent templates" of human locomotion that could be used for functional sensory stimulation. The proposed technique can be used to imitate or partially restore surrogate contact forces under body weight support conditions.
Collapse
Affiliation(s)
- S Gravano
- Laboratory of Neuromotor Physiology, IRCCS Fondazione Santa Lucia, via Ardeatina 306, 00179 Rome, Italy
| | | | | | | | | | | |
Collapse
|
11
|
Task-specificity vs. ceiling effect: step-training in shallow water after spinal cord injury. Exp Neurol 2010; 224:178-87. [PMID: 20302862 DOI: 10.1016/j.expneurol.2010.03.008] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2009] [Revised: 03/09/2010] [Accepted: 03/10/2010] [Indexed: 02/03/2023]
Abstract
While activity-based rehabilitation is one of the most promising therapeutic approaches for spinal cord injury, the necessary components for optimal locomotor retraining have not yet been determined. Currently, a number of different activity-based approaches are being investigated including body weight-supported treadmill training (with and without manual assistance), robotically-assisted treadmill training, bicycling and swimming, among others. We recently showed, in the adult rat, that intensive rehabilitation based on swimming brought about significant improvements in hindlimb performance during swimming but did not alter the normal course of recovery of over-ground walking (Smith et al., 2006a,b, 2009). However, swimming lacks the phasic limb-loading and plantar cutaneous feedback thought to be important for weight-supported step training. So, we are investigating an innovative approach based on walking in shallow water where buoyancy provides some body weight support and balance while still allowing for limb-loading and appropriate cutaneous afferent feedback during retraining. Thus, the aim of this study is to determine if spinal cord injured animals show improved overground locomotion following intensive body weight-supported locomotor training in shallow water. The results show that training in shallow water successfully improved stepping in shallow water, but was not able to bring about significant improvements in overground locomotion despite the fact that the shallow water provides sufficient body weight support to allow acutely injured rats to generate frequent plantar stepping. These observations support previous suggestions that incompletely injured animals retrain themselves while moving about in their cages and that daily training regimes are not able to improve upon this already substantial functional improvement due to a ceiling effect, rather than task-specificity, per se. These results also support the concept that moderately-severe thoracic contusion injuries decrease the capacity for body weight support, but do not decrease the capacity for pattern generation. In contrast, animals with severe contusion injuries could not support their body weight nor could they generate a locomotor pattern when provided with body weight support via buoyancy.
Collapse
|
12
|
Fitzsimmons NA, Lebedev MA, Peikon ID, Nicolelis MAL. Extracting kinematic parameters for monkey bipedal walking from cortical neuronal ensemble activity. Front Integr Neurosci 2009; 3:3. [PMID: 19404411 PMCID: PMC2659168 DOI: 10.3389/neuro.07.003.2009] [Citation(s) in RCA: 149] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2009] [Accepted: 02/23/2009] [Indexed: 11/18/2022] Open
Abstract
The ability to walk may be critically impacted as the result of neurological injury or disease. While recent advances in brain–machine interfaces (BMIs) have demonstrated the feasibility of upper-limb neuroprostheses, BMIs have not been evaluated as a means to restore walking. Here, we demonstrate that chronic recordings from ensembles of cortical neurons can be used to predict the kinematics of bipedal walking in rhesus macaques – both offline and in real time. Linear decoders extracted 3D coordinates of leg joints and leg muscle electromyograms from the activity of hundreds of cortical neurons. As more complex patterns of walking were produced by varying the gait speed and direction, larger neuronal populations were needed to accurately extract walking patterns. Extraction was further improved using a switching decoder which designated a submodel for each walking paradigm. We propose that BMIs may one day allow severely paralyzed patients to walk again.
Collapse
|
13
|
Bello O, Sanchez JA, Fernandez-del-Olmo M. Treadmill walking in Parkinson's disease patients: adaptation and generalization effect. Mov Disord 2009; 23:1243-9. [PMID: 18464281 DOI: 10.1002/mds.22069] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
We examined the adaptation and generalization effect of one familiarization treadmill walking session on gait in patients with Parkinson's disease (PD) with different degrees of disease severity. Eight moderate PD patients (Hoehn and Yahr stage 2-2.5), eight advanced PD patients (Hoehn and Yahr 3), and eight matched control subjects participated in this study. Subjects first walked overground on a 10-m walkway at a self-selected speed (pretreadmill). They then performed a 20-min treadmill training session, followed by three trials of overground walking (Post1, Post2, Post3). Cadence, step length, speed, and coefficient of variation of stride time (CV) were recorded. During the treadmill session the advanced PD patients significantly decreased their cadence (t = 3.9, P <or= 0.01) and increased their step length (t = 4.27, P <or= 0.01) compared with pretreadmill walking. After the treadmill, all subjects walked overground significantly faster (F = 16.51 P <or= 0.001) and with a larger step length (F = 13.03 P <or= 0.01) than pretreadmill walking. The present study shows a specific adaptation to walk over the treadmill for the advanced PD patients. Moreover, this confirms the potential therapeutic use of the treadmill for PD gait rehabilitation since a single familiarization session lead to an increase in the step length and thus to the improvement of the main gait impairment in PD.
