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Zwijgers E, van Dijsseldonk RB, Vos-van der Hulst M, Hijmans JM, Geurts ACH, Keijsers NLW. Efficacy of Walking Adaptability Training on Walking Capacity in Ambulatory People With Motor Incomplete Spinal Cord Injury: A Multicenter Pragmatic Randomized Controlled Trial. Neurorehabil Neural Repair 2024; 38:413-424. [PMID: 38661122 PMCID: PMC11097615 DOI: 10.1177/15459683241248088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
BACKGROUND AND OBJECTIVE Balance and walking capacity are often impaired in people with motor incomplete spinal cord injury (iSCI), frequently resulting in reduced functional ambulation and participation. This study aimed to assess the efficacy of walking adaptability training compared to similarly dosed conventional locomotor and strength training for improving walking capacity, functional ambulation, balance confidence, and participation in ambulatory people with iSCI. METHODS We conducted a 2-center, parallel-group, pragmatic randomized controlled trial. Forty-one people with iSCI were randomized to 6 weeks of (i) walking adaptability training (11 hours of Gait Real-time Analysis Interactive Lab (GRAIL) training-a treadmill in a virtual reality environment) or (ii) conventional locomotor and strength training (11 hours of treadmill training and lower-body strength exercises). The primary measure of walking capacity was maximal walking speed, measured with an overground 2-minute walk test. Secondary outcome measures included the Spinal Cord Injury Functional Ambulation Profile (SCI-FAP), the Activities-specific Balance Confidence (ABC) scale, and the Utrecht Scale for Evaluation of Rehabilitation-Participation (USER-P). RESULTS No significant difference in maximal walking speed between the walking adaptability (n = 17) and conventional locomotor and strength (n = 18) training groups was found 6 weeks after training at follow-up (-0.05 m/s; 95% CI = -0.12-0.03). In addition, no significant group differences in secondary outcomes were found. However, independent of intervention, significant improvements over time were found for maximal walking speed, SCI-FAP, ABC, and USER-P restrictions scores. Conclusions. Our findings suggest that walking adaptability training may not be superior to conventional locomotor and strength training for improving walking capacity, functional ambulation, balance confidence, or participation in ambulatory people with iSCI. TRIAL REGISTRATION Dutch Trial Register; Effect of GRAIL training in iSCI.
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Affiliation(s)
- Eline Zwijgers
- Department of Rehabilitation, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
- Department of Research, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - Rosanne B. van Dijsseldonk
- Department of Rehabilitation, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
- Department of Research, Sint Maartenskliniek, Nijmegen, The Netherlands
| | | | - Juha M. Hijmans
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Alexander C. H. Geurts
- Department of Rehabilitation, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
- Department of Rehabilitation, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - Noël L. W. Keijsers
- Department of Rehabilitation, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
- Department of Research, Sint Maartenskliniek, Nijmegen, The Netherlands
- Department of Sensorimotor Neuroscience, Radboud University, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
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Morgan DW, Stevens SL. Use of water- and land-based gait training to improve walking capacity in adults with complete spinal cord injury: A pilot study. J Spinal Cord Med 2024; 47:404-411. [PMID: 35796664 PMCID: PMC11044748 DOI: 10.1080/10790268.2022.2088507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
OBJECTIVE Little is known regarding the extent to which mobility can be improved using gait-based therapies in individuals with complete spinal cord injury (cSCI). Against this backdrop, the purpose of our study was to document changes in walking capacity following an extended period of underwater treadmill training (UTT) and supplemental overground walk training (OWT) in persons with cSCI. DESIGN Longitudinal design. SETTING University research center. PARTICIPANTS Five adults (mean age = 41.2 ± 5.9 years) with motor-complete (AIS A), chronic (mean years post-injury = 3.2 ± 1.6 years) cSCI who had not received epidural spinal cord stimulation (eSCS). INTERVENTION Participants underwent one year of UTT (3 walking bouts per day; 2-3 days per week). Once independent stepping activity in the water was observed, OWT, as tolerated, was performed prior to UTT. OUTCOME MEASURE Walking capacity was evaluated using the Walking Index for Spinal Cord Injury (WISCI-II) prior to UTT (Time 1: T1), six months after the start of UTT (Time 2: T2), and following completion of UTT (Time 3: T3). RESULTS Non-parametric analyses revealed a significant time effect (P < .05) for WISCI-II. Pre-planned comparisons revealed no difference in WISCI-II levels measured at T1 (0.20 ± 0.45) and T2 (4.80 ± 4.55) and at T2 (4.80 ± 4.55) and T3 (8.40 ± 1.34). However, the WISCI-II level obtained at T3 (8.40 ± 1.34) was significantly higher compared to the T1 value. CONCLUSION Our preliminary findings demonstrate that in the absence of eSCS, combined UTT and supplemental OWT can improve functional walking capacity in adults with cSCI.
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Affiliation(s)
- Don W. Morgan
- Department of Health and Human Performance, Middle Tennessee State University, Murfreesboro, TN, USA
| | - Sandra L. Stevens
- Department of Health and Human Performance, Middle Tennessee State University, Murfreesboro, TN, USA
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Martinache F, Foudhaïli A, Vigué B. Early rehabilitation after spinal cord injury: a scoping review protocol. JBI Evid Synth 2024:02174543-990000000-00294. [PMID: 38602049 DOI: 10.11124/jbies-22-00461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Abstract
OBJECTIVE The objective of this scoping review is to identify the timings and types of early rehabilitation after spinal cord injuries (SCI) that are documented in the literature, as well as identify possible research gaps in this field. INTRODUCTION Preclinical and clinical studies support the idea that early rehabilitation may be beneficial for patients with acute SCI. However, the timing and types of rehabilitation that should and could be used in the acute stage are still unclear. The first step towards such knowledge is to extensively review what is documented in the literature. INCLUSION CRITERIA This review will consider all papers focusing on early rehabilitation after SCI in adult humans or animals (<3 months post-SCI for humans and other primates and <3 weeks post-SCI for other animals). Interventions in the included papers must aim at sensorimotor or functional improvement and take place in a hospital or a rehabilitation center if they target human subjects. METHODS MEDLINE (PubMed), Scopus, Embase (Embase.com), PEDro, Web of Science Core Collection, CINAHL (EBSCOhost), Cochrane Database of Systematic Reviews, Cochrane CENTRAL, PROSPERO, ClinicalTrials.gov, and gray literature sources will be searched for eligible articles. This review will include published and unpublished experimental and observational studies, research protocols, conference abstracts, systematic reviews, and guidelines. No language or date limits will be applied. Two independent reviewers will perform study selection and data extraction, and the results will be presented according to the SCI type and severity. REVIEW REGISTRATION Open Science Framework https://osf.io/q45er.
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Affiliation(s)
- Florence Martinache
- Université Paris-Saclay, CIAMS, 91405, Orsay, France
- Techno Concept, Manosque, France
- Département d'Anesthésie Réanimation, Service de Rééducation Post-Réanimation (SRPR), AP-HP, CHU de Bicêtre, 94275, Le-Kremlin-Bicêtre, France
| | - Adéla Foudhaïli
- Département de Médecine Physique et Réadaptation, AP-HP, CHU Lariboisiére, F-75010, Paris, France
- Université Paris Cité, Inserm, MASCOT, F-75010 Paris, France
- Université Paris Cité, Institut des Sciences du Sport-Santé de Paris, F-75015 Paris, France
| | - Bernard Vigué
- Département d'Anesthésie Réanimation, Service de Rééducation Post-Réanimation (SRPR), AP-HP, CHU de Bicêtre, 94275, Le-Kremlin-Bicêtre, France
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Tefertiller C, Wojciehowski S, Sevigny M, Ketchum JM, Rozwod M. Comparison of One-Year Postinjury Mobility Outcomes Between Locomotor Training and Usual Care After Motor Incomplete Spinal Cord Injury. Top Spinal Cord Inj Rehabil 2024; 30:87-97. [PMID: 38433742 PMCID: PMC10906373 DOI: 10.46292/sci23-00013] [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: 03/05/2024]
Abstract
Objectives To compare 1-year mobility outcomes of individuals with traumatic motor incomplete spinal cord injury (miSCI) who participated in standardized locomotor training (LT) within the first year of injury to those who did not. Methods This retrospective case-control analysis conducted with six US rehabilitation hospitals used SCI Model Systems (SCIMS) data comparing 1-year postinjury outcomes between individuals with miSCI who participated in standardized LT to those who received usual care (UC). Participants were matched on age, gender, injury year, mode of mobility, and rehabilitation center. The primary outcome is the FIM Total Motor score. Other outcomes include the FIM Transfer Index, FIM Stairs, and self-reported independence with household mobility, community mobility, and stairs. Results LT participants reported significantly better FIM Total Motor (difference = 2.812, 95% confidence interval [CI] = 5.896, 17.282) and FIM Transfer Index scores (difference = 0.958, 95% CI = 0.993, 4.866). No significant between-group differences were found for FIM Stairs (difference = 0.713, 95% CI = -0.104, 1.530) or self-reported household mobility (odds ratio [OR] = 5.065, CI = 1.435, 17.884), community mobility (OR = 2.933, 95% CI = 0.868, 9.910), and stairs (OR = 5.817, 95% CI = 1.424, 23.756) after controlling for multiple comparisons. Conclusion LT participants reported significantly greater improvements in primary and secondary measures of mobility and independence (FIM Total Motor score; FIM Transfer Index) compared to UC participants. Self-reported mobility outcomes were not significant between groups.
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Arnold D, Gillespie J, Bennett M, Callender L, Sikka S, Hamilton R, Driver S, Swank C. Clinical Delivery of Overground Exoskeleton Gait Training in Persons With Spinal Cord Injury Across the Continuum of Care: A Retrospective Analysis. Top Spinal Cord Inj Rehabil 2024; 30:74-86. [PMID: 38433740 PMCID: PMC10906371 DOI: 10.46292/sci23-00001] [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: 03/05/2024]
Abstract
Background After spinal cord injury (SCI), inpatient rehabilitation begins and continues through outpatient therapy. Overground exoskeleton gait training (OEGT) has been shown to be feasible in both settings, yet its use as an intervention across the continuum has not yet been reported. Objectives This study describes OEGT for patients with SCI across the continuum and its effects on clinical outcomes. Methods Medical records of patients with SCI who completed at least one OEGT session during inpatient and outpatient rehabilitation from 2018 to 2021 were retrospectively reviewed. Demographic data, Walking Index for Spinal Cord Injury-II (WISCI-II) scores, and OEGT session details (frequency, "walk" time, "up" time, and step count) were extracted. Results Eighteen patients [male (83%), White (61%), aged 37.4 ± 15 years, with tetraplegia (50%), American Spinal Injury Association Impairment Scale A (28%), B (22%), C (39%), D (11%)] completed OEGT sessions (motor complete, 18.2 ± 10.3; motor incomplete, 16.7 ± 7.7) over approximately 18 weeks (motor complete, 15.1 ± 6.4; motor incomplete, 19.0 ± 8.2). Patients demonstrated improved OEGT session tolerance on device metrics including "walk" time (motor complete, 7:51 ± 4:42 to 24:50 ± 9:35 minutes; motor incomplete, 12:16 ± 6:01 to 20:01 ± 08:05 minutes), "up" time (motor complete, 16:03 ± 7:41 to 29:49 ± 12:44 minutes; motor incomplete, 16:38 ± 4:51 to 23:06 ± 08:50 minutes), and step count (motor complete, 340 ± 295.9 to 840.2 ± 379.4; motor incomplete, 372.3 ± 225.2 to 713.2 ± 272). Across therapy settings, patients with motor complete SCI experienced improvement in WISCI-II scores from 0 ± 0 at inpatient admission to 3 ± 4.6 by outpatient discharge, whereas the motor incomplete group demonstrated a change of 0.2 ± 0.4 to 9.0 ± 6.4. Conclusion Patients completed OEGT across the therapy continuum. Patients with motor incomplete SCI experienced clinically meaningful improvements in walking function.
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Affiliation(s)
- Dannae Arnold
- Baylor Scott and White Research Institute, Dallas, Texas
- Baylor Scott and White Institute for Rehabilitation, Dallas, Texas
| | - Jaime Gillespie
- Baylor Scott and White Research Institute, Dallas, Texas
- Baylor Scott and White Institute for Rehabilitation, Dallas, Texas
| | - Monica Bennett
- Baylor Scott and White Research Institute, Dallas, Texas
| | | | - Seema Sikka
- Baylor Scott and White Institute for Rehabilitation, Dallas, Texas
| | - Rita Hamilton
- Baylor Scott and White Institute for Rehabilitation, Dallas, Texas
| | - Simon Driver
- Baylor Scott and White Institute for Rehabilitation, Dallas, Texas
| | - Chad Swank
- Baylor Scott and White Research Institute, Dallas, Texas
- Baylor Scott and White Institute for Rehabilitation, Dallas, Texas
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Zhou G, Han S, Li Z, Li Y, Gao J. Comprehensive and Visualized Analysis of Interventional Clinical Trials of Spinal Cord Injury in the Past Two Decades: A Bibliometric Study. World Neurosurg 2024; 182:e546-e558. [PMID: 38052362 DOI: 10.1016/j.wneu.2023.11.144] [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] [Received: 10/15/2023] [Accepted: 11/29/2023] [Indexed: 12/07/2023]
Abstract
OBJECTIVE The aim of this study was to provide a bibliometric analysis of reported clinical trials of interventional spinal cord injury (SCI) and present the current status, global trends, and scholars' knowledge in this field. METHODS Data were obtained from PubMed and Web of Science (WOS) Core Collection. A literature screening process was conducted to select reports of interventional SCI clinical trials. Qualitative and quantitative analysis was performed based on information from the WOS database. Co-occurrence analysis of keywords, collaboration analysis, and co-citation analysis were performed using VOSviewer. RESULTS A total of 849 articles were selected for analysis. Therapeutic strategies in the articles were classified into 10 subgroups. Locomotor training, local complication-related treatments, and neuromodulation are the top 3 subgroups. Spinal Cord was the most productive and most frequently cited journal in SCI clinical trials. The most productive country, institution, and author are the United States, the University of Miami, and Harvey LA, respectively. The collaboration network analysis shows that researchers and institutions from the United States, Canada, the United Kingdom, and Australia were the pivotal driving forces in this field. Spinal cord injury, rehabilitation, individuals, electrical stimulation, and exercise are the top 5 most frequent keywords. The co-citation analysis shows that the most frequently cited references are all international standards and guidelines of SCI clinical trials. CONCLUSIONS There is a broad research collaboration network, although it is distributed unevenly worldwide. International standards and guidelines are needed to conduct high-quality clinical trials in the future.
