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Irrgang S, Himmelhaus S, Allek K, Debecker I, Gemperli A, Kynast K, von Reumont A, Scheel-Sailer A. Assessments and interventions on body functions, structures and activity to prepare adults with acute spinal cord injury or disease for participation: a scoping review. FRONTIERS IN REHABILITATION SCIENCES 2024; 5:1272682. [PMID: 38601217 PMCID: PMC11004486 DOI: 10.3389/fresc.2024.1272682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 03/18/2024] [Indexed: 04/12/2024]
Abstract
Introduction In the acute phase after a spinal cord injury or disease (SCI/D), various therapeutic assessments and interventions are applied with the goal of restoring structures, preventing complications and preparing the patient as best as possible for further activity and finally participation. The goal was to identify and evaluate the available evidence on assessments and interventions for body functions and structures to prepare adults with acute spinal cord SCI/D for activity and participation during the first 14 days. Methods A scoping review was conducted. The search was performed on June 19, 2023 using the databases PubMed, PEDro, Cochrane library and Embase. These were screened for studies including patients with acute SCI/D and physiotherapeutic or occupational therapy assessments and interventions. Only studies in English or German published between 2012 and 2023 were included. Results Twelve publications met the inclusion criteria, namely three systematic reviews, two randomized controlled trials, two observational studies and five clinical practice guidelines. Assessments as the Spinal Cord Independence Measure, as well as exercises such as daily passive mobilization of body structures against contractures were used in the entire population, while others were only applied in subgroups of SCI/D such as the Graded Redefined Assessment of Strength, Sensation and Prehension or functional electrical stimulation with and without additional movements. The methodological quality of the studies found varied greatly from good to very poor. Discussion Heterogeneity in research design and study population as well as lack of high-quality studies do not cover the standard of clinical management in the acute phase and further comprehensive research is needed.
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Affiliation(s)
- Sophie Irrgang
- Health Services and Clinical Care Group, Swiss Paraplegic Research, Nottwil, Switzerland
- Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Sandra Himmelhaus
- Health Services and Clinical Care Group, Swiss Paraplegic Research, Nottwil, Switzerland
| | - Kirstin Allek
- Spinal Cord Injury Center, Zentralklinik Bad Berka, Bad Berka, Germany
| | | | - Armin Gemperli
- Health Services and Clinical Care Group, Swiss Paraplegic Research, Nottwil, Switzerland
- Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Karen Kynast
- Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany
| | - Anne von Reumont
- Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany
| | - Anke Scheel-Sailer
- Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
- Swiss Paraplegic Center, Nottwil, Switzerland
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Readioff R, Siddiqui ZK, Stewart C, Fulbrook L, O’Connor RJ, Chadwick EK. Use and evaluation of assistive technologies for upper limb function in tetraplegia. J Spinal Cord Med 2022; 45:809-820. [PMID: 33606599 PMCID: PMC9662059 DOI: 10.1080/10790268.2021.1878342] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
CONTEXT More than half of all spinal cord injuries (SCI) occur at the cervical level leading to loss of upper limb function, restricted activity and reduced independence. Several technologies have been developed to assist with upper limb functions in the SCI population. OBJECTIVE There is no clear clinical consensus on the effectiveness of the current assistive technologies for the cervical SCI population, hence this study reviews the literature in the years between 1999 and 2019. METHODS A systematic review was performed on the state-of-the-art assistive technology that supports and improves the function of impaired upper limbs in cervical SCI populations. Combinations of terms, covering assistive technology, SCI, and upper limb, were used in the search, which resulted in a total of 1770 articles. Data extractions were performed on the selected studies which involved summarizing details on the assistive technologies, characteristics of study participants, outcome measures, and improved upper limb functions when using the device. RESULTS A total of 24 articles were found and grouped into five categories, including neuroprostheses (invasive and non-invasive), orthotic devices, hybrid systems, robots, and arm supports. Only a few selected studies comprehensively reported characteristics of the participants. There was a wide range of outcome measures and all studies reported improvements in upper limb function with the devices. CONCLUSIONS This study highlighted that assistive technologies can improve functions of the upper limbs in SCI patients. It was challenging to draw generalizable conclusions because of factors, such as heterogeneity of recruited participants, a wide range of outcome measures, and the different technologies employed.