Collapse
Affiliation(s)
- Olalla Bello
- Learning and Motor Control Group, INEF Galicia, University of A Coruña, A Coruña, Spain
| | | | | |
Collapse
|
14
|
Cardiovascular response to functional electrical stimulation and dynamic tilt table therapy to improve orthostatic tolerance. J Electromyogr Kinesiol 2008; 18:900-7. [DOI: 10.1016/j.jelekin.2008.08.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2008] [Revised: 08/18/2008] [Accepted: 08/18/2008] [Indexed: 11/20/2022] Open
|
15
|
van der Woude LHV, de Groot S, Janssen TWJ. Manual wheelchairs: Research and innovation in rehabilitation, sports, daily life and health. Med Eng Phys 2006; 28:905-15. [PMID: 16504565 DOI: 10.1016/j.medengphy.2005.12.001] [Citation(s) in RCA: 102] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2005] [Revised: 12/01/2005] [Accepted: 12/03/2005] [Indexed: 11/28/2022]
Abstract
Those with lower limb disabilities are often dependent on manually propelled wheelchairs for their mobility, in Europe today some 3.3 million people. This implies a transfer from leg to arm work for ambulation and all other activities of daily living (ADL). Compared to the legs, arm work is less efficient and more straining, and leads to a lower physical capacity. Also, there is a major risk of mechanical overuse. Problems of long-term wheelchair use are not only pain or discomfort, but also a risk of a physically inactive lifestyle. Subsequently, serious secondary impairments (obesity, diabetes and cardiovascular problems) may eventually emerge. Wheelchair quality, including the ergonomic fitting to the individual may play a preventive role here, but also other modes of physical activity, and the understanding of training, rehabilitation, active lifestyle and sports on health and wellbeing. The 'International Classification of Functioning, Health and Disability' (ICF) model, a stress-strain-work capacity model, as well as the ergonomics model that relates human-activity-assistive technology are instrumental to the concepts, structure and aims of research in assistive technology for mobility. Apart from empirical developments and innovations from within wheelchair sports, systematic research has played a role in wheelchair development and design in three important areas: (1) the vehicle mechanics, (2) the human movement system and (3) the wheelchair-user interface. Current practical developments in design and technology are discussed. A position stand on the key-issues of a current and future research agenda in this area is presented.
Collapse
Affiliation(s)
- Lucas H V van der Woude
- Institute for Fundamental and Clinical Human Movement Sciences, Faculty of Human Movement Sciences, Vrije Universiteit, Van der Boechorststraat 9, Amsterdam, The Netherlands.
| | | | | |
Collapse
|
16
|
Van der Woude L, de Groot S, Janssen T. Manual wheelchairs: research and innovation in sports and daily life. Sci Sports 2006. [DOI: 10.1016/j.scispo.2006.06.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
17
|
Lavrov I, Gerasimenko YP, Ichiyama RM, Courtine G, Zhong H, Roy RR, Edgerton VR. Plasticity of spinal cord reflexes after a complete transection in adult rats: relationship to stepping ability. J Neurophysiol 2006; 96:1699-710. [PMID: 16823028 DOI: 10.1152/jn.00325.2006] [Citation(s) in RCA: 138] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Changes in epidurally induced (S1) spinal cord reflexes were studied as a function of the level of restoration of stepping ability after spinal cord transection (ST). Three types of responses were observed. The early response (ER) had a latency of 2.5 to 3 ms and resulted from direct stimulation of motor fibers or motoneurons. The middle response (MR) had a latency of 5 to 7 ms and was monosynaptic. The late response (LR) had a latency of 9 to 11 ms and was polysynaptic. After a complete midthoracic ST, the LR was abolished, whereas the MR was facilitated and progressively increased. The LR reappeared about 3 wk after ST and increased during the following weeks. Restoration of stepping induced by epidural stimulation at 40 Hz coincided with changes in the LR. During the first 2 wk post-ST, rats were unable to step and electrophysiological assessment failed to show any LR. Three weeks post-ST, epidural stimulation resulted in a few steps and these coincided with reappearance of the LR. The ability of rats to step progressively improved from wk 3 to wk 6 post-ST. There was a continuously improved modulation of rhythmic EMG bursts that was correlated with restoration of the LR. These results suggest that restoration of polysynaptic spinal cord reflexes after complete ST coincides with restoration of stepping function when facilitated by epidural stimulation. Combined, these findings support the view that restoration of polysynaptic spinal cord reflexes induced epidurally may provide a measure of functional restoration of spinal cord locomotor networks after ST.
