1
|
Pinelli E, Zinno R, Barone G, Bragonzoni L. Barriers and facilitators to exoskeleton use in persons with spinal cord injury: a systematic review. Disabil Rehabil Assist Technol 2024; 19:2355-2363. [PMID: 38009458 DOI: 10.1080/17483107.2023.2287153] [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: 08/27/2023] [Revised: 11/15/2023] [Accepted: 11/18/2023] [Indexed: 11/28/2023]
Abstract
PURPOSE Exoskeleton can assist individuals with spinal cord injuries (SCI) with simple movements and transform their lives by enhancing strength and mobility. Nonetheless, the current utilization outside of rehabilitation contexts is limited. To promote the widespread adoption of exoskeletons, it is crucial to consider the acceptance of these devices for both rehabilitation and functional purposes. This systematic review aims to identify the barriers or facilitators of the use of lower limbs exoskeletons, thereby providing strategies to improve interventions and increase the adoption of these devices. METHODS A comprehensive search was conducted in EMBASE, Web of Science, Scopus, Cochrane, and PubMed. Studies reporting barriers and facilitators of exoskeleton use were included. The studies' quality was assessed using the Mixed Methods Appraisal Tool and undertook a thematic content analysis for papers examining the barriers and facilitators. RESULTS Fifteen articles met the inclusion criteria. These revealed various factors that impact the utilization of exoskeletons. Factors like age, engagement in an active lifestyle, and motivation were identified as facilitators, while fear of falling and unfulfilled expectations were recognized as barriers. Physical aspects such as fatigue, neuropathic discomfort, and specific health conditions were found to be barriers. CONCLUSION This systematic review provides a comprehensive overview of the barriers and facilitators to the use of exoskeleton technology. There are therefore still challenges to be faced, efforts must be made to improve its design, functionality, and accessibility. By addressing these barriers, exoskeletons can significantly improve the quality of life of people with SCI.
Collapse
Affiliation(s)
- Erika Pinelli
- Department for Life Quality Studies, University of Bologna, Rimini, Italy
| | - Raffaele Zinno
- Department for Life Quality Studies, University of Bologna, Rimini, Italy
| | - Giuseppe Barone
- Department for Life Quality Studies, University of Bologna, Rimini, Italy
| | - Laura Bragonzoni
- Department for Life Quality Studies, University of Bologna, Rimini, Italy
| |
Collapse
|
2
|
Echevarria-Cruz E, McMillan DW, Reid KF, Valderrábano RJ. Spinal Cord Injury Associated Disease of the Skeleton, an Unresolved Problem with Need for Multimodal Interventions. Adv Biol (Weinh) 2024:e2400213. [PMID: 39074256 DOI: 10.1002/adbi.202400213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 07/11/2024] [Indexed: 07/31/2024]
Abstract
Spinal cord injury is associated with skeletal unloading, sedentary behavior, decreases in skeletal muscle mass, and exercise intolerance, which results in rapid and severe bone loss. To date, monotherapy with physical interventions such as weight-bearing in standing frames, computer-controlled electrically stimulated cycling and ambulation exercise, and low-intensity vibration are unsuccessful in maintaining bone density after SCI. Strategies to maintain bone density with commonly used osteoporosis medications also fail to provide a significant clinical benefit, potentially due to a unique pathology of bone deterioration in SCI. In this review, the available data is discussed on evaluating and monitoring bone loss, fracture, and physical and pharmacological therapeutic approaches to SCI-associated disease of the skeleton. The treatment of SCI-associated disease of the skeleton, the implications for clinical management, and areas of need are considered for future investigation.
Collapse
Affiliation(s)
- Evelyn Echevarria-Cruz
- Research Program in Men's Health, Aging and Metabolism, and Boston Claude D. Brigham and Women's Hospital, Harvard Medical School, 221 Longwood Ave Boston, 5th Floor, Boston, MA, 02115, USA
| | - David W McMillan
- The Miami Project to Cure Paralysis, University of Miami Leonard M. Miller School of Medicine, 1611 NW 12th ave, Office 2.141, Miami, FL, 33136, USA
- Department of Neurological Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, FL, 33136, USA
| | - Kieran F Reid
- Research Program in Men's Health, Aging and Metabolism, and Boston Claude D. Brigham and Women's Hospital, Harvard Medical School, 221 Longwood Ave Boston, 5th Floor, Boston, MA, 02115, USA
- Laboratory of Exercise Physiology and Physical Performance, Boston Claude D. Pepper Older Americans Independence Center for Function Promoting Therapies, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Rodrigo J Valderrábano
- Research Program in Men's Health, Aging and Metabolism, and Boston Claude D. Brigham and Women's Hospital, Harvard Medical School, 221 Longwood Ave Boston, 5th Floor, Boston, MA, 02115, USA
| |
Collapse
|
3
|
Metzger CE, Moore RC, Pirkle AS, Tak LY, Rau J, Bryan JA, Stefanov A, Allen MR, Hook MA. A moderate spinal contusion injury in rats alters bone turnover both below and above the level of injury with sex-based differences apparent in long-term recovery. Bone Rep 2024; 21:101761. [PMID: 38646090 PMCID: PMC11033081 DOI: 10.1016/j.bonr.2024.101761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Accepted: 04/07/2024] [Indexed: 04/23/2024] Open
Abstract
Spinal cord injury (SCI) leads to significant sublesional bone loss and high fracture rates. While loss of mechanical loading plays a significant role in SCI-induced bone loss, animal studies have demonstrated mechanical loading alone does not fully account for loss of bone following SCI. Indeed, we have shown that bone loss occurs below the level of an incomplete moderate contusion SCI, despite the resumption of weight-bearing and stepping. As systemic factors could also impact bone after SCI, bone alterations may also be present in bone sites above the level of injury. To examine this, we assessed bone microarchitecture and bone turnover in the supralesional humerus in male and female rats at two different ages following a moderate contusion injury in both sub-chronic (30 days) and chronic (180 days) time points after injury. At the 30-day timepoint, we found that both young and adult male SCI rats had decrements in trabecular bone volume at the supralesional proximal humerus (PH), while female SCI rats were not different from age-matched shams. At the 180-day timepoint, there were no statistical differences between SCI and sham groups, irrespective of age or sex, at the supralesional proximal humerus. At the 30-day timepoint, all SCI rats had lower BFR and higher osteoclast-covered trabecular surfaces in the proximal humerus compared to age-matched sham groups generally matching the pattern of SCI-induced changes in bone turnover seen in the sublesional proximal tibia. However, at the 180-day timepoint, only male SCI rats had lower BFR at the supralesional proximal humerus while female SCI rats had higher or no different BFR than their age-matched counterparts. Overall, this preclinical study demonstrates that a moderate contusion SCI leads to alterations in bone turnover above the level of injury within 30-days of injury; however male SCI rats maintained lower BFR in the supralesional humerus into long-term recovery. These data further highlight that bone loss after SCI is not driven solely by disuse. Additionally, these data allude to potential systemic factors exerting influence on bone following SCI and highlight the need to consider treatments for SCI-induced bone loss that impact both sublesional and systemic factors.
Collapse
Affiliation(s)
- Corinne E. Metzger
- Department of Anatomy, Cell Biology, and Physiology, Indiana University School of Medicine, Indianapolis, IN, United States of America
| | - Robert C. Moore
- Department of Anatomy, Cell Biology, and Physiology, Indiana University School of Medicine, Indianapolis, IN, United States of America
| | - Alexander S. Pirkle
- Department of Anatomy, Cell Biology, and Physiology, Indiana University School of Medicine, Indianapolis, IN, United States of America
| | - Landon Y. Tak
- Department of Anatomy, Cell Biology, and Physiology, Indiana University School of Medicine, Indianapolis, IN, United States of America
| | - Josephina Rau
- Department of Neuroscience and Experimental Therapeutics, Texas A&M University School of Medicine, Bryan, TX, United States of America
| | - Jessica A. Bryan
- Department of Neuroscience and Experimental Therapeutics, Texas A&M University School of Medicine, Bryan, TX, United States of America
| | - Alexander Stefanov
- Department of Neuroscience and Experimental Therapeutics, Texas A&M University School of Medicine, Bryan, TX, United States of America
| | - Matthew R. Allen
- Department of Anatomy, Cell Biology, and Physiology, Indiana University School of Medicine, Indianapolis, IN, United States of America
| | - Michelle A. Hook
- Department of Neuroscience and Experimental Therapeutics, Texas A&M University School of Medicine, Bryan, TX, United States of America
| |
Collapse
|
4
|
Ibitoye MO, Hamzaid NA, Ahmed YK. Effectiveness of FES-supported leg exercise for promotion of paralysed lower limb muscle and bone health-a systematic review. BIOMED ENG-BIOMED TE 2023:bmt-2021-0195. [PMID: 36852605 DOI: 10.1515/bmt-2021-0195] [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: 06/17/2021] [Accepted: 02/07/2023] [Indexed: 03/01/2023]
Abstract
Leg exercises through standing, cycling and walking with/without FES may be used to preserve lower limb muscle and bone health in persons with physical disability due to SCI. This study sought to examine the effectiveness of leg exercises on bone mineral density and muscle cross-sectional area based on their clinical efficacy in persons with SCI. Several literature databases were searched for potential eligible studies from the earliest return date to January 2022. The primary outcome targeted was the change in muscle mass/volume and bone mineral density as measured by CT, MRI and similar devices. Relevant studies indicated that persons with SCI that undertook FES- and frame-supported leg exercise exhibited better improvement in muscle and bone health preservation in comparison to those who were confined to frame-assisted leg exercise only. However, this observation is only valid for exercise initiated early (i.e., within 3 months after injury) and for ≥30 min/day for ≥ thrice a week and for up to 24 months or as long as desired and/or tolerable. Consequently, apart from the positive psychological effects on the users, leg exercise may reduce fracture rate and its effectiveness may be improved if augmented with FES.