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Affiliation(s)
- Gang Zhou
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Shiyuan Han
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Zhimin Li
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yongning Li
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China; Department of International Medical Service, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Jun Gao
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
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Alotaibi A, Ibrahim A, Ahmed R, Abualait T. Effectiveness of Partial Body Weight-Supported Treadmill Training on Various Outcomes in Different Contexts among Children and Adolescents with Cerebral Palsy: A Systematic Review and Meta-Analysis. CHILDREN (BASEL, SWITZERLAND) 2023; 11:9. [PMID: 38275430 PMCID: PMC10813858 DOI: 10.3390/children11010009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 12/13/2023] [Accepted: 12/18/2023] [Indexed: 01/27/2024]
Abstract
The efficiency of partial body weight-supported treadmill training (PBWSTT) for treating various conditions in children and adolescents with cerebral palsy (CP) in diverse contexts of rehabilitation, households, or schools is unknown. The major objective of this systematic review and meta-analysis was to analyze the effectiveness of PBWSTT on various outcomes in different contexts among children and adolescents with CP. We incorporated full-text, randomized controlled trial studies that specifically assessed the effects of PBWSTT walking, motor function, stride, balance, and endurance in children and adolescents aged 3 to 18 years with CP. The literature search was carried out using Google Scholar, PubMed, Web of Science, CINAHL Plus, Scopus, PEDro, and ResearchGate databases. The methodological quality was evaluated using a Cochrane risk of bias instrument. A meta-analysis of pooled data from 10 studies with 255 participants demonstrated that PBWSTT for 4-12 weeks in rehabilitation (mean difference [MD] = 1.94, 95% confidence interval [CI] = 1.40-2.48, p < 0.0001), at home or in a school context (MD = 13.5, 95% CI = 13.9-16.0, p < 0.0001), was significantly effective for treating various conditions in children and adolescents suffering with CP. The period of 4-12 weeks of PBWSTT in rehabilitation and at-home/school settings is effective on various outcomes in children or adolescents with CP.
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Affiliation(s)
- Abdulmajeed Alotaibi
- Department of Physical Therapy, Children’s Hospital, Ministry of Health, Taif 26514, Saudi Arabia
- Department of Physical Therapy, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia; (A.I.); (R.A.); (T.A.)
| | - Alaa Ibrahim
- Department of Physical Therapy, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia; (A.I.); (R.A.); (T.A.)
| | - Raafat Ahmed
- Department of Physical Therapy, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia; (A.I.); (R.A.); (T.A.)
| | - Turki Abualait
- Department of Physical Therapy, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia; (A.I.); (R.A.); (T.A.)
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Park CS, Oh GB, Cho KH. Effects of gait training with weight support feedback walker on walker dependence, lower limb muscle activation, and gait ability in patients with incomplete spinal cord injury: A pilot randomized controlled trial. J Spinal Cord Med 2023:1-9. [PMID: 37769143 DOI: 10.1080/10790268.2023.2260532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND Spinal cord injury (SCI) is a devastating condition affecting an individual's life, particularly through lower extremity paralysis, which limits walking and daily activities. OBJECTIVES This study investigated the effects of weight support feedback walker (WSFW) gait training on walker dependence, lower limb muscle activation, and gait ability in patients with incomplete SCI (ISCI). METHODS Eleven subjects capable of walking > 20 m with and without a walker were randomly assigned to WSFW gait training (n = 6) or conventional walker (CW) gait training groups (n = 5). All subjects underwent standard physical therapy for 4 weeks. Additionally, the WSFW group participated in WSFW gait training, whereas the CW group participated in CW gait training conducted for 30 min per day, thrice per week, for 4 weeks. Walker dependence (the average force pressing WSFW with the user's arm during walker gait), lower extremity muscle activity (rectus femoris, biceps femoris, and medial gastrocnemius), and gait ability (gait elements: velocity, cadence, step length, and step length asymmetry) were measured to investigate the effects of training. RESULTS The WSFW group showed significant decrease in walker dependence compared to the CW group (P < 0.05). Some lower extremity muscle activation (left side biceps femoris) and velocity of the gait elements were increased in the WSFW group compared with those in the CW group (P < 0.05). CONCLUSION WSFW gait training could help patients with ISCI transfer their body weight to the paralyzed lower extremity. However, a randomized controlled trial with several subjects is essential to verify the effects of WSFW training.
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Affiliation(s)
- Chang Sune Park
- Department of Physical Therapy, Korea National University of Transportation, Jeungpyeong-gun, Republic of Korea
| | - Gku Bin Oh
- Department of Physical Therapy, Korea National University of Transportation, Jeungpyeong-gun, Republic of Korea
| | - Ki Hun Cho
- Department of Physical Therapy, Korea National University of Transportation, Jeungpyeong-gun, Republic of Korea
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Oh GB, Park CS, Cho KH. Immediate effect of weight load on lower limb muscle activity and gait ability in patients with incomplete spinal cord injury during walker gait training. J Spinal Cord Med 2023; 46:818-824. [PMID: 35792819 PMCID: PMC10446802 DOI: 10.1080/10790268.2022.2088502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
OBJECTIVE Walkers are actively used to improve gait ability in patients with incomplete spinal cord injury (ISCI). This study aimed to investigate the immediate effect of weight load during walker gait training on lower limb muscle activity and gait ability in patients with ISCI using a dependence feedback walker (DFW). DESIGN A single group cross-sectional design. SETTING Local rehabilitation hospital. PARTICIPANTS Fourteen patients with ISCI (62.00 years, Onset duration: 20.57months). INTERVENTIONS The DFW was used to measure the change in lower limb muscle activity and gait ability on walker dependence during the 20-meter walk. Based on the initial measurement of walker dependence, three levels of walker dependence threshold were set (100%, 60%, and 20%). If the weight loaded on the walker exceeded the three threshold levels of walker dependence, auditory and visual feedback was generated. OUTCOME MEASURES During the 20-meter walk, changes in both lower limb muscle activity (rectus femoris, biceps femoris, medial gastrocnemius, tibialis anterior, and gluteus medius) and gait ability (velocity, cadence, and single-limb support phase) were measured by surface electromyography and 3-axis accelerometer. RESULTS The increase in lower limb muscle activation and improvement of gait ability were greater during 20% walker dependence gait training than during 100% walker dependence gait training (P < 0.05). CONCLUSION Reduction of walker dependence by extrinsic feedback generated via DFW during walker gait training may lead to increased lower limb muscle activity and improved gait. These results could be useful for successful self-gait training and improving walking independence in patients with ISCI.
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Affiliation(s)
- Gku Bin Oh
- Department of Physical Therapy, Korea National University of Transportation, Jeungpyeong, Republic of Korea
| | - Chang Sune Park
- Department of Physical Therapy, Korea National University of Transportation, Jeungpyeong, Republic of Korea
| | - Ki Hun Cho
- Department of Physical Therapy, Korea National University of Transportation, Jeungpyeong, Republic of Korea
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Walsh CM, Gull K, Dooley D. Motor rehabilitation as a therapeutic tool for spinal cord injury: New perspectives in immunomodulation. Cytokine Growth Factor Rev 2023; 69:80-89. [PMID: 36114092 DOI: 10.1016/j.cytogfr.2022.08.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 08/27/2022] [Indexed: 02/07/2023]
Abstract
Traumatic spinal cord injury (SCI) is a devastating condition that significantly impacts motor, sensory and autonomic function in patients. Despite advances in therapeutic approaches, there is still no curative therapy currently available. Neuroinflammation is a persisting event of the secondary injury phase of SCI that affects functional recovery, and modulation of the inflammatory response towards a beneficial anti-inflammatory state can improve recovery in preclinical SCI models. In human SCI patients, rehabilitative exercise, or motor rehabilitation as we will refer to it from here on out, remains the cornerstone of treatment to increase functional capacity and prevent secondary health implications. Motor rehabilitation is known to have anti-inflammatory effects; however, current literature is lacking in the description of the effect of motor rehabilitation on inflammation in the context of SCI. Understanding the effect on different inflammatory markers after SCI should enable the optimization of motor rehabilitation as a therapeutic regime. This review extensively describes the effect of motor rehabilitation on selected inflammatory mediators in both preclinical and human SCI studies. Additionally, we summarize how the type, duration, and intensity of motor rehabilitation can affect the inflammatory response after SCI. In doing so, we introduce a new perspective on how motor rehabilitation can be optimized as an immunomodulatory therapy to improve patient outcome after SCI.
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Affiliation(s)
- Ciara M Walsh
- School of Medicine, Health Sciences Centre, University College Dublin, Belfield, Dublin 4, Ireland; UCD Conway Institute of Biomolecular & Biomedical Research, University College Dublin, Belfield, Dublin 4, Ireland
| | - Khadija Gull
- School of Medicine, Health Sciences Centre, University College Dublin, Belfield, Dublin 4, Ireland
| | - Dearbhaile Dooley
- School of Medicine, Health Sciences Centre, University College Dublin, Belfield, Dublin 4, Ireland; UCD Conway Institute of Biomolecular & Biomedical Research, University College Dublin, Belfield, Dublin 4, Ireland.
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Shin JC, Jeon HR, Kim D, Min WK, Lee JS, Cho SI, Oh DS, Yoo J. Effects of end-effector robot-assisted gait training on gait ability, muscle strength, and balance in patients with spinal cord injury. NeuroRehabilitation 2023; 53:335-346. [PMID: 37638457 DOI: 10.3233/nre-230085] [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: 08/29/2023]
Abstract
BACKGROUND There is no randomized controlled study about the effects of end-effector robot-assisted gait training (RAGT) in patients with spinal cord injury (SCI). OBJECTIVE To examine the effects of end-effector RAGT on gait and balance abilities in SCI. METHODS Thirty-one patients were randomly assigned to the RAGT (Morning Walk®, Curexo, Seoul, South Korea) or conventional therapy (CT) group. Patients were assessed using the 10-meter walk test (10MWT), 6-minute walk test (6mWT), lower extremity motor score (LEMS) and proprioception, Berg Balance Scale (BBS), Walking Index for Spinal Cord Injury-II (WISCI-II), and mobility category of Spinal Cord Independence Measure-III. RESULTS All clinical outcome measures significantly improved in both groups. The BBS and WISCI-II were significantly improved in the RAGT group compared to the CT group. In the RAGT group, pre-LEMS and pre-WISCI-II of the 10MWT improved group and pre-BBS of the 6mWT improved group were higher than those of the 10MWT non-improved and 6mWT non-improved group, respectively. CONCLUSION End-effector RAGT and CT in patients with incomplete SCI could lead to improvements in gait ability, lower extremity muscle strength, balance, proprioception, and mobility. Additionally, end-effector RAGT could improve balance and gait abilities substantially better than CT.
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Affiliation(s)
- Ji Cheol Shin
- Research Institute of Rehabilitation Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Ha Ra Jeon
- Department of Physical Medicine and Rehabilitation, National Health Insurance Service Ilsan Hospital, Goyang, South Korea
| | - Dahn Kim
- Research Institute of Rehabilitation Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Won Kyu Min
- Rehabilitation Center, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - June Sung Lee
- Rehabilitation Center, National Health Insurance Service Ilsan Hospital, Goyang, South Korea
| | - Sung Il Cho
- Rehabilitation Center, Inje University Ilsan Paik Hospital, Goyang, South Korea
| | - Da Som Oh
- Inje Industry, Academic Cooperation Foundation, Goyang, South Korea
| | - Jeehyun Yoo
- Department of Rehabilitation Medicine, Inje University Ilsan Paik Hospital, Goyang, South Korea
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Calabrò RS, Portaro S, Tomasello P, Porcari B, Balletta T, Naro A. Paving the way for a better management of pain in patients with spinal cord injury: An exploratory study on the use of Functional Electric Stimulation(FES)-cycling. J Spinal Cord Med 2023; 46:107-117. [PMID: 34369852 PMCID: PMC9897777 DOI: 10.1080/10790268.2021.1961050] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
CONTEXT/OBJECTIVE Chronic pain is common in patients with spinal cord injury (SCI), for whom it negatively affects quality of life, and its treatment requires an integrated approach. To this end, lower limb functional electrical stimulation (FES) cycling holds promise. OBJECTIVE To investigate pain reduction in a sample of patients with SCI by means of lower limb rehabilitation using FES cycling. DESIGN, SETTING AND PARTICIPANTS Sixteen patients with incomplete and complete SCIs, attending the Neurorobotic Unit of our research institute and reporting pain at or below the level of their SCI were recruited to this exploratory study. INTERVENTIONS Patients undertook two daily sessions of FES cycling, six times weekly, for 6 weeks. OUTCOME MEASURES Pain outcomes were measured using the 0-10 numerical rating scale (NRS), the Multidimensional Pain Inventory for SCI (MPI-SCI), and the 36-Item Short Form Survey (SF-36). Finally, we assessed the features of dorsal laser-evoked potentials (LEPs) to objectively evaluate Aδ fiber pathways. RESULTS All participants tolerated the intervention well, and completed the training without side effects. Statistically significant changes were found in pain-NRS, MPI-SCI, and SF-36 scores, and LEP amplitudes. Following treatment, we found that three patients experienced high pain relief (an NRS decrease of at least 80%), six individuals achieved moderate pain relief (an NRS decrease of about 30-70%), and five participants had mild pain relief (an NRS decrease of less than 30%). CONCLUSION Our preliminary results suggest that FES cycling training is capable of reducing the pain reported by patients with SCI, regardless of American Spinal Injury Association scoring, pain level, or the neurological level of injury. The neurophysiological mechanisms underlying such effects are likely to be both spinal and supraspinal.