Collapse
Affiliation(s)
- Igor Lavrov
- Department of Physiological Science, University of California, Los Angeles, CA 90095-1527, USA
| | | | | | | | | | | | | |
Collapse
|
18
|
Fong AJ, Cai LL, Otoshi CK, Reinkensmeyer DJ, Burdick JW, Roy RR, Edgerton VR. Spinal cord-transected mice learn to step in response to quipazine treatment and robotic training. J Neurosci 2006; 25:11738-47. [PMID: 16354932 PMCID: PMC6726027 DOI: 10.1523/jneurosci.1523-05.2005] [Citation(s) in RCA: 118] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
In the present study, concurrent treatment with robotic step training and a serotonin agonist, quipazine, generated significant recovery of locomotor function in complete spinal cord-transected mice (T7-T9) that otherwise could not step. The extent of recovery achieved when these treatments were combined exceeded that obtained when either treatment was applied independently. We quantitatively analyzed the stepping characteristics of spinal mice after alternatively administering no training, manual training, robotic training, quipazine treatment, or a combination of robotic training with quipazine treatment, to examine the mechanisms by which training and quipazine treatment promote functional recovery. Using fast Fourier transform and principal components analysis, significant improvements in the step rhythm, step shape consistency, and number of weight-bearing steps were observed in robotically trained compared with manually trained or nontrained mice. In contrast, manual training had no effect on stepping performance, yielding no improvement compared with nontrained mice. Daily bolus quipazine treatment acutely improved the step shape consistency and number of steps executed by both robotically trained and nontrained mice, but these improvements did not persist after quipazine was withdrawn. At the dosage used (0.5 mg/kg body weight), quipazine appeared to facilitate, rather than directly generate, stepping, by enabling the spinal cord neural circuitry to process specific patterns of sensory information associated with weight-bearing stepping. Via this mechanism, quipazine treatment enhanced kinematically appropriate robotic training. When administered intermittently during an extended period of robotic training, quipazine revealed training-induced stepping improvements that were masked in the absence of the pharmacological treatment.
Collapse
Affiliation(s)
- Andy J Fong
- Biomedical Engineering Interdepartmental Program, University of California, Los Angeles, California 90095, USA
| | | | | | | | | | | | | |
Collapse
|
19
|
Courtine G, Roy RR, Raven J, Hodgson J, McKay H, Yang H, Zhong H, Tuszynski MH, Edgerton VR. Performance of locomotion and foot grasping following a unilateral thoracic corticospinal tract lesion in monkeys (Macaca mulatta). ACTA ACUST UNITED AC 2005; 128:2338-58. [PMID: 16049043 DOI: 10.1093/brain/awh604] [Citation(s) in RCA: 106] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Six adult monkeys (Macaca mulatta) received a unilateral lesion of the lateral corticospinal tract (CST) in the thoracic spinal cord. Prior to surgery, the animals were trained to perform quadrupedal stepping on a treadmill, and item retrieval with the foot. Whole body kinematics and electromyogram (EMG) recordings were made prior to, and at regular intervals over a period of 12 weeks after the CST lesion. After 1 week of recovery, all monkeys were able to walk unaided quadrupedally on the treadmill. The animals, however, dragged the hindpaw ipsilateral to the lesion along the treadmill belt during the swing phase and showed a significant reorganization of the spatiotemporal pattern of hindlimb (HL) and forelimb (FL) displacements. The inability to appropriately trigger the swing phase resulted in an increase in the cycle duration and stride length of both HLs. The stance duration decreased in the ipsilateral HL, and increased in the contralateral HL and both FLs. Consequently, there was a dramatic disruption of interlimb and intralimb coupling that was reflected in the limb kinematic and EMG patterns. The CST lesion completely abolished the ability of the monkeys to retrieve items with the foot ipsilateral to the lesion and significantly disrupted the level of performance of the contralateral HL during the first 2 weeks post-lesion. Interestingly, selected HL muscles remained almost quiescent when the monkeys attempted to retrieve items, but were unsuccessful with the affected foot at 1 week post-lesion, whereas the capacity to activate the same muscles was preserved, although reduced, during stepping. Spatial and temporal parameters of gait, kinematics, and EMG patterns recorded during locomotion generally converged toward control values over time, but significant differences persisted up to 12 weeks post-lesion. Although some control was recovered over the distal foot musculature, fine foot grasping remained significantly impaired at the end of the testing period. These findings demonstrate that the CST pathway from the brain normally makes an important contribution to interlimb and intralimb coordination during basic locomotion, and to muscle activation to produce dexterous foot digit movements in the monkey. Furthermore, the present study indicates that the primate has the ability to rapidly accommodate locomotor performance, and to a lesser degree fine foot motor skills, to a reduction in supraspinal control. Identification of the neural substrates mediating the rapid recovery of motor function following injury to the primate spinal cord could provide insight into developing repair strategies to augment functional recovery from neuromotor impairments.
Collapse
Affiliation(s)
- Grégoire Courtine
- Department of Physiological Science, University of California, Los Angeles, CA 90095-1527, USA
| | | | | | | | | | | | | | | | | |
Collapse
|