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Rejc E, Zaccaron S, Bowersock C, Pisolkar T, Ugiliweneza B, Forrest GF, Agrawal S, Harkema SJ, Angeli CA. Effects of Robotic Postural Stand Training with Epidural Stimulation on Sitting Postural Control in Individuals with Spinal Cord Injury: A Pilot Study. J Clin Med 2024; 13:4309. [PMID: 39124576 PMCID: PMC11313204 DOI: 10.3390/jcm13154309] [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: 07/01/2024] [Revised: 07/18/2024] [Accepted: 07/22/2024] [Indexed: 08/12/2024] Open
Abstract
(1) Background. High-level spinal cord injury (SCI) disrupts trunk control, leading to an impaired performance of upright postural tasks in sitting and standing. We previously showed that a novel robotic postural stand training with spinal cord epidural stimulation targeted at facilitating standing (Stand-scES) largely improved standing trunk control in individuals with high-level motor complete SCI. Here, we aimed at assessing the effects of robotic postural stand training with Stand-scES on sitting postural control in the same population. (2) Methods. Individuals with cervical (n = 5) or high-thoracic (n = 1) motor complete SCI underwent approximately 80 sessions (1 h/day; 5 days/week) of robotic postural stand training with Stand-scES, which was performed with free hands (i.e., without using handlebars) and included periods of standing with steady trunk control, self-initiated trunk and arm movements, and trunk perturbations. Sitting postural control was assessed on a standard therapy mat, with and without scES targeted at facilitating sitting (Sit-scES), before and after robotic postural stand training. Independent sit time and trunk center of mass (CM) displacement were assessed during a 5 min time window to evaluate steady sitting control. Self-initiated antero-posterior and medial-lateral trunk movements were also attempted from a sitting position, with the goal of covering the largest distance in the respective cardinal directions. Finally, the four Neuromuscular Recovery Scale items focused on sitting trunk control (Sit, Sit-up, Trunk extension in sitting, Reverse sit-up) were assessed. (3) Results. In summary, neither statistically significant differences nor large Effect Size were promoted by robotic postural stand training for the sitting outcomes considered for analysis. (4) Conclusions. The findings of the present study, together with previous observations, may suggest that robotic postural stand training with Stand-scES promoted trunk motor learning that was posture- and/or task-specific and, by itself, was not sufficient to significantly impact sitting postural control.
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Affiliation(s)
- Enrico Rejc
- Tim and Caroline Reynolds Center for Spinal Stimulation, Kessler Foundation, 1199 Pleasant Valley Way, West Orange, NJ 07052, USA; (G.F.F.); (C.A.A.)
- Department of Medicine, University of Udine, P.le Kolbe 4, 33100 Udine (UD), Italy;
- Kentucky Spinal Cord Injury Research Center, University of Louisville, 220 Abraham Flexner Way, Louisville, KY 40202, USA; (C.B.); (T.P.); (B.U.); (S.J.H.)
| | - Simone Zaccaron
- Department of Medicine, University of Udine, P.le Kolbe 4, 33100 Udine (UD), Italy;
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37129 Verona, Italy
| | - Collin Bowersock
- Kentucky Spinal Cord Injury Research Center, University of Louisville, 220 Abraham Flexner Way, Louisville, KY 40202, USA; (C.B.); (T.P.); (B.U.); (S.J.H.)
- Biomechatronics Lab, Department of Mechanical Engineering, Northern Arizona University, S San Francisco St, Flagstaff, AZ 86011, USA
| | - Tanvi Pisolkar
- Kentucky Spinal Cord Injury Research Center, University of Louisville, 220 Abraham Flexner Way, Louisville, KY 40202, USA; (C.B.); (T.P.); (B.U.); (S.J.H.)
| | - Beatrice Ugiliweneza
- Kentucky Spinal Cord Injury Research Center, University of Louisville, 220 Abraham Flexner Way, Louisville, KY 40202, USA; (C.B.); (T.P.); (B.U.); (S.J.H.)
- Department of Neurological Surgery, University of Louisville, Louisville, KY 40202, USA
| | - Gail F. Forrest
- Tim and Caroline Reynolds Center for Spinal Stimulation, Kessler Foundation, 1199 Pleasant Valley Way, West Orange, NJ 07052, USA; (G.F.F.); (C.A.A.)
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ 07103, USA
| | - Sunil Agrawal
- Department of Mechanical Engineering, Columbia University, 220 S. W. Mudd Building, 500 West 120th Street, New York, NY 10027, USA;
- Department of Rehabilitation and Regenerative Medicine, Columbia University, New York, NY 10032, USA
| | - Susan J. Harkema
- Kentucky Spinal Cord Injury Research Center, University of Louisville, 220 Abraham Flexner Way, Louisville, KY 40202, USA; (C.B.); (T.P.); (B.U.); (S.J.H.)
- Department of Neurological Surgery, University of Louisville, Louisville, KY 40202, USA
| | - Claudia A. Angeli
- Tim and Caroline Reynolds Center for Spinal Stimulation, Kessler Foundation, 1199 Pleasant Valley Way, West Orange, NJ 07052, USA; (G.F.F.); (C.A.A.)
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Shackleton C, Evans R, West S, Bantjes J, Swartz L, Derman W, Albertus Y. Robotic locomotor training in a low-resource setting: a randomized pilot and feasibility trial. Disabil Rehabil 2024; 46:3363-3372. [PMID: 37605978 DOI: 10.1080/09638288.2023.2245751] [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: 01/16/2023] [Accepted: 08/04/2023] [Indexed: 08/23/2023]
Abstract
PURPOSE Activity-based Training (ABT) represents the current standard of neurological rehabilitation. Robotic Locomotor Training (RLT), an innovative technique, aims to enhance rehabilitation outcomes. This study aimed to conduct a randomized pilot and feasibility trial of a locomotor training program within South Africa. MATERIALS AND METHODS Individuals with chronic traumatic motor incomplete tetraplegia (n = 16). Each intervention involved 60-minute sessions, 3x per week, for 24-weeks. Outcomes included feasibility measures and functional capacity. RESULTS 17 out of 110 individuals initiated the program (recruitment rate = 15.4%) and 16 completed the program (drop-out rate = 5.8%) and attended sessions (attendance rate = 93.9%). Both groups showed a significant increase in upper extremity motor score (MS) and abdominal strength post intervention. Only the RLT group showed a significant change in lower extremity MS, with a mean increase of 3.00 [0.00; 16.5] points over time. Distance walked in the Functional Ambulatory Inventory (SCI-FAI) increased significantly (p = 0.02) over time only for the RLT group. CONCLUSIONS Feasibility rates of the intervention and functional outcomes justify a subsequent powered RCT comparing RLT to ABT as an effective rehabilitation tool for potentially improving functional strength and walking capacity in people with incomplete SCI.
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Affiliation(s)
- Claire Shackleton
- Physical Activity, Lifestyle and Sport Research Centre (HPALS), Department of Human Biology, University of Cape Town, Cape Town, South Africa
| | - Robert Evans
- Physical Activity, Lifestyle and Sport Research Centre (HPALS), Department of Human Biology, University of Cape Town, Cape Town, South Africa
| | - Sacha West
- Department of Sport Management, Cape Peninsula University of Technology, Cape Town, Western Cape, South Africa
| | - Jason Bantjes
- Mental Health, Alcohol, Substance Use and Tobacco (MAST) Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Leslie Swartz
- Department of Psychology, Faculty of Arts and Social Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Wayne Derman
- Institute of Sport and Exercise Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, Western Cape, South Africa
- International Olympic Committee Research Center, South Africa
| | - Yumna Albertus
- Physical Activity, Lifestyle and Sport Research Centre (HPALS), Department of Human Biology, University of Cape Town, Cape Town, South Africa
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Arellano CJ, Vega D. Exploring How the Arms Can Help the Legs in Facilitating Gait Rehabilitation. Adv Biol (Weinh) 2024; 8:e2300661. [PMID: 38519429 DOI: 10.1002/adbi.202300661] [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: 12/03/2023] [Revised: 02/26/2024] [Indexed: 03/24/2024]
Abstract
Inspired by the ideas from the fields of gait rehabilitation, neuroscience, and locomotion biomechanics and energetics, a body of work is reviewed that has led to propose a conceptual framework for novel "self-assistive" walking devices that could further promote walking recovery from incomplete spinal cord injuries. The underlying rationale is based on a neural coupling mechanism that governs the coordinated movements of the arms and legs during walking, and that the excitability of these neural pathways can be exploited by actively engaging the arms during locomotor training. Self-assistive treadmill walking rehabilitation devices are envisioned as an approach that would allow an individual to actively use their arms to help the legs during walking. It is hoped that the conceptual framework inspires the design and use of self-assistive walking devices that are tailored to assist individuals with an incomplete spinal cord injury to regain their functional walking ability.
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Affiliation(s)
- Christopher J Arellano
- Department of Orthopaedic Surgery, University of Arizona, Tucson, AZ, 85724, USA
- Department of Biomedical Engineering, University of Arizona, Tucson, AZ, 85721, USA
| | - Daisey Vega
- Department of Biomedical Engineering, University of Arizona, Tucson, AZ, 85721, USA
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Singh G, Keller A, Lucas K, Borders C, Stout D, King M, Parikh P, Stepp N, Ugiliweneza B, D'Amico JM, Gerasimenko Y, Behrman AL. Safety and Feasibility of Cervical and Thoracic Transcutaneous Spinal Cord Stimulation to Improve Hand Motor Function in Children With Chronic Spinal Cord Injury. Neuromodulation 2024; 27:661-671. [PMID: 37269282 DOI: 10.1016/j.neurom.2023.04.475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 04/25/2023] [Accepted: 04/25/2023] [Indexed: 06/05/2023]
Abstract
OBJECTIVE In adults with cervical spinal cord injury (SCI), transcutaneous spinal stimulation (scTS) has improved upper extremity strength and control. This novel noninvasive neurotherapeutic approach combined with training may modulate the inherent developmental plasticity of children with SCI, providing even greater improvements than training or stimulation alone. Because children with SCI represent a vulnerable population, we first must establish the safety and feasibility of any potential novel therapeutic approach. The objectives of this pilot study were to determine the safety, feasibility, and proof of principle of cervical and thoracic scTS for short-term effect on upper extremity strength in children with SCI. MATERIALS AND METHODS In this nonrandomized, within-subject repeated measure design, seven participants with chronic cervical SCI performed upper extremity motor tasks without and with cervical (C3-C4 and C6-C7) and thoracic (T10-T11) site scTS. Safety and feasibility of using cervical and thoracic sites scTS were determined by the frequency count of anticipated and unanticipated risks (eg, pain, numbness). Proof-of-principle concept was tested via change in force production during hand motor tasks. RESULTS All seven participants tolerated cervical and thoracic scTS across the three days, with a wide range of stimulation intensities (cervical sites = 20-70 mA and thoracic site = 25-190 mA). Skin redness at the stimulation sites was observed in four of 21 assessments (19%) and dissipated in a few hours. No episode of autonomic dysreflexia was observed or reported. Hemodynamic parameters (systolic blood pressure and heart rate) remained within stable limits (p > 0.05) throughout the assessment time points at baseline, with scTS, and after the experiment. Hand-grip and wrist-extension strength increased (p < 0.05) with scTS. CONCLUSIONS We indicated that short-term application of scTS via two cervical and one thoracic site is safe and feasible in children with SCI and resulted in immediate improvements in hand-grip and wrist-extension strength in the presence of scTS. CLINICAL TRIAL REGISTRATION The Clinicaltrials.gov registration number for the study is NCT04032990.
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Affiliation(s)
- Goutam Singh
- Kosair Charities School of Physical Therapy, Spalding University, Louisville, KY, USA; Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, USA.
| | | | - Kathryn Lucas
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, USA; Department of Neurological surgery, University of Louisville, KY, USA
| | | | | | - Molly King
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, USA; Department of Neurological surgery, University of Louisville, KY, USA
| | - Parth Parikh
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, USA; Department of Neurological surgery, University of Louisville, KY, USA
| | - Nicole Stepp
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, USA; Department of Neurological surgery, University of Louisville, KY, USA
| | - Beatrice Ugiliweneza
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, USA; Department of Neurological surgery, University of Louisville, KY, USA
| | - Jessica M D'Amico
- Glenrose Rehabilitation Hospital, Alberta Health Services, Edmonton, Alberta, Canada; Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Yury Gerasimenko
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, USA; Department of Neurological surgery, University of Louisville, KY, USA; Pavlov Institute of Physiology, St Petersburg, Russia
| | - Andrea L Behrman
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, USA; Department of Neurological surgery, University of Louisville, KY, USA
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Khande CK, Verma V, Regmi A, Ifthekar S, Sudhakar PV, Sethy SS, Kandwal P, Sarkar B. Effect on functional outcome of robotic assisted rehabilitation versus conventional rehabilitation in patients with complete spinal cord injury: a prospective comparative study. Spinal Cord 2024; 62:228-236. [PMID: 38491302 DOI: 10.1038/s41393-024-00970-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 01/30/2024] [Accepted: 02/27/2024] [Indexed: 03/18/2024]
Abstract
STUDY DESIGN Prospective Comparative Study. OBJECTIVE This study aims to compare the functional outcomes of Robotic-assisted rehabilitation by Lokomat system Vs. Conventional rehabilitation in participants with Dorsolumbar complete spinal cord injury (SCI). SETTING University level teaching hospital in a hilly state of northern India. METHODS 15 participants with Dorsolumbar SCI with ASIA A neurology were allocated to robotic rehabilitation and 15 participants to conventional rehabilitation after an operative procedure. Pre-and Post-rehabilitation parameters were noted in terms of ASIA Neurology, Motor and sensory function scores, WISCI II score (Walking Index in SCI score), LEMS (Lower Extremity Motor Score), SCI M III score (Spinal Cord Independence Measure III score), AO Spine PROST (AO Patient Reported Outcome Spine Trauma), McGill QOL score (Mc Gill Quality of Life score), VAS score (Visual Analogue Scale) for pain and Modified Ashworth scale for spasticity in lower limbs. RESULTS On comparing robotic group with conventional group there was a statistically significant improvement in Robotic-assisted rehabilitation group in terms of Motor score (p = 0.034), WISCI II score (p = 0.0001), SCIM III score (p = 0.0001), AO PROST score (p = 0.0001), Mc GILL QOL score (p = 0.0001), Max velocity (p = 0.0001) and Step length (p = 0.0001). Whereas LEMS score (p = 0.052), ASIA neurology (p = 0.264 (ASIA A); 1.000 (ASIA B); 0.053 (ASIA C)), VAS score (p = 0.099), Sensory score (p = 0.422) and Modified Ashworth scale for spasticity (p = 0.136) were not statically significant when comparing between two groups. CONCLUSION Robot-assisted rehabilitation is superior than conventional rehabilitation in people living with SCI with AIS A neurology. Differences in the patient group, type of a lesion its and severity, duration from onset to initiation of rehabilitation, devices employed, administration of the therapies and regulation of interventions are likely the cause of variations in the findings seen in the literature for robotic assisted training. LEVEL OF EVIDENCE III.
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Affiliation(s)
| | - Vishal Verma
- Department of Orthopedics, AIIMS, Rishikesh, 249203, Uttarakhand, India
| | - Anil Regmi
- Department of Orthopedics, AIIMS, Rishikesh, 249203, Uttarakhand, India
| | - Syed Ifthekar
- Department of Orthopedics, AIIMS, Rishikesh, 249203, Uttarakhand, India
| | | | | | - Pankaj Kandwal
- Department of Orthopedics, AIIMS, Rishikesh, 249203, Uttarakhand, India
| | - Bhaskar Sarkar
- Department of Trauma Surgery, AIIMS, Rishikesh, 249203, Uttarakhand, India.
