Efficacy and safety of 9 nonoperative regimens for the treatment of spinal cord injury: A network meta-analysis

Impact of Robotic-Assisted Gait Therapy on Depression and Anxiety Symptoms in Patients with Subacute Spinal Cord Injuries (SCIs)-A Prospective Clinical Study

BACKGROUND

Mood disorders, especially depression, and emotional difficulties such as anxiety are very common problems among patients with spinal cord injuries (SCIs). The lack of physical training may deteriorate their mental state, which, in turn, has a significant impact on their improvement in functioning. The aim of the present study was to examine the influence of innovative rehabilitation approaches involving robotic-assisted gait therapy (RAGT) on the depression and anxiety symptoms in patients with SCI.

METHODS

A total of 110 participants with subacute SCIs were enrolled in this single-center, single-blinded, single-arm, prospective study; patients were divided into experimental (robotic-assisted gait therapy (RAGT)) and control (conventional gait therapy with dynamic parapodium (DPT)) groups. They received five training sessions per week over 7 weeks. At the beginning and end of therapy, the severity of depression was assessed via the Depression Assessment Questionnaire (KPD), and that of anxiety symptoms was assessed via the State-Trait Anxiety Inventory (STAI X-1).

RESULTS

SCI patients in both groups experienced significantly lower levels of anxiety- and depression-related symptoms after completing the seven-week rehabilitation program (KPD: Z = 6.35, p < 0.001, r = 0.43; STAI X-1: Z = -6.20, p < 0.001, r = 0.42). In the RAGT group, post-rehabilitation measurements also indicated an improvement in psychological functioning (i.e., decreases in depression and anxiety and an increase in self-regulation (SR)). Significant results were noted for each variable (STAI X-1: Z = -4.93; KPD: Z = -5.26; SR: Z = -3.21). In the control group, there were also decreases in the effects on depression and state anxiety and an increase in self-regulation ability (STAI X-1: Z = -4.01; KPD: Z = -3.65; SR: Z = -2.83). The rehabilitation modality did not appear to have a statistically significant relationship with the magnitude of improvement in the Depression Assessment Questionnaire (KPD) (including self-regulation) and State-Trait Anxiety Inventory (STAI) scores. However, there were some significant differences when comparing the groups by the extent and depth of the injury and type of paralysis. Moreover, the study did not find any significant relationships between improvements in physical aspects and changes in psychological factors.

CONCLUSIONS

Subjects in the robotic-assisted gait therapy (RAGD) and dynamic parapodium training (DPT) groups experienced decreases in anxiety and depression after a 7-week rehabilitation program. However, the rehabilitation modality (DPT vs. RAGT) did not differentiate between the patients with spinal cord injuries in terms of the magnitude of this change. Our results suggest that individuals with severe neurological conditions and complete spinal cord injuries (AIS A, according to the Abbreviated Injury Scale classification) may experience greater benefits in terms of changes in the psychological parameters after rehabilitation with RAGT.

Treatment effects of monosialotetrahexosylganglioside on severe traumatic brain injury in adults

OBJECTIVE

To determine the effects of monosialotetrahexosylganglioside (GM-1) on the curative effect on severe traumatic brain injury (TBI) in adults and assess the changes of serum inflammatory factors.

METHODS

Retrospective analysis was used in this study. A total of 130 adult patients with severe TBI treated in our hospital from April 2019 to July 2021 were enrolled. Among them, 63 patients treated with conventional therapy were grouped as the control group (Con group), and 67 patients given GM-1 based on conventional therapy were grouped as the observation group (Obs group). The therapeutic efficacy and incidence of adverse reactions were compared between the two groups. The Mini-Mental State Examination (MMSE), Glasgow coma scale (GCS), serum neuron specific enolase (NSE), and Barthel index were adopted for evaluating the two groups after treatment, and the two groups were compared in inflammatory response and stress response.

RESULTS

After treatment, the Obs group showed a significantly higher total effective rate and a significantly lower total incidence of complications than the Con group (P<0.05), and also had significantly higher MMSE score, GCS score and Barthel index than the Con group (P<0.05). After treatment, the NSE level in the Obs group was significantly lower than that in the Con group. Additionally, after treatment, the Obs group showed significantly lower levels of IL-6, IL-8 and TNF-α, a significantly higher SOD level, and a significantly lower MDA level than the Con group (P<0.05).

CONCLUSION

For patients with severe TBI, adjuvant therapy with GM-1 can significantly raise the therapeutic effect and improve the nerve function and inflammatory reaction, which is worthy of clinical application.

Acute spinal cord injury: Pathophysiology and pharmacological intervention (Review)

Spinal cord injury (SCI) is one of the most debilitating of all the traumatic conditions that afflict individuals. For a number of years, extensive studies have been conducted to clarify the molecular mechanisms of SCI. Experimental and clinical studies have indicated that two phases, primary damage and secondary damage, are involved in SCI. The initial mechanical damage is caused by local impairment of the spinal cord. In addition, the fundamental mechanisms are associated with hyperflexion, hyperextension, axial loading and rotation. By contrast, secondary injury mechanisms are led by systemic and cellular factors, which may also be initiated by the primary injury. Although significant advances in supportive care have improved clinical outcomes in recent years, a number of studies continue to explore specific pharmacological therapies to minimize SCI. The present review summarized some important pathophysiologic mechanisms that are involved in SCI and focused on several pharmacological and non‑pharmacological therapies, which have either been previously investigated or have a potential in the management of this debilitating injury in the near future.