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Affiliation(s)
- Rocco Salvatore Calabrò
- IRCCS Centro Neurolesi Bonino Pulejo, Messina, Italy,Correspondence to: Rocco Salvatore Calabrò, IRCCS Centro Neurolesi Bonino Pulejo, via Palermo, SS 113, Ctr. Casazza, Messina98124, Italy; Ph: +3909060128166.
| | | | | | - Bruno Porcari
- IRCCS Centro Neurolesi Bonino Pulejo, Messina, Italy
| | - Tina Balletta
- IRCCS Centro Neurolesi Bonino Pulejo, Messina, Italy
| | - Antonino Naro
- IRCCS Centro Neurolesi Bonino Pulejo, Messina, Italy
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Stampacchia G, Gazzotti V, Olivieri M, Andrenelli E, Bonaiuti D, Calabro RS, Carmignano SM, Cassio A, Fundaro C, Companini I, Mazzoli D, Cerulli S, Chisari C, Colombo V, Dalise S, Mazzoleni D, Melegari C, Merlo A, Boldrini P, Mazzoleni S, Posteraro F, Mazzucchelli M, Benanti P, Castelli E, Draicchio F, Falabella V, Galeri S, Gimigliano F, Grigioni M, Mazzon S, Molteni F, Morone G, Petrarca M, Picelli A, Senatore M, Turchetti G, Bizzarrini E. Gait robot-assisted rehabilitation in persons with spinal cord injury: A scoping review. NeuroRehabilitation 2022; 51:609-647. [PMID: 36502343 DOI: 10.3233/nre-220061] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Many robots are available for gait rehabilitation (BWSTRT and ORET) and their application in persons with SCI allowed an improvement of walking function. OBJECTIVE The aim of the study is to compare the effects of different robotic exoskeletons gait training in persons with different SCI level and severity. METHODS Sixty-two studies were included in this systematic review; the study quality was assessed according to GRADE and PEDro's scale. RESULTS Quality assessment of included studies (n = 62) demonstrated a prevalence of evidence level 2; the quality of the studies was higher for BWSTRT (excellent and good) than for ORET (fair and good). Almost all persons recruited for BWSTRT had an incomplete SCI; both complete and incomplete SCI were recruited for ORET. The SCI lesion level in the persons recruited for BWSTRT are from cervical to sacral; mainly from thoracic to sacral for ORET; a high representation of AIS D lesion resulted both for BWSTRT (30%) and for ORET (45%). The walking performance, tested with 10MWT, 6MWT, TUG and WISCI, improved after exoskeleton training in persons with incomplete SCI lesions, when at least 20 sessions were applied. Persons with complete SCI lesions improved the dexterity in walking with exoskeleton, but did not recover independent walking function; symptoms such as spasticity, pain and cardiovascular endurance improved. CONCLUSION Different exoskeletons are available for walking rehabilitation in persons with SCI. The choice about the kind of robotic gait training should be addressed on the basis of the lesion severity and the possible comorbidities.
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Affiliation(s)
| | - Valeria Gazzotti
- Centro Protesi Vigorso di Budrio, Istituto Nazionale Assicurazione Infortuni sul Lavoro (INAIL), Bologna, Italy
| | | | - Elisa Andrenelli
- Department of Experimental and Clinical Medicine, Università Politecnica delle Marche, Ancona, Italy
| | | | | | - Simona Maria Carmignano
- Rehabilitation Therapeutic Center (CTR), Potenza, Italy.,University of Salerno, Salerno, Italy
| | - Anna Cassio
- Spinal Cord Unit and Intensive Rehabilitation Medicine, Ospedale di Fiorenzuola d'Arda, AUSL Piacenza, Piacenza, Italy
| | - Cira Fundaro
- Neurophysiopathology Unit, Istituti Clinici Scientifici Maugeri, IRCCS Montescano, Pavia, Italy
| | - Isabella Companini
- Department of Neuromotor and Rehabilitation, LAM-Motion Analysis Laboratory, San Sebastiano Hospital, AUSL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - David Mazzoli
- Gait and Motion Analysis Laboratory, Sol et Salus Ospedale Privato Accreditato, Rimini, Italy
| | - Simona Cerulli
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Carmelo Chisari
- Department of Translational Research and New Technologies in Medicine and Surgery, Neurorehabiltation Section, University of Pisa, Pisa, Italy
| | | | - Stefania Dalise
- Department of Translational Research and New Technologies in Medicine and Surgery, Neurorehabiltation Section, University of Pisa, Pisa, Italy
| | - Daniele Mazzoleni
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | | | - Andrea Merlo
- Gait and Motion Analysis Laboratory, Sol et Salus Ospedale Privato Accreditato, Rimini, Italy
| | - Paolo Boldrini
- Italian Society of Physical Medicine and Rehabilitation (SIMFER), Rome, Italy
| | - Stefano Mazzoleni
- Department of Electrical and Information Engineering, Politecnico di Bari, Bari, Italy
| | - Federico Posteraro
- Department of Rehabilitation, Versilia Hospital - AUSL12, Viareggio, Italy
| | | | | | - Enrico Castelli
- Department of Paediatric Neurorehabilitation, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - Francesco Draicchio
- Department of Occupational and Environmental Medicine Epidemiology and Hygiene, INAIL, Rome, Italy
| | - Vincenzo Falabella
- Italian Federation of Persons with Spinal Cord Injuries (FAIP Onlus), Rome, Italy
| | | | - Francesca Gimigliano
- Department of Mental, Physical Health and Preventive Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Mauro Grigioni
- National Center for Innovative Technologies in Public Health, Italian National Institute of Health, Rome, Italy
| | - Stefano Mazzon
- Rehabilitation Unit, ULSS (Local Health Authority) Euganea, Camposampiero Hospital, Padua, Italy
| | - Franco Molteni
- Department of Rehabilitation Medicine, Villa Beretta Rehabilitation Center, Valduce Hospital, Lecco, Italy
| | | | - Maurizio Petrarca
- Movement Analysis and Robotics Laboratory (MARlab), IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - Alessandro Picelli
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Michele Senatore
- Associazione Italiana dei Terapisti Occupazionali (AITO), Rome, Italy
| | | | - Emiliana Bizzarrini
- Department of Rehabilitation Medicine, Spinal Cord Unit, Gervasutta Hospital, Azienda Sanitaria Universitaria Friuli Centrale (ASU FC), Udine, Italy
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Gouveia D, Cardoso A, Carvalho C, Almeida A, Gamboa Ó, Ferreira A, Martins Â. Approach to Small Animal Neurorehabilitation by Locomotor Training: An Update. Animals (Basel) 2022; 12:ani12243582. [PMID: 36552502 PMCID: PMC9774773 DOI: 10.3390/ani12243582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 12/05/2022] [Accepted: 12/15/2022] [Indexed: 12/23/2022] Open
Abstract
Neurorehabilitation has a wide range of therapies to achieve neural regeneration, reorganization, and repair (e.g., axon regeneration, remyelination, and restoration of spinal circuits and networks) to achieve ambulation for dogs and cats, especially for grade 1 (modified Frankel scale) with signs of spinal shock or grade 0 (deep pain negative), similar to humans classified with ASIA A lesions. This review aims to explain what locomotor training is, its importance, its feasibility within a clinical setting, and some possible protocols for motor recovery, achieving ambulation with coordinated and modulated movements. In addition, it cites some of the primary key points that must be present in the daily lives of veterinarians or rehabilitation nurses. These can be the guidelines to improve this exciting exercise necessary to achieve ambulation with quality of life. However, more research is essential in the future years.
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Affiliation(s)
- Débora Gouveia
- Arrábida Veterinary Hospital—Arrábida Animal Rehabilitation Center, 2925-538 Setubal, Portugal
- Superior School of Health, Protection and Animal Welfare, Polytechnic Institute of Lusophony, Campo Grande, 1950-396 Lisboa, Portugal
- Faculty of Veterinary Medicine, Lusófona University, Campo Grande, 1749-024 Lisboa, Portugal
- Correspondence:
| | - Ana Cardoso
- Arrábida Veterinary Hospital—Arrábida Animal Rehabilitation Center, 2925-538 Setubal, Portugal
| | - Carla Carvalho
- Arrábida Veterinary Hospital—Arrábida Animal Rehabilitation Center, 2925-538 Setubal, Portugal
| | - António Almeida
- Faculty of Veterinary Medicine, University of Lisbon, 1300-477 Lisboa, Portugal
| | - Óscar Gamboa
- Faculty of Veterinary Medicine, University of Lisbon, 1300-477 Lisboa, Portugal
| | - António Ferreira
- Faculty of Veterinary Medicine, University of Lisbon, 1300-477 Lisboa, Portugal
- CIISA—Centro Interdisciplinar-Investigaçāo em Saúde Animal, Faculdade de Medicina Veterinária, Av. Universi dade Técnica de Lisboa, 1300-477 Lisboa, Portugal
| | - Ângela Martins
- Arrábida Veterinary Hospital—Arrábida Animal Rehabilitation Center, 2925-538 Setubal, Portugal
- Superior School of Health, Protection and Animal Welfare, Polytechnic Institute of Lusophony, Campo Grande, 1950-396 Lisboa, Portugal
- Faculty of Veterinary Medicine, Lusófona University, Campo Grande, 1749-024 Lisboa, Portugal
- Faculty of Veterinary Medicine, University of Lisbon, 1300-477 Lisboa, Portugal
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Chen H, Sui S, Yang L, Sha X, Wang C, Tao W, Yu X. Study on the influence and countermeasures of high-quality nursing in controlling wound infection in emergency treatment of hand trauma. Minerva Surg 2022; 77:612-614. [PMID: 34889554 DOI: 10.23736/s2724-5691.21.09178-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Hongmei Chen
- Department of Emergency, Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Sheng Sui
- Department of Nursing, Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Liping Yang
- Department of Emergency, Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Xiaomei Sha
- Department of Emergency, Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Chao Wang
- Department of Emergency, Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Wei Tao
- Department of Emergency, Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Xianqiu Yu
- Department of Hematology, Affiliated Hospital of Jiangsu University, Zhenjiang, China -
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16
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Sun X, Huang LY, Pan HX, Li LJ, Wang L, Pei GQ, Wang Y, Zhang Q, Cheng HX, He CQ, Wei Q. Bone marrow mesenchymal stem cells and exercise restore motor function following spinal cord injury by activating PI3K/AKT/mTOR pathway. Neural Regen Res 2022; 18:1067-1075. [PMID: 36254995 PMCID: PMC9827790 DOI: 10.4103/1673-5374.355762] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Although many therapeutic interventions have shown promise in treating spinal cord injury, focusing on a single aspect of repair cannot achieve successful and functional regeneration in patients following spinal cord injury . In this study, we applied a combinatorial approach for treating spinal cord injury involving neuroprotection and rehabilitation, exploiting cell transplantation and functional sensorimotor training to promote nerve regeneration and functional recovery. Here, we used a mouse model of thoracic contusive spinal cord injury to investigate whether the combination of bone marrow mesenchymal stem cell transplantation and exercise training has a synergistic effect on functional restoration. Locomotor function was evaluated by the Basso Mouse Scale, horizontal ladder test, and footprint analysis. Magnetic resonance imaging, histological examination, transmission electron microscopy observation, immunofluorescence staining, and western blotting were performed 8 weeks after spinal cord injury to further explore the potential mechanism behind the synergistic repair effect. In vivo, the combination of bone marrow mesenchymal stem cell transplantation and exercise showed a better therapeutic effect on motor function than the single treatments. Further investigations revealed that the combination of bone marrow mesenchymal stem cell transplantation and exercise markedly reduced fibrotic scar tissue, protected neurons, and promoted axon and myelin protection. Additionally, the synergistic effects of bone marrow mesenchymal stem cell transplantation and exercise on spinal cord injury recovery occurred via the PI3K/AKT/mTOR pathway. In vitro, experimental evidence from the PC12 cell line and primary cortical neuron culture also demonstrated that blocking of the PI3K/AKT/mTOR pathway would aggravate neuronal damage. Thus, bone marrow mesenchymal stem cell transplantation combined with exercise training can effectively restore motor function after spinal cord injury by activating the PI3K/AKT/mTOR pathway.
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Affiliation(s)
- Xin Sun
- Rehabilitation Medical Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China,Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan Province, China
| | - Li-Yi Huang
- Rehabilitation Medical Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China,Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan Province, China
| | - Hong-Xia Pan
- Rehabilitation Medical Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China,Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan Province, China
| | - Li-Juan Li
- Rehabilitation Medical Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China,Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan Province, China
| | - Lu Wang
- Rehabilitation Medical Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China,Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan Province, China
| | - Gai-Qin Pei
- Rehabilitation Medical Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China,Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan Province, China
| | - Yang Wang
- Rehabilitation Medical Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China,Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan Province, China
| | - Qing Zhang
- Rehabilitation Medical Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China,Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan Province, China
| | - Hong-Xin Cheng
- Rehabilitation Medical Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China,Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan Province, China
| | - Cheng-Qi He
- Rehabilitation Medical Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China,Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan Province, China
| | - Quan Wei
- Rehabilitation Medical Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China,Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan Province, China,Correspondence to: Quan Wei, .
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17
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Evans NH, Field-Fote EC. A Pilot Study of Intensive Locomotor-Related Skill Training and Transcranial Direct Current Stimulation in Chronic Spinal Cord Injury. J Neurol Phys Ther 2022; 46:281-292. [PMID: 35544283 DOI: 10.1097/npt.0000000000000403] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND PURPOSE Improved walking function is a priority among persons with motor-incomplete spinal cord injury (PwMISCI). Accessibility and cost limit long-term participation in locomotor training offered in specialized centers. Intensive motor training that facilitates neuroplastic mechanisms that support skill learning and can be implemented in the home/community may be advantageous for promoting long-term restoration of walking function. Additionally, increasing corticospinal drive via transcranial direct current stimulation (tDCS) may enhance training effects. In this pilot study, we investigated whether a moderate-intensity motor skill training (MST) circuit improved walking function in PwMISCI and whether augmenting training with tDCS influenced outcomes. METHODS Twenty-five adults (chronic, motor-incomplete spinal cord injury) were randomized to a 3-day intervention of a locomotor-related MST circuit and concurrent application of sham tDCS (MST+tDCS sham ) or active tDCS (MST+tDCS). The primary outcome was overground walking speed. Secondary outcomes included walking distance, cadence, stride length, and step symmetry index (SI). RESULTS Analyses revealed significant effects of the MST circuit on walking speed, walking distance, cadence, and bilateral stride length but no effect on interlimb SI. No significant between-groups differences were observed. Post hoc analyses revealed within-groups change in walking speed (ΔM = 0.13 m/s, SD = 0.13) that app-roached the minimally clinically important difference of 0.15 m/s. DISCUSSION AND CONCLUSIONS Brief, intensive MST involving locomotor-related activities significantly increased walking speed, walking distance, and spatiotemporal measures in PwMISCI. Significant additive effects of tDCS were not observed; however, participation in only 3 days of MST was associated with changes in walking speed that were comparable to longer locomotor training studies.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A386 ).