Collapse
Affiliation(s)
- Morufu Olusola Ibitoye
- Department of Biomedical Engineering, Faculty of Engineering and Technology, University of Ilorin, Ilorin, Nigeria
| | - Nur Azah Hamzaid
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur Malaysia
| | - Yusuf Kola Ahmed
- Department of Biomedical Engineering, Faculty of Engineering and Technology, University of Ilorin, Ilorin, Nigeria
| |
Collapse
|
5
|
Lippi L, Folli A, Turco A, Moalli S, Curci C, Ammendolia A, de Sire A, Invernizzi M. The impact of rehabilitation in bone loss management of patients with spinal cord injury: A systematic review. J Back Musculoskelet Rehabil 2023; 36:1219-1235. [PMID: 37482985 DOI: 10.3233/bmr-230006] [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: 07/25/2023]
Abstract
BACKGROUND Spinal cord injury (SCI) is a disabling condition characterized by multilevel skeletal muscle impairment and rapid cortical and trabecular bone loss. Rehabilitation is a cornerstone of the long-term management of patients with SCI; however, the optimal rehabilitation strategy for improving bone health has not been fully characterized. OBJECTIVE To characterize the current evidence supporting different rehabilitation interventions improving bone health in patients with SCI. METHODS On November 17th, 2022, five databases (PubMed, Scopus, Web of Science, Cochrane, and PEDro) were systematically searched for randomized controlled trials (RCTs) assessing SCI patients undergoing rehabilitation interventions. The primary outcomes were bone macroscopical effects. Secondary outcomes were changes in bone metabolisms and functional outcomes. RESULTS Out of 499 records, 11 RCTs met the eligibility criteria and were included. Electrical stimulation combined with physical exercise was assessed by 5 studies, standing intervention was assessed by 3 studies, vibration was assessed by 1 study, ultrasound therapy was assessed by 1 study, and electroacupuncture combined with a pulsed magnetic field was assessed by 1 study. The rehabilitation intervention was administered combined with pharmacological treatment (3 studies) or alone (8 studies). Positive effects in terms of BMD were reported by 3 studies. The quality assessment revealed some concerns in 9 out of 11 studies, in accordance with the Cochrane Risk of Bias assessment - version 2. CONCLUSION Our data suggest that multicomponent interventions including rehabilitation might be considered a suitable option to improve bone health management in SCI patients. Further studies are mandatory to characterize the optimal combination of non-pharmacological interventions reducing bone loss and improving the risk of fractures in patients with SCI.
Collapse
Affiliation(s)
- Lorenzo Lippi
- Physical and Rehabilitative Medicine, Department of Health Sciences, University of Eastern Piedmont "A. Avogadro", Novara, Italy
- Translational Medicine, Dipartimento Attività Integrate Ricerca e Innovazione (DAIRI), Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Arianna Folli
- Physical and Rehabilitative Medicine, Department of Health Sciences, University of Eastern Piedmont "A. Avogadro", Novara, Italy
| | - Alessio Turco
- Physical and Rehabilitative Medicine, Department of Health Sciences, University of Eastern Piedmont "A. Avogadro", Novara, Italy
| | - Stefano Moalli
- Physical and Rehabilitative Medicine, Department of Health Sciences, University of Eastern Piedmont "A. Avogadro", Novara, Italy
| | - Claudio Curci
- Physical Medicine and Rehabilitation Unit, Department of Neurosciences, ASST Carlo Poma, Mantova, Italy
| | - Antonio Ammendolia
- Physical Medicine and Rehabilitation Unit, Department of Medical and Surgical Sciences, University of Catanzaro Magna Graecia, Catanzaro, Italy
| | - Alessandro de Sire
- Physical Medicine and Rehabilitation Unit, Department of Medical and Surgical Sciences, University of Catanzaro Magna Graecia, Catanzaro, Italy
| | - Marco Invernizzi
- Physical and Rehabilitative Medicine, Department of Health Sciences, University of Eastern Piedmont "A. Avogadro", Novara, Italy
- Translational Medicine, Dipartimento Attività Integrate Ricerca e Innovazione (DAIRI), Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| |
Collapse
|
6
|
Chen S, Wang Z, Li Y, Tang J, Wang X, Huang L, Fang Z, Xu T, Xu J, Guo F, Wang Y, Long J, Wang X, Liu F, Luo J, Wang Y, Huang X, Jia Z, Shuai M, Li J. Safety and Feasibility of a Novel Exoskeleton for Locomotor Rehabilitation of Subjects With Spinal Cord Injury: A Prospective, Multi-Center, and Cross-Over Clinical Trial. Front Neurorobot 2022; 16:848443. [PMID: 35645758 PMCID: PMC9133609 DOI: 10.3389/fnbot.2022.848443] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 03/16/2022] [Indexed: 11/25/2022] Open
Abstract
Objective To evaluate the safety, walking efficiency, physiological cost, don and doff time cost, and user satisfaction of Ai-robot. Design Prospective, multi-center, and cross-over trial. Subjects Paraplegic subjects (n = 40) with T6-L2 level spinal cord injury. Methods Subjects who could walk independently using Aiwalker, Ailegs, and hip knee ankle foot orthosis (HKAFO) for 6 min within 30 days of training underwent 10 sets of tests. In each set, they completed three 6-min walk test (6MWT) sessions using the three aids in random order. Results Skin lesions, pressure sores, and fractures, were the main adverse events, likely due to a lack of experience in using exoskeleton systems. The average 6MWT distances of the Aiwalker, Ailegs, and HKAFO groups were 134.20 ± 18.74, 79.71 ± 18.06, and 48.31 ± 19.87 m, respectively. The average heart rate increases in the Aiwalker (4.21 ± 8.20%) and Ailegs (41.81 ± 23.47%) groups were both significantly lower than that in the HKAFO group (62.33 ± 28.32%) (both p < 0.001). The average donning/doffing time costs for Ailegs and Aiwalker were significantly shorter than that of HKAFO (both p < 0.001). Satisfaction was higher in the Ailegs and Aiwalker groups (both p < 0.001). Conclusion Subjects with paraplegia below T6 level were able to ambulate safely and efficiently with Ai-robot. The use of Ai-robot should be learned under the guidance of experienced medical personnel.
Collapse
Affiliation(s)
- Sijing Chen
- Center of Rehabilitation Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
- Jiangsu Zhongshan Geriatric Rehabilitation Hospital, Nanjing, China
| | - Zhanbin Wang
- School of Automation Science and Electrical Engineering, Beihang University, Beijing, China
| | - Yongqiang Li
- Center of Rehabilitation Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
- Jiangsu Zhongshan Geriatric Rehabilitation Hospital, Nanjing, China
| | - Jiashuai Tang
- Jiangsu Zhongshan Geriatric Rehabilitation Hospital, Nanjing, China
| | - Xue Wang
- Center of Rehabilitation Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
- Jiangsu Zhongshan Geriatric Rehabilitation Hospital, Nanjing, China
| | - Liping Huang
- Department of Rehabilitation, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Zhuangwei Fang
- Department of Rehabilitation, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Tao Xu
- Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jiang Xu
- Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Feng Guo
- Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yizhao Wang
- Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jianjun Long
- Department of Rehabilitation, Shenzhen Second People's Hospital, Shenzhen, China
- Department of Rehabilitation, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Xiaodong Wang
- Department of Rehabilitation, Shenzhen Second People's Hospital, Shenzhen, China
- Department of Rehabilitation, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Fang Liu
- Department of Rehabilitation, Shenzhen Second People's Hospital, Shenzhen, China
- Department of Rehabilitation, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Jianfeng Luo
- Department of Biostatistics, School of Public Health, Fudan University, Shanghai, China
- NHC Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, China
- Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
| | - Yulong Wang
- Department of Rehabilitation, Shenzhen Second People's Hospital, Shenzhen, China
- Department of Rehabilitation, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Xiaolin Huang
- Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zishan Jia
- Department of Rehabilitation, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Mei Shuai
- School of Biological Science and Medical Engineering, Beijing Advanced Innovation Centre for Biomedical Engineering, Beihang University, Beijing, China
| | - Jianan Li
- Center of Rehabilitation Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
- Jiangsu Zhongshan Geriatric Rehabilitation Hospital, Nanjing, China
| |
Collapse
|
7
|
Sutor TW, Kura J, Mattingly AJ, Otzel DM, Yarrow JF. The Effects of Exercise and Activity-Based Physical Therapy on Bone after Spinal Cord Injury. Int J Mol Sci 2022; 23:608. [PMID: 35054791 PMCID: PMC8775843 DOI: 10.3390/ijms23020608] [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] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 12/15/2021] [Accepted: 12/21/2021] [Indexed: 02/04/2023] Open
Abstract
Spinal cord injury (SCI) produces paralysis and a unique form of neurogenic disuse osteoporosis that dramatically increases fracture risk at the distal femur and proximal tibia. This bone loss is driven by heightened bone resorption and near-absent bone formation during the acute post-SCI recovery phase and by a more traditional high-turnover osteopenia that emerges more chronically, which is likely influenced by the continual neural impairment and musculoskeletal unloading. These observations have stimulated interest in specialized exercise or activity-based physical therapy (ABPT) modalities (e.g., neuromuscular or functional electrical stimulation cycling, rowing, or resistance training, as well as other standing, walking, or partial weight-bearing interventions) that reload the paralyzed limbs and promote muscle recovery and use-dependent neuroplasticity. However, only sparse and relatively inconsistent evidence supports the ability of these physical rehabilitation regimens to influence bone metabolism or to increase bone mineral density (BMD) at the most fracture-prone sites in persons with severe SCI. This review discusses the pathophysiology and cellular/molecular mechanisms that influence bone loss after SCI, describes studies evaluating bone turnover and BMD responses to ABPTs during acute versus chronic SCI, identifies factors that may impact the bone responses to ABPT, and provides recommendations to optimize ABPTs for bone recovery.
Collapse
Affiliation(s)
- Tommy W. Sutor
- Research Service, Malcom Randall Department of Veterans Affairs Medical Center, North Florida/South Georgia Veterans Health System, Gainesville, FL 32608, USA; (T.W.S.); (J.K.)