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Fell JD, Medina-Aguiñaga D, Burke DA, Hubscher CH. Impact of Activity-Based Training on Bowel Function in a Rat Model of Spinal Cord Injury. J Neurotrauma 2024; 41:1181-1195. [PMID: 38117145 DOI: 10.1089/neu.2023.0486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023] Open
Abstract
Significant bowel-related issues after spinal cord injury (SCI) that affect morbidity and quality of life (QOL) include diminished bowel motility, loss of sphincter control, gastric ulcers, autonomic dysreflexia, pain, diarrhea, constipation, and fecal incontinence. Clinical diagnoses and research in humans have largely relied on anorectal manometry (ARM) procedures to increase understanding of the functional effects of SCI on colorectal motility and defecation physiology. Recent pre-clinical rodent studies have also used ARM to further our understanding of bowel-related dysfunctions post-SCI. In the present study, the benefits of different activity-based training (ABT) durations on bowel function were examined. Six groups of male rats including two non-training (NT; uninjured and SCI) and four ABT (quadrupedal [Quad or Q] stepping on a treadmill) groups. All ABT animals received 4 weeks of 1-h daily stepping beginning 2 weeks post-SCI followed by variable amounts for 4 additional weeks (none; daily; once a week; daily for final 4th week only). Outcome measures included fecal output (home cage; metabolic cage) throughout the study and terminal measurements (post 8-week ABT) of external anal sphincter (EAS) electromyography, resting anorectal pressure, and giant contraction (GC) activation under urethane anesthesia. The results indicate that treadmill training normalized defecation amount based on feces weight and food intake, as well as GC frequency, EAS latency and amplitude during fecal expulsion, and resting pressure in specific areas within the colorectum. The two intermittent training groups consistently showed recorded metrics comparable to the non-injured group. The results demonstrate bowel dysfunction in the rodent SCI contusion model with improvements in functional outcomes following ABT. Importantly, the benefits to bowel-related functions with versus without intermittent ABT illustrate the need for periodic therapy to maintain the functional gains of ABT.
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Affiliation(s)
- Jason D Fell
- Department of Anatomical Sciences and Neurobiology, University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Daniel Medina-Aguiñaga
- Department of Anatomical Sciences and Neurobiology, University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Darlene A Burke
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky, USA
| | - Charles H Hubscher
- Department of Anatomical Sciences and Neurobiology, University of Louisville School of Medicine, Louisville, Kentucky, USA
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky, USA
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Cesca N, Lin C, Abu-Jurji Z, Wexler A, Mark J, McCullum S, Kamran R, Chan B, Musselman KE. Exploring knowledge and implementation gaps of activity-based therapy in centers lacking specialized spinal cord injury services: understanding therapists' perspectives. Spinal Cord Ser Cases 2024; 10:14. [PMID: 38514640 PMCID: PMC10957876 DOI: 10.1038/s41394-024-00619-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 02/14/2024] [Accepted: 02/16/2024] [Indexed: 03/23/2024] Open
Abstract
STUDY DESIGN Qualitative exploratory OBJECTIVES: Rehabilitation following spinal cord injury (SCI) is a life-long process involving healthcare in a variety of settings, including facilities lacking SCI-specific services (i.e., non-SCI-specialized centers). Activity-based therapy (ABT) is a neurorestorative approach involving intensive, task-specific movement practice below the injury level. This study explored the existing knowledge, perceptions, and implementation of ABT among physical and occupational therapists working in non-SCI-specialized centers. SETTING Canadian hospitals and community clinics DESIGN/METHODS: Semi-structured interviews were conducted with Canadian therapists who worked at non-SCI-specialized centers and treated at least one patient with SCI within the last 18 months. The Theoretical Domains Framework was used to develop interview questions that queried therapists' experiences in delivering SCI rehabilitation, their understanding of ABT and experience with its implementation. Interviews were audio-recorded, transcribed verbatim and analyzed using interpretive description. RESULTS Four physical therapists and three occupational therapists, from diverse settings (i.e., acute care, inpatient rehabilitation, long-term care, outpatient rehabilitation, rural outpatient clinic) participated. Three themes were identified: (1) Available knowledge, resources and therapy time in non-SCI-specialized centers challenge ABT implementation, (2) How current therapy practices in non-SCI-specialized centers align with ABT and (3) Desire for ABT knowledge. Although participants were not familiar with the term ABT, it was identified that they were unknowingly incorporating some components of ABT into their practice. Participants expressed a keenness to learn more about ABT. CONCLUSION Current knowledge and implementation of ABT in non-SCI-specialized centers is limited. Tailoring ABT education to therapists at non-SCI-specialized centers may increase ABT implementation.
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Affiliation(s)
- Nicole Cesca
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- KITE Research Institute, Toronto Rehabilitation Institute - University Health Network, Toronto, ON, Canada
| | - Chantal Lin
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Zeina Abu-Jurji
- Faculty of Health Sciences, Masters of Physiotherapy, McMaster University, Hamilton, ON, Canada
| | - Aaron Wexler
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Jonas Mark
- First Steps Wellness Centre, Winnipeg, MB, Canada
| | - Shane McCullum
- Stan Cassidy Centre for Rehabilitation, Horizon Health Network, Fredericton, NB, Canada
| | - Rija Kamran
- Rehabilitation Science, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - Brian Chan
- KITE Research Institute, Toronto Rehabilitation Institute - University Health Network, Toronto, ON, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Kristin E Musselman
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
- KITE Research Institute, Toronto Rehabilitation Institute - University Health Network, Toronto, ON, Canada.
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
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Arnold D, Gillespie J, Bennett M, Callender L, Sikka S, Hamilton R, Driver S, Swank C. Clinical Delivery of Overground Exoskeleton Gait Training in Persons With Spinal Cord Injury Across the Continuum of Care: A Retrospective Analysis. Top Spinal Cord Inj Rehabil 2024; 30:74-86. [PMID: 38433740 PMCID: PMC10906371 DOI: 10.46292/sci23-00001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2024]
Abstract
Background After spinal cord injury (SCI), inpatient rehabilitation begins and continues through outpatient therapy. Overground exoskeleton gait training (OEGT) has been shown to be feasible in both settings, yet its use as an intervention across the continuum has not yet been reported. Objectives This study describes OEGT for patients with SCI across the continuum and its effects on clinical outcomes. Methods Medical records of patients with SCI who completed at least one OEGT session during inpatient and outpatient rehabilitation from 2018 to 2021 were retrospectively reviewed. Demographic data, Walking Index for Spinal Cord Injury-II (WISCI-II) scores, and OEGT session details (frequency, "walk" time, "up" time, and step count) were extracted. Results Eighteen patients [male (83%), White (61%), aged 37.4 ± 15 years, with tetraplegia (50%), American Spinal Injury Association Impairment Scale A (28%), B (22%), C (39%), D (11%)] completed OEGT sessions (motor complete, 18.2 ± 10.3; motor incomplete, 16.7 ± 7.7) over approximately 18 weeks (motor complete, 15.1 ± 6.4; motor incomplete, 19.0 ± 8.2). Patients demonstrated improved OEGT session tolerance on device metrics including "walk" time (motor complete, 7:51 ± 4:42 to 24:50 ± 9:35 minutes; motor incomplete, 12:16 ± 6:01 to 20:01 ± 08:05 minutes), "up" time (motor complete, 16:03 ± 7:41 to 29:49 ± 12:44 minutes; motor incomplete, 16:38 ± 4:51 to 23:06 ± 08:50 minutes), and step count (motor complete, 340 ± 295.9 to 840.2 ± 379.4; motor incomplete, 372.3 ± 225.2 to 713.2 ± 272). Across therapy settings, patients with motor complete SCI experienced improvement in WISCI-II scores from 0 ± 0 at inpatient admission to 3 ± 4.6 by outpatient discharge, whereas the motor incomplete group demonstrated a change of 0.2 ± 0.4 to 9.0 ± 6.4. Conclusion Patients completed OEGT across the therapy continuum. Patients with motor incomplete SCI experienced clinically meaningful improvements in walking function.
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Affiliation(s)
- Dannae Arnold
- Baylor Scott and White Research Institute, Dallas, Texas
- Baylor Scott and White Institute for Rehabilitation, Dallas, Texas
| | - Jaime Gillespie
- Baylor Scott and White Research Institute, Dallas, Texas
- Baylor Scott and White Institute for Rehabilitation, Dallas, Texas
| | - Monica Bennett
- Baylor Scott and White Research Institute, Dallas, Texas
| | | | - Seema Sikka
- Baylor Scott and White Institute for Rehabilitation, Dallas, Texas
| | - Rita Hamilton
- Baylor Scott and White Institute for Rehabilitation, Dallas, Texas
| | - Simon Driver
- Baylor Scott and White Institute for Rehabilitation, Dallas, Texas
| | - Chad Swank
- Baylor Scott and White Research Institute, Dallas, Texas
- Baylor Scott and White Institute for Rehabilitation, Dallas, Texas
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Quel de Oliveira C, Bundy A, Middleton JW, Refshauge K, Rogers K, Davis GM. Activity-Based Therapy for Mobility, Function and Quality of Life after Spinal Cord Injuries-A Mixed-Methods Case Series. J Clin Med 2023; 12:7588. [PMID: 38137657 PMCID: PMC10743935 DOI: 10.3390/jcm12247588] [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: 10/30/2023] [Revised: 12/01/2023] [Accepted: 12/05/2023] [Indexed: 12/24/2023] Open
Abstract
(1) Background: Despite inconclusive evidence on the benefits of activity-based therapies (ABTs) in people with spinal cord injuries, implementation has occurred in clinics worldwide in response to consumers' requests. We explored the clinical changes and participants' perceptions from engaging in an ABT program in the community. (2) Methods: This mixed-methods study involved a pragmatic observational multiple-baseline design and an evaluation of participants' perceptions. Fifteen participants were included. Outcome measures were balance in sitting using the Seated Reach Distance test, mobility using the Modified Rivermead Mobility Index and quality of life using the Quality of Life Index SCI version pre- and post-participation in an ABT community-based program. Linear mixed models and logistic regressions were used to analyse the effects of intervention. Semi-structured interviews explored participants' perceptions using inductive thematic analysis. (3) Results: There was an increase of 9% in the standardised reach distance (95% CI 2-16) for sitting balance, 1.33 points (95% CI: 0.81-1.85) in mobility and 1.9 points (0.17-2.1) in quality of life. Two themes emerged from the interviews: (1) reduced impact of disability and an increased sense of life as before, and (2) the program was superior to usual rehabilitation. No adverse events related to the intervention were observed. (4) Conclusion: ABT delivered in the community improved clinical outcomes in people with a chronic SCI. High levels of satisfaction with the program were reported.
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Affiliation(s)
- Camila Quel de Oliveira
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia; (A.B.); (K.R.); (G.M.D.)
- Discipline of Physiotherapy, Graduate School of Health, Faculty of Health, University of Technology Sydney, Ultimo, NSW 2007, Australia
| | - Anita Bundy
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia; (A.B.); (K.R.); (G.M.D.)
- Department of Occupational Therapy, Colorado State University, Fort Collins, CO 80524, USA
| | - James W. Middleton
- John Walsh Center for Rehabilitation Research, Kolling Institute, Northern Sydney Local Health District and Sydney Medical School Northern, The University of Sydney, Sydney, NSW 2006, Australia;
| | - Kathryn Refshauge
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia; (A.B.); (K.R.); (G.M.D.)
| | - Kris Rogers
- Graduate School of Health, Faculty of Health, University of Technology Sydney, Ultimo, NSW 2007, Australia;
| | - Glen M. Davis
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia; (A.B.); (K.R.); (G.M.D.)
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10
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Wu YK, Wecht JM, Bloom OE, Panza GS, Harel NY. Remote Ischemic conditioning as an emerging tool to improve corticospinal transmission in individuals with chronic spinal cord injury. Curr Opin Neurol 2023; 36:523-530. [PMID: 37865833 DOI: 10.1097/wco.0000000000001216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2023]
Abstract
PURPOSE OF REVIEW Remote ischemic conditioning (RIC) involves transient blood flow restriction to one limb leading to systemic tissue-protective effects. RIC shares some potential underlying mechanisms with intermittent hypoxia (IH), in which brief bouts of systemic hypoxia trigger increases in growth factor expression and neural plasticity. RIC has shown promise in acute myocardial infarction and stroke but may be applicable toward chronic neuropathology as well. Consequently, this review discusses similarities and differences between RIC and IH and presents preliminary and ongoing research findings regarding RIC. RECENT FINDINGS Several publications demonstrated that combining RIC with motor training may enhance motor learning in adults with intact nervous systems, though the precise mechanisms were unclear. Our own preliminary data has found that RIC, in conjunction with task specific exercise, can increase corticospinal excitability in a subset of people without neurological injury and in those with chronic cervical spinal cord injury or amyotrophic lateral sclerosis. SUMMARY RIC is a low-cost intervention easy to deliver in a clinical or home setting. Its potential application to facilitate neural plasticity and motor learning during rehabilitation training for individuals with chronic neurological disorders is a novel concept requiring further investigation to characterize mechanisms, safety, and efficacy.
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Affiliation(s)
- Yu-Kuang Wu
- Icahn School of Medicine at Mount Sinai
- James J. Peters VA Medical Center
| | - Jill M Wecht
- Icahn School of Medicine at Mount Sinai
- James J. Peters VA Medical Center
| | - Ona E Bloom
- James J. Peters VA Medical Center
- The Feinstein Institute for Medical Research
- The Zucker School of Medicine at Hofstra Northwell
| | - Gino S Panza
- The Department of Healthcare Science Program of Occupational Therapy, Wayne State University
- John D. Dingell VA Medical Center, USA
| | - Noam Y Harel
- Icahn School of Medicine at Mount Sinai
- James J. Peters VA Medical Center
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11
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Angeli C, Wagers S, Harkema S, Rejc E. Sensory Information Modulates Voluntary Movement in an Individual with a Clinically Motor- and Sensory-Complete Spinal Cord Injury: A Case Report. J Clin Med 2023; 12:6875. [PMID: 37959340 PMCID: PMC10647542 DOI: 10.3390/jcm12216875] [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: 09/13/2023] [Revised: 10/26/2023] [Accepted: 10/27/2023] [Indexed: 11/15/2023] Open
Abstract
Motor recovery following a complete spinal cord injury is not likely. This is partially due to insurance limitations. Rehabilitation strategies for individuals with this type of severe injury focus on the compensation for the activities of daily living in the home and community and not on the restoration of function. With limited time in therapies, the initial goals must focus on getting the patient home safely without the expectation of recovery of voluntary movement below the level of injury. In this study, we report a case of an individual with a chronic, cervical (C3)-level clinically motor- and sensory-complete injury who was able to perform voluntary movements with both upper and lower extremities when positioned in a sensory-rich environment conducive to the specific motor task. We show how he is able to intentionally perform push-ups, trunk extensions and leg presses only when appropriate sensory information is available to the spinal circuitry. These data show that the human spinal circuitry, even in the absence of clinically detectable supraspinal input, can generate motor patterns effective for the execution of various upper and lower extremity tasks, only when appropriate sensory information is present. Neurorehabilitation in the right sensory-motor environment that can promote partial recovery of voluntary movements below the level of injury, even in individuals diagnosed with a clinically motor-complete spinal cord injury.
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Affiliation(s)
- Claudia Angeli
- Tim and Caroline Reynolds Center for Spinal Stimulation, Kessler Foundation, West Orange, NJ 07052, USA;
- Department of Bioengineering, University of Louisville, Louisville, KY 40292, USA
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY 40202, USA; (S.W.); (S.H.)
| | - Sarah Wagers
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY 40202, USA; (S.W.); (S.H.)
- Division of Physical Medicine and Rehabilitation, University of Louisville, Louisville, KY 40292, USA
| | - Susan Harkema
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY 40202, USA; (S.W.); (S.H.)
| | - Enrico Rejc
- Tim and Caroline Reynolds Center for Spinal Stimulation, Kessler Foundation, West Orange, NJ 07052, USA;
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY 40202, USA; (S.W.); (S.H.)