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Affiliation(s)
- Nicholas H Evans
- Crawford Research Institute, Shepherd Center, Atlanta, Georgia (N.H.E., E.F.F.); Program in Applied Physiology, Georgia Institute of Technology, Atlanta (N.H.E., E.F.F.); and Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, Georgia (E.F.F.)
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18
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Steps to recovery: Body weight-supported treadmill training for critically ill patients: A randomized controlled trial. J Crit Care 2022; 69:154000. [DOI: 10.1016/j.jcrc.2022.154000] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 01/20/2022] [Indexed: 12/28/2022]
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Lin JT, Hsu CJ, Dee W, Chen D, Rymer WZ, Wu M. Anodal transcutaneous DC stimulation enhances learning of dynamic balance control during walking in humans with spinal cord injury. Exp Brain Res 2022; 240:1943-1955. [PMID: 35622090 PMCID: PMC9297533 DOI: 10.1007/s00221-022-06388-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 05/12/2022] [Indexed: 11/29/2022]
Abstract
Deficits in locomotor function, including impairments in walking speed and balance, are major problems for many individuals with incomplete spinal cord injury (iSCI). However, it remains unclear which type of training paradigms are more effective in improving balance, particularly dynamic balance, in individuals with iSCI. The purpose of this study was to determine whether anodal transcutaneous spinal direct current stimulation (tsDCS) can facilitate learning of balance control during walking in individuals with iSCI. Fifteen individuals with iSCI participated in this study and were tested in two sessions (i.e., tsDCS and sham conditions). Each session consisted of 1 min of treadmill walking without stimulation or perturbation (baseline), 10 min of walking with either anodal tsDCS or sham stimulation, paired with bilateral pelvis perturbation (adaptation), and finally 2 min of walking without stimulation and perturbation (post-adaptation). The outcome measures were the dynamic balance, assessed using the minimal margin of stability (MoS), and electromyography of leg muscles. Participants demonstrated a smaller MoS during the late adaptation period for the anodal tsDCS condition compared to sham (p = 0.041), and this MoS intended to retain during the early post-adaptation period (p = 0.05). In addition, muscle activity of hip abductors was greater for the anodal tsDCS condition compared to sham during the late adaptation period and post-adaptation period (p < 0.05). Results from this study suggest that anodal tsDCS may modulate motor adaptation to pelvis perturbation and facilitate learning of dynamic balance control in individuals with iSCI.
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Affiliation(s)
- Jui-Te Lin
- Legs and Walking Lab, Shirley Ryan AbilityLab, 355 E. Erie Street, Chicago, IL, 60611, USA.,Seton Hall University, South Orange, NJ, USA
| | - Chao-Jung Hsu
- Legs and Walking Lab, Shirley Ryan AbilityLab, 355 E. Erie Street, Chicago, IL, 60611, USA
| | - Weena Dee
- Legs and Walking Lab, Shirley Ryan AbilityLab, 355 E. Erie Street, Chicago, IL, 60611, USA
| | - David Chen
- Legs and Walking Lab, Shirley Ryan AbilityLab, 355 E. Erie Street, Chicago, IL, 60611, USA
| | - W Zev Rymer
- Legs and Walking Lab, Shirley Ryan AbilityLab, 355 E. Erie Street, Chicago, IL, 60611, USA.,Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, USA
| | - Ming Wu
- Legs and Walking Lab, Shirley Ryan AbilityLab, 355 E. Erie Street, Chicago, IL, 60611, USA. .,Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, USA. .,Department of Biomedical Engineering, University of Illinois at Chicago, Chicago, IL, USA.
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20
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Gollie JM, Guccione AA, Keyser RE, Chin LMK, Panza GS, Herrick JE. Walking endurance, muscle oxygen extraction, and perceived fatigability after overground locomotor training in incomplete spinal cord injury: A pilot study. J Spinal Cord Med 2022; 45:381-389. [PMID: 32795157 PMCID: PMC9135420 DOI: 10.1080/10790268.2020.1798137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Objective: The purpose of this study was to examine the effects of overground locomotor training (OLT) on walking endurance and gastrocnemius oxygen extraction in people with chronic cervical motor-incomplete spinal cord injury (SCI).Design: Prospective single-arm pre-post pilot study.Setting: Human Performance Research Laboratory.Participants: Adult men with traumatic chronic cervical SCI (n = 6; age = 30.8 ± 12.5).Intervention: Twenty-four sessions of structured OLT.Outcome measures: Walking endurance was determined during a constant work-rate time-to-exhaustion treadmill test. Normalized perceived fatigability was calculated by dividing subjective ratings of tiredness by walking time. Cardiorespiratory outcomes and muscle oxygen extraction were analyzed using breath-by-breath gas-exchange and near-infrared spectroscopy.Results: OLT resulted in large effects on walking endurance (1232 ± 446 s vs 1645 ± 255 s; d = 1.1; P = 0.045) and normalized perceived fatigability (5.3 ± 1.5 a.u. vs 3.6 ± 0.9 a.u.; d = 1.3; P = 0.033). Small-to-medium effects on absolute (2.8 ± 2.5 a.u. vs 4.2 ± 3.5 a.u.; d = 0.42; P = 0.035) and isotime (2.8 ± 2.5 a.u. vs 3.8 ± 3.0 a.u.; d = 0.33; P = 0.023) muscle oxygen extraction were also observed after OLT.Conclusion: These findings provide preliminary data supporting the potential for improved walking endurance, enhanced muscle O2 extraction, and reduced perceived fatigability in people with chronic cervical motor-incomplete SCI following the OLT program described in this study.
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Affiliation(s)
- Jared M. Gollie
- Research Services, Veterans Affairs Medical Center, Washington, District of Columbi, USA
- Department of Health, Human Function, and Rehabilitation Sciences, The George Washington University, Washington, District of Columbi, USA
- Rehabilitation Science Department, George Mason University, Fairfax, Virginia, USA
| | - Andrew A. Guccione
- Rehabilitation Science Department, George Mason University, Fairfax, Virginia, USA
| | - Randall E. Keyser
- Rehabilitation Science Department, George Mason University, Fairfax, Virginia, USA
- Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Lisa M. K. Chin
- Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Gino S. Panza
- Department of Physiology, Wayne State University, Detroit, Michigan, USA
- Research Services, John D. Dingell Veterans Affairs Medical Center, Detroit, Michigan, USA
| | - Jeffrey E. Herrick
- Department of Exercise Physiology, University of Lynchburg, Lynchburg, Virginia, USA
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21
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Hawkins KA, DeMark LA, Vistamehr A, Snyder HJ, Conroy C, Wauneka C, Tonuzi G, Fuller DD, Clark DJ, Fox EJ. Feasibility of transcutaneous spinal direct current stimulation combined with locomotor training after spinal cord injury. Spinal Cord 2022; 60:971-977. [PMID: 35477745 PMCID: PMC9606142 DOI: 10.1038/s41393-022-00801-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 03/30/2022] [Accepted: 04/01/2022] [Indexed: 11/16/2022]
Abstract
Study Design: Feasibility study, consisting of random-order, cross-over study of a single intervention session, followed by a parallel-arm study of 16 sessions Objectives: To investigate the feasibility of a novel combinatorial approach with simultaneous delivery of transcutaneous spinal direct current stimulation (tsDCS) and locomotor training (tsDCS+LT) after spinal cord injury, compared to sham stimulation and locomotor training (sham+LT), and examine preliminary effects on walking function. Setting: Clinical research center in the southeastern United States Methods: Eight individuals with chronic incomplete spinal cord injury (ISCI) completed the two-part protocol. Feasibility was assessed based on safety (adverse responses), tolerability (pain, spasticity, skin integrity), and protocol achievement (session duration, intensity). Walking function was assessed with the 10-meter and 6-minute walk tests. Results: There were no major adverse responses. Minimal reports of skin irritation and musculoskeletal pain were consistent between groups. Average training peak heart rate as percent of maximum (mean(SD); tsDCS+LT: 66(4)%, sham+LT: 69(10)%) and Borg ratings of perceived exertion (tsDCS+LT: 17.5(1.2), sham+LT: 14.4(1.8)) indicate both groups trained at high intensities. Walking speed gains exceeded the minimal clinically important difference (MCID) in three of four who received tsDCS+LT (0.18(0.29) m/s) and one of four in sham+LT (−0.05(0.23) m/s). Gains in walking endurance exceeded the MCID in one of four in each group (tsDCS+LT: 36.4(69.0) m, sham+LT: 4.9(56.9) m). Conclusions: Combinatorial tsDCS and locomotor training is safe and feasible for individuals with chronic ISCI, even those with considerable walking impairment. Study outcomes support the need to investigate the efficacy of this approach.
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Affiliation(s)
- Kelly A Hawkins
- Department of Physical Therapy, University of Florida, Gainesville, FL, USA
| | | | | | | | | | | | | | - David D Fuller
- Department of Physical Therapy, University of Florida, Gainesville, FL, USA
| | - David J Clark
- Brain Rehabilitation Research Center of Excellence, North Florida/South Georgia Veterans Health System, Gainesville, FL, USA.,Department of Aging and Geriatric Research, University of Florida, Gainesville, FL, USA
| | - Emily J Fox
- Department of Physical Therapy, University of Florida, Gainesville, FL, USA. .,Brooks Rehabilitation, Jacksonville, FL, USA.
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22
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Boerger TF, Hyngstrom AS, Furlan JC, Kalsi-Ryan S, Curt A, Kwon BK, Kurpad SN, Fehlings MG, Harrop JS, Aarabi B, Rahimi-Movaghar V, Guest JD, Wilson JR, Davies BM, Kotter MRN, Koljonen PA. Developing Peri-Operative Rehabilitation in Degenerative Cervical Myelopathy [AO Spine RECODE-DCM Research Priority Number 6]: An Unexplored Opportunity? Global Spine J 2022; 12:97S-108S. [PMID: 35174735 PMCID: PMC8859699 DOI: 10.1177/21925682211050925] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
STUDY DESIGN Narrative review. OBJECTIVE Degenerative cervical myelopathy is one of the most frequent impairments of the spinal cord encountered internationally in adults. Currently, surgical decompression is the recommended treatment for people with DCM (PwCM) presenting with moderate to severe symptoms or neurological deficits. However, despite surgical intervention, not all patients make a complete recovery due to the irreversible tissue damage within the spinal cord. The objective of this review is to describe the state and gaps in the current literature on rehabilitation for PwCM and possible innovative rehabilitation strategies. METHODS Literature search. RESULTS In other neurological disorders such as stroke and acute traumatic spinal cord injury (SCI), timely and strategic rehabilitation has been shown to be indispensable for maximizing functional outcomes, and it is imperative that appropriate perioperative rehabilitative interventions accompany surgical approaches in order to enable the best outcomes. In this review, the current state of knowledge regarding rehabilitation for PwCM is described. Additionally, various therapies that have shown to improve outcomes in comparable neurological conditions such as stroke and SCI which may be translated to DCM will be reviewed. CONCLUSIONS We conclude that locomotor training and arm/hand therapy may benefit PwCM. Further, we conclude that body weight support, robotic assistance, and virtual/augmented reality therapies may be beneficial therapeutic analogs to locomotor and hand therapies.
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Affiliation(s)
- Timothy F. Boerger
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | | | - Julio C. Furlan
- KITE Research Institute, University Health Network, Toronto, ON, Canada
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Sukhvinder Kalsi-Ryan
- KITE Research Institute, University Health Network, Toronto, ON, Canada
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Armin Curt
- University Spine Center, Balgrist University Hospital, Zurich, Switzerland
| | - Brian K. Kwon
- Department of Orthopedics, Vancouver Spine Surgery Institute, The University of British Columbia, Vancouver, BC, Canada
| | - Shekar N. Kurpad
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Michael G. Fehlings
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - James S. Harrop
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Bizhan Aarabi
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Vafa Rahimi-Movaghar
- Department of Neurosurgery, Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - James D. Guest
- Department of Neurosurgery and The Miami Project to Cure Paralysis, The Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Jefferson R. Wilson
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | | | | | - Paul A. Koljonen
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
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23
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Xue X, Yang X, Tu H, Liu W, Kong D, Fan Z, Deng Z, Li N. The improvement of the lower limb exoskeletons on the gait of patients with spinal cord injury: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2022; 101:e28709. [PMID: 35089234 PMCID: PMC8797539 DOI: 10.1097/md.0000000000028709] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 01/10/2022] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Spinal Cord Injury is a severely disabling disease. In the process of Spinal Cord Injury rehabilitation treatment, improving patients' walking ability, improving their self-care ability, and enhancing patients' self-esteem is an important aspect of their return to society, which can also reduce the cost of patients, so the rehabilitation of lower limbs is very important. The lower limb exoskeleton robot is a bionic robot designed according to the principles of robotics, mechanism, bionics, control theory, communication technology, and information processing technology, which can be worn on the lower limb of the human body and complete specific tasks under the user's control. The purpose of this study was to evaluate the effect of the lower limb exoskeleton on the improvement of gait function in patients with spinal cord injury. METHODS The following electronic databases will be searched from inception to January 2022: PubMed, the Cochrane Library, Embase, Scopus, EBSCO, Web of Science, China National Knowledge Infrastructure, WanFang Data, Weipu Electronics. In addition, reference lists of the included studies were manually searched to identify additional relevant studies. Randomized controlled trials were collected to examine the effect of lower limb exoskeletons on lower limb functional recovery in spinal cord injury patients. We will consider inclusion, select high-quality articles for data extraction and analysis, and summarize the intervention effect of lower limb exoskeletons on the upper limb function of spinal cord injury patients. Two reviewers will screen titles, abstracts, and full texts independently according to inclusion criteria; Data extraction and risk of bias assessment were performed in the included studies. We will use a hierarchy of recommended assessment, development, and assessment methods to assess the overall certainty of the evidence and report findings accordingly. Endnote X8 will be applied in selecting the study, Review Manager 5.3 will be applied in analyzing and synthesizing. RESULTS The results will provide evidence for judging whether lower limb exoskeletons are effective and safe in improving lower limb function in patients with spinal cord injury. CONCLUSION Our study will provide reliable evidence for the effect of lower limb exoskeletons on the improvement of lower limb function in spinal cord injury patients. INPLASY REGISTRATION NUMBER INPLASY202180095.