- Brain Rehabilitation Research Center, Malcom Randall Department of Veterans Affairs Medical Center, North Florida/South Georgia Veterans Health System, Gainesville, FL 32608, USA;
| | - Jayachandra Kura
- Research Service, Malcom Randall Department of Veterans Affairs Medical Center, North Florida/South Georgia Veterans Health System, Gainesville, FL 32608, USA; (T.W.S.); (J.K.)
| | - Alex J. Mattingly
- Geriatrics Research, Education, and Clinical Center, North Florida/South Georgia Veterans Health System, Gainesville, FL 32608, USA;
| | - Dana M. Otzel
- Brain Rehabilitation Research Center, Malcom Randall Department of Veterans Affairs Medical Center, North Florida/South Georgia Veterans Health System, Gainesville, FL 32608, USA;
| | - Joshua F. Yarrow
- Research Service, Malcom Randall Department of Veterans Affairs Medical Center, North Florida/South Georgia Veterans Health System, Gainesville, FL 32608, USA; (T.W.S.); (J.K.)
- Brain Rehabilitation Research Center, Malcom Randall Department of Veterans Affairs Medical Center, North Florida/South Georgia Veterans Health System, Gainesville, FL 32608, USA;
- Division of Endocrinology, Diabetes, and Metabolism, University of Florida College of Medicine, Gainesville, FL 32611, USA
| |
Collapse
|
8
|
Holman ME, Chang G, Ghatas MP, Saha PK, Zhang X, Khan MR, Sima AP, Adler RA, Gorgey AS. Bone and non-contractile soft tissue changes following open kinetic chain resistance training and testosterone treatment in spinal cord injury: an exploratory study. Osteoporos Int 2021; 32:1321-1332. [PMID: 33443609 DOI: 10.1007/s00198-020-05778-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 12/04/2020] [Indexed: 01/30/2023]
Abstract
UNLABELLED Twenty men with spinal cord injury (SCI) were randomized into two 16-week intervention groups receiving testosterone treatment (TT) or TT combined with resistance training (TT + RT). TT + RT appears to hold the potential to reverse or slow down bone loss following SCI if provided over a longer period. INTRODUCTION Persons with SCI experience bone loss below the level of injury. The combined effects of resistance training and TT on bone quality following SCI remain unknown. METHODS Men with SCI were randomized into 16-week treatments receiving TT or TT + RT. Magnetic resonance imaging (MRI) of the right lower extremity before participation and post-intervention was used to visualize the proximal, middle, and distal femoral shaft, the quadriceps tendon, and the intermuscular fascia of the quadriceps. For the TT + RT group, MRI microarchitecture techniques were utilized to elucidate trabecular changes around the knee. Individual mixed models were used to estimate effect sizes. RESULTS Twenty participants completed the pilot trial. A small effect for yellow marrow in the distal femur was indicated as increases following TT and decreases following TT + RT were observed. Another small effect was observed as the TT + RT group displayed greater increases in intermuscular fascia length than the TT arm. Distal femur trabecular changes for the TT + RT group were generally small in effect (decreased trabecular thickness variability, spacing, and spacing variability; increased network area). Medium effects were generally observed in the proximal tibia (increased plate width, trabecular thickness, and network area; decreased trabecular spacing and spacing variability). CONCLUSIONS This pilot suggests longer TT + RT interventions may be a viable rehabilitation technique to combat bone loss following SCI. CLINICAL TRIAL REGISTRATION Registered with clinicaltrials.gov : NCT01652040 (07/27/2012).
Collapse
Affiliation(s)
- M E Holman
- Spinal Cord Injury and Disorders, Hunter Holmes McGuire VAMC, Richmond, VA, 23249, USA
| | - G Chang
- Department of Radiology, NYU School of Medicine, New York, NY, 10016, USA
| | - M P Ghatas
- Spinal Cord Injury and Disorders, Hunter Holmes McGuire VAMC, Richmond, VA, 23249, USA
| | - P K Saha
- Department of Electrical and Computer Engineering, University of Iowa, Iowa City, IA, 52242, USA
- Department of Radiology, University of Iowa, Iowa City, IA, 52242, USA
| | - X Zhang
- Department of Electrical and Computer Engineering, University of Iowa, Iowa City, IA, 52242, USA
| | - M R Khan
- Department of Radiology, Hunter Holmes McGuire VAMC, Richmond, VA, 23249, USA
| | - A P Sima
- Department of Biostatistics, Virginia Commonwealth University, Richmond, VA, 23284, USA
| | - R A Adler
- Spinal Cord Injury and Disorders, Hunter Holmes McGuire VAMC, Richmond, VA, 23249, USA
| | - A S Gorgey
- Spinal Cord Injury and Disorders, Hunter Holmes McGuire VAMC, Richmond, VA, 23249, USA.
- Department of Physical Medicine & Rehabilitation, Virginia Commonwealth University, Richmond, VA, 23284, USA.
| |
Collapse
|
9
|
Fang Y, Morse LR, Nguyen N, Battaglino RA, Goldstein RF, Troy KL. Functional electrical stimulation (FES)-assisted rowing combined with zoledronic acid, but not alone, preserves distal femur strength and stiffness in people with chronic spinal cord injury. Osteoporos Int 2021; 32:549-558. [PMID: 32888047 DOI: 10.1007/s00198-020-05610-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 08/25/2020] [Indexed: 01/04/2023]
Abstract
UNLABELLED We investigated the effect of 12 months of functional electrical stimulation-assisted rowing with and without zoledronic acid (ZA) on computationally estimated bone strength and stiffness in individuals with spinal cord injury. We found that rowing with ZA, but not rowing alone, improved stiffness at the distal femur, but not the proximal tibia. INTRODUCTION People with spinal cord injury (SCI) have high fracture risk at the knee after the injury. Therapies that prevent bone loss or stimulate an anabolic response in bone have been proposed to reduce fractures. Zoledronic acid (ZA) is a potent bisphosphonate that inhibits osteoclastic resorption. Functional electrical stimulation (FES)-assisted rowing is a potentially osteogenic exercise involving mechanical stimulation to the lower extremities. Here, we investigated the effect of FES-assisted rowing with and without ZA on bone strength and stiffness in individuals with SCI. METHODS Twenty individuals from a cohort of adults with SCI who participated in a clinical trial were included in the study. CT scans of their knees before and after the intervention were converted to finite element models. Bone failure strength (Tult) and stiffness were calculated at the proximal tibia and distal femur. RESULTS Tult at the distal femur increased 4.6% among people who received rowing + ZA and decreased 13.9% among those with rowing only (p < 0.05 for group). Torsional and compressive stiffness at the femur metaphysis increased in people with rowing + ZA (+ 3 to +4%) and decreased in people with rowing only (- 7 to -8%; p < 0.05). Tult in the proximal tibia decreased in everyone, but the loss was attenuated in the rowing + ZA group. People with initially stronger bone tended to lose more strength. CONCLUSION Overall, we observed increases in bone strength at the distal femur but not the proximal tibia, with FES-assisted rowing combined with ZA treatment. Rowing alone did not significantly prevent bone loss at either site, which might be attributed to insufficient mechanical loading.
Collapse
Affiliation(s)
- Y Fang
- Department of Mechanical Engineering, Northern Arizona University, Flagstaff, AZ, USA
| | - L R Morse
- Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, MN, USA
| | - N Nguyen
- Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, MN, USA
| | - R A Battaglino
- Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, MN, USA
| | - R F Goldstein
- Spaulding Rehabilitation Hospital, Department of Physical Medicine and Rehabilitation, Harvard Medical School, Cambridge, MA, USA
| | - K L Troy
- Department of Biomedical Engineering, Worcester Polytechnic Institute, Worcester, MA, USA.
| |
Collapse
|
10
|
Ferrigno B, Bordett R, Duraisamy N, Moskow J, Arul MR, Rudraiah S, Nukavarapu SP, Vella AT, Kumbar SG. Bioactive polymeric materials and electrical stimulation strategies for musculoskeletal tissue repair and regeneration. Bioact Mater 2020; 5:468-485. [PMID: 32280836 PMCID: PMC7139146 DOI: 10.1016/j.bioactmat.2020.03.010] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 03/15/2020] [Accepted: 03/20/2020] [Indexed: 12/14/2022] Open
Abstract
Electrical stimulation (ES) is predominantly used as a physical therapy modality to promote tissue healing and functional recovery. Research efforts in both laboratory and clinical settings have shown the beneficial effects of this technique for the repair and regeneration of damaged tissues, which include muscle, bone, skin, nerve, tendons, and ligaments. The collective findings of these studies suggest ES enhances cell proliferation, extracellular matrix (ECM) production, secretion of several cytokines, and vasculature development leading to better tissue regeneration in multiple tissues. However, there is still a gap in the clinical relevance for ES to better repair tissue interfaces, as ES applied clinically is ineffective on deeper tissue. The use of a conducting material can transmit the stimulation applied from skin electrodes to the desired tissue and lead to an increased function on the repair of that tissue. Ionically conductive (IC) polymeric scaffolds in conjunction with ES may provide solutions to utilize this approach effectively. Injectable IC formulations and their scaffolds may provide solutions for applying ES into difficult to reach tissue types to enable tissue repair and regeneration. A better understanding of ES-mediated cell differentiation and associated molecular mechanisms including the immune response will allow standardization of procedures applicable for the next generation of regenerative medicine. ES, along with the use of IC scaffolds is more than sufficient for use as a treatment option for single tissue healing and may fulfill a role in interfacing multiple tissue types during the repair process.