- Department of Medicine, University of Udine, 33100 Udine, Italy
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12
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Buczak MK, Zollinger JM, Alsaleem A, Imburgia R, Rosenbluth J, George JA. Intuitive, Myoelectric Control of Adaptive Sports Equipment for Individuals with Tetraplegia. IEEE Int Conf Rehabil Robot 2023; 2023:1-6. [PMID: 37941260 DOI: 10.1109/icorr58425.2023.10304759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
This research aims to develop safe, robust, and easy-to-use adaptive technology for individuals with tetraplegia. After a debilitating spinal cord injury, clinical care focuses on improving quality of life. Participation in adaptive sports has been shown to improve several aspects of participants' well-being. The TetraSki is a power-assisted ski chair that allows individuals with tetraplegia to participate in downhill skiing by sipping and puffing air on an integrated straw to turn their skis. Here, we introduce a new intuitive and dexterous control strategy for the TetraSki using surface electromyography (sEMG) from the neck and shoulder muscles. As an initial assessment, six healthy participants completed a virtual ski racecourse using sEMG and Sip-and-Puff control. Participants also completed a detection response task of cognitive load and the NASA-TLX survey of subjective workload. No significant differences were observed between the performance of sEMG control and the performance of Sip-and-Puff control. However, sEMG control required significantly less cognitive load and subjective workload than Sip-and-Puff control. These results indicate that sEMG can effectively control the equipment and is significantly more intuitive than traditional Sip-and-Puff control. This suggests that sEMG is a promising control method for further validation with individuals with tetraplegia. Ultimately, long-term use of sEMG control may promote neuroplasticity and drive rehabilitation.
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13
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Jovanovic LI, Jervis Rademeyer H, Pakosh M, Musselman KE, Popovic MR, Marquez-Chin C. Scoping Review on Brain-Computer Interface-Controlled Electrical Stimulation Interventions for Upper Limb Rehabilitation in Adults: A Look at Participants, Interventions, and Technology. Physiother Can 2023; 75:276-290. [PMID: 37736411 PMCID: PMC10510539 DOI: 10.3138/ptc-2021-0074] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 11/07/2021] [Accepted: 12/07/2021] [Indexed: 09/23/2023]
Abstract
Purpose While current rehabilitation practice for improving arm and hand function relies on physical/occupational therapy, a growing body of research evaluates the effects of technology-enhanced rehabilitation. We review interventions that combine a brain-computer interface (BCI) with electrical stimulation (ES) for upper limb movement rehabilitation to summarize the evidence on (1) populations of study participants, (2) BCI-ES interventions, and (3) the BCI-ES systems. Method After searching seven databases, two reviewers identified 23 eligible studies. We consolidated information on the study participants, interventions, and approaches used to develop integrated BCI-ES systems. The included studies investigated the use of BCI-ES interventions with stroke and spinal cord injury (SCI) populations. All studies used electroencephalography to collect brain signals for the BCI, and functional electrical stimulation was the most common type of ES. The BCI-ES interventions were typically conducted without a therapist, with sessions varying in both frequency and duration. Results Of the 23 eligible studies, only 3 studies involved the SCI population, compared to 20 involving individuals with stroke. Conclusions Future BCI-ES interventional studies could address this gap. Additionally, standardization of device and rehabilitation modalities, and study-appropriate involvement with therapists, can be considered to advance this intervention towards clinical implementation.
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Affiliation(s)
- Lazar I. Jovanovic
- From the:
Institute of Biomedical Engineering, University of Toronto, Toronto, Canada
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
- The Center for Advancing Neurotechnological Innovation to Application (CRANIA), University Health Network, Toronto, Canada
| | - Hope Jervis Rademeyer
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Maureen Pakosh
- Library & Information Services, University Health Network, Toronto Rehabilitation Institute, Toronto, Canada
| | - Kristin E. Musselman
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Milos R. Popovic
- From the:
Institute of Biomedical Engineering, University of Toronto, Toronto, Canada
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
- The Center for Advancing Neurotechnological Innovation to Application (CRANIA), University Health Network, Toronto, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Cesar Marquez-Chin
- From the:
Institute of Biomedical Engineering, University of Toronto, Toronto, Canada
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
- The Center for Advancing Neurotechnological Innovation to Application (CRANIA), University Health Network, Toronto, Canada
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14
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Charbonneau JA, Bennett JL, Chau K, Bliss-Moreau E. Reorganization in the macaque interoceptive-allostatic network following anterior cingulate cortex damage. Cereb Cortex 2023; 33:4334-4349. [PMID: 36066407 PMCID: PMC10110454 DOI: 10.1093/cercor/bhac346] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 08/08/2022] [Accepted: 08/09/2022] [Indexed: 11/14/2022] Open
Abstract
Accumulating evidence indicates that the adult brain is capable of significant structural change following damage-a capacity once thought to be largely limited to developing brains. To date, most existing research on adult plasticity has focused on how exteroceptive sensorimotor networks compensate for damage to preserve function. Interoceptive networks-those that represent and process sensory information about the body's internal state-are now recognized to be critical for a wide range of physiological and psychological functions from basic energy regulation to maintaining a sense of self, but the extent to which these networks remain plastic in adulthood has not been established. In this report, we used detailed histological analyses to pinpoint precise changes to gray matter volume in the interoceptive-allostatic network in adult rhesus monkeys (Macaca mulatta) who received neurotoxic lesions of the anterior cingulate cortex (ACC) and neurologically intact control monkeys. Relative to controls, monkeys with ACC lesions had significant and selective unilateral expansion of the ventral anterior insula and significant relative bilateral expansion of the lateral nucleus of the amygdala. This work demonstrates the capacity for neuroplasticity in the interoceptive-allostatic network which, given that changes included expansion rather than atrophy, is likely to represent an adaptive response following damage.
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Affiliation(s)
- Joey A Charbonneau
- Neuroscience Graduate Program, University of California Davis, 1544 Newton Court, Davis, CA 95618, United States
- California National Primate Research Center, University of California Davis, One Shields Avenue, Davis, CA 95616, United States
| | - Jeffrey L Bennett
- California National Primate Research Center, University of California Davis, One Shields Avenue, Davis, CA 95616, United States
- Department of Psychiatry and Behavioral Sciences, University of California Davis School of Medicine, 2230 Stockton Blvd, Sacramento, CA 95817, United States
- The MIND Institute, University of California Davis, 2825 50th Street, Sacramento, CA 95817, United States
| | - Kevin Chau
- California National Primate Research Center, University of California Davis, One Shields Avenue, Davis, CA 95616, United States
| | - Eliza Bliss-Moreau
- California National Primate Research Center, University of California Davis, One Shields Avenue, Davis, CA 95616, United States
- Department of Psychology, University of California Davis, 135 Young Hall One Shields Avenue, Davis, CA 95616, United States
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15
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Gauthier C, Walden K, Jervis-Rademeyer H, Musselman KE, Kaiser A, Wolfe DL, Noonan VK, Donkers SJ. Technology used in activity based therapy for individuals living with spinal cord injury across Canada. Spinal Cord Ser Cases 2023; 9:1. [PMID: 36646680 PMCID: PMC9842763 DOI: 10.1038/s41394-022-00558-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 12/05/2022] [Accepted: 12/29/2022] [Indexed: 01/18/2023] Open
Abstract
STUDY DESIGN Cross-sectional equipment inventory. OBJECTIVES The objective of this study was to describe the equipment used in activity-based therapy (ABT) programs for individuals with spinal cord injury or disorder (SCI/D) across Canada. SETTINGS Publicly funded and private SCI/D care settings. METHODS A survey on equipment available for ABT for different therapeutic goals was answered by Canadian sites providing SCI/D rehabilitation. Information about the setting and type of client were also collected. The survey results were compiled into an inventory of the reported types and use of ABT related equipment, with equipment grouped into varying levels of technology. Descriptive statistics and qualitative descriptive analysis were used to answer the questions: (1) 'who' used the equipment, (2) 'what' types of equipment are used, (3) 'why' (i.e., for which therapeutic goals), and (4) 'how' it is used. RESULTS Twenty-two sites from eight Canadian provinces completed the survey. Reported equipment was classified into 5 categories (from low to high-tech). Most equipment reported was used to train balance. The high-tech equipment reported as available, was mostly used for walking training and strengthening of the lower limbs. Low-tech equipment was reported as being used most frequently, while high-tech devices, although available, were reported as infrequently or rarely used. CONCLUSIONS A large spectrum of equipment with varying levels of technology were reported as available, but were inconsistently used to provide ABT interventions across sites. In order to increase the clinical use of available equipment for ABT, education tools such as protocols regarding ABT principles and implementation are needed.
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Affiliation(s)
- Cindy Gauthier
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,KITE, Toronto Rehabilitation Institute -University Health Network, Toronto, ON, Canada
| | | | - Hope Jervis-Rademeyer
- KITE, Toronto Rehabilitation Institute -University Health Network, Toronto, ON, Canada.,Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Kristin E Musselman
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,KITE, Toronto Rehabilitation Institute -University Health Network, Toronto, ON, Canada.,Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Anita Kaiser
- KITE, Toronto Rehabilitation Institute -University Health Network, Toronto, ON, Canada.,Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Dalton L Wolfe
- Parkwood Institute, Lawson Health Research Institute, London, ON, Canada
| | - Vanessa K Noonan
- Praxis Spinal Cord Institute, Vancouver, BC, Canada.,International Collaboration on Repair Discoveries, Vancouver, BC, Canada
| | - Sarah J Donkers
- School of Rehabilitation Science, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada.
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16
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Jervis-Rademeyer H, Ong K, Djuric A, Munce S, Musselman KE, Marquez-Chin C. Therapists' perspectives on using brain-computer interface-triggered functional electrical stimulation therapy for individuals living with upper extremity paralysis: a qualitative case series study. J Neuroeng Rehabil 2022; 19:127. [PMID: 36419166 PMCID: PMC9684970 DOI: 10.1186/s12984-022-01107-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 10/31/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Brain computer interface-triggered functional electrical stimulation therapy (BCI-FEST) has shown promise as a therapy to improve upper extremity function for individuals who have had a stroke or spinal cord injury. The next step is to determine whether BCI-FEST could be used clinically as part of broader therapy practice. To do this, we need to understand therapists' opinions on using the BCI-FEST and what limitations potentially exist. Therefore, we conducted a qualitative exploratory study to understand the perspectives of therapists on their experiences delivering BCI-FEST and the feasibility of large-scale clinical implementation. METHODS Semi-structured interviews were conducted with physical therapists (PTs) and occupational therapists (OTs) who have delivered BCI-FEST. Interview questions were developed using the COM-B (Capability, Opportunity, Motivation-Behaviour) model of behaviour change. COM-B components were used to inform deductive content analysis while other subthemes were detected using an inductive approach. RESULTS We interviewed PTs (n = 3) and OTs (n = 3), with 360 combined hours of experience delivering BCI-FEST. Components and subcomponents of the COM-B determined deductively included: (1) Capability (physical, psychological), (2) Opportunity (physical, social), and (3) Motivation (automatic, reflective). Under each deductive subcomponent, one to two inductive subthemes were identified (n = 8). Capability and Motivation were perceived as strengths, and therefore supported therapists' decisions to use BCI-FEST. Under Opportunity, for both subcomponents (physical, social), therapists recognized the need for more support to clinically implement BCI-FEST. CONCLUSIONS We identified facilitating and limiting factors to BCI-FEST delivery in a clinical setting according to clinicians. These factors implied that education, training, a support network or mentors, and restructuring the physical environment (e.g., scheduling) should be targeted as interventions. The results of this study may help to inform future development of new technologies and interventions.
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Affiliation(s)
- Hope Jervis-Rademeyer
- grid.17063.330000 0001 2157 2938Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada ,grid.231844.80000 0004 0474 0428The KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Kenneth Ong
- grid.231844.80000 0004 0474 0428The KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada ,grid.17063.330000 0001 2157 2938Department of Physical Therapy, University of Toronto, Toronto, Canada
| | - Alexander Djuric
- grid.231844.80000 0004 0474 0428The KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada ,grid.17063.330000 0001 2157 2938Department of Physical Therapy, University of Toronto, Toronto, Canada
| | - Sarah Munce
- grid.17063.330000 0001 2157 2938Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada ,grid.231844.80000 0004 0474 0428The KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada ,grid.17063.330000 0001 2157 2938Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada
| | - Kristin E. Musselman
- grid.17063.330000 0001 2157 2938Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada ,grid.231844.80000 0004 0474 0428The KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada ,grid.17063.330000 0001 2157 2938Department of Physical Therapy, University of Toronto, Toronto, Canada
| | - Cesar Marquez-Chin
- grid.231844.80000 0004 0474 0428The KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada ,grid.17063.330000 0001 2157 2938Institute of Biomedical Engineering, University of Toronto, Toronto, Canada
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17
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Charbonneau R, Loyola-Sanchez A, McIntosh K, MacKean G, Ho C. Exoskeleton use in acute rehabilitation post spinal cord injury: A qualitative study exploring patients' experiences. J Spinal Cord Med 2022; 45:848-856. [PMID: 34855574 PMCID: PMC9662053 DOI: 10.1080/10790268.2021.1983314] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
CONTEXT/OBJECTIVE Spinal cord injury (SCI) is intensely life altering, affecting multiple body systems and functions, including the ability to walk. Exoskeleton assisted walking (EAW) is a rehabilitation tool that aims to support locomotor training, yet little is known about the patient experience. The purpose of this qualitative study, part of a prospective observational case series, was to increase our understanding of SCI patient experience using a robotic exoskeleton in this acute post-injury period. DESIGN A qualitative descriptive approach was implemented in this study, with the aim to explore and understand participants' experience with EAW training. PARTICIPANTS/SETTING Nine of the 11 participants enrolled in the observational study agreed to participate in an interview. All participants had suffered a SCI, and had received their trauma care and inpatient rehabilitation at a tertiary center in Calgary, Alberta, Canada. RESULTS The benefits to EAW use described by participants were primarily psychological and included the joy of eye level contact, excitement at being able to walk with assistance, improvement in mood, and hope for the future. Potential physiological benefits include increased strength, decreased spasticity and reduced pain. Challenges to EAW use include weakness and fatigue, and a fear of incontinence. CONCLUSION Qualitative research will continue to be an important component in future research on the use of EAW training as part of the rehabilitation process. Increasing understanding of the participants experience with this novel therapeutic modality and technology will be fundamental to improve its implementation in clinical practice.
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Affiliation(s)
- Rebecca Charbonneau
- Department of Clinical Neuroscience, University of Calgary, Calgary, Canada,Correspondence to: Rebecca Charbonneau, Lead Spinal Cord Injury Program, Division of Physical Medicine & Rehabilitation, Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.Ph: (403)-944-4475.
| | | | - Kyle McIntosh
- Department of Clinical Neuroscience, University of Calgary, Calgary, Canada
| | - Gail MacKean
- Department of Clinical Neuroscience, University of Calgary, Calgary, Canada
| | - Chester Ho
- Department of Medicine, University of Alberta, Edmonton, Canada
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18
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Chen M, Chen Z, Xiao X, Zhou L, Fu R, Jiang X, Pang M, Xia J. Corticospinal circuit neuroplasticity may involve silent synapses: Implications for functional recovery facilitated by neuromodulation after spinal cord injury. IBRO Neurosci Rep 2022; 14:185-194. [PMID: 36824667 PMCID: PMC9941655 DOI: 10.1016/j.ibneur.2022.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 08/15/2022] [Indexed: 10/15/2022] Open
Abstract
Spinal cord injury (SCI) leads to devastating physical consequences, such as severe sensorimotor dysfunction even lifetime disability, by damaging the corticospinal system. The conventional opinion that SCI is intractable due to the poor regeneration of neurons in the adult central nervous system (CNS) needs to be revisited as the CNS is capable of considerable plasticity, which underlie recovery from neural injury. Substantial spontaneous neuroplasticity has been demonstrated in the corticospinal motor circuitry following SCI. Some of these plastic changes appear to be beneficial while others are detrimental toward locomotor function recovery after SCI. The beneficial corticospinal plasticity in the spared corticospinal circuits can be harnessed therapeutically by multiple contemporary neuromodulatory approaches, especially the electrical stimulation-based modalities, in an activity-dependent manner to improve functional outcomes in post-SCI rehabilitation. Silent synapse generation and unsilencing contribute to profound neuroplasticity that is implicated in a variety of neurological disorders, thus they may be involved in the corticospinal motor circuit neuroplasticity following SCI. Exploring the underlying mechanisms of silent synapse-mediated neuroplasticity in the corticospinal motor circuitry that may be exploited by neuromodulation will inform a novel direction for optimizing therapeutic repair strategies and rehabilitative interventions in SCI patients.