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Affiliation(s)
- Xiali Xue
- Institute of Sports Medicine and Health, Chengdu Sport University, Chengdu, Sichuan Province, China
| | - Xinwei Yang
- School of Sports Medicine and Health, Chengdu Sport University, Chengdu, Sichuan Province, China
| | - Huan Tu
- Institute of Sports Medicine and Health, Chengdu Sport University, Chengdu, Sichuan Province, China
| | - Wanna Liu
- Institute of Sports Medicine and Health, Chengdu Sport University, Chengdu, Sichuan Province, China
| | - Dezhi Kong
- Institute of Sports Medicine and Health, Chengdu Sport University, Chengdu, Sichuan Province, China
| | - Zhonghe Fan
- Institute of Sports Medicine and Health, Chengdu Sport University, Chengdu, Sichuan Province, China
| | - Zhongyi Deng
- Institute of Sports Medicine and Health, Chengdu Sport University, Chengdu, Sichuan Province, China
| | - Ning Li
- Institute of Sports Medicine and Health, Chengdu Sport University, Chengdu, Sichuan Province, China
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24
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Samejima S, Caskey CD, Inanici F, Shrivastav SR, Brighton LN, Pradarelli J, Martinez V, Steele KM, Saigal R, Moritz CT. Multisite Transcutaneous Spinal Stimulation for Walking and Autonomic Recovery in Motor-Incomplete Tetraplegia: A Single-Subject Design. Phys Ther 2022; 102:6514473. [PMID: 35076067 PMCID: PMC8788019 DOI: 10.1093/ptj/pzab228] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 06/07/2021] [Accepted: 08/23/2021] [Indexed: 12/20/2022]
Abstract
OBJECTIVE This study investigated the effect of cervical and lumbar transcutaneous spinal cord stimulation (tSCS) combined with intensive training to improve walking and autonomic function after chronic spinal cord injury (SCI). METHODS Two 64-year-old men with chronic motor incomplete cervical SCI participated in this single-subject design study. They each underwent 2 months of intensive locomotor training and 2 months of multisite cervical and lumbosacral tSCS paired with intensive locomotor training. RESULTS The improvement in 6-Minute Walk Test distance after 2 months of tSCS with intensive training was threefold greater than after locomotor training alone. Both participants improved balance ability measured by the Berg Balance Scale and increased their ability to engage in daily home exercises. Gait analysis demonstrated increased step length for each individual. Both participants experienced improved sensation and bowel function, and 1 participant eliminated the need for intermittent catheterization after the stimulation phase of the study. CONCLUSION These results suggest that noninvasive spinal cord stimulation might promote recovery of locomotor and autonomic functions beyond traditional gait training in people with chronic incomplete cervical SCI. IMPACT Multisite transcutaneous spinal stimulation may induce neuroplasticity of the spinal networks and confer functional benefits following chronic cervical SCI.
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Affiliation(s)
- Soshi Samejima
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA,Center for Neurotechnology, University of Washington, Seattle, Washington, USA,Department of Electrical and Computer Engineering, University of Washington, Seattle, Washington, USA
| | - Charlotte D Caskey
- Department of Mechanical Engineering, University of Washington, Seattle, Washington, USA
| | - Fatma Inanici
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA,Center for Neurotechnology, University of Washington, Seattle, Washington, USA,Department of Electrical and Computer Engineering, University of Washington, Seattle, Washington, USA
| | - Siddhi R Shrivastav
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA,Center for Neurotechnology, University of Washington, Seattle, Washington, USA,Department of Electrical and Computer Engineering, University of Washington, Seattle, Washington, USA
| | - Lorie N Brighton
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
| | - Jared Pradarelli
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
| | - Vincente Martinez
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
| | - Katherine M Steele
- Department of Mechanical Engineering, University of Washington, Seattle, Washington, USA
| | - Rajiv Saigal
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Chet T Moritz
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA,Center for Neurotechnology, University of Washington, Seattle, Washington, USA,Department of Electrical and Computer Engineering, University of Washington, Seattle, Washington, USA,Department of Physiology and Biophysics, University of Washington, Seattle, Washington, USA,Address all correspondence to Dr Moritz at:
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25
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Naro A, Billeri L, Balletta T, Lauria P, Onesta MP, Calabrò RS. Finding the Way to Improve Motor Recovery of Patients with Spinal Cord Lesions: A Case-Control Pilot Study on a Novel Neuromodulation Approach. Brain Sci 2022; 12:119. [PMID: 35053862 PMCID: PMC8773706 DOI: 10.3390/brainsci12010119] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/12/2022] [Accepted: 01/13/2022] [Indexed: 12/16/2022] Open
Abstract
Robot-assisted rehabilitation (RAR) and non-invasive brain stimulation (NIBS) are interventions that, both individually and combined, can significantly enhance motor performance after spinal cord injury (SCI). We sought to determine whether repetitive transcranial magnetic stimulation (rTMS) combined with active transvertebral direct current stimulation (tvDCS) (namely, NIBS) in association with RAR (RAR + NIBS) improves lower extremity motor function more than RAR alone in subjects with motor incomplete SCI (iSCI). Fifteen adults with iSCI received one daily session of RAR+NIBS in the early afternoon, six sessions weekly, for eight consecutive weeks. Outcome measures included the 6 min walk test (6MWT), the 10 m walk test (10MWT), the timed up and go (TUG) to test mobility and balance, the Walking Index for Spinal Cord Injury (WISCI II), the Functional Independence Measure-Locomotion (FIM-L), the manual muscle testing for lower extremity motor score (LEMS), the modified Ashworth scale for lower limbs (MAS), and the visual analog scale (VAS) for pain. The data of these subjects were compared with those of 20 individuals matched for clinical and demographic features who previously received the same amount or RAR without NIBS (RAR - NIBS). All patients completed the trial, and none reported any side effects either during or following the training. The 10MWT improved in both groups, but the increase was significantly greater following RAR + NIBS than RAR - NIBS. The same occurred for the FIM-L, LEMS, and WISCI II. No significant differences were appreciable concerning the 6MWT and TUG. Conversely, RAR - NIBS outperformed RAR + NIBS regarding the MAS and VAS. Pairing tvDCS with rTMS during RAR can improve lower extremity motor function more than RAR alone can do. Future research with a larger sample size is recommended to determine longer-term effects on motor function and activities of daily living.
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Affiliation(s)
- Antonino Naro
- IRCCS Centro Neurolesi Bonino Pulejo Piemonte, Via Palermo, SS 113, Ctr. Casazza, 98124 Messina, Italy; (A.N.); (L.B.); (T.B.); (P.L.)
| | - Luana Billeri
- IRCCS Centro Neurolesi Bonino Pulejo Piemonte, Via Palermo, SS 113, Ctr. Casazza, 98124 Messina, Italy; (A.N.); (L.B.); (T.B.); (P.L.)
| | - Tina Balletta
- IRCCS Centro Neurolesi Bonino Pulejo Piemonte, Via Palermo, SS 113, Ctr. Casazza, 98124 Messina, Italy; (A.N.); (L.B.); (T.B.); (P.L.)
| | - Paola Lauria
- IRCCS Centro Neurolesi Bonino Pulejo Piemonte, Via Palermo, SS 113, Ctr. Casazza, 98124 Messina, Italy; (A.N.); (L.B.); (T.B.); (P.L.)
| | | | - Rocco Salvatore Calabrò
- IRCCS Centro Neurolesi Bonino Pulejo Piemonte, Via Palermo, SS 113, Ctr. Casazza, 98124 Messina, Italy; (A.N.); (L.B.); (T.B.); (P.L.)
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26
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Shushtari M, Nasiri R, Arami A. Online Reference Trajectory Adaptation: A Personalized Control Strategy for Lower Limb Exoskeletons. IEEE Robot Autom Lett 2022. [DOI: 10.1109/lra.2021.3115572] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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27
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Flores Á, López-Santos D, García-Alías G. When Spinal Neuromodulation Meets Sensorimotor Rehabilitation: Lessons Learned From Animal Models to Regain Manual Dexterity After a Spinal Cord Injury. FRONTIERS IN REHABILITATION SCIENCES 2021; 2:755963. [PMID: 36188826 PMCID: PMC9397786 DOI: 10.3389/fresc.2021.755963] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 11/16/2021] [Indexed: 12/22/2022]
Abstract
Electrical neuromodulation has strongly hit the foundations of spinal cord injury and repair. Clinical and experimental studies have demonstrated the ability to neuromodulate and engage spinal cord circuits to recover volitional motor functions lost after the injury. Although the science and technology behind electrical neuromodulation has attracted much of the attention, it cannot be obviated that electrical stimulation must be applied concomitantly to sensorimotor rehabilitation, and one would be very difficult to understand without the other, as both need to be finely tuned to efficiently execute movements. The present review explores the difficulties faced by experimental and clinical neuroscientists when attempting to neuromodulate and rehabilitate manual dexterity in spinal cord injured subjects. From a translational point of view, we will describe the major rehabilitation interventions employed in animal research to promote recovery of forelimb motor function. On the other hand, we will outline some of the state-of-the-art findings when applying electrical neuromodulation to the spinal cord in animal models and human patients, highlighting how evidences from lumbar stimulation are paving the path to cervical neuromodulation.
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Affiliation(s)
- África Flores
- Department of Cell Biology, Physiology and Immunology, Institute of Neuroscience, Universitat Autònoma de Barcelona and Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Bellaterra, Spain
| | - Diego López-Santos
- Department of Cell Biology, Physiology and Immunology, Institute of Neuroscience, Universitat Autònoma de Barcelona and Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Bellaterra, Spain
| | - Guillermo García-Alías
- Department of Cell Biology, Physiology and Immunology, Institute of Neuroscience, Universitat Autònoma de Barcelona and Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Bellaterra, Spain
- Institut Guttmann de Neurorehabilitació, Badalona, Spain
- *Correspondence: Guillermo García-Alías
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28
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Zieriacks A, Aach M, Brinkemper A, Koller D, Schildhauer TA, Grasmücke D. Rehabilitation of Acute Vs. Chronic Patients With Spinal Cord Injury With a Neurologically Controlled Hybrid Assistive Limb Exoskeleton: Is There a Difference in Outcome? Front Neurorobot 2021; 15:728327. [PMID: 34776919 PMCID: PMC8578862 DOI: 10.3389/fnbot.2021.728327] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 10/04/2021] [Indexed: 11/30/2022] Open
Abstract
This study aimed to assess the outcome of acute and chronic participants with spinal cord injury (SCI) after 12 weeks of bodyweight supported treadmill training (BWSTT) with a hybrid assistive limb exoskeleton (HAL). Acute participants were defined as ≤12 months between SCI and training, chronic participants >12 months between SCI and training. We assessed whether HAL-assisted BWSTT is advantageous for acute and chronic participants and if length of time post injury impacts the outcome of HAL-assisted BWSTT. As the primary outcome, we assessed the time needed for the 10 meter walk test (10MWT). Hundred and twenty-one individuals participated in a 12-week HAL-assisted BWSTT five times a week. We regularly conducted a 10MWT, a 6 minute walk test (6MWT), and assessed the walking index for spinal cord injury (WISCI II) and lower extremity motor score (LEMS) to evaluate the gait performance without the exoskeleton. Distance and time were recorded by the treadmill while the participant was walking with the exoskeleton. All participants benefit from the 12-week HAL-assisted BWSTT. A significant difference between acute and chronic participants' outcomes was found in 6MWT, LEMS, and WISCI II, though not in 10MWT. Although chronic participants improved significantly lesser than acute participants, they did improve their outcome significantly compared to the beginning. Hybrid assistive limb-assisted BWSTT in the rehabilitation of patients with SCI is advantageous for both acute and chronic patients. We could not define a time related cut-off threshold following SCI for effectiveness of HAL-assisted BWSTT.
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Affiliation(s)
- Amrei Zieriacks
- Department of Spinal Cord Injuries, BG University Hospital Bergmannsheil, Bochum, Germany
| | - Mirko Aach
- Department of Spinal Cord Injuries, BG University Hospital Bergmannsheil, Bochum, Germany
| | - Alexis Brinkemper
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Bochum, Germany
| | - Daniela Koller
- Institute for Medical Information Processing, Biometrics and Epidemiology, Ludwig-Maximilians-University Munich, Munich, Germany
| | | | - Dennis Grasmücke
- Department of Spinal Cord Injuries, BG University Hospital Bergmannsheil, Bochum, Germany
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29
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Miranda DB, Neves Rocha Martins ÂP, Diniz R. Functional neurorehabilitation in a dog with acute non‐compressive nucleus pulposus extrusion. VETERINARY RECORD CASE REPORTS 2021. [DOI: 10.1002/vrc2.216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
| | - Ângela Paula Neves Rocha Martins
- Functional Neurorehabilitation Department Universidade Lusófona de Humanidades e Tecnologias Campo Grande Lisboa Portugal
- Centro de Reabilitação Animal da Arrábida, Hospital Veterinário da Arrábida R. José Augusto Coelho Azeitão Portugal
| | - Renata Diniz
- RehabilitaCans Carrer de Juan Gris Palma de Mallorca Baleares‐España Spain
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30
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Randelman M, Zholudeva LV, Vinit S, Lane MA. Respiratory Training and Plasticity After Cervical Spinal Cord Injury. Front Cell Neurosci 2021; 15:700821. [PMID: 34621156 PMCID: PMC8490715 DOI: 10.3389/fncel.2021.700821] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 08/11/2021] [Indexed: 12/30/2022] Open
Abstract
While spinal cord injuries (SCIs) result in a vast array of functional deficits, many of which are life threatening, the majority of SCIs are anatomically incomplete. Spared neural pathways contribute to functional and anatomical neuroplasticity that can occur spontaneously, or can be harnessed using rehabilitative, electrophysiological, or pharmacological strategies. With a focus on respiratory networks that are affected by cervical level SCI, the present review summarizes how non-invasive respiratory treatments can be used to harness this neuroplastic potential and enhance long-term recovery. Specific attention is given to "respiratory training" strategies currently used clinically (e.g., strength training) and those being developed through pre-clinical and early clinical testing [e.g., intermittent chemical stimulation via altering inhaled oxygen (hypoxia) or carbon dioxide stimulation]. Consideration is also given to the effect of training on non-respiratory (e.g., locomotor) networks. This review highlights advances in this area of pre-clinical and translational research, with insight into future directions for enhancing plasticity and improving functional outcomes after SCI.