Collapse
Affiliation(s)
- Bryan Ferrigno
- Department of Orthopedic Surgery, University of Connecticut Health, Farmington, CT, USA
| | - Rosalie Bordett
- Department of Orthopedic Surgery, University of Connecticut Health, Farmington, CT, USA
| | - Nithyadevi Duraisamy
- Department of Orthopedic Surgery, University of Connecticut Health, Farmington, CT, USA
| | - Joshua Moskow
- Department of Orthopedic Surgery, University of Connecticut Health, Farmington, CT, USA
| | - Michael R. Arul
- Department of Orthopedic Surgery, University of Connecticut Health, Farmington, CT, USA
| | - Swetha Rudraiah
- Department of Orthopedic Surgery, University of Connecticut Health, Farmington, CT, USA
- Department of Pharmaceutical Sciences, University of Saint Joseph, Hartford, CT, USA
| | - Syam P. Nukavarapu
- Department of Biomedical Engineering, University of Connecticut, Storrs, CT, USA
- Department of Orthopedic Surgery, University of Connecticut Health, Farmington, CT, USA
| | - Anthony T. Vella
- Department of Department of Immunology, University of Connecticut Health, Farmington, CT, USA
| | - Sangamesh G. Kumbar
- Department of Biomedical Engineering, University of Connecticut, Storrs, CT, USA
- Department of Orthopedic Surgery, University of Connecticut Health, Farmington, CT, USA
| |
Collapse
|
11
|
Zleik N, Weaver F, Harmon RL, Le B, Radhakrishnan R, Jirau-Rosaly WD, Craven BC, Raiford M, Hill JN, Etingen B, Guihan M, Heggeness MH, Ray C, Carbone L. Prevention and management of osteoporosis and osteoporotic fractures in persons with a spinal cord injury or disorder: A systematic scoping review. J Spinal Cord Med 2019; 42:735-759. [PMID: 29745791 PMCID: PMC6830234 DOI: 10.1080/10790268.2018.1469808] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Objectives: The primary objective was to review the literature regarding methodologies to assess fracture risk, to prevent and treat osteoporosis and to manage osteoporotic fractures in SCI/D.Study Design: Scoping review.Settings/Participants: Human adult subjects with a SCI/D.Outcome measures: Strategies to identify persons with SCI/D at risk for osteoporotic fractures, nonpharmacological and pharmacological therapies for osteoporosis and management of appendicular fractures.Results: 226 articles were included in the scoping review. Risk of osteoporotic fractures in SCI is predicted by a combination of DXA-defined low BMD plus clinical and demographic characteristics. Screening for secondary causes of osteoporosis, in particular hyperparathyroidism, hyperthyroidism, vitamin D insufficiency and hypogonadism, should be considered. Current antiresorptive therapies for treatment of osteoporosis have limited efficacy. Use of surgery to treat fractures has increased and outcomes are good and comparable to conservative treatment in most cases. A common adverse event following fracture was delayed healing.Conclusions: Most of the research in this area is limited by small sample sizes, weak study designs, and significant variation in populations studied. Future research needs to address cohort definition and study design issues.
Collapse
Affiliation(s)
- Nour Zleik
- Charlie Norwood Veterans Administration Medical Center, Augusta, Georgia, USA
- Department of Medicine, Division of Rheumatology, Medical College of Georgia at Augusta University, Augusta, Georgia, USA
| | - Frances Weaver
- Center of Innovation for Complex Chronic Healthcare (CINCCH), Health Services Research & Development, Department of Veterans Affairs, Hines VA Hospital, Hines, Illinois, USA
- Department of Public Health Sciences, Stritch School of Medicine, Loyola University, Maywood, Illinois, USA
| | - Robert L. Harmon
- Charlie Norwood Veterans Administration Medical Center, Augusta, Georgia, USA
| | - Brian Le
- Charlie Norwood Veterans Administration Medical Center, Augusta, Georgia, USA
- Department of Medicine, Division of Rheumatology, Medical College of Georgia at Augusta University, Augusta, Georgia, USA
| | | | - Wanda D. Jirau-Rosaly
- Department of Medicine, Division of Geriatrics, Medical College of Georgia at Augusta University, Augusta, Georgia, USA
| | - B. Catharine Craven
- Department of Medicine, Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, Ontario, Canada
| | - Mattie Raiford
- School of Medicine, Medical College of Georgia at Augusta University, Augusta, Georgia, USA
| | - Jennifer N. Hill
- Department of Public Health Sciences, Stritch School of Medicine, Loyola University, Maywood, Illinois, USA
| | - Bella Etingen
- Center of Innovation for Complex Chronic Healthcare (CINCCH), Health Services Research & Development, Department of Veterans Affairs, Hines VA Hospital, Hines, Illinois, USA
| | - Marylou Guihan
- Center of Innovation for Complex Chronic Healthcare (CINCCH), Health Services Research & Development, Department of Veterans Affairs, Hines VA Hospital, Hines, Illinois, USA
| | - Michael H. Heggeness
- Department of Orthopaedic Surgery, University of Kansas School of Medicine, Wichita, Kansas, USA
| | - Cara Ray
- Center of Innovation for Complex Chronic Healthcare (CINCCH), Health Services Research & Development, Department of Veterans Affairs, Hines VA Hospital, Hines, Illinois, USA
- Department of Public Health Sciences, Stritch School of Medicine, Loyola University, Maywood, Illinois, USA
| | - Laura Carbone
- Charlie Norwood Veterans Administration Medical Center, Augusta, Georgia, USA
- Department of Medicine, Division of Rheumatology, Medical College of Georgia at Augusta University, Augusta, Georgia, USA
| |
Collapse
|
12
|
Morse LR, Biering-Soerensen F, Carbone LD, Cervinka T, Cirnigliaro CM, Johnston TE, Liu N, Troy KL, Weaver FM, Shuhart C, Craven BC. Bone Mineral Density Testing in Spinal Cord Injury: 2019 ISCD Official Position. J Clin Densitom 2019; 22:554-566. [PMID: 31501005 DOI: 10.1016/j.jocd.2019.07.012] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 07/29/2019] [Indexed: 02/06/2023]
Abstract
Spinal cord injury (SCI) causes rapid osteoporosis that is most severe below the level of injury. More than half of those with motor complete SCI will experience an osteoporotic fracture at some point following their injury, with most fractures occurring at the distal femur and proximal tibia. These fractures have devastating consequences, including delayed union or nonunion, cellulitis, skin breakdown, lower extremity amputation, and premature death. Maintaining skeletal integrity and preventing fractures is imperative following SCI to fully benefit from future advances in paralysis cure research and robotic-exoskeletons, brain computer interfaces and other evolving technologies. Clinical care has been previously limited by the lack of consensus derived guidelines or standards regarding dual-energy X-ray absorptiometry-based diagnosis of osteoporosis, fracture risk prediction, or monitoring response to therapies. The International Society of Clinical Densitometry convened a task force to establish Official Positions for bone density assessment by dual-energy X-ray absorptiometry in individuals with SCI of traumatic or nontraumatic etiology. This task force conducted a series of systematic reviews to guide the development of evidence-based position statements that were reviewed by an expert panel at the 2019 Position Development Conference in Kuala Lumpur, Malaysia. The resulting the International Society of Clinical Densitometry Official Positions are intended to inform clinical care and guide the diagnosis of osteoporosis as well as fracture risk management of osteoporosis following SCI.
Collapse
Affiliation(s)
- Leslie R Morse
- Department of Rehabilitation Medicine, University of Minnesota School of Medicine, Minneapolis, MN, USA.
| | - Fin Biering-Soerensen
- Clinic for Spinal Cord Injuries, Neuroscience Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Laura D Carbone
- Charlie Norwood Veterans Affairs Medical Center, Augusta, GA, USA; Department of Medicine, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Tomas Cervinka
- Department of Physiotherapy and Rehabilitation, Faculty of Health and Welfare, Satakunta University of Applied Sciences, Pori, Finland
| | - Christopher M Cirnigliaro
- Department of Veterans Affairs Rehabilitation Research & Development Service National Center for the Medical Consequences of Spinal Cord Injury, James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA
| | - Therese E Johnston
- Department of Physical Therapy, Jefferson College of Rehabilitation Sciences, Thomas Jefferson University, Philadelphia, PA
| | - Nan Liu
- Department of Rehabilitation Medicine and Osteoporosis and Metabolic Bone Disease Center, Peking University Third Hospital, Beijing, China
| | - Karen L Troy
- Department of Biomedical Engineering, Worcester Polytechnic Institute, Worcester, MA, USA
| | - Frances M Weaver
- Center of Innovation for Complex Chronic Healthcare (CINCCH), Health Services Research & Development, Department of Veterans Affairs, Hines VA Hospital, Hines, IL, USA; Department of Public Health Sciences, Stritch School of Medicine, Loyola University, Maywood, IL, USA
| | - Christopher Shuhart
- Swedish Bone Health and Osteoporosis Center, Swedish Medical Group, Seattle WA, USA
| | - Beverley C Craven
- Neural Engineering and Therapeutics Team, KITE Research Institute - University Health Network, Department of Medicine, University of Toronto, Toronto, Ontario Canada
| |
Collapse
|
13
|
Paillard T. Regular Muscle Electrical Stimulation Could Act Favorably On Bone Mineral Density in Healthy Aged Subjects. Front Physiol 2018; 9:1035. [PMID: 30108520 PMCID: PMC6079577 DOI: 10.3389/fphys.2018.01035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 07/11/2018] [Indexed: 01/08/2023] Open
|
14
|
Evidence-based prevention and treatment of osteoporosis after spinal cord injury: a systematic review. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2017; 27:1798-1814. [PMID: 28497215 DOI: 10.1007/s00586-017-5114-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Accepted: 04/29/2017] [Indexed: 12/23/2022]
Abstract
PURPOSE Spinal cord injury (SCI) results in accelerated bone mineral density (BMD) loss and disorganization of trabecular bone architecture. The mechanisms underlying post-SCI osteoporosis are complex and different from other types of osteoporosis. Findings of studies investigating efficacy of pharmacological or rehabilitative interventions in SCI-related osteoporosis are controversial. The aim of this study was to review the literature pertaining to prevention and evidence-based treatments of SCI-related osteoporosis. METHODS In this systematic review, MEDLINE, EMBASE, PubMed, and the Cochrane Library were used to identify papers from 1946 to December 31, 2015. The search strategy involved the following keywords: spinal cord injury, osteoporosis, and bone loss. RESULTS Finally, 56 studies were included according to the inclusion criteria. Only 16 randomized controlled trials (involving 368 patients) were found. We found following evidences for effectiveness of bisphosphonates in prevention of BMD loss in acute SCI: very low-quality evidence for clodronate and etidronate, low-quality evidence for alendronate, and moderate-quality evidence for zoledronic acid. Low-quality evidence showed no effectiveness for tiludronate. In chronic SCI cases, we found low-quality evidence for effectiveness of vitamin D3 analogs combined with 1-alpha vitamin D2. However, low-quality inconsistent evidence exists for alendronate. For non-pharmacologic interventions, very low-quality evidence exists for effectiveness of standing with or without treadmill walking in acute SCI. Other low-quality evidences indicated that electrical stimulation, tilt-table standing, and ultrasound provide no significant effects. Very low-quality evidence did not show any benefit for low-intensity (3 days per week) cycling with functional electrical stimulator in chronic SCI. CONCLUSIONS No recommendations can be made from this review, regarding overall low quality of evidence as a result of high risk of bias, low sample size in most of the studies, and notable heterogeneity in type of intervention, outcome measurement, and duration of treatment. Therefore, future high-quality RCT studies with higher sample sizes and more homogeneity are strongly recommended to provide high-quality evidence and make applicable recommendations for prevention and treatment of SCI-related bone loss.