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Affiliation(s)
- Rosti Readioff
- School of Pharmacy and Bioengineering, Keele University, Stoke-on-Trent, UK,Correspondence to: Rosti Readioff, Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, LeedsLS2 9JT, UK. ; @Dr_Rosti
| | - Zaha Kamran Siddiqui
- Academic Department of Rehabilitation Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Caroline Stewart
- School of Pharmacy and Bioengineering, Keele University, Stoke-on-Trent, UK,The Orthotic Research and Locomotor Assessment Unit (ORLAU), the Robert Jones and Agnes Hunt Orthopaedic Hospital, NHS Foundation Trust, Oswestry, UK
| | - Louisa Fulbrook
- The Orthotic Research and Locomotor Assessment Unit (ORLAU), the Robert Jones and Agnes Hunt Orthopaedic Hospital, NHS Foundation Trust, Oswestry, UK
| | - Rory J. O’Connor
- Academic Department of Rehabilitation Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, UK
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Cardoso LRL, Bochkezanian V, Forner-Cordero A, Melendez-Calderon A, Bo APL. Soft robotics and functional electrical stimulation advances for restoring hand function in people with SCI: a narrative review, clinical guidelines and future directions. J Neuroeng Rehabil 2022; 19:66. [PMID: 35773733 PMCID: PMC9245887 DOI: 10.1186/s12984-022-01043-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 06/02/2022] [Indexed: 11/10/2022] Open
Abstract
Background Recovery of hand function is crucial for the independence of people with spinal cord injury (SCI). Wearable devices based on soft robotics (SR) or functional electrical stimulation (FES) have been employed to assist the recovery of hand function both during activities of daily living (ADLs) and during therapy. However, the implementation of these wearable devices has not been compiled in a review focusing on the functional outcomes they can activate/elicit/stimulate/potentiate. This narrative review aims at providing a guide both for engineers to help in the development of new technologies and for clinicians to serve as clinical guidelines based on the available technology in order to assist and/or recover hand function in people with SCI. Methods A literature search was performed in Scopus, Pubmed and IEEE Xplore for articles involving SR devices or FES systems designed for hand therapy or assistance, published since 2010. Only studies that reported functional outcomes from individuals with SCI were selected. The final collections of both groups (SR and FES) were analysed based on the technical aspects and reported functional outcomes. Results A total of 37 out of 1101 articles were selected, 12 regarding SR and 25 involving FES devices. Most studies were limited to research prototypes, designed either for assistance or therapy. From an engineering perspective, technological improvements for home-based use such as portability, donning/doffing and the time spent with calibration were identified. From the clinician point of view, the most suitable technical features (e.g., user intent detection) and assessment tools should be determined according to the particular patient condition. A wide range of functional assessment tests were adopted, moreover, most studies used non-standardized tests. Conclusion SR and FES wearable devices are promising technologies to support hand function recovery in subjects with SCI. Technical improvements in aspects such as the user intent detection, portability or calibration as well as consistent assessment of functional outcomes were the main identified limitations. These limitations seem to be be preventing the translation into clinical practice of these technological devices created in the laboratory.
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Affiliation(s)
- Lucas R L Cardoso
- Biomedical Engineering, School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, Australia.
| | - Vanesa Bochkezanian
- College of Health Sciences, School of Health, Medical and Applied Sciences, Central Queensland University, North Rockhampton, Australia
| | - Arturo Forner-Cordero
- Biomechatronics Laboratory, Escola Politecnica, University of São Paulo, São Paulo, Brazil
| | - Alejandro Melendez-Calderon
- Biomedical Engineering, School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, Australia.,School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia.,Jamieson Trauma Institute, Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Brisbane, Australia
| | - Antonio P L Bo
- Biomedical Engineering, School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, Australia
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Aspinall P, Harrison L, Scheuren P, Cragg JJ, Ferguson AR, Guest JD, Hsieh J, Jones L, Kirshblum S, Lammertse D, Kwon BK, Kramer JLK. A Systematic Review of Safety Reporting in Acute Spinal Cord Injury Clinical Trials: Challenges and Recommendations. J Neurotrauma 2021; 38:2047-2054. [PMID: 33899507 DOI: 10.1089/neu.2020.7540] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Accurate safety information in published clinical trials guides the assessment of risk-benefit, as well as the design of future clinical trials. Comprehensive reporting of adverse events, toxicity, and discontinuations from acute spinal cord injury clinical trials is an essential step in this process. Here, we sought to assess the degree of "satisfactoriness" of reporting in past clinical trials in spinal cord injury. A review of citations from MEDLINE and EMBASE identified eligible clinical trials in acute (within 30 days) spinal cord injury. English language studies, published between 1980 and 2020, with sensory, motor, or autonomic neurological assessments as the primary outcome measure were eligible for inclusion. Criteria were then established to qualify the safety reporting as satisfactory (i.e., distinguished severe/life-threatening events), partially satisfactory, or unsatisfactory (i.e., only mentioned in general statements, or reported but without distinguishing severe events). A total of 40 trials were included. Satisfactory reporting for clinical adverse events was observed in 30% of trials; partially satisfactory was achieved by 10% of the trials, and the remaining 60% were unsatisfactory. The majority of trials were determined to be unsatisfactory for the reporting of laboratory-defined toxicity (82.5%); only 17.5% were satisfactory. Discontinuations were satisfactorily reported for the majority of trials (80%), with the remaining partially satisfactory (5%) or unsatisfactory (15%). Reporting of safety in clinical trials for acute spinal cord injury is suboptimal. Due to the complexities of acute spinal cord injury (e.g., polytrauma, multiple systems affected), tailored and specific standards for tracking adverse events and safety reporting should be established.
