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Akhuj A, Deodhe NP, Jachak S. Gait Training With Motor Relearning Program in Conjunction With Functional Electrical Stimulation in Quadriparesis Secondary to Cervical and Lumbar Myelopathy. Cureus 2024; 16:e54449. [PMID: 38510883 PMCID: PMC10951938 DOI: 10.7759/cureus.54449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Accepted: 02/19/2024] [Indexed: 03/22/2024] Open
Abstract
Degenerative cervical myelopathy is a frequently encountered age-related pathology following compression of the spinal cord. This case report delineates the clinical manifestation of cervical and lumbar myelopathy in a 78-year-old male patient, characterised by chief complaints of difficulty in moving bilateral upper and lower extremities and difficulty in bed mobility. Motor impairment can manifest in three different presentations, which are paraparesis, hemiparesis, or quadriparesis. The motor relearning program incorporating functional electrical stimulation constitutes a rehabilitative approach used for the restoration of motor function. This study outlines the protocol for the physiotherapy intervention protocol, mainly focusing on gait training. Along with it, balance training, proprioceptive neuromuscular facilitation, etc., were also included. The goal of physiotherapy rehabilitation was to improve the patient's ability to do tasks related to daily living. The outcome measures used were the dynamic gait index, functional independence measure, and Modified Japanese Orthopaedic Association score. We document significant increases in muscular tone and power, improved active range of motion, enhancements in gait parameters, and notable advancements in the individual's functional independence through the implementation of a physiotherapeutic regimen.
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Affiliation(s)
- Aditi Akhuj
- Neurophysiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Nishigandha P Deodhe
- Neurophysiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Shrushti Jachak
- Neurophysiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Akhuj AM, Fating T. Rehabilitation Towards Functional Independence in a Patient With Metastatic Carcinoma of Lung and Paraplegia: A Case Report. Cureus 2023; 15:e50675. [PMID: 38229796 PMCID: PMC10790158 DOI: 10.7759/cureus.50675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 12/17/2023] [Indexed: 01/18/2024] Open
Abstract
Lung cancer metastasis is a complex process. This case report describes a case of a 58-year-old man with carcinoma of the lung with bony metastasis to spine T9-T11 with the chief complaints of inability to move both lower limbs, breathlessness, and difficulty in bed mobility. Motor impairments may transpire in three different forms, which are paraplegia, hemiplegia, or quadriplegia. Functional electrical stimulation (FES) with body weight support treadmill training (BWSTT) is a widespread rehabilitation approach used to restore motor function of the lower limb and balance. This case report specifies the physiotherapeutic rehabilitation protocol, which includes dyspnea management, FES with BWSTT, proprioceptive neuromuscular facilitation, etc. for a patient undergoing physiotherapy The patient's occupational requirements and enhancement in executing daily living tasks were the focus of the physiotherapeutic rehabilitation. The outcomes used were the modified Medical Research Council (mMRC) grading of dyspnea and the Functional Independence Measure (FIM). We report a marked increment in muscle tone and strength, active range of motion (AROM), and significant enhancement in the individual's functional independence with physiotherapeutic protocol.
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Affiliation(s)
- Aditi M Akhuj
- Department of Community Health Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Tejaswini Fating
- Department of Community Health Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Cui Y, Cheng S, Chen X, Xu G, Ma N, Li H, Zhang H, Li Z. Advances in the clinical application of orthotic devices for stroke and spinal cord injury since 2013. Front Neurol 2023; 14:1108320. [PMID: 36873455 PMCID: PMC9981677 DOI: 10.3389/fneur.2023.1108320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 01/27/2023] [Indexed: 02/19/2023] Open
Abstract
Stroke and spinal cord injury are common neurological disorders that can cause various dysfunctions. Motor dysfunction is a common dysfunction that easily leads to complications such as joint stiffness and muscle contracture and markedly impairs the daily living activities and long-term prognosis of patients. Orthotic devices can prevent or compensate for motor dysfunctions. Using orthotic devices early can help prevent and correct deformities and treat muscle and joint problems. An orthotic device is also an effective rehabilitation tool for improving motor function and compensatory abilities. In this study, we reviewed the epidemiological characteristics of stroke and spinal cord injury, provided the therapeutic effect and recent advances in the application of conventional and new types of orthotic devices used in stroke and spinal cord injury in different joints of the upper and lower limbs, identified the shortcomings with these orthotics, and suggested directions for future research.