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Key Words
- AMPARs, α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptors
- BDNF, brain-derived neurotrophic factor
- BMIs, brain-machine interfaces
- CPG, central pattern generator
- CST, corticospinal tract
- Corticospinal motor circuitry
- DBS, deep brain stimulation
- ESS, epidural spinal stimulation
- MEPs, motor-evoked potentials
- NHPs, non-human primates
- NMDARs, N-methyl-d-aspartate receptors
- Neuromodulation
- Neuroplasticity
- PSNs, propriospinal neurons
- Rehabilitation
- SCI, spinal cord injury
- STDP, spike timing-dependent plasticity
- Silent synapses
- Spinal cord injury
- TBS, theta burst stimulation
- TMS, transcranial magnetic stimulation
- TrkB, tropomyosin-related kinase B
- cTBS, continuous TBS
- iTBS, intermittent TBS
- mTOR, mammalian target of rapamycin
- rTMS, repetitive TMS
- tDCS, transcranial direct current stimulation
- tcSCS, transcutaneous spinal cord stimulation
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Affiliation(s)
- Mingcong Chen
- Department of Orthopedics and Traumatology, Shenzhen University General Hospital, Shenzhen, Guangdong 518055, China
| | - Zuxin Chen
- Shenzhen Key Laboratory of Drug Addiction, Shenzhen Neher Neural Plasticity Laboratory, the Brain Cognition and Brain Disease Institute, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences (CAS); Shenzhen-Hong Kong Institute of Brain Science-Shenzhen Fundamental Research Institutions, Shenzhen, Guangdong 518055, China
| | - Xiao Xiao
- Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence, Ministry of Education; Behavioral and Cognitive Neuroscience Center, Institute of Science and Technology for Brain-Inspired Intelligence; MOE Frontiers Center for Brain Science, Fudan University, Shanghai 200433, China
| | - Libing Zhou
- Guangdong-Hongkong-Macau CNS Regeneration Institute of Jinan University, Key Laboratory of CNS Regeneration (Jinan University)-Ministry of Education, Guangzhou, Guangdong 510632, China
| | - Rao Fu
- Department of Anatomy, School of Medicine, Sun Yat-sen University, Shenzhen, Guangdong 518100, China
| | - Xian Jiang
- Institute of Neurological and Psychiatric Disorder, Shenzhen Bay laboratory, Shenzhen, Guangdong 518000, China
| | - Mao Pang
- Department of Spine Surgery, the Third Affiliated Hospital of Sun Yat-sen University, Guangdong Provincial Center for Engineering and Technology Research of Minimally Invasive Spine Surgery, Guangzhou, Guangdong 510630, China
| | - Jianxun Xia
- Department of Basic Medical Sciences, Yunkang School of Medicine and Health, Nanfang College, Guangzhou, Guangdong 510970, China,Corresponding author.
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19
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Bourguignon L, Tong B, Geisler F, Schubert M, Röhrich F, Saur M, Weidner N, Rupp R, Kalke YBB, Abel R, Maier D, Grassner L, Chhabra HS, Liebscher T, Cragg JJ, Kramer J, Curt A, Jutzeler CR. International surveillance study in acute spinal cord injury confirms viability of multinational clinical trials. BMC Med 2022; 20:225. [PMID: 35705947 PMCID: PMC9202190 DOI: 10.1186/s12916-022-02395-0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 05/04/2022] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The epidemiological international landscape of traumatic spinal cord injury (SCI) has evolved over the last decades along with given inherent differences in acute care and rehabilitation across countries and jurisdictions. However, to what extent these differences may influence neurological and functional recovery as well as the integrity of international trials is unclear. The latter also relates to historical clinical data that are exploited to inform clinical trial design and as potential comparative data. METHODS Epidemiological and clinical data of individuals with traumatic and ischemic SCI enrolled in the European Multi-Center Study about Spinal Cord Injury (EMSCI) were analyzed. Mixed-effect models were employed to account for the longitudinal nature of the data, efficiently handle missing data, and adjust for covariates. The primary outcomes comprised demographics/injury characteristics and standard scores to quantify neurological (i.e., motor and sensory scores examined according to the International Standards for the Neurological Classification of Spinal Cord Injury) and functional recovery (walking function). We externally validated our findings leveraging data from a completed North American landmark clinical trial. RESULTS A total of 4601 patients with acute SCI were included. Over the course of 20 years, the ratio of male to female patients remained stable at 3:1, while the distribution of age at injury significantly shifted from unimodal (2001/02) to bimodal distribution (2019). The proportional distribution of injury severities and levels remained stable with the largest percentages of motor complete injuries. Both, the rate and pattern of neurological and functional recovery, remained unchanged throughout the surveillance period despite the increasing age at injury. The findings related to recovery profiles were confirmed by an external validation cohort (n=791). Lastly, we built an open-access and online surveillance platform ("Neurosurveillance") to interactively exploit the study results and beyond. CONCLUSIONS Despite some epidemiological changes and considerable advances in clinical management and rehabilitation, the neurological and functional recovery following SCI has remained stable over the last two decades. Our study, including a newly created open-access and online surveillance tool, constitutes an unparalleled resource to inform clinical practice and implementation of forthcoming clinical trials targeting neural repair and plasticity in acute spinal cord injury.
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Affiliation(s)
- Lucie Bourguignon
- Department of Health Sciences and Technology (D-HEST), ETH Zurich, Zürich, Switzerland.,SIB Swiss Institute of Bioinformatics, Lausanne, Switzerland
| | - Bobo Tong
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, Canada
| | - Fred Geisler
- University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Martin Schubert
- Spinal Cord Injury Center, University Hospital Balgrist, University of Zurich, Lengghalde 2, 8006, Zürich, Switzerland
| | - Frank Röhrich
- Berufsgenossenschaftliche Klinik Bergmanstrost of Halle, Halle, Germany
| | - Marion Saur
- Orthopädische Klinik, Hessisch Lichtenau, Germany
| | - Norbert Weidner
- Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany
| | - Rüdiger Rupp
- Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Rainer Abel
- Spinal Cord Injury Center, Bayreuth, Germany
| | - Doris Maier
- Spinal Cord Injury Center, Trauma Center Murnau, Murnau, Germany
| | - Lukas Grassner
- Spinal Cord Injury Center, Trauma Center Murnau, Murnau, Germany.,Department of Neurosurgery, Medical University Innsbruck, Innsbruck, Austria
| | - Harvinder S Chhabra
- Spine Service, Indian Spinal Injuries Centre, Sector C, Vasant Kunj, New Delhi, India
| | - Thomas Liebscher
- Treatment Centre for Spinal Cord Injuries, Trauma Hospital Berlin, Berlin, Germany
| | - Jacquelyn J Cragg
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, Canada.,Collaboration for Outcomes Research and Evaluation (CORE), Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada
| | | | - John Kramer
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, Canada.,Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada.,Department of Anesthesiology, Pharmacology, and Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Armin Curt
- Spinal Cord Injury Center, University Hospital Balgrist, University of Zurich, Lengghalde 2, 8006, Zürich, Switzerland
| | - Catherine R Jutzeler
- Department of Health Sciences and Technology (D-HEST), ETH Zurich, Zürich, Switzerland. .,SIB Swiss Institute of Bioinformatics, Lausanne, Switzerland. .,Spinal Cord Injury Center, University Hospital Balgrist, University of Zurich, Lengghalde 2, 8006, Zürich, Switzerland.
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20
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Leon Machado L, Noonan K, Bickel S, Singh G, Brothers K, Calvery M, Behrman AL. Spinal Cord Injury at Birth, Expected Medical and Health Complexity in Chronic Injury Guided Anew by Activity-Based Restorative Therapy: Case Report. Front Psychol 2022; 13:800091. [PMID: 35465488 PMCID: PMC9021874 DOI: 10.3389/fpsyg.2022.800091] [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] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 02/21/2022] [Indexed: 11/13/2022] Open
Abstract
As infancy is characterized by rapid physical growth and critical periods of development, disruptions due to illness or disease reveal vulnerability associated with this period. Spinal cord injury (SCI) has devastating consequences at any age, but its onset neonatally, at birth, or within the first year of life multiplies its impact. The immediate physical and physiological consequences are obvious and immense, but the effects on the typical trajectory of development are profound. Activity-based restorative therapies (ABRT) capitalize on activity-dependent plasticity of the neuromuscular system below the lesion and when provided to children with SCI aim to improve the child's neuromuscular capacity, health and quality of life. This is a report of an infant with a cervical SCI at birth resulting in paralysis of leg and trunk muscles and paresis of arm and hands who was enrolled in an ABRT program at 3 years of age. After 59 sessions of ABRT, the child demonstrated significant improvements in trunk control and arm function, as well as social and emotional development. Despite the chronicity of injury and low expectations for improvement with therapeutic interventions, ABRT had a positive impact on the child's physical capacity and provided benefits across multiple developmental domains.
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Affiliation(s)
- Laura Leon Machado
- UofL Health, Frazier Rehab Institute, Kosair Charities Center for Pediatric NeuroRecovery, Louisville, KY, United States
| | - Kathryn Noonan
- UofL Health, Frazier Rehab Institute, Kosair Charities Center for Pediatric NeuroRecovery, Louisville, KY, United States
| | - Scott Bickel
- Division of Pediatric Pulmonology, Allergy and Immunology, Norton Children's Hospital, Louisville, KY, United States.,School of Medicine, University of Louisville, Louisville, KY, United States
| | - Goutam Singh
- Kosair Charities School of Physical Therapy, Spalding University, Louisville, KY, United States
| | - Kyle Brothers
- Norton Children's Research Institute, Affiliated With the University of Louisville School of Medicine, Louisville, KY, United States
| | - Margaret Calvery
- Norton Children's Medical Group, Louisville, KY, United States.,Department of Pediatrics, University of Louisville, Louisville, KY, United States
| | - Andrea L Behrman
- Department of Neurological Surgery, Kentucky Spinal Cord Injury Research Center, Kosair Charities Center for Pediatric NeuroRecovery, University of Louisville, Louisville, KY, United States
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21
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Wu YK, Harel NY, Wecht JM, Bloom OE. Effects of Remote Ischemic Conditioning on Hand Engagement in individuals with Spinal cord Injury (RICHES): protocol for a pilot crossover study. F1000Res 2022; 10:464. [PMID: 35342620 PMCID: PMC8924555 DOI: 10.12688/f1000research.52670.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/06/2022] [Indexed: 11/20/2022] Open
Abstract
Background: Most spinal cord injuries (SCI) are not full transections, indicating that residual nerve circuits are retained. Rehabilitation interventions have been shown to beneficially reorganize motor pathways in the brain, corticospinal tract, and at the spinal level. However, rehabilitation training require a large number of repetitions, and intervention effects may be absent or show transient retention. Therefore, the need remains for an effective approach to synergistically improve the amount and duration of neuroplasticity in combination with other interventions. Remote ischemic conditioning (RIC) demonstrates several potential advantages as a candidate for such an approach. Therefore, we propose a protocol to investigate RIC coupled with physical training to promote neuroplasticity in hand muscles. Methods: This will be a prospective randomized-order crossover trial to be performed in eight able-bodied participants and eight participants with chronic cervical SCI. Patients will participate in two experimental sessions consisting of either active or sham RIC preceding a bout of pinch movement exercise. Serial evaluations will be conducted at baseline, after RIC, immediately after pinch exercise, and follow up 15-minutes later. The primary outcome is the change in corticospinal excitability (primarily measured by the motor evoked potential of abductor pollicis brevis muscle). Secondary outcomes will include maximal volitional pinch force, and inflammatory biomarkers. To ensure safety, we will monitor tolerability and hemodynamic responses during RIC. Discussion: This protocol will be the first to test RIC in people with cervical SCI and to investigate whether RIC alters corticospinal excitability. By sharing the details of our protocol, we hope other interested researchers will seek to investigate similar approaches – depending on overlap with the current study and mutual sharing of participant-level data, this could increase the sample size, power, and generalizability of the analysis and results. Trial registration: ClinicalTrial.gov, ID: NCT03851302; Date of registration: February 22, 2019
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Affiliation(s)
- Yu-Kuang Wu
- Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY, 10003, USA
- Bronx Veterans Medical Research Foundation, Bronx, NY, 10468, USA
| | - Noam Y. Harel
- Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY, 10003, USA
- Bronx Veterans Medical Research Foundation, Bronx, NY, 10468, USA
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, 10003, USA
| | - Jill M. Wecht
- Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY, 10003, USA
- Bronx Veterans Medical Research Foundation, Bronx, NY, 10468, USA
| | - Ona E. Bloom
- Bronx Veterans Medical Research Foundation, Bronx, NY, 10468, USA
- The Feinstein Institute for Medical Research, Manhasset, NY, 11030, USA
- The Zucker School of Medicine at Hofstra Northwell, Hempstead, NY, 11549, USA
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22
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Naro A, Billeri L, Balletta T, Lauria P, Onesta MP, Calabrò RS. Finding the Way to Improve Motor Recovery of Patients with Spinal Cord Lesions: A Case-Control Pilot Study on a Novel Neuromodulation Approach. Brain Sci 2022; 12:119. [PMID: 35053862 PMCID: PMC8773706 DOI: 10.3390/brainsci12010119] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/12/2022] [Accepted: 01/13/2022] [Indexed: 12/16/2022] Open
Abstract
Robot-assisted rehabilitation (RAR) and non-invasive brain stimulation (NIBS) are interventions that, both individually and combined, can significantly enhance motor performance after spinal cord injury (SCI). We sought to determine whether repetitive transcranial magnetic stimulation (rTMS) combined with active transvertebral direct current stimulation (tvDCS) (namely, NIBS) in association with RAR (RAR + NIBS) improves lower extremity motor function more than RAR alone in subjects with motor incomplete SCI (iSCI). Fifteen adults with iSCI received one daily session of RAR+NIBS in the early afternoon, six sessions weekly, for eight consecutive weeks. Outcome measures included the 6 min walk test (6MWT), the 10 m walk test (10MWT), the timed up and go (TUG) to test mobility and balance, the Walking Index for Spinal Cord Injury (WISCI II), the Functional Independence Measure-Locomotion (FIM-L), the manual muscle testing for lower extremity motor score (LEMS), the modified Ashworth scale for lower limbs (MAS), and the visual analog scale (VAS) for pain. The data of these subjects were compared with those of 20 individuals matched for clinical and demographic features who previously received the same amount or RAR without NIBS (RAR - NIBS). All patients completed the trial, and none reported any side effects either during or following the training. The 10MWT improved in both groups, but the increase was significantly greater following RAR + NIBS than RAR - NIBS. The same occurred for the FIM-L, LEMS, and WISCI II. No significant differences were appreciable concerning the 6MWT and TUG. Conversely, RAR - NIBS outperformed RAR + NIBS regarding the MAS and VAS. Pairing tvDCS with rTMS during RAR can improve lower extremity motor function more than RAR alone can do. Future research with a larger sample size is recommended to determine longer-term effects on motor function and activities of daily living.
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Affiliation(s)
- Antonino Naro
- IRCCS Centro Neurolesi Bonino Pulejo Piemonte, Via Palermo, SS 113, Ctr. Casazza, 98124 Messina, Italy; (A.N.); (L.B.); (T.B.); (P.L.)
| | - Luana Billeri
- IRCCS Centro Neurolesi Bonino Pulejo Piemonte, Via Palermo, SS 113, Ctr. Casazza, 98124 Messina, Italy; (A.N.); (L.B.); (T.B.); (P.L.)
| | - Tina Balletta
- IRCCS Centro Neurolesi Bonino Pulejo Piemonte, Via Palermo, SS 113, Ctr. Casazza, 98124 Messina, Italy; (A.N.); (L.B.); (T.B.); (P.L.)
| | - Paola Lauria
- IRCCS Centro Neurolesi Bonino Pulejo Piemonte, Via Palermo, SS 113, Ctr. Casazza, 98124 Messina, Italy; (A.N.); (L.B.); (T.B.); (P.L.)
| | | | - Rocco Salvatore Calabrò
- IRCCS Centro Neurolesi Bonino Pulejo Piemonte, Via Palermo, SS 113, Ctr. Casazza, 98124 Messina, Italy; (A.N.); (L.B.); (T.B.); (P.L.)