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Affiliation(s)
- Margo Randelman
- Department of Neurobiology and Anatomy, Drexel University College of Medicine, Philadelphia, PA, United States.,Marion Murray Spinal Cord Research Center, Drexel University College of Medicine, Philadelphia, PA, United States
| | - Lyandysha V Zholudeva
- Department of Neurobiology and Anatomy, Drexel University College of Medicine, Philadelphia, PA, United States.,Marion Murray Spinal Cord Research Center, Drexel University College of Medicine, Philadelphia, PA, United States.,Gladstone Institutes, San Francisco, CA, United States
| | - Stéphane Vinit
- INSERM, END-ICAP, Université Paris-Saclay, UVSQ, Versailles, France
| | - Michael A Lane
- Department of Neurobiology and Anatomy, Drexel University College of Medicine, Philadelphia, PA, United States.,Marion Murray Spinal Cord Research Center, Drexel University College of Medicine, Philadelphia, PA, United States
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31
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Panza GS, Sutor T, Gee CM, Graco M, McCully KK, Chiodo A, Badr MS, Nash MS. Is Sleep Disordered Breathing Confounding Rehabilitation Outcomes in Spinal Cord Injury Research? Arch Phys Med Rehabil 2021; 103:1034-1045. [PMID: 34537222 DOI: 10.1016/j.apmr.2021.08.015] [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: 08/15/2021] [Accepted: 08/24/2021] [Indexed: 11/02/2022]
Abstract
The purpose of this article is to highlight the importance of considering sleep-disordered breathing (SDB) as a potential confounder to rehabilitation research interventions in spinal cord injury (SCI). SDB is highly prevalent in SCI, with increased prevalence in individuals with higher and more severe lesions, and the criterion standard treatment with continuous positive airway pressure remains problematic. Despite its high prevalence, SDB is often untested and untreated in individuals with SCI. In individuals without SCI, SDB is known to negatively affect physical function and many of the physiological systems that negatively affect physical rehabilitation in SCI. Thus, owing to the high prevalence, under testing, low treatment adherence, and known negative effect on the physical function, it is contended that underdiagnosed SDB in SCI may be confounding physical rehabilitation research studies in individuals with SCI. Studies investigating the effect of treating SDB and its effect on physical rehabilitation in SCI were unable to be located. Thus, studies investigating the likely integrated relationship among physical rehabilitation, SDB, and proper treatment of SDB in SCI are needed. Owing to rapid growth in both sleep medicine and physical rehabilitation intervention research in SCI, the authors contend it is the appropriate time to begin the conversations and collaborations between these fields. We discuss a general overview of SDB and physical training modalities, as well as how SDB could be affecting these studies.
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Affiliation(s)
- Gino S Panza
- John D. Dingell Veterans Affairs Medical Center, Detroit, MI; Department of Physiology, Wayne State University School of Medicine, Detroit, MI.
| | - Tommy Sutor
- Research Service, Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, VA
| | - Cameron M Gee
- International Collaboration on Repair Discoveries, Vancouver, BC, Canada
| | - Marnie Graco
- Institute for Breathing and Sleep, Austin Health; and School of Physiotherapy, University of Melbourne, Melbourne, Australia
| | | | - Anthony Chiodo
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI
| | - M Safwan Badr
- John D. Dingell Veterans Affairs Medical Center, Detroit, MI; Department of Internal Medicine, Wayne State University School of Medicine, Detroit, MI
| | - Mark S Nash
- Department of Neurological Surgery, Physical Medicine & Rehabiliation, and Physical Therapy, Miami, FL; The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, FL
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32
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Falls from height: Ambulation following spinal cord injury and lower extremity polytrauma. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2021.101137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Abstract
In this paper, we present a novel adaptation rule to optimize the exoskeleton assistance in rehabilitation tasks. The proposed method adapts the exoskeleton contribution to user impairment severity without any prior knowledge about the user motor capacity. The proposed controller is a combination of an adaptive feedforward controller and a low gain adaptive PD controller. The PD controller guarantees the stability of the human-exoskeleton system during feedforward torque adaptation by utilizing only the human-exoskeleton joint positions as the sensory feedback for assistive torque optimization. In addition to providing a convergence proof, in order to study the performance of our method we applied it to a simplified 2-DOF model of human-arm and a generic 9-DOF model of lower limb to perform walking. In each simulated task, we implemented the impaired human torque to be insufficient for the task completion. Moreover, the scenarios that violate our convergence proof assumptions are considered. The simulation results show a converging behavior for the proposed controller; the maximum convergence time of 20 s is observed. In addition, a stable control performance that optimally supplements the remaining user motor contribution is observed; the joint angle tracking error in steady condition and its improvement compared to the start of adaptation are as follows: shoulder 0.96±2.53° (76%); elbow −0.35±0.81° (33%); hip 0.10±0.86° (38%); knee −0.19±0.67° (25%); and ankle −0.05±0.20° (60%). The presented simulation results verify the robustness of proposed adaptive method in cases that differ from our mathematical assumptions and indicate its potentials to be used in practice.
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34
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Koljonen PA, Virk AS, Jeong Y, McKinley M, Latorre J, Caballero A, Hu Y, Wong YW, Cheung K, Kazerooni H. Outcomes of a Multicenter Safety and Efficacy Study of the SuitX Phoenix Powered Exoskeleton for Ambulation by Patients With Spinal Cord Injury. Front Neurol 2021; 12:689751. [PMID: 34349722 PMCID: PMC8326794 DOI: 10.3389/fneur.2021.689751] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 06/07/2021] [Indexed: 11/29/2022] Open
Abstract
Objective: To examine the safety and efficacy of ambulation utilizing a semi-passive and lightweight powered exoskeleton by spinal cord injury (SCI) patients. Methods: This is a multi-center, open-label, prospective cohort study across three facilities. A cohort of 40 individuals with SCI from T4-L5 was recruited into a 20-session training and assessment protocol, utilizing the SuitX Phoenix. All patients were tested using a 10-m-walk test (10 MWT), 6-min-walk test (6 MWT), and Timed up & Go test (TUG). Patient satisfaction, pain, exertion, changes in affect, as well as overall comfort and confidence were reported using a satisfaction survey, Rated Perceived Exertion (RPE) scale, and Positive and Negative Affect Schedule (PANAS). Safety outcomes, adverse events, and device malfunctions were reported. Results: Forty participants completed the study. There were no serious adverse events. All participants reported moderate to high levels of comfort and confidence using the device. All patients were able to achieve FIM of >4 on transitional movements and walking. The neurological level of injury had a statistically significant association with walking speed, WISCI-II, and FIM. Participants with an incomplete spinal cord injury had a higher FIM, faster speed, and higher WISCI-II in all outcome measures. Conclusion: This is the first study to examine the safety and efficacy of SuitX Phoenix for ambulation by SCI patients. We have shown that Phoenix is efficacious in allowing adults with SCI T4 to L5 perform walking and transitional movements. This study also reports the safety-profile of the device, user satisfaction, and psychological trends during training.
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Affiliation(s)
- Paul Aarne Koljonen
- Department of Orthopaedics and Traumatology, Maclehose Medical Rehabilitation Centre, Hong Kong West Cluster, Hospital Authority, Hong Kong, China.,Department of Orthopaedics and Traumatology, The University of Hong Kong Li Ka Shing Faculty of Medicine, Hong Kong, China
| | | | - Yoon Jeong
- US Bionics at Emeryville, Emeryville, CA, United States
| | | | - Juan Latorre
- St. David's Medical Center, Austin, TX, United States
| | - Amaya Caballero
- University of Virginia School of Medicine, Charlottesville, VA, United States
| | - Yong Hu
- Department of Orthopaedics and Traumatology, The University of Hong Kong Li Ka Shing Faculty of Medicine, Hong Kong, China
| | - Yat Wa Wong
- Department of Orthopaedics and Traumatology, The University of Hong Kong Li Ka Shing Faculty of Medicine, Hong Kong, China
| | - Kenneth Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong Li Ka Shing Faculty of Medicine, Hong Kong, China
| | - Homayoon Kazerooni
- Department of Mechanical Engineering, University of California, Berkeley, Berkeley, CA, United States
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MacLean MK, Ferris DP. Human muscle activity and lower limb biomechanics of overground walking at varying levels of simulated reduced gravity and gait speeds. PLoS One 2021; 16:e0253467. [PMID: 34260611 PMCID: PMC8279339 DOI: 10.1371/journal.pone.0253467] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 06/04/2021] [Indexed: 12/03/2022] Open
Abstract
Reducing the mechanical load on the human body through simulated reduced gravity can reveal important insight into locomotion biomechanics. The purpose of this study was to quantify the effects of simulated reduced gravity on muscle activation levels and lower limb biomechanics across a range of overground walking speeds. Our overall hypothesis was that muscle activation amplitudes would not decrease proportionally to gravity level. We recruited 12 participants (6 female, 6 male) to walk overground at 1.0, 0.76, 0.55, and 0.31 G for four speeds: 0.4, 0.8, 1.2, and 1.6 ms-1. We found that peak ground reaction forces, peak knee extension moment in early stance, peak hip flexion moment, and peak ankle extension moment all decreased substantially with reduced gravity. The peak knee extension moment at late stance/early swing did not change with gravity. The effect of gravity on muscle activity amplitude varied considerably with muscle and speed, often varying nonlinearly with gravity level. Quadriceps (rectus femoris, vastus lateralis, & vastus medialis) and medial gastrocnemius activity decreased in stance phase with reduced gravity. Soleus and lateral gastrocnemius activity had no statistical differences with gravity level. Tibialis anterior and biceps femoris increased with simulated reduced gravity in swing and stance phase, respectively. The uncoupled relationship between simulated gravity level and muscle activity have important implications for understanding biomechanical muscle functions during human walking and for the use of bodyweight support for gait rehabilitation after injury.
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Affiliation(s)
- Mhairi K. MacLean
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, Florida, United States of America
- * E-mail: (MKM); (DPF)
| | - Daniel P. Ferris
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, Florida, United States of America
- * E-mail: (MKM); (DPF)
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Effect of robotic-assisted gait training on functional status, walking and quality of life in complete spinal cord injury. Int J Rehabil Res 2021; 44:262-268. [PMID: 34356038 DOI: 10.1097/mrr.0000000000000486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The purpose of this study was to investigate the effect of robotic-assisted gait training (RAGT) on functional status and the quality of life in patients with subacute complete spinal cord injury (SCI). Thirty-seven patients with complete SCI were included in this study. All patients underwent conventional rehabilitation 5 days a week for 8 weeks. The patients were divided into two groups: those who received RAGT (group I, n = 17) and those who received only conventional rehabilitation (group II, n = 20) for 30 min twice a week for a total of 8 weeks. Evaluations were performed using the Walking Index SCI II (WISCI II) for ambulation, Functional Independence Measure (FIM) for functional status and Short Form 36 (SF-36) for the quality of life at the beginning and end of rehabilitation. The mean duration of injury was 3.5 ± 2.1 months in group I and 3.8 ± 2.6 months in group II (P > 0.05). Significant improvement was observed in both groups as per WISCI II and FIM scores (P < 0.05). However, no significant inter-group difference was noted in pre- and post-treatment FIM and WISCI II change scores (P > 0.05). In groups I and II, there was significant improvement only in physical activity scores of SF-36 compared with baseline scores (P < 0.05); however, other SF-36 subparameter scores did not differ significantly between pre- and post-treatment (P > 0.05). Treatment with RAGT has positive effects on functional independence, ambulation and the quality of life in patients with subacute complete SCI. RAGT combined with conventional therapy in patients with complete SCI may facilitate the improvement of patient condition more than conventional therapy alone.
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Chemogenetic stimulation of proprioceptors remodels lumbar interneuron excitability and promotes motor recovery after SCI. Mol Ther 2021; 29:2483-2498. [PMID: 33895324 DOI: 10.1016/j.ymthe.2021.04.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 02/05/2021] [Accepted: 04/16/2021] [Indexed: 12/21/2022] Open
Abstract
Motor recovery after severe spinal cord injury (SCI) is limited due to the disruption of direct descending commands. Despite the absence of brain-derived descending inputs, sensory afferents below injury sites remain intact. Among them, proprioception acts as an important sensory source to modulate local spinal circuits and determine motor outputs. Yet, it remains unclear whether enhancing proprioceptive inputs promotes motor recovery after severe SCI. Here, we first established a viral system to selectively target lumbar proprioceptive neurons and then introduced the excitatory Gq-coupled Designer Receptors Exclusively Activated by Designer Drugs (DREADD) virus into proprioceptors to achieve specific activation of lumbar proprioceptive neurons upon CNO administration. We demonstrated that chronic activation of lumbar proprioceptive neurons promoted the recovery of hindlimb stepping ability in a bilateral hemisection SCI mouse model. We further revealed that chemogenetic proprioceptive stimulation led to coordinated activation of proprioception-receptive spinal interneurons and facilitated transmission of supraspinal commands to lumbar motor neurons, without affecting the regrowth of proprioceptive afferents or brain-derived descending axons. Moreover, application of 4-aminopyridine-3-methanol (4-AP-MeOH) that enhances nerve conductance further improved the transmission of supraspinal inputs and motor recovery in proprioception-stimulated mice. Our study demonstrates that proprioception-based combinatorial modality may be a promising strategy to restore the motor function after severe SCI.