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Affiliation(s)
- Yinxing Cui
- Rehabilitation Medicine Department, First Hospital of Jilin University, Changchun, China
| | - Shihuan Cheng
- Rehabilitation Medicine Department, First Hospital of Jilin University, Changchun, China
| | - Xiaowei Chen
- Rehabilitation Medicine Department, First Hospital of Jilin University, Changchun, China
| | - Guoxing Xu
- Rehabilitation Medicine Department, First Hospital of Jilin University, Changchun, China
| | - Ningyi Ma
- Rehabilitation Medicine Department, First Hospital of Jilin University, Changchun, China
| | - He Li
- Rehabilitation Medicine Department, First Hospital of Jilin University, Changchun, China
| | - Hong Zhang
- Rehabilitation Medicine Department, First Hospital of Jilin University, Changchun, China
| | - Zhenlan Li
- Rehabilitation Medicine Department, First Hospital of Jilin University, Changchun, China
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Muacevic A, Adler JR, Gachake AA, Chitale NV, Phansopkar P. Rehabilitation Towards Functional Independence in a Patient With Intertrochanteric Fracture and Paraplegia: A Case Report. Cureus 2022; 14:e32689. [PMID: 36686125 PMCID: PMC9847962 DOI: 10.7759/cureus.32689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 12/19/2022] [Indexed: 12/23/2022] Open
Abstract
Traumatic spinal cord injury (SCI) causes significant neurological deficits that adversely affect the quality of life of patients and caregivers. Patients with SCI present with the symptoms of weakness and loss of sensations in the limbs. Motor deficits may occur in the form of paraplegia, hemiplegia, or quadriplegia. Patients remain immobilized for a prolonged period which may lead to complications like muscle wasting, atrophy, joint stiffness, contractures, bed sores, and osteoporosis. Patients are prone to fractures owing to osteoporosis. The fractures may occur even due to trivial trauma. Our case report presents the case of a 45-year-old male patient who is already diagnosed with paraplegia having a history of SCI one-and-a-half years ago. He has recent history of intertrochanteric (IT) fracture that occurs during the transfer from bed to wheelchair. Admitted to the hospital with a complaint of a popping sound along with low back pain. Further investigation and management were started.
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Tashiro S, Tsuji O, Shinozaki M, Shibata T, Yoshida T, Tomioka Y, Unai K, Kondo T, Itakura G, Kobayashi Y, Yasuda A, Nori S, Fujiyoshi K, Nagoshi N, Kawakami M, Uemura O, Yamada S, Tsuji T, Okano H, Nakamura M. Current progress of rehabilitative strategies in stem cell therapy for spinal cord injury: a review. NPJ Regen Med 2021; 6:81. [PMID: 34824291 PMCID: PMC8616941 DOI: 10.1038/s41536-021-00191-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 10/21/2021] [Indexed: 12/21/2022] Open
Abstract
Stem cell-based regenerative therapy has opened an avenue for functional recovery of patients with spinal cord injury (SCI). Regenerative rehabilitation is attracting wide attention owing to its synergistic effects, feasibility, non-invasiveness, and diverse and systemic properties. In this review article, we summarize the features of rehabilitation, describe the mechanism of combinatorial treatment, and discuss regenerative rehabilitation in the context of SCI. Although conventional rehabilitative methods have commonly been implemented alone, especially in studies of acute-to-subacute SCI, the combinatorial effects of intensive and advanced methods, including various neurorehabilitative approaches, have also been reported. Separating the concept of combined rehabilitation from regenerative rehabilitation, we suggest that the main roles of regenerative rehabilitation can be categorized as conditioning/reconditioning, functional training, and physical exercise, all of which are indispensable for enhancing functional recovery achieved using stem cell therapies.