Collapse
|
15
|
Bethel M, Weaver FM, Bailey L, Miskevics S, Svircev JN, Burns SP, Hoenig H, Lyles K, Carbone LD. Risk factors for osteoporotic fractures in persons with spinal cord injuries and disorders. Osteoporos Int 2016; 27:3011-21. [PMID: 27230522 DOI: 10.1007/s00198-016-3627-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 05/02/2016] [Indexed: 01/15/2023]
Abstract
UNLABELLED Clinical risk factors for fracture were explored among Veterans with a spinal cord injury. At the end of 11 years of follow-up, the absolute risk of fracture was approximately 20 %. Among the clinical and SCI-related factors explored, a prior history of fracture was strongly associated with incident fracture. INTRODUCTION Few studies to date have comprehensively addressed clinical risk factors for fracture in persons with spinal cord injury (SCI). The purpose of this study was to identify risk factors for incident osteoporotic fractures in persons with a SCI that can be easily determined at the point of care. METHODS The Veteran's Affairs Spinal Cord Dysfunction Registry, a national database of persons with a SCI, was used to examine clinical and SCI-related risk factors for fracture. Incident fractures were identified in a cohort of persons with chronic SCI, defined as SCI present for at least 2 years. Cox regression models were used to estimate the risk of incident fractures. RESULTS There were 22,516 persons with chronic SCI included in the cohort with 3365 incident fractures. The mean observational follow-up time for the overall sample was 6.2 years (median 6.0, IQR 2.9-11.0). The mean observational follow-up time for the fracture group was 3.9 years (median 3.3, IQR 1.4-6.1) and 6.7 years (median 6.7, IQR 3.1-11.0) for the nonfracture group. By the end of the study, which included predominantly older Veterans with a SCI observed for a relatively short period of time, the absolute (i.e., cumulative hazard) for incident fractures was 0.17 (95%CI 0.14-0.21). In multivariable analysis, factors associated with an increased risk of fracture included White race, traumatic etiology of SCI, paraplegia, complete extent of SCI, longer duration of SCI, use of anticonvulsants and opioids, prevalent fractures, and higher Charlson Comorbidity Indices. Women aged 50 and older were also at higher risk of sustaining an incident fracture at any time during the 11-year follow-up period. CONCLUSIONS There are multiple clinical and SCI-related risk factors which can be used to predict fracture in persons with a SCI. Clinicians should be particularly concerned about incident fracture risk in persons with a SCI who have had a previous fracture.
Collapse
Affiliation(s)
- M Bethel
- Charlie Norwood Veterans Affairs Medical Center, Augusta, GA, USA.
- Department of Medicine, Medical College of Georgia, Augusta University, 1120 15th St, Augusta, GA, USA.
| | - F M Weaver
- Center of Innovation for Complex Chronic Healthcare, Edward J. Hines, Jr. VA Hospital, Hines, IL, USA
- Stritch School of Medicine, Loyola University, Maywood, IL, USA
| | - L Bailey
- Center of Innovation for Complex Chronic Healthcare, Edward J. Hines, Jr. VA Hospital, Hines, IL, USA
- Department of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, IL, USA
| | - S Miskevics
- Center of Innovation for Complex Chronic Healthcare, Edward J. Hines, Jr. VA Hospital, Hines, IL, USA
| | - J N Svircev
- VA Puget Sound Health Care System-Seattle Division, Seattle, WA, USA
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - S P Burns
- VA Puget Sound Health Care System-Seattle Division, Seattle, WA, USA
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - H Hoenig
- Durham VA Medical Center, Durham, NC, USA
| | - K Lyles
- Department of Medicine, Duke University, Durham, NC, USA
- Geriatric Research, Education, and Clinical Center, VAMC, Durham, NC, USA
| | - L D Carbone
- Charlie Norwood Veterans Affairs Medical Center, Augusta, GA, USA
- Department of Medicine, Medical College of Georgia, Augusta University, 1120 15th St, Augusta, GA, USA
| |
Collapse
|
16
|
Popovic MR, Zivanovic V, Valiante TA. Restoration of Upper Limb Function in an Individual with Cervical Spondylotic Myelopathy using Functional Electrical Stimulation Therapy: A Case Study. Front Neurol 2016; 7:81. [PMID: 27375547 PMCID: PMC4901066 DOI: 10.3389/fneur.2016.00081] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 05/05/2016] [Indexed: 11/13/2022] Open
Abstract
Non-traumatic spinal cord pathology is responsible for 25–52% of all spinal cord lesions. Studies have revealed that spinal stenosis accounts for 16–21% of spinal cord injury (SCI) admissions. Impaired grips as well as slow unskilled hand and finger movements are the most common complaints in patients with spinal cord disorders, such as myelopathy secondary to cervical spondylosis. In the past, our team carried out couple of successful clinical trials, including two randomized control trials, showing that functional electrical stimulation therapy (FEST) can restore voluntary reaching and/or grasping function, in people with stroke and traumatic SCI. Motivated by this success, we decided to examine changes in the upper limb function following FEST in a patient who suffered loss of hand function due to myelopathy secondary to cervical spondylosis. The participant was a 61-year-old male who had C3–C7 posterior laminectomy and instrumented fusion for cervical myelopathy. The participant presented with progressive right hand weakness that resulted in his inability to voluntarily open and close the hand and to manipulate objects unilaterally with his right hand. The participant was enrolled in the study ~22 months following initial surgical intervention. Participant was assessed using Toronto Rehabilitation Institute’s Hand Function Test (TRI-HFT), Action Research Arm Test (ARAT), Functional Independence Measure (FIM), and Spinal Cord Independence Measure (SCIM). The pre–post differences in scores on all measures clearly demonstrated improvement in voluntary hand function following 15 1-h FEST sessions. The changes observed were meaningful and have resulted in substantial improvement in performance of activities of daily living. These results provide preliminary evidence that FEST has a potential to improve upper limb function in patients with non-traumatic SCI, such as myelopathy secondary to cervical spondylosis.
Collapse
Affiliation(s)
- Milos R Popovic
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON, Canada; Rehabilitation Engineering Laboratory, Lyndhurst Centre, Toronto Rehabilitation Institute - University Health Network, Toronto, ON, Canada
| | - Vera Zivanovic
- Rehabilitation Engineering Laboratory, Lyndhurst Centre, Toronto Rehabilitation Institute - University Health Network , Toronto, ON , Canada
| | - Taufik A Valiante
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON, Canada; Krembil Research Institute - University Health Network, Toronto, ON, Canada
| |
Collapse
|
17
|
Dolbow DR, Gorgey AS. Effects of Use and Disuse on Non-paralyzed and Paralyzed Skeletal Muscles. Aging Dis 2016; 7:68-80. [PMID: 26816665 PMCID: PMC4723235 DOI: 10.14336/ad.2015.0826] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 08/26/2015] [Indexed: 01/03/2023] Open
Abstract
Skeletal muscle is an integral part of the somatic nervous system and plays a primary role in the performance of physical activities. Because physical activity is vital to countering the effects of aging and age related diseases and is a key component in the maintenance of healthy body composition it is important to understand the effects of use and disuse on skeletal muscle. While voluntary muscle activity provides optimal benefits to muscle and the maintenance of healthy body composition, neuromuscular electrical stimulation may be a viable alternative activity for individuals with paralysis. Body composition with a healthy muscle to fat ratio has been associated with healthy blood lipid and glucose profiles that may decrease the risk of cardiovascular and metabolic diseases.