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23
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Goode-Roberts M, Noonan K, Stout D, Calvery M, Brothers K, Doonan NW, Behrman AL. Case Report: Capitalizing on Development and Activity-Dependent Plasticity, an Interaction With Pediatric-Onset Spinal Cord Injury. Front Pediatr 2022; 10:804622. [PMID: 35425730 PMCID: PMC9002091 DOI: 10.3389/fped.2022.804622] [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] [Received: 11/02/2021] [Accepted: 02/16/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Spinal cord injury (SCI) in infancy halts typical development secondary to paralysis/paresis and the limited ability to engage with the environment. Traditional therapies further restrict a child via bracing, equipment, and medications. In contrast, activity-based restorative therapies (ABRT) promote activation of the neuromuscular system below the level of injury and affords a more typical sensorimotor experience. CASE DESCRIPTION A premature male infant exhibiting hypotonia, poor head control, and extremity weakness was diagnosed at age 5 months with a remote incomplete upper cervical SCI based on magnetic resonance imaging (MRI), presumed to have occurred perinatally. From 4 to 15 months of age, he received physical, occupational and speech therapies. Enrolled in an ABRT program at 15 months, he was unable to sit, pull-to-stand, stand, or walk and had upper extremity impairments. Results of the Bayley-III Scales of Infant and Toddler Development revealed gross and fine motor scores consistent with a 4-month-old. METHODS Activity-based restorative therapies was provided 5 day/week: 1.5 h of activity-based locomotor training and 1 h of activity-based occupational therapy. RESULTS Activity-based restorative therapies are reported for 177 sessions and are on-going. Improvements are noted in trunk control, standing, walking, grasp, in-hand manipulation, and associated kinematics. Bayley-III fine motor score improved to that of a 16-month-old and gross motor score to that of a 7-month-old. DISCUSSION While the two treatment periods (i.e., 4-15 months old and 15-24 months) were each ∼9 months, the child's accelerated progress toward typical development during the latter, ABRT period is noteworthy. In comparison to the period of traditional therapies in which paralysis was compounded by a restrictive environment and compensation, ABRT provided a potentially rich sensorimotor experience with an emphasis on active weight-bearing and proper kinematics to activate the neuromuscular system below the lesion in an age-appropriate, task-specific context of activities. Improved physical capacity enabled exploration more typically associated with development at this age expanding the positive impact to other developmental domains.
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Affiliation(s)
- MacKenzie Goode-Roberts
- UofL Health, Frazier Rehab Institute, Kosair Charities Center for Pediatric NeuroRecovery, Louisville, KY, United States
| | - Kathryn Noonan
- UofL Health, Frazier Rehab Institute, Kosair Charities Center for Pediatric NeuroRecovery, Louisville, KY, United States
| | - Danielle Stout
- UofL Health, Frazier Rehab Institute, Kosair Charities Center for Pediatric NeuroRecovery, Louisville, KY, United States
| | - Margaret Calvery
- Norton Children's Medical Group, Louisville, KY, United States.,Department of Pediatrics, University of Louisville, Louisville, KY, United States
| | - Kyle Brothers
- Norton Children's Research Institute, Affiliated With the University of Louisville School of Medicine, Louisville, KY, United States
| | - Nicole Williams Doonan
- Department of Neurology, Gillette Children's Specialty Healthcare, St. Paul, MN, United States
| | - Andrea L Behrman
- Department of Neurological Surgery, Kosair Charities Endowed Chair in Pediatric NeuroRecovery, University of Louisville, Louisville, KY, United States
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24
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Postol N, Spratt NJ, Bivard A, Marquez J. Physiotherapy using a free-standing robotic exoskeleton for patients with spinal cord injury: a feasibility study. J Neuroeng Rehabil 2021; 18:180. [PMID: 34953501 PMCID: PMC8709973 DOI: 10.1186/s12984-021-00967-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 11/30/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Evidence is emerging for the use of overground lower limb robotic exoskeletons in the rehabilitation of people with spinal cord injury (SCI), with suggested benefits for gait speed, bladder and bowel function, pain management and spasticity. To date, research has focused on devices that require the user to support themselves with a walking aid. This often precludes use by those with severe trunk, postural or upper limb deficits and places the user in a suboptimal, flexed standing position. Free-standing exoskeletons enable people with higher level injuries to exercise in an upright position. This study aimed to evaluate the feasibility of therapy with a free-standing exoskeleton for those with SCI, and to determine the potential health-related benefits of this intervention. METHODS This 12-week intervention study with 12-week waitlist control and 12-week follow up, provided people with SCI scoring < 5 on the mobility section of the spinal cord independence measure (SCIM-III) twice weekly therapy in the REX (Rex Bionics, Auckland, NZ), a free-standing lower limb robotic exoskeleton. The primary outcome measure of interest was function, as measured on the SCIM-III. A battery of secondary outcomes was included. Participants also completed a survey on their perceptions of this treatment modality, to determine acceptability. RESULTS Forty-one potential participants were screened for eligibility. Two females (one ASIA A, one ASIA C) and one male (ASIA B) completed all 24 intervention sessions, and the follow up assessment. One participant showed positive trends in function, fatigue, quality of life and mood during the intervention phase. Grip and quadriceps strength, and lower limb motor function improved in another. Two improved their percentage of lean body mass during the intervention phase. Remaining results were varied across patients, time points and outcomes. The intervention was highly acceptable to all participants. CONCLUSION With three of 41 potential participants being eligible and completing this study, our results show that there are potential benefits of exercise in a free-standing exoskeleton for people with severe mobility impairment due to SCI, for a small subset of patients. Further research is warranted to determine those most likely to benefit, and the type of benefit depending on the patient characteristics. Trial registration The trial was registered prospectively on 20 April 2018 at www.anzctr.org.au/ (ACTRN12618000626268).
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Affiliation(s)
- Nicola Postol
- University of Newcastle, Callaghan, Australia.
- Hunter Medical Research Institute, New Lambton Heights, Australia.
| | - Neil J Spratt
- University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton Heights, Australia
- Hunter New England Local Health District, New South Wales, Australia
| | - Andrew Bivard
- Hunter Medical Research Institute, New Lambton Heights, Australia
- University of Melbourne, Melbourne, Australia
| | - Jodie Marquez
- University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton Heights, Australia
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25
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Gour-Provencal G, Mac-Thiong JM, Feldman DE, Bégin J, Richard-Denis A. Decreasing pressure injuries and acute care length of stay in patients with acute traumatic spinal cord injury. J Spinal Cord Med 2021; 44:949-957. [PMID: 32045340 PMCID: PMC8725680 DOI: 10.1080/10790268.2020.1718265] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVES Identifying factors associated with the occurrence of pressure injuries (PI) during acute care and with longer length of stay (LOS), focusing on modifiable factors that can be addressed and optimized by the acute rehabilitation team. DESIGN Prospective cohort study. SETTING A single Level-1 trauma center specialized in SCI care. PARTICIPANTS A cohort of 301 patients with acute TSCI was studied. OUTCOME MEASURES The primary outcome was the occurrence of PI during acute care stay. The secondary outcome was acute care LOS. Bivariate and multivariate logistic or linear regression analyses were performed to determine the association between non-modifiable factors and outcomes (PI of any stage and acute LOS), whereas bivariate and hierarchical multivariate logistic or linear regression analyses were used for modifiable factors. RESULTS When controlling for the level and severity of the TSCI, the occurrence of pneumonia (OR = 2.1, CI = 1.1-4.1) was significantly associated with the occurrence of PI. When controlling for the level and severity of the TSCI, the occurrence of medical complications (PI, urinary tract infection and pneumonia) and lesser daily therapy resulted in significantly longer acute care LOS (P < .001). CONCLUSIONS Prevention of PI occurrence and the optimization of the acute care LOS represent crucial challenges of the acute rehabilitation team, as they are significantly associated with higher functional outcomes. Patients who develop pneumonia may benefit from more aggressive prevention strategies to reduce PI occurrence. Systematic protocols for the prevention of complications as well as greater volume of therapy interventions should be considered to optimize the acute care LOS.
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Affiliation(s)
| | - Jean-Marc Mac-Thiong
- Hôpital du Sacré-Cœur de Montréal, Montreal, Quebec, Canada
- Faculty of Medicine, Department of Surgery, University of Montreal, Montreal, Quebec, Canada
- Sainte-Justine University Hospital Research Center, Montréal, Quebec, Canada
| | - Debbie E. Feldman
- École de réadaptation, Pavillon du Parc, Université de Montréal, Québec, Canada
| | - Jean Bégin
- Hôpital du Sacré-Cœur de Montréal, Montreal, Quebec, Canada
| | - Andréane Richard-Denis
- Faculty of Medicine, Department of Medicine, University of Montreal, Montreal, Quebec, Canada
- Hôpital du Sacré-Cœur de Montréal, Montreal, Quebec, Canada
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26
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Postol N, Grissell J, McHugh C, Bivard A, Spratt NJ, Marquez J. Effects of therapy with a free-standing robotic exoskeleton on motor function and other health indicators in people with severe mobility impairment due to chronic stroke: A quasi-controlled study. J Rehabil Assist Technol Eng 2021; 8:20556683211045837. [PMID: 34707883 PMCID: PMC8543702 DOI: 10.1177/20556683211045837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction Robotic exoskeletons facilitate therapy in upright postures. This study aimed to evaluate potential health-related effects of this therapy for people with severe mobility impairment due to chronic stroke. Methods This quasi-controlled trial with 12 weeks of twice weekly therapy in a free-standing exoskeleton, and 12 weeks follow up, included people dependent for mobility, with stroke at least 3 months prior. The primary outcome was lower limb motor function. A battery of secondary outcomes was evaluated. Results Nine participants were enrolled. There was no change in motor function. There was a significant between phase difference in level of independence with activities of daily living (median post-intervention change = 5, IQR = 0, 10, p = 0.01), and grip strength (affected limb) (median post-intervention change = 1, IQR = 0, 2, p = 0.03). A significant difference was found for quadriceps strength (affected limb) (median change in wait phase = 4, IQR = 2, 7.5, p = 0.01). Participants consistently reported positive perceptions of the therapy. Conclusions Therapy with a free-standing exoskeleton is acceptable to participants and can facilitate improvements in level of independence and grip strength. Restrictions regarding eligibility to use the device, may reduce the clinical application of this therapy for people with stroke.
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Affiliation(s)
| | | | | | - Andrew Bivard
- University of Newcastle, University of Melbourne, Hunter Medical Research Institute, Callaghan, NSW, Australia
| | - Neil J Spratt
- University of Newcastle, Hunter Medical Research Institute, Hunter New England Local Area Health Distric, Callaghan, NSW, Australia
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27
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Seáñez I, Capogrosso M. Motor improvements enabled by spinal cord stimulation combined with physical training after spinal cord injury: review of experimental evidence in animals and humans. Bioelectron Med 2021; 7:16. [PMID: 34706778 PMCID: PMC8555080 DOI: 10.1186/s42234-021-00077-5] [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: 09/07/2021] [Accepted: 09/30/2021] [Indexed: 12/20/2022] Open
Abstract
Electrical spinal cord stimulation (SCS) has been gaining momentum as a potential therapy for motor paralysis in consequence of spinal cord injury (SCI). Specifically, recent studies combining SCS with activity-based training have reported unprecedented improvements in motor function in people with chronic SCI that persist even without stimulation. In this work, we first provide an overview of the critical scientific advancements that have led to the current uses of SCS in neurorehabilitation: e.g. the understanding that SCS activates dormant spinal circuits below the lesion by recruiting large-to-medium diameter sensory afferents within the posterior roots. We discuss how this led to the standardization of implant position which resulted in consistent observations by independent clinical studies that SCS in combination with physical training promotes improvements in motor performance and neurorecovery. While all reported participants were able to move previously paralyzed limbs from day 1, recovery of more complex motor functions was gradual, and the timeframe for first observations was proportional to the task complexity. Interestingly, individuals with SCI classified as AIS B and C regained motor function in paralyzed joints even without stimulation, but not individuals with motor and sensory complete SCI (AIS A). Experiments in animal models of SCI investigating the potential mechanisms underpinning this neurorecovery suggest a synaptic reorganization of cortico-reticulo-spinal circuits that correlate with improvements in voluntary motor control. Future experiments in humans and animal models of paralysis will be critical to understand the potential and limits for functional improvements in people with different types, levels, timeframes, and severities of SCI.
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Affiliation(s)
- Ismael Seáñez
- Biomedical Engineering, Washington University in St. Louis, St. Louis, USA. .,Neurosurgery, Washington University School of Medicine in St. Louis, St. Louis, USA.
| | - Marco Capogrosso
- Neurological Surgery, University of Pittsburgh, Pittsburgh, USA.,Department of Physical Medicine and Rehabilitation, Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, USA.,Department of Bioengineering, University of Pittsburgh, Pittsburgh, USA
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28
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Engel-Haber E, Radomislensky I, Peleg K, Bodas M, Bondi M, Noy S, Zeilig G. Early Trauma Predictors of Mobility in People with Spinal Cord Injury. Spine (Phila Pa 1976) 2021; 46:E1089-E1096. [PMID: 33813583 DOI: 10.1097/brs.0000000000004053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A retrospective cohort study. OBJECTIVE This study aims to assess the potential value of very early trauma variables such as Abbreviated Injury Scale (AIS) and the Injury Severity Score for predicting independent ambulation following a traumatic spinal cord injury (TSCI). SUMMARY OF BACKGROUND DATA Several models for prediction of ambulation early after TSCI have been published and validated. The vast majority rely on the initial examination of American Spinal Injury Association (ASIA) impairment scale and level of injury; however, in many locations and clinical situations this examination is not feasible early after the injury. METHODS Patient characteristics, trauma data, and ASIA scores on admission to rehabilitation were collected for each of the 144 individuals in the study. Outcome measure was the indoor mobility item of the Spinal Cord Independence Measure taken upon discharge from rehabilitation. Univariate and multivariable models were created for each predictor, Odds ratios (ORs) were obtained by a multivariable logistic regression analysis, and area under the receiver operator curve was calculated for each model. RESULTS We observed a significant correlation between the trauma variables and independent ambulation upon discharge from rehabilitation. Of the early variables, the AIS for the spine region showed the strongest correlation. CONCLUSION These findings support using preliminary trauma variables for early prognostication of ambulation following a TSCI, allowing for tailored individual interventions.Level of Evidence: 3.
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Affiliation(s)
- Einat Engel-Haber
- Department of Neurological Rehabilitation, The Chaim Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Irina Radomislensky
- Israel National Centre for Trauma and Emergency Medicine Research, The Gertner institute for Epidemiology and Health Policy Research, The Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Kobi Peleg
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Israel National Centre for Trauma and Emergency Medicine Research, The Gertner institute for Epidemiology and Health Policy Research, The Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Moran Bodas
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Israel National Centre for Trauma and Emergency Medicine Research, The Gertner institute for Epidemiology and Health Policy Research, The Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Moshe Bondi
- Department of Neurological Rehabilitation, The Chaim Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Shlomo Noy
- The Chaim Sheba Medical Center, Tel Hashomer, Israel
- School of Health Professions, Ono Academic College, Kiryat Ono, Israel
| | - Gabi Zeilig
- Department of Neurological Rehabilitation, The Chaim Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
- School of Health Professions, Ono Academic College, Kiryat Ono, Israel
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Noninvasive spinal stimulation safely enables upright posture in children with spinal cord injury. Nat Commun 2021; 12:5850. [PMID: 34615867 PMCID: PMC8494794 DOI: 10.1038/s41467-021-26026-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 09/06/2021] [Indexed: 12/23/2022] Open
Abstract
In children with spinal cord injury (SCI), scoliosis due to trunk muscle paralysis frequently requires surgical treatment. Transcutaneous spinal stimulation enables trunk stability in adults with SCI and may pose a non-invasive preventative therapeutic alternative. This non-randomized, non-blinded pilot clinical trial (NCT03975634) determined the safety and efficacy of transcutaneous spinal stimulation to enable upright sitting posture in 8 children with trunk control impairment due to acquired SCI using within-subject repeated measures study design. Primary safety and efficacy outcomes (pain, hemodynamics stability, skin irritation, trunk kinematics) and secondary outcomes (center of pressure displacement, compliance rate) were assessed within the pre-specified endpoints. One participant did not complete the study due to pain with stimulation on the first day. One episode of autonomic dysreflexia during stimulation was recorded. Following hemodynamic normalization, the participant completed the study. Overall, spinal stimulation was well-tolerated and enabled upright sitting posture in 7 out of the 8 participants. Scoliosis due to trunk muscle paralysis frequently requires surgical treatment in children with spinal cord injury. The authors demonstrate the safety and efficacy of transcutaneous spinal stimulation to enable upright sitting posture in 7/8 children with trunk control impairment in a within-subjects, repeated measures pilot clinical trial.