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Affiliation(s)
- Syoichi Tashiro
- Department of Rehabilitation Medicine, Keio University School of Medicine, Shinjuku, Tokyo, Japan. .,Department of Rehabilitation Medicine, Kyorin University School of Medicine, Mitaka, Tokyo, Japan.
| | - Osahiko Tsuji
- Department of Orthopaedic Surgery, Keio University School of Medicine, Shinjuku, Tokyo, Japan
| | - Munehisa Shinozaki
- Department of Physiology, Keio University School of Medicine, Shinjuku, Tokyo, Japan
| | - Takahiro Shibata
- Department of Orthopaedic Surgery, Keio University School of Medicine, Shinjuku, Tokyo, Japan
| | - Takashi Yoshida
- Department of Rehabilitation Medicine, Keio University School of Medicine, Shinjuku, Tokyo, Japan
| | - Yohei Tomioka
- Department of Rehabilitation, Murayama Medical Center, Musashi-Murayama, Tokyo, Japan
| | - Kei Unai
- Department of Rehabilitation Medicine, Keio University School of Medicine, Shinjuku, Tokyo, Japan
| | - Takahiro Kondo
- Department of Physiology, Keio University School of Medicine, Shinjuku, Tokyo, Japan
| | - Go Itakura
- Department of Orthopaedic Surgery, Keio University School of Medicine, Shinjuku, Tokyo, Japan
| | - Yoshiomi Kobayashi
- Department of Orthopaedic Surgery, Keio University School of Medicine, Shinjuku, Tokyo, Japan.,Department of Orthopaedic Surgery, Murayama Medical Center, Musashi-Murayama, Tokyo, Japan
| | - Akimasa Yasuda
- Department of Orthopaedic Surgery, Keio University School of Medicine, Shinjuku, Tokyo, Japan.,Department of Orthopaedic surgery, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Satoshi Nori
- Department of Orthopaedic Surgery, Keio University School of Medicine, Shinjuku, Tokyo, Japan
| | - Kanehiro Fujiyoshi
- Department of Orthopaedic Surgery, Keio University School of Medicine, Shinjuku, Tokyo, Japan.,Department of Orthopaedic Surgery, Murayama Medical Center, Musashi-Murayama, Tokyo, Japan
| | - Narihito Nagoshi
- Department of Orthopaedic Surgery, Keio University School of Medicine, Shinjuku, Tokyo, Japan
| | - Michiyuki Kawakami
- Department of Rehabilitation Medicine, Keio University School of Medicine, Shinjuku, Tokyo, Japan
| | - Osamu Uemura
- Department of Rehabilitation Medicine, Keio University School of Medicine, Shinjuku, Tokyo, Japan.,Department of Rehabilitation, Murayama Medical Center, Musashi-Murayama, Tokyo, Japan
| | - Shin Yamada
- Department of Rehabilitation Medicine, Kyorin University School of Medicine, Mitaka, Tokyo, Japan
| | - Tetsuya Tsuji
- Department of Rehabilitation Medicine, Keio University School of Medicine, Shinjuku, Tokyo, Japan
| | - Hideyuki Okano
- Department of Physiology, Keio University School of Medicine, Shinjuku, Tokyo, Japan
| | - Masaya Nakamura
- Department of Orthopaedic Surgery, Keio University School of Medicine, Shinjuku, Tokyo, Japan
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Lai B, Che M, Feng B, Bai Y, Li G, Ma Y, Wang L, Huang M, Wang Y, Jiang B, Ding Y, Zeng X, Zeng Y. Tissue-Engineered Neural Network Graft Relays Excitatory Signal in the Completely Transected Canine Spinal Cord. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2019; 6:1901240. [PMID: 31763143 PMCID: PMC6864506 DOI: 10.1002/advs.201901240] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 07/19/2019] [Indexed: 05/10/2023]
Abstract
Tissue engineering produces constructs with defined functions for the targeted treatment of damaged tissue. A complete spinal cord injury (SCI) model is generated in canines to test whether in vitro constructed neural network (NN) tissues can relay the excitatory signal across the lesion gap to the caudal spinal cord. Established protocols are used to construct neural stem cell (NSC)-derived NN tissue characterized by a predominantly neuronal population with robust trans-synaptic activities and myelination. The NN tissue is implanted into the gap immediately following complete transection SCI of canines at the T10 spinal cord segment. The data show significant motor recovery of paralyzed pelvic limbs, as evaluated by Olby scoring and cortical motor evoked potential (CMEP) detection. The NN tissue survives in the lesion area with neuronal phenotype maintenance, improves descending and ascending nerve fiber regeneration, and synaptic integration with host neural circuits that allow it to serve as a neuronal relay to transmit excitatory electrical signal across the injured area to the caudal spinal cord. These results suggest that tissue-engineered NN grafts can relay the excitatory signal in the completely transected canine spinal cord, providing a promising strategy for SCI treatment in large animals, including humans.