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Koh MH, Yen SC, Leung LY, Gans S, Sullivan K, Adibnia Y, Pavel M, Hasson CJ. Exploiting telerobotics for sensorimotor rehabilitation: a locomotor embodiment. J Neuroeng Rehabil 2021; 18:66. [PMID: 33882949 PMCID: PMC8059234 DOI: 10.1186/s12984-021-00856-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 03/18/2021] [Indexed: 12/01/2022] Open
Abstract
Background Manual treadmill training is used for rehabilitating locomotor impairments but can be physically demanding for trainers. This has been addressed by enlisting robots, but in doing so, the ability of trainers to use their experience and judgment to modulate locomotor assistance on the fly has been lost. This paper explores the feasibility of a telerobotics approach for locomotor training that allows patients to receive remote physical assistance from trainers. Methods In the approach, a trainer holds a small robotic manipulandum that shadows the motion of a large robotic arm magnetically attached to a locomoting patient's leg. When the trainer deflects the manipulandum, the robotic arm applies a proportional force to the patient. An initial evaluation of the telerobotic system’s transparency (ability to follow the leg during unassisted locomotion) was performed with two unimpaired participants. Transparency was quantified by the magnitude of unwanted robot interaction forces. In a small six-session feasibility study, six individuals who had prior strokes telerobotically interacted with two trainers (separately), who assisted in altering a targeted gait feature: an increase in the affected leg’s swing length. Results During unassisted walking, unwanted robot interaction forces averaged 3−4 N (swing–stance) for unimpaired individuals and 2−3 N for the patients who survived strokes. Transients averaging about 10 N were sometimes present at heel-strike/toe-off. For five of six patients, these forces increased with treadmill speed during stance (R2 = .99; p < 0.001) and increased with patient height during swing (R2 = .71; p = 0.073). During assisted walking, the trainers applied 3.0 ± 2.8 N (mean ± standard deviation across patients) and 14.1 ± 3.4 N of force anteriorly and upwards, respectively. The patients exhibited a 20 ± 21% increase in unassisted swing length between Days 1−6 (p = 0.058). Conclusions The results support the feasibility of locomotor assistance with a telerobotics approach. Simultaneous measurement of trainer manipulative actions, patient motor responses, and the forces associated with these interactions may prove useful for testing sensorimotor rehabilitation hypotheses. Further research with clinicians as operators and randomized controlled trials are needed before conclusions regarding efficacy can be made.
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Affiliation(s)
- Min Hyong Koh
- Department of Physical Therapy, Movement and Rehabilitation Sciences, Northeastern University, 360 Huntington Avenue, 301 Robinson Hall, Boston, MA, 02115-5005, USA
| | - Sheng-Che Yen
- Department of Physical Therapy, Movement and Rehabilitation Sciences, Northeastern University, 360 Huntington Avenue, 301 Robinson Hall, Boston, MA, 02115-5005, USA
| | - Lester Y Leung
- Division of Stroke and Cerebrovascular Diseases, Department of Neurology, Tufts Medical Center, Boston, USA
| | - Sarah Gans
- Division of Stroke and Cerebrovascular Diseases, Department of Neurology, Tufts Medical Center, Boston, USA
| | - Keri Sullivan
- Division of Stroke and Cerebrovascular Diseases, Department of Neurology, Tufts Medical Center, Boston, USA
| | - Yasaman Adibnia
- Division of Stroke and Cerebrovascular Diseases, Department of Neurology, Tufts Medical Center, Boston, USA
| | - Misha Pavel
- Khoury College of Computer Sciences, Northeastern University, Boston, USA
| | - Christopher J Hasson
- Department of Physical Therapy, Movement and Rehabilitation Sciences, Northeastern University, 360 Huntington Avenue, 301 Robinson Hall, Boston, MA, 02115-5005, USA. .,Departments of Bioengineering and Biology, Northeastern University, Boston, USA.
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Lorenzo-García P, Cavero-Redondo I, Torres-Costoso AI, Guzmán-Pavón MJ, Núñez de Arenas-Arroyo S, Álvarez-Bueno C. Body Weight Support Gait Training for Patients With Parkinson Disease: A Systematic Review and Meta-analyses. Arch Phys Med Rehabil 2021; 102:2012-2021. [PMID: 33684361 DOI: 10.1016/j.apmr.2021.02.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 02/13/2021] [Accepted: 02/17/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To determine the effectiveness of body weight support (BWS) gait training to improve the clinical severity, gait, and balance in patients with Parkinson disease (PD). DATA SOURCES A literature search was conducted until July 2020 in MEDLINE, Physiotherapy Evidence Database, Cochrane Central Register of Controlled Trials, and Cumulative Index to Nursing and Allied Health Literature. STUDY SELECTION Randomized controlled trials that aimed at determining the effectiveness of physical activity interventions with BWS during gait training in patients with PD. DATA EXTRACTION The methodological quality of randomized controlled trials was assessed using the Cochrane risk of bias tool (RoB 2.0). Effect size (ES) and 95% confidence intervals [CIs] were calculated for the Unified Parkinson Disease Rating Scale (UPDRS), the UPDRS section III, the 6-minute walk test (6MWT), gait parameters (ie, velocity, cadence, stride length), and the Berg Balance Scale (BBS). DATA SYNTHESIS Twelve studies were included in the systematic review. The pooled ES for the effect of BWS on total UPDRS was -0.35 (95% CI, -0.57 to -0.12; I2=1.9%, P=.418), whereas for UPDRS III it was -0.35 (95% CI, -0.68 to -0.01; I2=66.4 %, P<.001). Furthermore, the pooled ES for 6MWT was 0.56 (95% CI, -0.07 to 1.18; I2=77.1%, P=.002), for gait velocity was 0.37 (95% CI, -0.10 to 0.84); I2=78.9%, P<.001), for cadence was 0.03 (95% CI, -0.25 to 0.30; I2=0.0%, P=.930), for stride length was 1.00 (95% CI, 0.23 to 1.78; I2=79.5%, P=.001), and for BBS was 0.65 (95% CI, 0.30, 0.99; I2=51.8%, P=.042). CONCLUSIONS Interventions with BWS could improve the general and motor clinical severity of patients with PD, as well as other parameters such as stride length and balance. However, the effect does not appear to be statistically significant in improving gait parameters such as velocity, cadence, and distance.
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Affiliation(s)
| | - Iván Cavero-Redondo
- Health and Social Research Center, Universidad de Castilla La Mancha, Cuenca, Spain; Rehabilitation and Health Research Center (CIRES), Universidad de las Amércias, Santiago, Chile.
| | - Ana Isabel Torres-Costoso
- Health and Social Research Center, Universidad de Castilla La Mancha, Cuenca, Spain; Faculty of Physiotherapy and Nursing, Universidad de Castilla-La Mancha, Toledo, Spain
| | - María José Guzmán-Pavón
- Health and Social Research Center, Universidad de Castilla La Mancha, Cuenca, Spain; Faculty of Physiotherapy and Nursing, Universidad de Castilla-La Mancha, Toledo, Spain
| | | | - Celia Álvarez-Bueno
- Health and Social Research Center, Universidad de Castilla La Mancha, Cuenca, Spain; Universidad Politécnica y Artística del Paraguay, Asunción, Paraguay
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Cao Y, DiPiro ND, Brotherton SS, Krause JS. Assistive devices and future fall-related injuries among ambulatory adults with spinal cord injury: a prospective cohort study. Spinal Cord 2020; 59:747-752. [PMID: 33130822 DOI: 10.1038/s41393-020-00572-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 10/19/2020] [Accepted: 10/21/2020] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Prospective cohort study with two times of measurement. OBJECTIVE To assess the relationship between use of assistive devices for walking (at baseline) and the number of annual fall-related injuries (at follow-up) among a cohort of ambulatory adults with spinal cord injury (SCI). SETTING Medical University in the Southeastern United States. METHODS There were 622 ambulatory adults who met the eligibility criteria, 317 of whom completed both baseline and follow-up assessments. The participants completed a mailed self-report assessment (SRA) that measured self-reported number of fall-related injuries in the previous year, and the use of orthopedic equipment (assistive devices) for walking, including cane(s), crutches, walker, and braces, was assessed at both baseline and follow-up. RESULTS The percentage of at least one self-reported fall-related injury decreased from 22% at baseline to 13% at the follow-up. Walker and cane use at baseline was significantly associated with fall-related injuries at follow-up. Participants using one walking device related to 194% greater number of fall injures, and using multiple device related to 730% greater number of fall injures than those who used no devices. We also found walker users were associated with 214% greater number of fall injures, while cane users were associated with 160% greater number of fall injures. CONCLUSIONS The probability of fall-related injury remained high among persons who are ambulatory after SCI. Health care professionals should be aware of the balance between the goal of ambulation and the potential increased risk of fall-related injuries associated with assistive device use.
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Affiliation(s)
- Yue Cao
- College of Health Professions, Medical University of South Carolina, Charleston, SC, USA.
| | - Nicole D DiPiro
- College of Health Professions, Medical University of South Carolina, Charleston, SC, USA
| | - Sandra S Brotherton
- College of Health Professions, Medical University of South Carolina, Charleston, SC, USA
| | - James S Krause
- College of Health Professions, Medical University of South Carolina, Charleston, SC, USA
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Bass A, Aubertin-Leheudre M, Vincent C, Karelis AD, Morin SN, McKerral M, Duclos C, Gagnon DH. Effects of an Overground Walking Program With a Robotic Exoskeleton on Long-Term Manual Wheelchair Users With a Chronic Spinal Cord Injury: Protocol for a Self-Controlled Interventional Study. JMIR Res Protoc 2020; 9:e19251. [PMID: 32663160 PMCID: PMC7545333 DOI: 10.2196/19251] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 06/30/2020] [Accepted: 07/07/2020] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND In wheelchair users with a chronic spinal cord injury (WUSCI), prolonged nonactive sitting time and reduced physical activity-typically linked to this mode of mobility-contribute to the development or exacerbation of cardiorespiratory, musculoskeletal, and endocrine-metabolic health complications that are often linked to increased risks of chronic pain or psychological morbidity. Limited evidence suggests that engaging in a walking program with a wearable robotic exoskeleton may be a promising physical activity intervention to counter these detrimental health effects. OBJECTIVE This study's overall goals are as follows: (1) to determine the effects of a 16-week wearable robotic exoskeleton-assisted walking program on organic systems, functional capacities, and multifaceted psychosocial factors and (2) to determine self-reported satisfaction and perspectives with regard to the intervention and the device. METHODS A total of 20 WUSCI, who have had their injuries for more than 18 months, will complete an overground wearable robotic exoskeleton-assisted walking program (34 sessions; 60 min/session) supervised by a physiotherapist over a 16-week period (one to three sessions/week). Data will be collected 1 month prior to the program, at the beginning, and at the end as well as 2 months after completing the program. Assessments will characterize sociodemographic characteristics; anthropometric parameters; sensorimotor impairments; pain; lower extremity range of motion and spasticity; wheelchair abilities; cardiorespiratory fitness; upper extremity strength; bone architecture and mineral density at the femur, tibia, and radius; total and regional body composition; health-related quality of life; and psychological health. Interviews and an online questionnaire will be conducted to measure users' satisfaction levels and perspectives at the end of the program. Differences across measurement times will be verified using appropriate parametric or nonparametric analyses of variance for repeated measures. RESULTS This study is currently underway with active recruitment in Montréal, Québec, Canada. Results are expected in the spring of 2021. CONCLUSIONS The results from this study will be essential to guide the development, implementation, and evaluation of future evidence-based wearable robotic exoskeleton-assisted walking programs offered in the community, and to initiate a reflection regarding the use of wearable robotic exoskeletons during initial rehabilitation following a spinal cord injury. TRIAL REGISTRATION ClinicalTrials.gov NCT03989752; https://clinicaltrials.gov/ct2/show/NCT03989752. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/19251.
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Affiliation(s)
- Alec Bass
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Centre Intégré Universitaire de Santé et Services Sociaux du Centre-Sud-de-l'Île-de-Montréal, Montréal, QC, Canada
| | | | - Claude Vincent
- Department of Rehabilitation, Faculty of Medicine, Université Laval, Québec, QC, Canada
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Québec, QC, Canada
| | - Antony D Karelis
- Department of Exercise Science, Université du Québec à Montréal, Montréal, QC, Canada
| | - Suzanne N Morin
- Department of Medicine, McGill University, Montréal, QC, Canada
| | - Michelle McKerral
- Departement of Psychology, Faculty of Arts and Sciences, Université de Montréal, Montréal, QC, Canada
| | - Cyril Duclos
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Centre Intégré Universitaire de Santé et Services Sociaux du Centre-Sud-de-l'Île-de-Montréal, Montréal, QC, Canada
| | - Dany H Gagnon
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Centre Intégré Universitaire de Santé et Services Sociaux du Centre-Sud-de-l'Île-de-Montréal, Montréal, QC, Canada
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Jeffery ND, Olby NJ, Moore SA. Clinical Trial Design-A Review-With Emphasis on Acute Intervertebral Disc Herniation. Front Vet Sci 2020; 7:583. [PMID: 33134333 PMCID: PMC7512142 DOI: 10.3389/fvets.2020.00583] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 07/20/2020] [Indexed: 11/13/2022] Open
Abstract
There is a clear need for new methods of treatment of acute disc herniation in dogs, most obviously to address the permanent loss of function that can arise because of the associated spinal cord injury. Clinical trials form the optimal method to introduce new therapies into everyday clinical practice because they are a reliable source of unbiased evidence of effectiveness. Although many designs are available, parallel cohort trials are most widely applicable to acute disc herniation in dogs. In this review another key trial design decision—that between pragmatic and explanatory approaches—is highlighted and used as a theme to illustrate the close relationship between trial objective and design. Acute disc herniation, and acute spinal cord injury, is common in dogs and there is a multitude of candidate interventions that could be trialed. Most current obstacles to large-scale clinical trials in dogs can be overcome by collaboration and cooperation amongst interested veterinarians.
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Affiliation(s)
- Nick D Jeffery
- Department of Small Animal Clinical Sciences, Texas A&M University, College Station, TX, United States
| | - Natasha J Olby
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, United States
| | - Sarah A Moore
- Department of Veterinary Clinical Sciences, The Ohio State University, Columbus, OH, United States
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Delgado AD, Escalon MX, Bryce TN, Weinrauch W, Suarez SJ, Kozlowski AJ. Safety and feasibility of exoskeleton-assisted walking during acute/sub-acute SCI in an inpatient rehabilitation facility: A single-group preliminary study. J Spinal Cord Med 2020; 43:657-666. [PMID: 31603395 PMCID: PMC7534310 DOI: 10.1080/10790268.2019.1671076] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Context/objective: Information on the safety and feasibility of lower extremity powered exoskeletons for persons with acute/sub-acute spinal cord injury (SCI) is limited. Understanding the safety and feasibility of employing powered exoskeletons in acute/sub-acute (<6 months post injury) at a SCI acute inpatient rehabilitation (SCI-AIR) facility could guide clinical practice and provide a basis for larger clinical trials on efficacy and effectiveness. Design: Single group observational study. Setting: SCI-AIR. Participants: Participants (n = 12; age: 28-71 years; 58% AIS D; 58% male) with neurological levels of injuries ranging from C2 to L3. Interventions: Up to 90 min of exoskeleton-assisted locomotor training was provided up to three times per week during SCI-AIR. Outcome measures: Safety of device use during inpatient locomotor training was quantified as the number of adverse events (AE) per device exposure hour. Feasibility of device use was defined in terms of protocol compliance, intensity, and proficiency. Results: Concerning safety, symptomatic hypotension was the most common AE reported at 111-events/exoskeleton-hours. Protocol compliance had a mean (SD) of 54% (30%). For intensity, 77% of participants incorporated variable assistance into at least 1 walking session; 70% of participants' sessions were completed with a higher RPE than the physical therapist. In proficiency, 58% achieved at least minimal assistance when walking with the device. Conclusion: Exoskeleton training in SCI-AIR can be safe and feasible for newly injured individuals with SCI who have clinically defined ambulatory goals. Nonetheless, sufficient controls to minimize risks for AEs, such as hypotensive events, are required.