Collapse
Affiliation(s)
- David R. Dolbow
- School of Kinesiology, College of Health, University of Southern Mississippi, Hattiesburg, MS 39406, USA
| | - Ashraf S. Gorgey
- Spinal Cord Injury and Disorders Service, Hunter Holmes McGuire VAMC, Richmond, VA 23249, USA
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA 23298, USA
| |
Collapse
|
18
|
Nagai MK, Marquez-Chin C, Popovic MR. Why Is Functional Electrical Stimulation Therapy Capable of Restoring Motor Function Following Severe Injury to the Central Nervous System? Transl Neurosci 2016. [DOI: 10.1007/978-1-4899-7654-3_25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
|
19
|
Panisset MG, Galea MP, El-Ansary D. Does early exercise attenuate muscle atrophy or bone loss after spinal cord injury? Spinal Cord 2015; 54:84-92. [PMID: 26345485 DOI: 10.1038/sc.2015.150] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 07/27/2015] [Accepted: 07/29/2015] [Indexed: 11/09/2022]
Abstract
OBJECTIVES To systematically identify and assess the evidence on the efficacy of exercise initiated early after traumatic spinal cord injury (SCI). METHODS A comprehensive search (Any-2014) of eleven databases identified studies evaluating exercise interventions initiated within 12 weeks after SCI on muscle and bone loss in paralyzed limbs and comparing with standard care or immobilization. Two reviewers assessed methodological quality. One reviewer extracted data and critiqued results according to the Spinal Cord Injury Rehabilitation Evidence body of evidence framework. RESULTS A total of 2811 titles were screened. Eleven studies were included: five randomized controlled trials, four cohort studies and two within-subject control studies. All provided level II evidence with a moderate risk of bias. Two studies found significant positive effects of high-load FES-resisted stance on physiological measures of muscle. Three reported positive effects of 3 months of Functional Electrical Stimulation (FES) on muscle size. Two studies found positive effects of 6-month body-weight supported treadmill training or FES on trabecular bone using pQCT. CONCLUSION We found consistent evidence of positive effects of early exercise on muscle, possibly related to load intensity of the protocol. However, the heterogeneity of interventions and outcomes makes this determination speculative. Evidence for the effectiveness of early exercise on bone is scant and confined to measures of trabecular bone mineral density via pQCT. Transparent reporting of methods and variability of data, combined with standardization of valid and sensitive measures of muscle atrophy and bone loss, could facilitate future meta-analysis on this topic.
Collapse
Affiliation(s)
- M G Panisset
- Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia
| | - M P Galea
- Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia
| | - D El-Ansary
- Department of Physiotherapy, Melbourne School of Health Sciences, The University of Melbourne, Parkville, Victoria, Australia
| |
Collapse
|
20
|
Wuermser LA, Beck LA, Lamb JL, Atkinson EJ, Amin S. The effect of low-magnitude whole body vibration on bone density and microstructure in men and women with chronic motor complete paraplegia. J Spinal Cord Med 2015; 38:178-86. [PMID: 24621040 PMCID: PMC4397199 DOI: 10.1179/2045772313y.0000000191] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVE To examine the effect of low-magnitude whole body vibration on bone density and microstructure in women and men with chronic motor complete paraplegia. METHODS We studied nine subjects (four women and five men) with motor complete paraplegia of 2 years duration or more, age 20-50 years. Subjects were instructed to stand on a low-magnitude vibration plate within a standing frame for 20 minutes per day, 5 days a week, and for 6 months. Bone density at the proximal femur by dual-energy X-ray absorptiometry and bone microstructure at the distal tibia by high-resolution peripheral quantitative computed tomography were assessed at four timepoints over 12 months (baseline, at 3 months and 6 months while on intervention, and after 6 months off intervention). RESULTS Standing on the low-magnitude vibration plate with a standing frame was well tolerated by participants. However, most subjects did not show an improvement in bone density or microstructure after 6 months of intervention, or any relevant changes 6 months following the discontinuation of the low-magnitude vibration. CONCLUSION We were unable to identify an improvement in either bone density or microstructure following 6 months use of a low-magnitude vibration plate in women or men with chronic motor complete paraplegia. Longer duration of use may be necessary, or it is possible that this intervention is of limited benefit following chronic spinal cord injury.
Collapse
Affiliation(s)
- Lisa-Ann Wuermser
- Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Lisa A. Beck
- Department of Physical Medicine and Rehabilitation, College of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Jeffry L. Lamb
- Department of Physical Medicine and Rehabilitation, College of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Elizabeth J. Atkinson
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, College of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Shreyasee Amin
- Correspondence to: Shreyasee Amin, Division of Rheumatology, College of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
| |
Collapse
|
21
|
Bone mass in individuals with chronic spinal cord injury: associations with activity-based therapy, neurologic and functional status, a retrospective study. Arch Phys Med Rehabil 2014; 95:2342-9. [PMID: 25083557 DOI: 10.1016/j.apmr.2014.07.395] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Revised: 07/11/2014] [Accepted: 07/12/2014] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To describe the prevalence of osteoporosis and its association with functional electrical stimulation (FES) use in individuals with spinal cord injury (SCI)-related paralysis. DESIGN Retrospective cross-sectional evaluation. SETTING Clinic. PARTICIPANTS Consecutive persons with SCI (N=364; 115 women, 249 men) aged between 18 and 80 years who underwent dual-energy x-ray absorptiometry (DXA) examinations. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE Prevalence of osteoporosis defined as DXA T score ≤-2.5. RESULTS The prevalence of osteoporosis was 34.9% (n=127). Use of FES was associated with 31.2% prevalence of osteoporosis compared with 39.5% among persons not using FES. In multivariate adjusted logistic regression analysis, FES use was associated with 42% decreased odds of osteoporosis after adjusting for sex, age, body mass index, type and duration of injury, Lower Extremity Motor Scores, ambulation, previous bone fractures, and use of calcium, vitamin D, and anticonvulsant; (adjusted odds ratio [OR]=.58; 95% confidence interval [CI], .35-.99; P=.039). Duration of injury >1 year was associated with a 3-fold increase in odds of osteoporosis compared with individuals with injury <1 year; (adjusted OR=3.02; 95% CI, 1.60-5.68; P=.001). CONCLUSIONS FES cycling ergometry may be associated with a decreased loss of bone mass after paralysis. Further prospective examination of the role of FES in preserving bone mass will improve our understanding of this association.
Collapse
|
22
|
Zamarioli A, Maranho DA, Butezloff MM, Moura PA, Volpon JB, Shimano AC. Anatomic changes in the macroscopic morphology and microarchitecture of denervated long bone tissue after spinal cord injury in rats. BIOMED RESEARCH INTERNATIONAL 2014; 2014:853159. [PMID: 25136632 PMCID: PMC4127270 DOI: 10.1155/2014/853159] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Revised: 06/23/2014] [Accepted: 06/24/2014] [Indexed: 11/17/2022]
Abstract
To study the effects of mechanical loading on bones after SCI, we assessed macro- and microscopic anatomy in rats submitted to passive standing (PS) and electrical stimulation (ES). The study design was based on two main groups of juvenile male Wistar rats with SCI: one was followed for 33 days with therapies starting at day 3 and the other was followed for 63 days with therapies starting at day 33. Both groups were composed of four subgroups (n = 10/group): (1) Sham, (2) SCI, (3) SCI + PS, and (4) SCI + ES. Rehabilitation protocol consisted of a 20-minute session, 3x/wk for 30 days. The animals were sequentially weighed and euthanized. The femur and tibia were assessed macroscopically and microscopically by scanning electronic microscopy (SEM). The SCI rats gained less weight than Sham-operated animals. Significant reduction of bone mass and periosteal radii was observed in the SCI rats, whereas PS and ES efficiently improved the macroscopic parameters. The SEM images showed less and thin trabecular bone in SCI rats. PS and ES efficiently ameliorated the bone microarchitecture deterioration by thickening and increasing the trabeculae. Based on the detrimental changes in bone tissue following SCI, the mechanical loading through weight bearing and muscle contraction may decrease the bone loss and restore the macro- and microanatomy.
Collapse
Affiliation(s)
- Ariane Zamarioli
- Department of Biomechanics, Medicine and Rehabilitation, School of Medicine of Ribeirão Preto, University of São Paulo, Avenida Bandeirantes 3900, 14049-900 Ribeirão Preto, SP, Brazil
- Laboratory of Bioengineering, School of Medicine of Ribeirão Preto, University of São Paulo, Pedreira de Freitas, Casa 1, Avenida Bandeirantes 3900, 14049-900 Ribeirão Preto, SP, Brazil
| | - Daniel A. Maranho
- Department of Biomechanics, Medicine and Rehabilitation, School of Medicine of Ribeirão Preto, University of São Paulo, Avenida Bandeirantes 3900, 14049-900 Ribeirão Preto, SP, Brazil
| | - Mariana M. Butezloff
- Department of Biomechanics, Medicine and Rehabilitation, School of Medicine of Ribeirão Preto, University of São Paulo, Avenida Bandeirantes 3900, 14049-900 Ribeirão Preto, SP, Brazil
| | - Patrícia A. Moura
- Department of Biomechanics, Medicine and Rehabilitation, School of Medicine of Ribeirão Preto, University of São Paulo, Avenida Bandeirantes 3900, 14049-900 Ribeirão Preto, SP, Brazil
| | - José Batista Volpon
- Department of Biomechanics, Medicine and Rehabilitation, School of Medicine of Ribeirão Preto, University of São Paulo, Avenida Bandeirantes 3900, 14049-900 Ribeirão Preto, SP, Brazil
| | - Antônio C. Shimano
- Department of Biomechanics, Medicine and Rehabilitation, School of Medicine of Ribeirão Preto, University of São Paulo, Avenida Bandeirantes 3900, 14049-900 Ribeirão Preto, SP, Brazil
| |
Collapse
|
23
|
Sabour H, Norouzi Javidan A, Latifi S, Larijani B, Shidfar F, Vafa MR, Heshmat R, Emami Razavi H. Bone biomarkers in patients with chronic traumatic spinal cord injury. Spine J 2014; 14:1132-8. [PMID: 24139865 DOI: 10.1016/j.spinee.2013.07.475] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2012] [Revised: 06/27/2013] [Accepted: 07/25/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Bone loss after spinal cord injury (SCI) occurs because of pathologic changes in osteoblastic and osteoclastic activities due to mechanical unloading. Some biochemical changes in bone metabolism after SCI are described before that were related to bone mineral loss. PURPOSE Our purpose was to determine bone markers' changes and related effective factors in patients with chronic traumatic SCI. STUDY DESIGN This investigation was designed as an observational cross-sectional study. PATIENT SAMPLE All patients with chronic SCI who were referred to Brain and Spinal Injury Research Center and did not meet our exclusion criteria entered the study. OUTCOME MEASURES Self-reporting measures including patient's demographic features and date of accident were obtained using a questionnaire and physiologic measures including spinal magnetic resonance imaging to determine the level of injury accompanied with physical examination along with dual-energy X-ray absorptiometry were performed. Blood samples were analyzed in the laboratory. METHODS Dual-energy X-ray was used to determine bone mineral density in femoral and spinal vertebrae bone sites. Serum level of C-telopeptide cross-linked Type 1 collagen (CTX), parathyroid hormone, calcitonin, osteocalcin, and bone alkaline phosphatase (BALP) were measured. RESULTS We detected a negative association between CTX level and bone mineral density in femoral and spinal bone sites that confirms that CTX is a bone resorption marker. C-telopeptide cross-linked Type 1 collagen and BALP levels did not show any significant correlation with postduration injury. Patients with spinal injury at lumbar level had the highest calcitonin level (p<.04). C-telopeptide cross-linked Type 1 collagen was positively related with osteocalcin and BALP (p<.0001, r=0.51), and osteocalcin was positively related with BALP (p<.0001, r=0.44). Osteocalcin was related negatively only to femoral intertrochanteric zone bone mineral density. CONCLUSIONS Some bone biomarkers undergo noticeable changes after SCI. C-telopeptide cross-linked Type 1 collagen was positively correlated with BALP and osteocalcin that shows the coincidental occurrence of osteoblastic and osteoclastic activities. Our data also support this fact that although bone reduction after 2 years is slower than acute phase after SCI, bone resorption rate is higher than bone formation. These bone markers also revealed different site of action as osteocalcin level only affected femoral intertrochanteric bone mineral density. Generally, it seems that the coincidental consideration of these factors that influence bone mineral density can lead to a better understanding of bone changes after SCI.