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Affiliation(s)
- Bi‐Qin Lai
- Key Laboratory for Stem Cells and Tissue Engineering (Sun Yat‐sen University)Ministry of EducationGuangzhou510080China
- Department of Histology and EmbryologyZhongshan School of MedicineSun Yat‐sen UniversityGuangzhou510080China
- Institute of Spinal Cord InjurySun Yat‐sen UniversityGuangzhou510120China
- Co‐innovation Center of NeuroregenerationNantong UniversityNantong226001China
| | - Ming‐Tian Che
- Key Laboratory for Stem Cells and Tissue Engineering (Sun Yat‐sen University)Ministry of EducationGuangzhou510080China
| | - Bo Feng
- Key Laboratory for Stem Cells and Tissue Engineering (Sun Yat‐sen University)Ministry of EducationGuangzhou510080China
| | - Yu‐Rong Bai
- Key Laboratory for Stem Cells and Tissue Engineering (Sun Yat‐sen University)Ministry of EducationGuangzhou510080China
| | - Ge Li
- Key Laboratory for Stem Cells and Tissue Engineering (Sun Yat‐sen University)Ministry of EducationGuangzhou510080China
- Department of Histology and EmbryologyZhongshan School of MedicineSun Yat‐sen UniversityGuangzhou510080China
- Institute of Spinal Cord InjurySun Yat‐sen UniversityGuangzhou510120China
| | - Yuan‐Huan Ma
- Department of Histology and EmbryologyZhongshan School of MedicineSun Yat‐sen UniversityGuangzhou510080China
- Institute of Spinal Cord InjurySun Yat‐sen UniversityGuangzhou510120China
| | - Lai‐Jian Wang
- Guangdong Provincial Key Laboratory of Brain Function and DiseaseZhongshan School of MedicineSun Yat‐sen UniversityGuangzhou510080China
| | - Meng‐Yao Huang
- Guangdong Provincial Key Laboratory of Brain Function and DiseaseZhongshan School of MedicineSun Yat‐sen UniversityGuangzhou510080China
| | - Ya‐Qiong Wang
- Department of Electron MicroscopeZhongshan School of MedicineSun Yat‐sen UniversityGuangzhou510080China
| | - Bin Jiang
- Guangdong Provincial Key Laboratory of Brain Function and DiseaseZhongshan School of MedicineSun Yat‐sen UniversityGuangzhou510080China
| | - Ying Ding
- Department of Histology and EmbryologyZhongshan School of MedicineSun Yat‐sen UniversityGuangzhou510080China
- Institute of Spinal Cord InjurySun Yat‐sen UniversityGuangzhou510120China
| | - Xiang Zeng
- Key Laboratory for Stem Cells and Tissue Engineering (Sun Yat‐sen University)Ministry of EducationGuangzhou510080China
- Department of Histology and EmbryologyZhongshan School of MedicineSun Yat‐sen UniversityGuangzhou510080China
- Institute of Spinal Cord InjurySun Yat‐sen UniversityGuangzhou510120China
| | - Yuan‐Shan Zeng
- Key Laboratory for Stem Cells and Tissue Engineering (Sun Yat‐sen University)Ministry of EducationGuangzhou510080China
- Department of Histology and EmbryologyZhongshan School of MedicineSun Yat‐sen UniversityGuangzhou510080China
- Institute of Spinal Cord InjurySun Yat‐sen UniversityGuangzhou510120China
- Co‐innovation Center of NeuroregenerationNantong UniversityNantong226001China
- Guangdong Provincial Key Laboratory of Brain Function and DiseaseZhongshan School of MedicineSun Yat‐sen UniversityGuangzhou510080China
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Review of the Current Knowledge on the Role of Stem Cell Transplantation in Neurorehabilitation. BIOMED RESEARCH INTERNATIONAL 2019; 2019:3290894. [PMID: 30931325 PMCID: PMC6413404 DOI: 10.1155/2019/3290894] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 10/05/2018] [Accepted: 01/30/2019] [Indexed: 12/14/2022]
Abstract
The management involving stem cell (SC) therapy along with physiotherapy offers tremendous chance for patients after spinal cord injury (SCI), traumatic brain injury (TBI), stroke, etc. However, there are still only a limited number of reports assessing the impact of stem cells (SCs) on the rehabilitation process and/or the results of the simultaneous use of SC and rehabilitation. Additionally, since there is still not enough convincing evidence about the effect of SCT on humans, e.g., in stroke, there have been no studies conducted concerning rehabilitation program formation and expected outcomes. It has been shown that bone marrow-derived mesenchymal stem cell (BMSCs) transplantation in rats combined with hyperbaric oxygen therapy (HBO) can promote the functional recovery of hind limbs after SCI. An anti-inflammatory effect has been shown. One case study showed that, after the simultaneous use of SCT and rehabilitation, an SCI patient progressed from ASIA Grade A to ASIA Grade C. Such promising data in the case of complete tetraplegia could be a breakthrough in the treatment of neurologic disorders in humans. Although SCT appears as a promising method for the treatment of neurological conditions, e.g., complete tetraplegia, much work should be done towards the development of rehabilitation protocols.