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Affiliation(s)
- Andrew D. Delgado
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York City, New York, USA,The Graduate School, Icahn School of Medicine at Mount Sinai, New York City, New York, USA,Correspondence to: Andrew D. Delgado, Department of Rehabilitation Medicine and Human Performance, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, New York10029, USA; Ph: 212-241-9478.
| | - Miguel X. Escalon
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Thomas N. Bryce
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - William Weinrauch
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Stephanie J. Suarez
- Sports Therapy and Rehabilitation Services (STARS), Northwell Health, East Meadow, New York, USA
| | - Allan J. Kozlowski
- Department of Epidemiology and Biostatistics, Michigan State University, Grand Rapids, Michigan, USA,John F. Butzer Center for Research & Innovation, Mary Free Bed Rehabilitation Hospital, Grand Rapids, Michigan, USA
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Duffell LD, Donaldson NDN. A Comparison of FES and SCS for Neuroplastic Recovery After SCI: Historical Perspectives and Future Directions. Front Neurol 2020; 11:607. [PMID: 32714270 PMCID: PMC7344227 DOI: 10.3389/fneur.2020.00607] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 05/25/2020] [Indexed: 12/17/2022] Open
Abstract
There is increasing evidence that neuroplastic changes can occur even years after spinal cord injury, leading to reduced disability and better health which should reduce the cost of healthcare. In motor-incomplete spinal cord injury, recovery of leg function may occur if repetitive training causes afferent input to the lumbar spinal cord. The afferent input may be due to activity-based therapy without electrical stimulation but we present evidence that it is faster with electrical stimulation. This may be spinal cord stimulation or peripheral nerve stimulation. Recovery is faster if the stimulation is phasic and that the patient is trying to use their legs during the training. All the published studies are small, so all conclusions are provisional, but it appears that patients with more disability (AIS A and B) may need to continue using stimulation and for them, an implanted stimulator is likely to be convenient. Patients with less disability (AIS C and D) may make useful recovery and improve their quality of life from a course of therapy. This might be locomotion therapy but we argue that cycling with electrical stimulation, which uses biofeedback to encourage descending drive, causes rapid recovery and might be used with little supervision at home, making it much less expensive. Such an electrical therapy followed by conventional physiotherapy might be affordable for the many people living with chronic SCI. To put this in perspective, we present some information about what treatments are funded in the UK and the US.
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Affiliation(s)
- Lynsey D Duffell
- Implanted Devices Group, University College London, London, United Kingdom.,Aspire CREATe, University College London, London, United Kingdom
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Hicks AL. Locomotor training in people with spinal cord injury: is this exercise? Spinal Cord 2020; 59:9-16. [PMID: 32581307 DOI: 10.1038/s41393-020-0502-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 06/02/2020] [Accepted: 06/05/2020] [Indexed: 11/09/2022]
Abstract
Locomotor training holds tremendous appeal to people with spinal cord injury who are wheelchair dependent, as the reacquisition of gait remains one of the most coveted goals in this population. For the last few decades this type of training has remained primarily in the clinical environment, as it requires the use of expensive treadmills with bodyweight support or complex overhead suspension tracks to facilitate overground walking. The development of powered exoskeletons has taken locomotor training out of the clinic, both improving accessibility and providing a potential option for community ambulation in people with lower limb paralysis. A question that has yet to be answered, however, is whether or not locomotor training offers a sufficiently intense stimulus to induce improvements in fitness or health. As inactivity-related secondary health complications are a major source of morbidity and mortality in people with SCI, it would be important to characterize the potential of locomotor training to not only improve functional walking ability, but also improve health-related fitness. This narrative review will summarize the key literature in this area to determine whether locomotor training challenges the cardiovascular, muscular or metabolic systems enough to be considered a viable form of exercise.
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Affiliation(s)
- Audrey L Hicks
- Department of Kinesiology, McMaster University, Hamilton, ON, Canada.
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Kwakman RCH, Sommers J, Horn J, Nollet F, Engelbert RHH, van der Schaaf M. Steps to recovery: body weight-supported treadmill training for critically ill patients: a randomized controlled trial. Trials 2020; 21:409. [PMID: 32414411 PMCID: PMC7227333 DOI: 10.1186/s13063-020-04333-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 04/19/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Early mobilization has been proven effective for patients in intensive care units (ICUs) to improve functional recovery. However, early mobilization of critically ill, often mechanically ventilated, patients is cumbersome because of the attachment to tubes, drains, monitoring devices and muscle weakness. A mobile treadmill with bodyweight support may help to initiate mobilization earlier and more effectively. The aim of this study is to assess the effectiveness of weight-supported treadmill training in critically ill patients during and after ICU stay on time to independent functional ambulation. METHODS In this randomized controlled trial, a custom-built bedside body weight-supported treadmill will be used and evaluated. Patients are included if they have been mechanically ventilated for at least 48 hours, are able to follow instructions, have quadriceps muscle strength of Medical Research Council sum-score 2 (MRC 2) or higher, can sit unsupported and meet the safety criteria for physical exercise. Exclusion criteria are language barriers, no prior walking ability, contraindications for physiotherapy or a neurological condition as reason for ICU admission. We aim to include 88 patients and randomize them into either the intervention or the control group. The intervention group will receive usual care plus bodyweight-supported treadmill training (BWSTT) daily. The BWSSTT consists of walking on a mobile treadmill while supported by a harness. The control group will receive usual care physiotherapy treatment daily consisting of progressive activities such as bed-cycling and active functional training exercises. In both groups, we will aim for a total of 40 minutes of physiotherapy treatment time every day in one or two sessions, as tolerated by the patient. The primary outcome is time to functional ambulation as measured in days, secondary outcomes include walking distance, muscle strength, status of functional mobility and symptoms of post-traumatic stress. All measurements will be done by assessors who are blinded to the intervention on the regular wards until hospital discharge. DISCUSSION This will be the first study comparing the effects of BWSTT and conventional physiotherapy for critically ill patients during and after ICU stay. The results of this study contribute to a better understanding of the effectiveness of early physiotherapy interventions for critically ill patients. TRIAL REGISTRATION Dutch Trial Register (NTR) ID: NL6766. Registered at 1 December 2017.
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Affiliation(s)
- Robin C. H. Kwakman
- Department of Rehabilitation, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, Netherlands
- Faculty of Health, Center of Expertise Urban Vitality, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
- Education of Physiotherapy, University of Applied Sciences Amsterdam, Amsterdam, The Netherlands
| | - Juultje Sommers
- Department of Rehabilitation, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, Netherlands
| | - Janneke Horn
- Department of Intensive Care, Neurosciences, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, Netherlands
| | - Frans Nollet
- Department of Rehabilitation, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, Netherlands
| | - Raoul H. H. Engelbert
- Department of Rehabilitation, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, Netherlands
- Faculty of Health, Center of Expertise Urban Vitality, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Marike van der Schaaf
- Department of Rehabilitation, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, Netherlands
- Faculty of Health, Center of Expertise Urban Vitality, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
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van Silfhout L, Edwards MJ. Mobilising the patient: With emphasis on innovative technologies. Injury 2020; 51 Suppl 2:S15-S17. [PMID: 31948779 DOI: 10.1016/j.injury.2020.01.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 11/13/2019] [Accepted: 01/05/2020] [Indexed: 02/02/2023]
Abstract
Treatment of trauma patients and fractures has changed dramatically throughout the years. From conservative methods to nowadays various kinds of screws, pins, plates and nails for optimal fixation of fractures. This lead to changes in post-operative management as well, from bedrest to (partial) weight bearing. Some patients however have very limited to no ability to mobilise, such as critical ill patients on the Intensive Care Unit, amputees or spinal cord injured patients. Due to innovations such as hydrotherapy, osseointegrated prosthesis and exoskeletons, even these people can mobilise. Thanks to innovations like these an increasing number of trauma patients are able to fully reintegrate into community life and get back to an active and independent life style.
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Affiliation(s)
- Lysanne van Silfhout
- Department of Trauma Surgery, Radboud University Medical Centre, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands.
| | - Michael Jr Edwards
- Department of Trauma Surgery, Radboud University Medical Centre, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands.
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Escalona MJ, Bourbonnais D, Goyette M, Duclos C, Gagnon DH. Wearable exoskeleton control modes selected during overground walking affect muscle synergies in adults with a chronic incomplete spinal cord injury. Spinal Cord Ser Cases 2020; 6:26. [PMID: 32332703 DOI: 10.1038/s41394-020-0269-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 03/09/2020] [Accepted: 03/10/2020] [Indexed: 12/27/2022] Open
Abstract
STUDY DESIGN Case series. BACKGROUND Changes in the number of muscle synergies (MSs) and in the weighting of muscles composing each MS are typically altered following an incomplete spinal cord injury (iSCI). Wearable robotic exoskeletons (WRE) represent a promising rehabilitation option, though the effects of various WRE control modes on MSs still remain unknown. OBJECTIVE This case series characterizes how WRE control modes affect the number of MSs and the weighting of muscles composing each MS in individuals with iSCI. SETTING Pathokinesioly laboratory of a rehabilitation research center. METHODS Three participants with a chronic iSCI walked at a self-selected comfortable speed without and with a WRE set in two trajectory-controlled (Total Assistance, TOT; Assistance-as-Needed, ADAPT) and three non-trajectory controlled modes (High Assistance, HASSIST; High Resistance, HRESIST; NEUTRAL). Surface EMG of eight lower extremity (L/E) muscles was recorded and used to extract MSs using a nonnegative matrix factorization algorithm. Cosine similarity and weighting relative differences characterized similarities in MSs between individuals with iSCI and able-bodied controls. RESULTS The mode providing movement assistance within a self-selected L/E trajectory (HASSIST) best replicated MSs in able-bodied controls during overground walking. MSs extracted with the trajectory-controlled modes differed to the greatest extent from able-bodied group MSs. CONCLUSIONS Most WRE control modes did not replicate the motor control required for typical L/E muscle coordination during stereotypical overground walking. These results highlight the need to gain a better understanding of the effects of various control modes on L/E motor control for rehabilitation professionals to incorporate research evidence when selecting WRE control mode(s) during WRE locomotor interventions.
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Affiliation(s)
- Manuel J Escalona
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada.,Pathokinesiology Laboratory, Center for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Institut universitaire sur la readaptation en deficience physique de Montreal, CIUSSS Centre-Sud-de-l'Ile-de-Montréal, Montreal, QC, Canada
| | - Daniel Bourbonnais
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada.,Pathokinesiology Laboratory, Center for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Institut universitaire sur la readaptation en deficience physique de Montreal, CIUSSS Centre-Sud-de-l'Ile-de-Montréal, Montreal, QC, Canada
| | - Michel Goyette
- Pathokinesiology Laboratory, Center for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Institut universitaire sur la readaptation en deficience physique de Montreal, CIUSSS Centre-Sud-de-l'Ile-de-Montréal, Montreal, QC, Canada
| | - Cyril Duclos
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada.,Pathokinesiology Laboratory, Center for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Institut universitaire sur la readaptation en deficience physique de Montreal, CIUSSS Centre-Sud-de-l'Ile-de-Montréal, Montreal, QC, Canada
| | - Dany H Gagnon
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada. .,Pathokinesiology Laboratory, Center for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Institut universitaire sur la readaptation en deficience physique de Montreal, CIUSSS Centre-Sud-de-l'Ile-de-Montréal, Montreal, QC, Canada.
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Lawrason SVC, Todd KR, Shaw RB, Martin Ginis KA. Physical activity among individuals with spinal cord injury who ambulate: a systematic scoping review. Spinal Cord 2020; 58:735-745. [DOI: 10.1038/s41393-020-0460-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 03/23/2020] [Accepted: 03/24/2020] [Indexed: 12/27/2022]
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Stampacchia G, Olivieri M, Rustici A, D'Avino C, Gerini A, Mazzoleni S. Gait rehabilitation in persons with spinal cord injury using innovative technologies: an observational study. Spinal Cord 2020; 58:988-997. [PMID: 32251368 DOI: 10.1038/s41393-020-0454-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 03/04/2020] [Accepted: 03/09/2020] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Prospective, quasi-experimental study, pre- and post-design, single arm study. OBJECTIVES Investigate whether persons affected by SCI can safely experience walking function using Robotic Exoskeletons and Functional Electrical Stimulation (FES). SETTING Inpatient METHODS: 52 persons with SCI were recruited (36 completed the protocol) and assigned to one of two groups based on their Lower Limb Motor Scores (LEMS): Group A: LEMS ≥ 10 and Group B: LEMS < 10. Participants in Group A (n = 19) underwent 20 sessions of Robot-Assisted Gait Training (RAGT) on a treadmill followed by 20 sessions of FES during Overground Gait (FES-OG). Participants in Group B (n = 17) received 20 sessions of FES-cycling followed by 20 sessions of overground RAGT. The main outcome measures were: WISCI-II, 10MWT, 6MWT, TUG and SCIM-II. RESULTS 36 persons completed the study with no complications; only 4 of the 16 dropped out because of mild complications during the RAGT. Participants in Group A exhibited significant improvements in WISCI-II, 10MWT, 6MWT and TUG (p < 0.05), while those in Group B did not significantly improve their gait function but their walking velocity and resistance with the assistance of the robotic exoskeleton increased. SCIM-II scores increased followed therapy only in Group A. CONCLUSIONS Persons affected by SCI can safely experience their walking function with RAGT and FES therapy; only few mild complications were observed. Our data provides initial evidence of the potential value of these technologies, especially in persons with SCI having LEMS > 10.
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Affiliation(s)
| | | | | | - Carla D'Avino
- Spinal Cord Unit, Pisa University Hospital, Pisa, Italy
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