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Corticospinal Motor Circuit Plasticity After Spinal Cord Injury: Harnessing Neuroplasticity to Improve Functional Outcomes. Mol Neurobiol 2021; 58:5494-5516. [PMID: 34341881 DOI: 10.1007/s12035-021-02484-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 07/07/2021] [Indexed: 10/20/2022]
Abstract
Spinal cord injury (SCI) is a devastating condition that affects approximately 294,000 people in the USA and several millions worldwide. The corticospinal motor circuitry plays a major role in controlling skilled movements and in planning and coordinating movements in mammals and can be damaged by SCI. While axonal regeneration of injured fibers over long distances is scarce in the adult CNS, substantial spontaneous neural reorganization and plasticity in the spared corticospinal motor circuitry has been shown in experimental SCI models, associated with functional recovery. Beneficially harnessing this neuroplasticity of the corticospinal motor circuitry represents a highly promising therapeutic approach for improving locomotor outcomes after SCI. Several different strategies have been used to date for this purpose including neuromodulation (spinal cord/brain stimulation strategies and brain-machine interfaces), rehabilitative training (targeting activity-dependent plasticity), stem cells and biological scaffolds, neuroregenerative/neuroprotective pharmacotherapies, and light-based therapies like photodynamic therapy (PDT) and photobiomodulation (PMBT). This review provides an overview of the spontaneous reorganization and neuroplasticity in the corticospinal motor circuitry after SCI and summarizes the various therapeutic approaches used to beneficially harness this neuroplasticity for functional recovery after SCI in preclinical animal model and clinical human patients' studies.
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Koljonen PA, Virk AS, Jeong Y, McKinley M, Latorre J, Caballero A, Hu Y, Wong YW, Cheung K, Kazerooni H. Outcomes of a Multicenter Safety and Efficacy Study of the SuitX Phoenix Powered Exoskeleton for Ambulation by Patients With Spinal Cord Injury. Front Neurol 2021; 12:689751. [PMID: 34349722 PMCID: PMC8326794 DOI: 10.3389/fneur.2021.689751] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 06/07/2021] [Indexed: 11/29/2022] Open
Abstract
Objective: To examine the safety and efficacy of ambulation utilizing a semi-passive and lightweight powered exoskeleton by spinal cord injury (SCI) patients. Methods: This is a multi-center, open-label, prospective cohort study across three facilities. A cohort of 40 individuals with SCI from T4-L5 was recruited into a 20-session training and assessment protocol, utilizing the SuitX Phoenix. All patients were tested using a 10-m-walk test (10 MWT), 6-min-walk test (6 MWT), and Timed up & Go test (TUG). Patient satisfaction, pain, exertion, changes in affect, as well as overall comfort and confidence were reported using a satisfaction survey, Rated Perceived Exertion (RPE) scale, and Positive and Negative Affect Schedule (PANAS). Safety outcomes, adverse events, and device malfunctions were reported. Results: Forty participants completed the study. There were no serious adverse events. All participants reported moderate to high levels of comfort and confidence using the device. All patients were able to achieve FIM of >4 on transitional movements and walking. The neurological level of injury had a statistically significant association with walking speed, WISCI-II, and FIM. Participants with an incomplete spinal cord injury had a higher FIM, faster speed, and higher WISCI-II in all outcome measures. Conclusion: This is the first study to examine the safety and efficacy of SuitX Phoenix for ambulation by SCI patients. We have shown that Phoenix is efficacious in allowing adults with SCI T4 to L5 perform walking and transitional movements. This study also reports the safety-profile of the device, user satisfaction, and psychological trends during training.
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Affiliation(s)
- Paul Aarne Koljonen
- Department of Orthopaedics and Traumatology, Maclehose Medical Rehabilitation Centre, Hong Kong West Cluster, Hospital Authority, Hong Kong, China.,Department of Orthopaedics and Traumatology, The University of Hong Kong Li Ka Shing Faculty of Medicine, Hong Kong, China
| | | | - Yoon Jeong
- US Bionics at Emeryville, Emeryville, CA, United States
| | | | - Juan Latorre
- St. David's Medical Center, Austin, TX, United States
| | - Amaya Caballero
- University of Virginia School of Medicine, Charlottesville, VA, United States
| | - Yong Hu
- Department of Orthopaedics and Traumatology, The University of Hong Kong Li Ka Shing Faculty of Medicine, Hong Kong, China
| | - Yat Wa Wong
- Department of Orthopaedics and Traumatology, The University of Hong Kong Li Ka Shing Faculty of Medicine, Hong Kong, China
| | - Kenneth Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong Li Ka Shing Faculty of Medicine, Hong Kong, China
| | - Homayoon Kazerooni
- Department of Mechanical Engineering, University of California, Berkeley, Berkeley, CA, United States
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Cheung L, Musselman KE, Kaiser A, Jervis Rademeyer H, Walden K, Marshall S, Gauthier C. Activity-based therapy in the community for individuals living with spinal cord injury or disease: qualitative interviews with clinicians. Disabil Rehabil 2021; 44:4821-4830. [PMID: 34078196 DOI: 10.1080/09638288.2021.1923072] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
PURPOSE Activity-based therapy (ABT) is a restorative approach that promotes neurological recovery below the level of injury in individuals with spinal cord injury or disease (SCI/D). This study sought to understand how ABT and its associated technologies were being used in community-based facilities across Canada. METHODS One to two participants from ten community-based ABT facilities completed a semi-structured interview that queried types of technologies or techniques used in ABT, and barriers and facilitators to providing ABT for individuals with SCI/D. Interviews were audio-recorded and transcribed verbatim, and analyzed using an interpretive description approach to identify themes and categories. RESULTS The overarching theme that emerged was that ABT in the community is a client-centered approach characterized by variety in techniques, clinicians, and clientele. The researchers identified three categories within this theme: characteristics of ABT in the community, perceived challenges, and a need for advocacy. Participants advocated for earlier implementation, increased education, and reduced costs of ABT to address the challenges with implementation and accessibility. CONCLUSIONS The use of ABT and its associated technologies varied across participating community-based facilities in Canada, despite a consistent focus on client goals and well-being. Addressing system-level limitations of ABT may improve implementation and accessibility in Canada.Implications for rehabilitationActivity-based therapy (ABT) is a group of interventions targeting recovery of sensory and motor function below the level of injury in individuals with spinal cord injury or disease (SCI/D).ABT in the community emphasizes a client-centered approach and is characterized by variety in techniques, clinicians, and clientele.Participants advocated that earlier implementation, reduced costs, and increased education will help overcome barriers to providing ABT, ultimately assisting to facilitate neurorecovery in individuals with SCI/D.Challenges in implementation, accessibility, and knowledge of ABT exist, highlighting a need to explore and address system-level limitations in Canada.
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Affiliation(s)
- Lovisa Cheung
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, Canada.,KITE, Toronto Rehabilitation Institute - University Health Network, Toronto, Canada
| | - Kristin E Musselman
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, Canada.,KITE, Toronto Rehabilitation Institute - University Health Network, Toronto, Canada.,Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Anita Kaiser
- KITE, Toronto Rehabilitation Institute - University Health Network, Toronto, Canada.,Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Hope Jervis Rademeyer
- KITE, Toronto Rehabilitation Institute - University Health Network, Toronto, Canada.,Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Canada
| | | | | | - Cindy Gauthier
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, Canada.,KITE, Toronto Rehabilitation Institute - University Health Network, Toronto, Canada
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Rink S, Manthou ME, Arnold J, Grigo M, Dicken P, Abdulla DSY, Bendella H, Nohroudi K, Angelov DN. Motor, sensitive, and vegetative recovery in rats with compressive spinal-cord injury after combined treatment with erythropoietin and whole-body vibration. Restor Neurol Neurosci 2021; 39:85-100. [PMID: 33612500 DOI: 10.3233/rnn-201120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Physical therapy with whole body vibration (WBV) following compressive spinal cord injury (SCI) in rats restores density of perisomatic synapses, improves body weight support and leads to a better bladder function. The purpose of the study was to determine whether the combined treatment with WBV plus erythropoietin (EPO) would further improve motor, sensory and vegetative functions after SCI in rats. METHODS Severe compressive SCI at low thoracic level was followed by a single i.p. injection of 2,5μg (250 IU) human recombinant EPO. Physical therapy with WBV started on 14th day after injury and continued over a 12-week post injury period. Locomotor recovery, sensitivity tests and urinary bladder scores were analysed at 1, 3, 6, 9, and 12 weeks after SCI. The closing morphological measurements included lesion volume and numbers of axons in the preserved perilesional neural tissue bridges (PNTB). RESULTS Assessment of motor performance sensitivity and bladder function revealed no significant effects of EPO when compared to the control treatments. EPO treatment neither reduced the lesion volume, nor increased the number of axons in PNTB. CONCLUSIONS The combination of WBV + EPO exerts no positive effects on hind limbs motor performance and bladder function after compressive SCI in rats.
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Affiliation(s)
- Svenja Rink
- Department of Prosthetic Dentistry, School of Dental and Oral Medicine, University of Cologne, Cologne, Germany
| | - Maria Eleni Manthou
- Department of Histology and Embryology, School of Medicine, Faculty of Health Sciences, Aristotle University Thessaloniki, Thessaloniki, Greece
| | - Julia Arnold
- Department of Anatomy I, University of Cologne, Cologne, Germany
| | - Merle Grigo
- Department of Anatomy I, University of Cologne, Cologne, Germany
| | - Paulina Dicken
- Department of Anatomy I, University of Cologne, Cologne, Germany
| | - Diana Saad Yousif Abdulla
- Department I of Internal Medicine, Faculty of Medicine and University Hospital of Cologne, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Network Genomic Medicine, Lung Cancer Group Cologne, University of Cologne, Cologne, Germany
| | - Habib Bendella
- Department of Neurosurgery, University of Witten/Herdecke, Cologne Merheim Medical Center (CMMC), Cologne, Germany
| | - Klaus Nohroudi
- Department of Anatomy I, University of Cologne, Cologne, Germany
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Pizzolato C, Gunduz MA, Palipana D, Wu J, Grant G, Hall S, Dennison R, Zafonte RD, Lloyd DG, Teng YD. Non-invasive approaches to functional recovery after spinal cord injury: Therapeutic targets and multimodal device interventions. Exp Neurol 2021; 339:113612. [DOI: 10.1016/j.expneurol.2021.113612] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 12/24/2020] [Accepted: 01/11/2021] [Indexed: 12/16/2022]
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Nedergård H, Arumugam A, Sandlund M, Bråndal A, Häger CK. Effect of robotic-assisted gait training on objective biomechanical measures of gait in persons post-stroke: a systematic review and meta-analysis. J Neuroeng Rehabil 2021; 18:64. [PMID: 33863345 PMCID: PMC8052671 DOI: 10.1186/s12984-021-00857-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 03/21/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Robotic-Assisted Gait Training (RAGT) may enable high-intensive and task-specific gait training post-stroke. The effect of RAGT on gait movement patterns has however not been comprehensively reviewed. The purpose of this review was to summarize the evidence for potentially superior effects of RAGT on biomechanical measures of gait post-stroke when compared with non-robotic gait training alone. METHODS Nine databases were searched using database-specific search terms from their inception until January 2021. We included randomized controlled trials investigating the effects of RAGT (e.g., using exoskeletons or end-effectors) on spatiotemporal, kinematic and kinetic parameters among adults suffering from any stage of stroke. Screening, data extraction and judgement of risk of bias (using the Cochrane Risk of bias 2 tool) were performed by 2-3 independent reviewers. The Grading of Recommendations Assessment Development and Evaluation (GRADE) criteria were used to evaluate the certainty of evidence for the biomechanical gait measures of interest. RESULTS Thirteen studies including a total of 412 individuals (mean age: 52-69 years; 264 males) met eligibility criteria and were included. RAGT was employed either as monotherapy or in combination with other therapies in a subacute or chronic phase post-stroke. The included studies showed a high risk of bias (n = 6), some concerns (n = 6) or a low risk of bias (n = 1). Meta-analyses using a random-effects model for gait speed, cadence, step length (non-affected side) and spatial asymmetry revealed no significant differences between the RAGT and comparator groups, while stride length (mean difference [MD] 2.86 cm), step length (affected side; MD 2.67 cm) and temporal asymmetry calculated in ratio-values (MD 0.09) improved slightly more in the RAGT groups. There were serious weaknesses with almost all GRADE domains (risk of bias, consistency, directness, or precision of the findings) for the included outcome measures (spatiotemporal and kinematic gait parameters). Kinetic parameters were not reported at all. CONCLUSION There were few relevant studies and the review synthesis revealed a very low certainty in current evidence for employing RAGT to improve gait biomechanics post-stroke. Further high-quality, robust clinical trials on RAGT that complement clinical data with biomechanical data are thus warranted to disentangle the potential effects of such interventions on gait biomechanics post-stroke.
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Affiliation(s)
- Heidi Nedergård
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden.
| | - Ashokan Arumugam
- Department of Physiotherapy, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Marlene Sandlund
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
| | - Anna Bråndal
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
| | - Charlotte K Häger
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
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Teng YD, Zafonte RD. Prelude to the special issue on novel neurocircuit, cellular and molecular targets for developing functional rehabilitation therapies of neurotrauma. Exp Neurol 2021; 341:113689. [PMID: 33745921 DOI: 10.1016/j.expneurol.2021.113689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 03/07/2021] [Indexed: 11/15/2022]
Abstract
The poor endogenous recovery capacity and other impediments to reinstating sensorimotor or autonomic function after adult neurotrauma have perplexed modern neuroscientists, bioengineers, and physicians for over a century. However, despite limited improvement in options to mitigate acute pathophysiological sequalae, the past 20 years have witnessed marked progresses in developing efficacious rehabilitation strategies for chronic spinal cord and brain injuries. The achievement is mainly attributable to research advancements in elucidating neuroplastic mechanisms for the potential to enhance clinical prognosis. Innovative cross-disciplinary studies have established novel therapeutic targets, theoretical frameworks, and regiments to attain treatment efficacy. This Special Issue contained eight papers that described experimental and human data along with literature reviews regarding the essential roles of the conventionally undervalued factors in neural repair: systemic inflammation, neural-respiratory inflammasome axis, modulation of glutamatergic and monoaminergic neurotransmission, neurogenesis, nerve transfer, recovery neurobiology components, and the spinal cord learning, respiration and central pattern generator neurocircuits. The focus of this work was on how to induce functional recovery from manipulating these underpinnings through their interactions with secondary injury events, peripheral and supraspinal inputs, neuromusculoskeletal network, and interventions (i.e., activity training, pharmacological adjuncts, electrical stimulation, and multimodal neuromechanical, brain-computer interface [BCI] and robotic assistance [RA] devices). The evidence suggested that if key neurocircuits are therapeutically reactivated, rebuilt, and/or modulated under proper sensory feedback, neurological function (e.g., cognition, respiration, limb movement, locomotion, etc.) will likely be reanimated after neurotrauma. The efficacy can be optimized by individualizing multimodal rehabilitation treatments via BCI/RA-integrated drug administration and neuromechanical protheses.
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Affiliation(s)
- Yang D Teng
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA; Neurotrauma Recovery Research, Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital Network, Mass General Brigham, and Harvard Medical School, Boston, MA, USA; Spaulding Research Institute, Spaulding Rehabilitation Hospital Network, Boston, MA, USA.
| | - Ross D Zafonte
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA; Neurotrauma Recovery Research, Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital Network, Mass General Brigham, and Harvard Medical School, Boston, MA, USA; Spaulding Research Institute, Spaulding Rehabilitation Hospital Network, Boston, MA, USA.