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Wang W, Huang X, Lin W, Qiu Y, He Y, Yu J, Xi Y, Ye X. Hypoxic preconditioned bone mesenchymal stem cells ameliorate spinal cord injury in rats via improved survival and migration. Int J Mol Med 2018; 42:2538-2550. [PMID: 30106084 PMCID: PMC6192716 DOI: 10.3892/ijmm.2018.3810] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 06/06/2018] [Indexed: 12/20/2022] Open
Abstract
The unique hypoxic inflammatory microenvironment observed in the spinal cord following spinal cord injury (SCI) limits the survival and efficacy of transplanted bone mesenchymal stem cells (BMSCs). The aim of the present study was to determine whether hypoxic preconditioning (HP) increased the therapeutic effects of BMSC on SCI. BMSCs were pretreated with cobalt chloride (CoCl2) in vitro, and the proliferative apoptotic and migratory abilities of these hypoxic BMSCs (H‑BMSCs) were assessed. BMSCs and H‑BMSCs derived from green fluorescent protein (GFP) rats were transplanted into SCI rats in vivo. The neurological function, histopathology, inflammation, and number and migration of transplanted cells were examined. HP significantly enhanced BMSC migration (increased hypoxia inducible factor 1α and C‑X‑C motif chemokine receptor 4 expression) and tolerance to apoptotic conditions (decreased caspase‑3 and increased B‑cell lymphoma 2 expression) in vitro. In vivo, H‑BMSC transplantation significantly improved neurological function, decreased spinal cord damage and suppressed the inflammatory response associated with microglial activation. The number of GFP‑positive cells in the SCI core and peripheral region of H‑BMSC animals was increased compared with that in those of BMSC animals, suggesting that HP may increase the survival and migratory abilities of BMSCs and highlights their therapeutic potential for SCI.
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Affiliation(s)
- Weiheng Wang
- Department of Orthopedics, Changzheng Hospital, Second Military Medical University, Shanghai 200003, P.R. China
| | - Xiaodong Huang
- Department of Orthopedics, Changzheng Hospital, Second Military Medical University, Shanghai 200003, P.R. China
| | - Wenbo Lin
- Department of Orthopedics, Changzheng Hospital, Second Military Medical University, Shanghai 200003, P.R. China
| | - Yuanyuan Qiu
- Department of Respiration, Shanghai Electric Power Hospital, Shanghai 200050, P.R. China
| | - Yunfei He
- Department of Orthopedics, Changzheng Hospital, Second Military Medical University, Shanghai 200003, P.R. China
| | - Jiangming Yu
- Department of Orthopedics, Changzheng Hospital, Second Military Medical University, Shanghai 200003, P.R. China
| | - Yanhai Xi
- Department of Orthopedics, Changzheng Hospital, Second Military Medical University, Shanghai 200003, P.R. China
| | - Xiaojian Ye
- Department of Orthopedics, Changzheng Hospital, Second Military Medical University, Shanghai 200003, P.R. China
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Shroff G, Thakur D, Dhingra V, Baroli DS, Khatri D, Gautam RD. Expression of Concern to: Role of physiotherapy in the mobilization of patients with spinal cord injury undergoing human embryonic stem cells transplantation. Clin Transl Med 2017; 6:35. [PMID: 28921476 PMCID: PMC5603460 DOI: 10.1186/s40169-017-0166-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Affiliation(s)
- Geeta Shroff
- Nutech Mediworld, H‑8, Green Park Extension, New Delhi, 110016, India. .,Nutech Mediworld, New Delhi, 110016, India.
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