Collapse
Affiliation(s)
- Hadis Sabour
- Brain and Spinal Injury (BASIR) Research Center, Imam Khomeini Hospital, Tehran University of Medical Sciences, Keshavarz Avenu, Tehran, Iran
| | - Abbas Norouzi Javidan
- Brain and Spinal Injury (BASIR) Research Center, Imam Khomeini Hospital, Tehran University of Medical Sciences, Keshavarz Avenu, Tehran, Iran.
| | - Sahar Latifi
- Brain and Spinal Injury (BASIR) Research Center, Imam Khomeini Hospital, Tehran University of Medical Sciences, Keshavarz Avenu, Tehran, Iran
| | - Bagher Larijani
- Endocrinology and Metabolism Research Institute (EMRI), Endocrinology Department, Tehran University of Medical Sciences, North Kargar St, Tehran, Iran
| | - Farzad Shidfar
- Department of Nutrition, Iran University of Medical Sciences, Hemat Highway, Tehran, Iran
| | - Mohammad Reza Vafa
- Department of Nutrition, Iran University of Medical Sciences, Hemat Highway, Tehran, Iran
| | - Ramin Heshmat
- Endocrinology and Metabolism Research Institute (EMRI), Endocrinology Department, Tehran University of Medical Sciences, North Kargar St, Tehran, Iran
| | - Hassan Emami Razavi
- Brain and Spinal Injury (BASIR) Research Center, Imam Khomeini Hospital, Tehran University of Medical Sciences, Keshavarz Avenu, Tehran, Iran
| |
Collapse
|
24
|
Meng Q, Liu X, Shan Q, Yu P, Mao Z, Zhang F, Li J, Zhao T. Acupuncture for treatment of secondary osteoporosis in patients with spinal cord injury: a controlled study. Acupunct Med 2014; 32:381-6. [PMID: 24926075 DOI: 10.1136/acupmed-2013-010463] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE We explored the effect of adjunctive acupuncture on secondary osteoporosis in patients with spinal cord injury (SCI). METHODS Patients with subacute SCI were recruited and divided into two groups by patient choice: group 1 patients received standard combination therapy and group 2 patients received combination therapy plus acupuncture for 3 months. The concentrations of IgG, IgM and tumour necrosis factor α (TNFα) in serum and the bone mineral density were measured before and after treatment. RESULT The decrease in the concentration of TNFα and IgM in patients in group 2 compared with those in group 1 was statistically significant. The IgG level showed no significant change in either group. Bone mineral density increased more after adjunctive acupuncture, but the difference was not significant. CONCLUSIONS Further research is needed to determine whether acupuncture as an adjunct to combination therapy can reduce osteoporosis in patients with subacute SCI. TRIAL REGISTRATION NUMBER P153-2008-36.
Collapse
Affiliation(s)
- Qingxi Meng
- Department of Spinal Cord Injury, Institute of Orthopedics and Traumatology of Chinese PLA, General Hospital of Jinan Military Area Command, Jinan, Shandong, China
| | - Xin Liu
- Department of Spinal Cord Injury, Institute of Orthopedics and Traumatology of Chinese PLA, General Hospital of Jinan Military Area Command, Jinan, Shandong, China
| | - Qunqun Shan
- Department of Spinal Cord Injury, Institute of Orthopedics and Traumatology of Chinese PLA, General Hospital of Jinan Military Area Command, Jinan, Shandong, China
| | - Peng Yu
- The First Veteran Institute of Jinan Military Region, Jinan, Shandong, China
| | - Zhaohu Mao
- Department of Spinal Cord Injury, Institute of Orthopedics and Traumatology of Chinese PLA, General Hospital of Jinan Military Area Command, Jinan, Shandong, China
| | - Fan Zhang
- Department of Spinal Cord Injury, Institute of Orthopedics and Traumatology of Chinese PLA, General Hospital of Jinan Military Area Command, Jinan, Shandong, China
| | - Jian Li
- Department of Spinal Cord Injury, Institute of Orthopedics and Traumatology of Chinese PLA, General Hospital of Jinan Military Area Command, Jinan, Shandong, China
| | - Tingbao Zhao
- Department of Spinal Cord Injury, Institute of Orthopedics and Traumatology of Chinese PLA, General Hospital of Jinan Military Area Command, Jinan, Shandong, China
| |
Collapse
|
25
|
Arija-Blázquez A, Ceruelo-Abajo S, Díaz-Merino MS, Godino-Durán JA, Martínez-Dhier L, Martin JLR, Florensa-Vila J. Effects of electromyostimulation on muscle and bone in men with acute traumatic spinal cord injury: A randomized clinical trial. J Spinal Cord Med 2014; 37:299-309. [PMID: 24090427 PMCID: PMC4064579 DOI: 10.1179/2045772313y.0000000142] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
OBJECTIVE To study the effect of 14 weeks of electromyostimulation (EMS) training (47 minutes/day, 5 days/week) on both muscle and bone loss prevention in persons with recent, complete spinal cord injury (SCI). DESIGN Prospective, experimental, controlled, single-blind randomized trial with external blind evaluation by third parties. METHODS Eight men with recent SCI (8 weeks from injury; ASIA Impairment Scale (AIS) "A") were randomized into the intervention or the control groups. Cross-sectional area of the quadriceps femoris (QF) muscle was quantified using magnetic resonance imaging. Bone mineral density changes were assessed with a dual-energy X-ray absorptiometry. Several bone biomarkers (i.e. total testosterone, cortisol, growth hormone, insulin-growth factor I, osteocalcin, serum type I collagen C-telopeptide), lipid, and lipoprotein profiles were quantified. A standard oral glucose tolerance test was performed before and after the 14-week training. All analyses were conducted at the beginning and after the intervention. RESULTS The intervention group showed a significant increase in QF muscle size when compared with the control group. Bone losses were similar in both groups. Basal levels of bone biomarkers did not change over time. Changes in lipid and lipoprotein were similar in both groups. Glucose and insulin peaks moved forward after the training in the intervention group. CONCLUSIONS This study indicates that skeletal muscle of patients with complete SCI retains the ability to grow in response to a longitudinal EMS training, while bone does not respond to similar external stimulus. Increases in muscle mass might have induced improvements in whole body insulin-induced glucose uptake.
Collapse
Affiliation(s)
- Alfredo Arija-Blázquez
- GENUD Toledo Research Group, University of Castilla-La Mancha, Toledo, Spain,Correspondence to: Alfredo Arija-Blázquez, GENUD Toledo Research Group, University of Castilla-La Mancha, Campus Tecnológico Fábrica de Armas, Avda. Carlos III, s/n, 45071, Toledo, Spain.
| | | | | | | | | | - José L. R. Martin
- Centro de Excelencia de Investigación en Salud y Ciencias de la Vida, Escuela de Doctorado e Investigación, Universidad Europea de Madrid, Spain
| | | |
Collapse
|
26
|
Carbone LD, Chin AS, Burns SP, Svircev JN, Hoenig H, Heggeness M, Bailey L, Weaver F. Mortality after lower extremity fractures in men with spinal cord injury. J Bone Miner Res 2014; 29:432-9. [PMID: 23873733 DOI: 10.1002/jbmr.2050] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Revised: 06/28/2013] [Accepted: 07/11/2013] [Indexed: 01/22/2023]
Abstract
In the United States, there are over 200,000 men with spinal cord injuries (SCIs) who are at risk for lower limb fractures. The risk of mortality after fractures in SCI is unknown. This was a population-based, cohort study of all male veterans (mean age 54.1; range, 20.3-100.5 years) with a traumatic SCI of at least 2 years' duration enrolled in the Veterans Affairs (VA) Spinal Cord Dysfunction Registry from FY2002 to FY2010 to determine the association between lower extremity fractures and mortality. Mortality for up to 5 years was determined. The lower extremity fracture rate was 2.14 per 100 patient-years at risk for at least one fracture. In unadjusted models and in models adjusted for demographic, SCI-related factors, healthcare use, and comorbidities, there was a significant association between incident lower extremity fracture and increased mortality (hazard ratio [HR], 1.38; 95% confidence interval [CI], 1.17-1.63; HR, 1.36; 95% CI, 1.15-1.61, respectively). In complete SCI, the hazard of death after lower extremity fracture was also increased (unadjusted model: HR, 1.46; 95% CI, 1.13-1.89; adjusted model: HR, 1.32; 95% CI, 1.02-1.71). In fully-adjusted models, the association of incident lower extremity fracture with increased mortality was substantially greater in older men (age ≥50 years) for the entire cohort (HR, 3.42; 95% CI, 2.75-4.25) and for those with complete SCI (HR, 3.13; 95% CI, 2.19-4.45), compared to younger men (age <50 years) (entire cohort: HR, 1.42; 95% CI, 0.94-2.14; complete SCI: HR, 1.71; 95% CI, 0.98-3.01). Every additional point in the Charlson comorbidity index was associated with a 10% increase in the hazard of death in models involving the entire cohort (HR, 1.11; 95% CI, 1.09-1.13) and also in models limited to men with complete SCI (HR, 1.10; 95% CI, 1.06-1.15). These data support the concept that both the fracture itself and underlying comorbidities are drivers of death in men with SCI.