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Li Hi Shing S, Lope J, McKenna MC, Chipika RH, Hardiman O, Bede P. Increased cerebral integrity metrics in poliomyelitis survivors: putative adaptation to longstanding lower motor neuron degeneration. J Neurol Sci 2021; 424:117361. [PMID: 33773768 DOI: 10.1016/j.jns.2021.117361] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 02/14/2021] [Accepted: 02/17/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Post-polio syndrome (PPS) has been traditionally considered a slowly progressive condition that affects poliomyelitis survivors decades after their initial infection. Cerebral changes in poliomyelitis survivors are poorly characterised and the few existing studies are strikingly conflicting. OBJECTIVE The overarching aim of this study is the comprehensive characterisation of cerebral grey and white matter alterations in poliomyelitis survivors with reference to healthy- and disease-controls using quantitative imaging metrics. METHODS Thirty-six poliomyelitis survivors, 88 patients with ALS and 117 healthy individuals were recruited in a prospective, single-centre neuroimaging study using uniform MRI acquisition parameters. All participants underwent standardised clinical assessments, T1-weighted structural and diffusion tensor imaging. Whole-brain and region-of-interest morphometric analyses were undertaken to evaluate patterns of grey matter changes. Tract-based spatial statistics were performed to evaluate diffusivity alterations in a study-specific whiter matter skeleton. RESULTS In contrast to healthy controls, poliomyelitis survivors exhibited increased grey matter partial volumes in the brainstem, cerebellum and occipital lobe, accompanied by increased FA in the corticospinal tracts, cerebellum, bilateral mesial temporal lobes and inferior frontal tracts. Polio survivors exhibited increased integrity metrics in the same anatomical regions where ALS patients showed degenerative changes. CONCLUSIONS Our findings indicate considerable cortical and white matter reorganisation in poliomyelitis survivors which may be interpreted as compensatory, adaptive change in response to severe lower motor neuron injury in infancy.
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Affiliation(s)
- Stacey Li Hi Shing
- Computational Neuroimaging Group, Biomedical Sciences Institute, Trinity College Dublin, Ireland
| | - Jasmin Lope
- Computational Neuroimaging Group, Biomedical Sciences Institute, Trinity College Dublin, Ireland
| | - Mary Clare McKenna
- Computational Neuroimaging Group, Biomedical Sciences Institute, Trinity College Dublin, Ireland
| | - Rangariroyashe H Chipika
- Computational Neuroimaging Group, Biomedical Sciences Institute, Trinity College Dublin, Ireland
| | - Orla Hardiman
- Computational Neuroimaging Group, Biomedical Sciences Institute, Trinity College Dublin, Ireland
| | - Peter Bede
- Computational Neuroimaging Group, Biomedical Sciences Institute, Trinity College Dublin, Ireland.
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Swaffield E, Cheung L, Khalili A, Lund E, Boileau M, Chechlacz D, Musselman KE, Gauthier C. Perspectives of people living with a spinal cord injury on activity-based therapy. Disabil Rehabil 2021; 44:3632-3640. [PMID: 33561372 DOI: 10.1080/09638288.2021.1878293] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
PURPOSE Activity-Based Therapy (ABT) targets recovery of function below the injury level in individuals with spinal cord injury (SCI). This qualitative study is the first to capture the perspectives of individuals with SCI on community ABT programs in Canada. METHODS Ten participants (6 males, aged 23.0-65.0 years, 2.5-23.0 years post-SCI) were recruited using purposive sampling, and completed semi-structured interviews. Interview questions explored benefits and challenges, facilitators and barriers to access, and motivations for participating in ABT. Themes were identified using conventional content analysis and collaboratively analyzed using the DEPICT model. RESULTS An overarching theme of ABT as a key part of participants' evolving and lifelong recovery process emerged. Motivations for initiating ABT included dissatisfaction with early rehabilitation, and a desire to improve function and stay active. Participants perceived that ABT contributed to neurological recovery, physical and mental health benefits, independence, and hope. Factors contributing to recovery and factors limiting accessibility and participation in ABT were identified. Participants discussed advocating for ABT, and how ABT empowered self-management. CONCLUSIONS ABT was perceived to play a significant role in promoting ongoing recovery and well-being in individuals with SCI. Addressing limitations in awareness and availability of ABT may improve participation in ABT programs.Implications for rehabilitationActivity-Based Therapy (ABT) targets recovery of function and sensation below the level of injury in individuals with spinal cord injury (SCI).ABT plays a key role in the evolving and lifelong recovery process of individuals with SCI.Participants reported that ABT has a positive impact on physical, functional, and psychosocial domains, leading to improved independence and quality of life.Awareness and availability of ABT remain limited, highlighting a need to further explore and address factors limiting access to this therapy.
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Affiliation(s)
- Emma Swaffield
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, Canada.,KITE, Toronto Rehabilitation Institute- University Health Network, Toronto, Canada
| | - Lovisa Cheung
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, Canada.,KITE, Toronto Rehabilitation Institute- University Health Network, Toronto, Canada
| | - Avideh Khalili
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, Canada.,KITE, Toronto Rehabilitation Institute- University Health Network, Toronto, Canada
| | - Emily Lund
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, Canada.,KITE, Toronto Rehabilitation Institute- University Health Network, Toronto, Canada
| | - Michelle Boileau
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, Canada.,KITE, Toronto Rehabilitation Institute- University Health Network, Toronto, Canada
| | - Damian Chechlacz
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, Canada.,KITE, Toronto Rehabilitation Institute- University Health Network, Toronto, Canada
| | - Kristin E Musselman
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, Canada.,KITE, Toronto Rehabilitation Institute- University Health Network, Toronto, Canada.,Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Cindy Gauthier
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, Canada.,KITE, Toronto Rehabilitation Institute- University Health Network, Toronto, Canada
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Kumprou M, Amatachaya P, Sooknuan T, Arayawichanon P, Thaweewannakij T, Amatachaya S. The utility of upper limb loading device in determining optimal walking ability in ambulatory individuals with spinal cord injury. Hong Kong Physiother J 2021; 41:55-63. [PMID: 34054257 PMCID: PMC8158402 DOI: 10.1142/s1013702521500050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 12/11/2020] [Indexed: 11/28/2022] Open
Abstract
Background: Walking devices are frequently prescribed for many individuals, including those with spinal cord injury (SCI), to promote their independence. However, without proper screening and follow-up care, the individuals may continue using the same device when their conditions have progressed, that may possibly worsen their walking ability. Objective: This study developed an upper limb loading device (ULLD), and assessed the possibility of using the tool to determine the optimal walking ability of ambulatory participants with SCI who used a walking device daily (n=49). Methods: All participants were assessed for their optimal walking ability, i.e., the ability of walking with the least support device or no device as they could do safely and confidently. The participants were also assessed for their amount of weight-bearing on the upper limbs or upper limb loading while walking, amount of weight-bearing on the lower limbs or lower limb loading while stepping of the other leg, and walking performance. Results: The findings indicated that approximately one third of the participants (31%) could progress their walking ability from their current ability, whereby four participants could even walk without a walking device. The amount of upper limb loading while walking, lower limb loading ability, and walking performance were significantly different among the groups of optimal walking ability (p<0.05). Furthermore, the amount of upper limb loading showed negative correlation to the amount of lower limb loading and walking performance (ρ=−0.351 to −0.493, p<0.05). Conclusion: The findings suggest the potential benefit of using the upper limb loading device and the amount of upper limb loading for walking device prescription, and monitoring the change of walking ability among ambulatory individuals with SCI.
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Affiliation(s)
- Makamas Kumprou
- School of Physical Therapy, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen 40002, Thailand.,Improvement of Physical Performance and Quality of Life (IPQ) Research Group, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Pipatana Amatachaya
- Improvement of Physical Performance and Quality of Life (IPQ) Research Group, Khon Kaen University, Khon Kaen 40002, Thailand.,School of Mechanical Engineering, Faculty of Engineering and Architecture, Rajamangala University of Technology Isan, Nakhon Ratchasima 30000, Thailand
| | - Thanat Sooknuan
- Improvement of Physical Performance and Quality of Life (IPQ) Research Group, Khon Kaen University, Khon Kaen 40002, Thailand.,Department of Electronics Engineering, Faculty of Engineering and Architecture Rajamangala University of Technology Isan, Nakhon Ratchasima 30000, Thailand
| | - Preeda Arayawichanon
- Improvement of Physical Performance and Quality of Life (IPQ) Research Group, Khon Kaen University, Khon Kaen 40002, Thailand.,Department of Rehabilitation Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Thiwabhorn Thaweewannakij
- School of Physical Therapy, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen 40002, Thailand.,Improvement of Physical Performance and Quality of Life (IPQ) Research Group, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Sugalya Amatachaya
- School of Physical Therapy, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen 40002, Thailand.,Improvement of Physical Performance and Quality of Life (IPQ) Research Group, Khon Kaen University, Khon Kaen 40002, Thailand
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Amatachaya S, Promkeaw D, Arayawichanon P, Thaweewannakij T, Amatachaya P. Various Surfaces Benefited Functional Outcomes and Fall Incidence in Individuals With Spinal Cord Injury: A Randomized Controlled Trial With Prospective Data Follow-up. Arch Phys Med Rehabil 2020; 102:19-26. [PMID: 32926851 DOI: 10.1016/j.apmr.2020.08.009] [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: 01/30/2020] [Revised: 06/07/2020] [Accepted: 08/11/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To compare effects of walking training on a walking track with different surfaces (WTDS), including artificial grass, soft, and pebbles, as compared to overground walking training on the functional ability necessary for independence and incidence of falls of ambulatory individuals with spinal cord injury (SCI). DESIGN A randomized controlled trial (single-blinded design) with 6-month prospective fall data follow-up. SETTING Tertiary rehabilitation centers and several communities. PARTICIPANTS Independent ambulatory individuals (N=54) with SCI who walked with or without a walking device. INTERVENTION Participants were randomly arranged into a control group (overground walking training, n=26) or experimental group (walking training over a WTDS, n=28) for 30 min/d, 5 d/wk over 4 weeks. MAIN OUTCOME MEASURES The 10-m walk test, timed Up and Go test, five times sit-to-stand test, and 6-minute walk test were repeatedly measured 4 times, including before training, and after 2 and 4 weeks, and 6 months. In addition, participants were prospectively monitored for the fall data over 6 months. RESULTS Participants who walked with an average speed of 0.52 m/s and postinjury time >7 years could safely walk over a WTDS. They demonstrated significant improvement at 2 and 4 weeks after experimental training (P<.001), but not after control training. During the 6-month follow-up, participants in the experimental group also had the number of those who fell (n=5, 18%) fewer than those in the control group (n=12, 46%). CONCLUSIONS Being at a chronic SCI with ability of independent walking, participants needed a challenging task to promote their functional outcomes and minimize fall risk. The findings suggest the use of various surfaces as an alternative rehabilitation strategy for these individuals.
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Affiliation(s)
- Sugalya Amatachaya
- School of Physical Therapy, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen; Improvement of Physical Performanceo and Quality of Life (IPQ) Research Group, Khon Kaen University, Khon Kaen.
| | - Donlaya Promkeaw
- School of Physical Therapy, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen; Improvement of Physical Performanceo and Quality of Life (IPQ) Research Group, Khon Kaen University, Khon Kaen
| | - Preeda Arayawichanon
- Improvement of Physical Performanceo and Quality of Life (IPQ) Research Group, Khon Kaen University, Khon Kaen; Department of Rehabilitation Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen
| | - Thiwabhorn Thaweewannakij
- School of Physical Therapy, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen; Improvement of Physical Performanceo and Quality of Life (IPQ) Research Group, Khon Kaen University, Khon Kaen
| | - Pipatana Amatachaya
- Improvement of Physical Performanceo and Quality of Life (IPQ) Research Group, Khon Kaen University, Khon Kaen; Department of Mechanical Engineering, Faculty of Engineering and Architecture, Rajamangala University of Technology Isan, Nakhon Ratchasima, Thailand
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Nogueira F, Shirahige L, Brito R, Monte-Silva K. Independent community walking after a short protocol of repetitive transcranial magnetic stimulation associated with body weight-support treadmill training in a patient with chronic spinal cord injury: a case report. Physiother Theory Pract 2020; 38:839-845. [PMID: 32787480 DOI: 10.1080/09593985.2020.1802797] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE Our report describes the effect of repetitive transcranial magnetic stimulation (rTMS) combined with body weight-supported treadmill training (BWSTT) on independent gait recovery in a patient with incomplete spinal cord injury (iSCI). CASE DESCRIPTION The patient was a 31-year-old male, household ambulator (aid walker) and community wheelchair user who was 8.5 year post traumatic iSCI (T8 vertebra injury, AIS D). INTERVENTION The patient participated in 12 sessions (three times/week for four weeks) of rTMS (1800 pulses, 10 Hz, intensity of 90% resting motor threshold) followed by BWSTT (15-20 min, moderate intensity). OUTCOMES After treatment, the patient's score increased 3 points on the Walking Index for Spinal Cord Injury II (walking independence) and he became a community ambulator with crutches. His American Spinal Injury Association (ASIA) lower extremities motor score (motor function) increased from 33 to 45 points and the Spinal Cord Independence Measure III (functional independence) score increased from 23 to 29 for the mobility indoors/outdoors subscale. The patient's lower limb spasticity was reduced (Modified Ashworth Scale), and quality of life improved based on the Short-Form Health Survey - 36, and the Patient Global Impression of Change Scale showed considerable perception of improvement. CONCLUSION Our report suggests that a short protocol of rTMS combined with BWSTT improved walking independence, motor function, spasticity, functional mobility and quality of life in this patient with iSCI.
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Affiliation(s)
- Fernanda Nogueira
- Applied Neuroscience Laboratory, Department of Physical Therapy, Universidade Federal de Pernambuco, Recife, Brazil
| | - Lívia Shirahige
- Applied Neuroscience Laboratory, Department of Physical Therapy, Universidade Federal de Pernambuco, Recife, Brazil
| | - Rodrigo Brito
- Applied Neuroscience Laboratory, Department of Physical Therapy, Universidade Federal de Pernambuco, Recife, Brazil
| | - Katia Monte-Silva
- Applied Neuroscience Laboratory, Department of Physical Therapy, Universidade Federal de Pernambuco, Recife, Brazil
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Santamaria V, Luna T, Khan M, Agrawal S. The robotic Trunk-Support-Trainer (TruST) to measure and increase postural workspace during sitting in people with spinal cord injury. Spinal Cord Ser Cases 2020; 6:1. [PMID: 31934353 PMCID: PMC6944685 DOI: 10.1038/s41394-019-0245-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 11/10/2019] [Accepted: 11/10/2019] [Indexed: 11/09/2022] Open
Abstract
Study design Cross-sectional study. Objectives To measure and expand the sitting workspace of participants with spinal cord injury (SCI) with the Trunk-Support-Trainer (TruST). Setting Columbia University. Methods TruST is a motorized-cable belt placed around the torso. Participants performed maximal trunk excursions along eight directions, radiating in a star-shape, to define their seated postural limits and workspace area (cm2). TruST was configured to apply "assist-as-needed" forces when the trunk moved beyond these postural limits. Kinematics were collected to examine trunk control. The clinical features of the sample (n = 5) were documented by neurological injury, dynamometry, the American Spinal Injury Association Impairment Scale, and Spinal Cord Independence Measure-III. Results Statistical significance was examined with paired t-tests. TruST successfully recreated the postural limits of participants and expanded their active sitting workspace (Mean: 123.3 ± SE: 42.8 cm2, p < 0.05). Furthermore, participants improved their trunk excursions to posterior (Mean: 5.1 ± SE: 0.8 cm, p < 0.01), right (Mean: 3.1 ± SE: 1.1 cm, p < 0.05), and left (Mean: 5.0 ± SE: 1.7 cm, p = 0.05) directions with TruST-force field. Conclusions TruST can accurately define and expand the active seated workspace of people with SCI during volitional trunk movements. The capacity of TruST to deliver continuous force-feedback at the user's postural limits opens new frontiers to implement motor learning-based paradigms to retrain functional sitting in people with SCI.