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Affiliation(s)
- Paul Aspinall
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, British Columbia, Canada
| | - Liam Harrison
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, British Columbia, Canada
| | - Paulina Scheuren
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Jacquelyn J Cragg
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, British Columbia, Canada
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Adam R Ferguson
- Data Science, Brain and Spinal Injury Center, Department of Neurological Surgery, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, California, USA
- San Francisco Veteran's Affairs Healthcare System, San Francisco, California, USA
| | - James D Guest
- Department of Neurological Surgery, University of Miami and the Miami Project to Cure Paralysis, Miami, Florida, USA
| | | | - Linda Jones
- Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Steven Kirshblum
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, New Jersey, USA
- Kessler Institute for Rehabilitation, West Orange, New Jersey, USA
| | | | - Brian K Kwon
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, British Columbia, Canada
| | - John L K Kramer
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, British Columbia, Canada
- Department of Anesthesiology, Pharmacology, and Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada
- Djavad Mowafaghian Center for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada
- Hugill Center for Anesthesiology, University of British Columbia, Vancouver, British Columbia, Canada
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Liu X, Wang J, Li G, Lv H. Effect of combined chondroitinase ABC and hyperbaric oxygen therapy in a rat model of spinal cord injury. Mol Med Rep 2018; 18:25-30. [PMID: 29749479 PMCID: PMC6059675 DOI: 10.3892/mmr.2018.8933] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Accepted: 11/10/2017] [Indexed: 01/03/2023] Open
Abstract
The present study aimed to investigate the effect of combined hyperbaric oxygen (HBO) and chondroitinase ABC (ChABC) enzyme therapy in a rat model of spinal cord injury (SCI) and to explore the underlying mechanisms. A total of 48 healthy male Wistar rats were randomly divided into six groups: Sham, SCI, vehicle, HBO, ChABC enzyme and HBO + ChABC. Excluding the sham group, SCI was established in rats by a clip compression injury and rats subsequently received HBO treatment for 2 weeks with or without an intraspinal injection of 0.1 U/µl ChABC. Neuromotor functions were examined using the Basso‑Beattie‑Bresnahan locomotor rating scale and the inclined plane assessment at baseline and for 4 weeks following SCI establishment. Superoxide dismutase (SOD) and malondialdehyde (MDA) levels were also measured, in addition to the expression of glycogen synthase kinase‑3β (GSK3β) and aquaporin 4 (AQP4). Results revealed that combined HBO and ChABC treatment significantly improved neuromotor function compared with the HBO or ChABC treatments alone. HBO and/or ChABC treatment significantly increased SOD and decreased MDA levels, as well as GSK3β expression, compared with the sham and SCI rats. The combined HBO and ChABC treatment significantly inhibited SCI‑induced AQP4 expression, but ChABC alone did not. Functional recovery in the HBO + ChABC group was significantly increased compared with the HBO or ChABC groups. These results indicate that combined HBO and ChABC treatment is more effective in treating SCI than either therapy alone.
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Affiliation(s)
- Xiaoyang Liu
- Department of Spine Surgery, Yantai Yuhuangding Hospital, Yantai, Shandong 264000, P.R. China
| | - Jiefeng Wang
- Department of Spine Surgery, Yantai Yuhuangding Hospital, Yantai, Shandong 264000, P.R. China
| | - Guangkuo Li
- Department of Spine Surgery, Yantai Yuhuangding Hospital, Yantai, Shandong 264000, P.R. China
| | - Honglin Lv
- Department of Spine Surgery, Yantai Yuhuangding Hospital, Yantai, Shandong 264000, P.R. China
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