Collapse
Affiliation(s)
- Laura D Carbone
- Veterans Affairs Medical Center, Memphis, TN, USA; Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | | | | | | | | | | | | | | |
Collapse
|
27
|
Pall ML. Electromagnetic fields act via activation of voltage-gated calcium channels to produce beneficial or adverse effects. J Cell Mol Med 2013; 17:958-65. [PMID: 23802593 PMCID: PMC3780531 DOI: 10.1111/jcmm.12088] [Citation(s) in RCA: 246] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Accepted: 05/20/2013] [Indexed: 12/27/2022] Open
Abstract
The direct targets of extremely low and microwave frequency range electromagnetic fields (EMFs) in producing non-thermal effects have not been clearly established. However, studies in the literature, reviewed here, provide substantial support for such direct targets. Twenty-three studies have shown that voltage-gated calcium channels (VGCCs) produce these and other EMF effects, such that the L-type or other VGCC blockers block or greatly lower diverse EMF effects. Furthermore, the voltage-gated properties of these channels may provide biophysically plausible mechanisms for EMF biological effects. Downstream responses of such EMF exposures may be mediated through Ca2+/calmodulin stimulation of nitric oxide synthesis. Potentially, physiological/therapeutic responses may be largely as a result of nitric oxide-cGMP-protein kinase G pathway stimulation. A well-studied example of such an apparent therapeutic response, EMF stimulation of bone growth, appears to work along this pathway. However, pathophysiological responses to EMFs may be as a result of nitric oxide-peroxynitrite-oxidative stress pathway of action. A single such well-documented example, EMF induction of DNA single-strand breaks in cells, as measured by alkaline comet assays, is reviewed here. Such single-strand breaks are known to be produced through the action of this pathway. Data on the mechanism of EMF induction of such breaks are limited; what data are available support this proposed mechanism. Other Ca2+-mediated regulatory changes, independent of nitric oxide, may also have roles. This article reviews, then, a substantially supported set of targets, VGCCs, whose stimulation produces non-thermal EMF responses by humans/higher animals with downstream effects involving Ca2+/calmodulin-dependent nitric oxide increases, which may explain therapeutic and pathophysiological effects.
Collapse
Affiliation(s)
- Martin L Pall
- Professor Emeritus of Biochemistry and Basic Medical Sciences, Washington State University, Portland, OR, USA.
| |
Collapse
|
28
|
Battaglino RA, Lazzari AA, Garshick E, Morse LR. Spinal cord injury-induced osteoporosis: pathogenesis and emerging therapies. Curr Osteoporos Rep 2012; 10:278-85. [PMID: 22983921 PMCID: PMC3508135 DOI: 10.1007/s11914-012-0117-0] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Spinal cord injury causes rapid, severe osteoporosis with increased fracture risk. Mechanical unloading after paralysis results in increased osteocyte expression of sclerostin, suppressed bone formation, and indirect stimulation of bone resorption. At this time, there are no clinical guidelines to prevent bone loss after SCI, and fractures are common. More research is required to define the pathophysiology and epidemiology of SCI-induced osteoporosis. This review summarizes emerging therapeutics including anti-sclerostin antibodies, mechanical loading of the lower extremity with electrical stimulation, and mechanical stimulation via vibration therapy.
Collapse
|
29
|
Dudley-Javoroski S, Saha PK, Liang G, Li C, Gao Z, Shields RK. High dose compressive loads attenuate bone mineral loss in humans with spinal cord injury. Osteoporos Int 2012; 23:2335-46. [PMID: 22187008 PMCID: PMC3374128 DOI: 10.1007/s00198-011-1879-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2011] [Accepted: 11/04/2011] [Indexed: 10/14/2022]
Abstract
UNLABELLED People with spinal cord injury (SCI) lose bone and muscle integrity after their injury. Early doses of stress, applied through electrically induced muscle contractions, preserved bone density at high-risk sites. Appropriately prescribed stress early after the injury may be an important consideration to prevent bone loss after SCI. INTRODUCTION Skeletal muscle force can deliver high compressive loads to bones of people with spinal cord injury (SCI). The effective osteogenic dose of load for the distal femur, a chief site of fracture, is unknown. The purpose of this study is to compare three doses of bone compressive loads at the distal femur in individuals with complete SCI who receive a novel stand training intervention. METHODS Seven participants performed unilateral quadriceps stimulation in supported stance [150% body weight (BW) compressive load-"High Dose" while opposite leg received 40% BW-"Low Dose"]. Five participants stood passively without applying quadriceps electrical stimulation to either leg (40% BW load-"Low Dose"). Fifteen participants performed no standing (0% BW load-"Untrained") and 14 individuals without SCI provided normative data. Participants underwent bone mineral density (BMD) assessment between one and six times over a 3-year training protocol. RESULTS BMD for the High Dose group significantly exceeded BMD for both the Low Dose and the Untrained groups (p < 0.05). No significant difference existed between the Low Dose and Untrained groups (p > 0.05), indicating that BMD for participants performing passive stance did not differ from individuals who performed no standing. High-resolution CT imaging of one High Dose participant revealed 86% higher BMD and 67% higher trabecular width in the High Dose limb. CONCLUSION Over 3 years of training, 150% BW compressive load in upright stance significantly attenuated BMD decline when compared to passive standing or to no standing. High-resolution CT indicated that trabecular architecture was preserved by the 150% BW dose of load.
Collapse
Affiliation(s)
- S. Dudley-Javoroski
- Physical Therapy and Rehabilitation Science, Carver College of Medicine, The University of Iowa, 1-252 Medical Education Building, Iowa City, IA 52242-1190, USA
| | - P. K. Saha
- Department of Electrical and Computer Engineering, The University of Iowa, Iowa City, IA 52242-1190, USA
- Department of Radiology, Carver College of Medicine, The University of Iowa, Iowa City, IA 52242-1190, USA
| | - G. Liang
- Department of Electrical and Computer Engineering, The University of Iowa, Iowa City, IA 52242-1190, USA
| | - C. Li
- Department of Electrical and Computer Engineering, The University of Iowa, Iowa City, IA 52242-1190, USA
| | - Z. Gao
- Department of Electrical and Computer Engineering, The University of Iowa, Iowa City, IA 52242-1190, USA
| | - R. K. Shields
- Physical Therapy and Rehabilitation Science, Carver College of Medicine, The University of Iowa, 1-252 Medical Education Building, Iowa City, IA 52242-1190, USA
| |
Collapse
|
30
|
Arija-Blázquez A, Ceruelo-Abajo S, Díaz-Merino MS, Godino-Durán JA, Martínez-Dhier L, Florensa-Vila J. Time-course response in serum markers of bone turnover to a single-bout of electrical stimulation in patients with recent spinal cord injury. Eur J Appl Physiol 2012; 113:89-97. [PMID: 22576416 DOI: 10.1007/s00421-012-2416-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2012] [Accepted: 04/30/2012] [Indexed: 12/14/2022]
Abstract
The objective of the present repeat-measures study was to determine whether plasma serum levels of testosterone, cortisol, osteocalcin or type I collagen C-telopeptide (CT) are acutely affected following an electro-myostimulation (EMS) bout, and their relation to bone mineral density and muscle mass. Ten men with recent (8 weeks) thoracic spinal cord injury (SCI) (ASIA A) and 10 age-matched able-bodied (AB) men performed one EMS bout on the quadriceps femoris muscle. Blood samples were drawn at basal condition, immediately after EMS, and 15 min, 30 min, 24 h and 48 h post-EMS. Muscle cross-sectional area was measured by magnetic resonance imaging. Bone mineral density (BMD) was determined by dual-energy X-ray absorptiometry. In the SCI group, a significant decrease in testosterone, cortisol and CT together with a significant increase in testosterone/cortisol ratio and osteocalcin/CT ratio was observed after EMS. For the AB subjects, only testosterone and CT decreased significantly following EMS. Muscle size was only related to testosterone/cortisol ratio in the SCI sample (R = 0.659, p < 0.05), whereas BMD did not show any relation to any biomarker. Acute EMS in recent spinal cord injured men seems to induce positive effects on bone turnover biomarkers, and anabolic and catabolic hormones.
Collapse
|
31
|
Abstract
SETTING Spinal cord injury (SCI) causes devastating loss of function and can result in serious secondary complications. Although significant advances are being made to develop cellular and molecular therapies to promote regeneration, it is important to optimize physical interventions. OBJECTIVES The objective of this review was to examine the evidence for the effects of physical rehabilitation strategies on health and fitness, and maintenance of target systems below the level of injury (for example, muscle, bone, circulation). RESULTS Exercise appears to be a potent means of achieving these goals, using a variety of strategies. CONCLUSION Physical rehabilitation after SCI needs to move beyond the goal of maximizing independence to focus on maintenance of optimum health and fitness as well as maintenance of target system function below the level of injury. Issues requiring further investigation include identification of the optimum dosage of interventions to achieve specific goals, for example, prevention of muscle atrophy and osteoporosis, and development and validation of simple clinical measures to monitor the changes in body composition. Adoption of a classification system for physical interventions and standardized outcome measures would facilitate large-scale observational studies to identify the critical variables contributing to better outcomes.
Collapse
Affiliation(s)
- M P Galea
- Rehabilitation Sciences Research Centre, The University of Melbourne, Parkville, Victoria, Australia.
| |
Collapse
|