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Affiliation(s)
- Victor Santamaria
- Department of Mechanical Engineering, Columbia University, New York, NY 10027 USA
| | - Tatiana Luna
- Department of Mechanical Engineering, Columbia University, New York, NY 10027 USA
| | - Moiz Khan
- Department of Radiology at BWH, Harvard Medical School, Boston, MA 02115 USA
| | - Sunil Agrawal
- Department of Mechanical Engineering, Columbia University, New York, NY 10027 USA
- Department of Rehabilitation and Regenerative Medicine, Columbia University, New York, NY 10032 USA
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Tsai CY, Delgado AD, Weinrauch WJ, Manente N, Levy I, Escalon MX, Bryce TN, Spungen AM. Exoskeletal-Assisted Walking During Acute Inpatient Rehabilitation Leads to Motor and Functional Improvement in Persons With Spinal Cord Injury: A Pilot Study. Arch Phys Med Rehabil 2019; 101:607-612. [PMID: 31891715 DOI: 10.1016/j.apmr.2019.11.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 11/05/2019] [Accepted: 11/17/2019] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To explore the potential effects of incorporating exoskeletal-assisted walking (EAW) into spinal cord injury (SCI) acute inpatient rehabilitation (AIR) on facilitating functional and motor recovery when compared with standard of care AIR. DESIGN A quasi-experimental design with a prospective intervention group (AIR with EAW) and a retrospective control group (AIR only). SETTING SCI AIR facility. PARTICIPANTS Ten acute inpatient participants with SCI who were eligible for locomotor training were recruited in the intervention group. Twenty inpatients with SCI were identified as matched controls by reviewing an AIR database, Uniform Data System for Medical Rehabilitation, by an individual blinded to the study. Both groups (N=30) were matched based on etiology, paraplegia/tetraplegia, completeness of injury, age, and sex. INTERVENTION EAW incorporated into SCI AIR. MAIN OUTCOME MEASURES FIM score, International Standards for Neurological Classification of Spinal Cord Injury Upper Extremity Motor Score and Lower Extremity Motor Scores (LEMS), and EAW session results, including adverse events, walking time, and steps. RESULTS Changes from admission to discharge LEMS and FIM scores were significantly greater in the intervention group (LEMS change: 14.3±10.1; FIM change: 37.8±10.8) compared with the control group (LEMS change: 4.6±6.1; FIM change: 26.5±14.3; Mann-Whitney U tests: LEMS, P<.01 and FIM, P<.05). One adverse event (minor skin abrasion) occurred during 42 walking sessions. Participants on average achieved 31.5 minutes of up time and 18.2 minutes of walk time with 456 steps in one EAW session. CONCLUSIONS Incorporation of EAW into standard of care AIR is possible. AIR with incorporated EAW has the potential to facilitate functional and motor recovery compared with AIR without EAW.
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Affiliation(s)
- Chung-Ying Tsai
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, New York; Spinal Cord Damage Research Center, James J. Peters VA Medical Center, Bronx, New York.
| | - Andrew D Delgado
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, New York
| | - William J Weinrauch
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Nicholas Manente
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Isaiah Levy
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Miguel X Escalon
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Thomas N Bryce
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ann M Spungen
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, New York; Spinal Cord Damage Research Center, James J. Peters VA Medical Center, Bronx, New York
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McIntosh K, Charbonneau R, Bensaada Y, Bhatiya U, Ho C. The Safety and Feasibility of Exoskeletal-Assisted Walking in Acute Rehabilitation After Spinal Cord Injury. Arch Phys Med Rehabil 2019; 101:113-120. [PMID: 31568761 DOI: 10.1016/j.apmr.2019.09.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 08/28/2019] [Accepted: 09/01/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To assess safety and feasibility for persons with acute spinal cord injury (SCI) using the robotic exoskeleton. DESIGN Case series observational study. SETTING A level-1 trauma center in Canada with both acute and tertiary inpatient SCI rehabilitation units. PARTICIPANTS Eight male and 3 female (N=11) participants were recruited with a mean age of 41 years and with neurologic level of injury (C6-L2) and severity (American Spinal Injury Association Impairment Scale [AIS] A-D). The time since injury is a range of 3-15 weeks at the onset of training. INTERVENTIONS Up to 25 one-hour sessions of exoskeletal-assisted walking gait training, with participants less than 6 months from initial SCI. MAIN OUTCOME MEASURES Cardiopulmonary outcomes including blood pressure, heart rate, and peripheral oxygen saturation; and perceived physical exertion using the Borg CR10 Scale were recorded. Gait parameters were measured by 6-minute walk test (6MWT) and 10-meter walk test (10MWT). Up Time, walk time, and number of steps were detailed longitudinally. Safety was assessed with regard to pain, falls, and skin integrity. RESULTS No serious adverse events occurred. Blood pressure decreased following initial sit to stand and increased during walking. Symptoms of hypotension were rare and improved with increased number of sessions. Perceived exertion was reported on average to be moderate (mean of 3.1). There was no significant increase in pain scores by Visual Analog Scale. On 6MWT, participants covered more distance (mean [m] ± SD, 117.1±11.7) in session 25 compared to session 2 (mean [m] ± SD, 47.6±6.6). On the 10MWT, all participants showed consistently improved gait speed; with participants traveling an average of 3.2 times faster during their last training session (mean [m/s] ± SD, 0.40±0.04) in comparison to session 2 (mean [m/s] ± SD, 0.12±0.01). CONCLUSIONS Exoskeletal-assisted walking in acute rehabilitation (<6mo) following SCI appears to be both safe and feasible.
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Affiliation(s)
- Kyle McIntosh
- Department of Clinical Neurosciences, Foothills Medical Centre, Calgary, Alberta, Canada.
| | - Rebecca Charbonneau
- Division of Physical Medicine & Rehabilitation, Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Yassine Bensaada
- Division of Physical Medicine & Rehabilitation, Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Urchit Bhatiya
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Chester Ho
- Division of Physical Medicine & Rehabilitation, Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
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Jung JH, Lee HJ, Cho DY, Lim JE, Lee BS, Kwon SH, Kim HY, Lee SJ. Effects of Combined Upper Limb Robotic Therapy in Patients With Tetraplegic Spinal Cord Injury. Ann Rehabil Med 2019; 43:445-457. [PMID: 31499598 PMCID: PMC6734021 DOI: 10.5535/arm.2019.43.4.445] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 02/21/2019] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To confirm the effects of combined upper limb robotic therapy (RT) as compared to conventional occupational therapy (OT) in tetraplegic spinal cord injury (SCI) patients and to suggest the optimized treatment guidelines of combined upper limb RT. METHODS After subject recruitment and screening for eligibility, the baseline evaluation for outcome measures were performed. We evaluated the Graded and Redefined Assessment of Strength, Sensibility, and Prehension (GRASSP), the American Spinal Injury Association upper extremity motor score, grip and pinch strength, and the Spinal Cord Independence Measurement III (SCIM-III). In this study, the pre-tested participants were divided randomly into the RT and OT group. The utilized interventions included combined upper limb RT using ArmeoPower and Amadeo (RT group), or conventional OT (OT group) in addition to daily inpatient rehabilitation program. The participants underwent 40 minutes×3 sessions×5 weeks of interventions. RESULTS A total of 30 tetraplegic SCI patients completed entire study program. After 5 weeks of intervention, both groups demonstrated increases in GRASSP-strength and SCIM-III. The manual muscle test scores of elbow flexion, elbow extension, 2-5th metacarpophalangeal extension, and SCIM-III subscores of bathing-upper, dressing-upper, and grooming as well as the GRASSP-qualitative prehension score were noted to have been significantly increased in the RT group as evaluated. The OT group showed improvements in the GRASSP-quantitative prehension score and some items in grip and pinch strength. There was no significant difference between the two groups in almost all measurements except for the SCIM-III bathing-upper subscore. CONCLUSION Combined upper limb RT demonstrated beneficial effects on the upper limb motor function in patients with tetraplegic SCI, which were comparable with conventional OT.
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Affiliation(s)
- Joo Hwan Jung
- Department of Rehabilitation Medicine, National Rehabilitation Center, Seoul, Korea
| | - Hye Jin Lee
- Department of Rehabilitation Medicine, National Rehabilitation Center, Seoul, Korea
| | - Duk Youn Cho
- Translational Research Center for Rehabilitation Robots, National Rehabilitation Center, Seoul, Korea
| | - Jung-Eun Lim
- Translational Research Center for Rehabilitation Robots, National Rehabilitation Center, Seoul, Korea
| | - Bum Suk Lee
- Translational Research Center for Rehabilitation Robots, National Rehabilitation Center, Seoul, Korea
| | - Seung Hyun Kwon
- Department of Rehabilitation Medicine, National Rehabilitation Center, Seoul, Korea
| | - Hae Young Kim
- Department of Rehabilitation Medicine, National Rehabilitation Center, Seoul, Korea
| | - Su Jeong Lee
- Department of Rehabilitation Medicine, National Rehabilitation Center, Seoul, Korea
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Abstract
OBJECTIVE To evaluate the differences between walking on an advanced robotic locomotion interface called the Treadport and walking overground with healthy subjects. BACKGROUND Previous studies have compared treadmill-based and overground walking in terms of gait parameters. The Treadport's unique features including self-selected speed capability, large belt, kinesthetic force feedback, and virtual reality environment distinguish it from other locomotion interfaces and could provide a natural walking experience for the users. METHOD Young, healthy subjects (N = 17) walked 10 meters 10 times each for both overground and the Treadport environments. Comparison between walking conditions used spatiotemporal and kinematic parameters. In addition, electromyographic data was collected for five of the 17 subjects to compare muscle activity between the two conditions. RESULTS Gait on the Treadport was found to have no significant differences (p > .05) with overground walking in terms of hip and knee joint angles, cadence and stride length and stride speed, and muscle activation of the four muscle groups measured. Differences (p < .05) were observed in ankle dorsiflexion which was reduced by 2.47 ± 0.01 degrees on the Treadport. CONCLUSION Walking overground and on the Treadport is highly correlated and not significantly different in 13 of 14 parameters. APPLICATION This study suggests that the Treadport creates an environment for natural walking experience, where natural gait of users is almost preserved, with great potential to be useful for other applications, such as gait rehabilitation of individuals with walking impairments.
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Activity-Based Training Alters Penile Reflex Responses in a Rat Model of Spinal Cord Injury. J Sex Med 2019; 16:1143-1154. [PMID: 31277969 DOI: 10.1016/j.jsxm.2019.05.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 05/29/2019] [Accepted: 05/30/2019] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Multisystem functional gains have been reported in males with spinal cord injury (SCI) after undergoing activity-based training (ABT), including increases in scoring of sexual function and reports of improved erectile function. AIM This study aims to examine the effect of daily 60-minute locomotor training and exercise in general on sexual function in a rat SCI contusion model. METHODS Male Wistar rats received a T9 contusion SCI. Animals were randomized into 4 groups: a quadrupedal stepping group (SCI + QT), a forelimb-only exercise group (SCI + FT), a non-trained harnessed group (SCI + NT), and a home cage non-trained group (SCI + HC). The 2 non-trained groups were combined (SCI) post hoc. Daily training sessions were 60 minutes in duration for 8 weeks. Urine samples were collected during bi-weekly 24-hour metabolic cage behavioral testing. Latency, numbers of penile dorsiflexion, and glans cupping were recorded during bi-weekly penile dorsiflexion reflex (PDFR) testing. Terminal electromyography (EMG) recordings of the bulbospongiosus muscle (BSM) were recorded in response to stimulation of the dorsal nerve of the penis (DNP). OUTCOMES ABT after SCI had a significant effect on PDFR, as well as BSM EMG latency and burst duration. RESULTS SCI causes a significant decrease in the latency to onset of PDFR. After 8 weeks of ABT, SCI + QT animals had a significantly increased latency relative to the post-SCI baseline. BSM EMG response to DNP stimulation had a significantly decreased latency and increase in average and maximum amplitude in SCI + QT animals. SCI animals had a significantly longer burst duration than trained animals. Time between PDFR events, penile dorsiflexion, glans cupping, and urine testosterone were not affected by ABT. CLINICAL IMPLICATIONS ABT has a positive influence on sexual function and provides a potential therapy to enhance the efficacy of current sexual dysfunction therapies in the male SCI population. STRENGTHS AND LIMITATIONS Several significant small improvements in sexual function were found in a clinically relevant rat model of SCI using a readily available rehabilitative therapy. The limited findings could reflect insensitivity of the PDFR as a measure of erectile function. CONCLUSIONS These results indicate that task-specific stepping and/or loading provide sensory input to the spinal cord impacting the neural circuitry responsible for sexual function. Steadman CJ, Hoey RF, Montgomery LR, et al. Activity-Based Training Alters Penile Reflex Responses in a Rat Model of Spinal Cord Injury. J Sex Med 2019; 16:1143-1154.
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Cheung EYY, Yu KKK, Kwan RLC, Ng CKM, Chau RMW, Cheing GLY. Effect of EMG-biofeedback robotic-assisted body weight supported treadmill training on walking ability and cardiopulmonary function on people with subacute spinal cord injuries - a randomized controlled trial. BMC Neurol 2019; 19:140. [PMID: 31234791 PMCID: PMC6591819 DOI: 10.1186/s12883-019-1361-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 06/06/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Body weight supported treadmill training (BWSTT) is a frequently used approach for restoring the ability to walk after spinal cord injury (SCI). However, the duration of BWSTT is usually limited by fatigue of the therapists and patients. Robotic-assisted body weight supported treadmill training (RABWSTT) was developed to tackle the aforesaid limitation. Currently, limited randomized controlled trials are available to investigate its effectiveness, especially on cardiopulmonary function. The aim of this two-arm, parallel-group randomized controlled trial is to examine the feasibility of adapting an EMG-biofeedback system for assist-as-needed RABWSTT and its effects on walking and cardiopulmonary function in people with SCI. METHODS Sixteen incomplete SCI subjects were recruited and randomly allocated into an intervention group or control group. The intervention group received 30 min of RABWSTT with EMG biofeedback system over the vastus lateralis muscle to enhance active participation. Dose equivalent passive lower limbs mobilization exercise was provided to subjects in the control group. RESULTS Significant time-group interaction was found in the Walking Index for Spinal Cord Injury version II (WISCI II) (p = 0.020), Spinal Cord Independence Measure version III (SCIM III) mobility sub-score (p < 0.001), bilateral symmetry (p = 0.048), maximal oxygen consumption (p = 0.014) and peak expiratory flow rate (p = 0.048). Wilcoxon signed-rank test showed that the intervention group had significant improvement in the above-mentioned outcomes after the intervention except WISCI II, which also yielded marginal significance level. CONCLUSION The present study demonstrated that the use of EMG-biofeedback RABWSTT enhanced the walking performance for SCI subjects and improve cardiopulmonary function. Positive outcomes reflect that RABSTT training may be able to enhance their physical fitness. TRIAL REGISTRATION The study protocol was approved by the Research Ethics Committee (Kowloon Central/ Kowloon East), Hospital Authority on 6 December 2013, and the Human Subjects Ethics Sub-committee of The Hong Kong Polytechnic University on 15 May 2013, with reference numbers KC/KC-13-0181/ER-2 and HSEARS20130510002 respectively. The study was registered in ClinicalTrials.gov on 20 November 2013, with reference number NCT01989806 .).
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Affiliation(s)
- Eddy Yu Yeung Cheung
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region, China.,Physiotherapy Department, Kowloon Hospital, Hospital Authority, Hong Kong Special Administrative Region, China
| | - Kevin Ka Ki Yu
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region, China.,University Research Facility in Behavioral and Systems Neuroscience, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region, China
| | - Rachel Lai Chu Kwan
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region, China
| | - Carmen Ka Man Ng
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region, China
| | - Rosanna Mei Wa Chau
- Physiotherapy Department, Kowloon Hospital, Hospital Authority, Hong Kong Special Administrative Region, China
| | - Gladys Lai Ying Cheing
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region, China. .,Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China.
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Boehm WL, Gruben KG. Development of KIINCE: A kinetic feedback-based robotic environment for study of neuromuscular coordination and rehabilitation of human standing and walking. J Rehabil Assist Technol Eng 2019; 5:2055668318793585. [PMID: 31191950 PMCID: PMC6453043 DOI: 10.1177/2055668318793585] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Accepted: 07/04/2018] [Indexed: 11/25/2022] Open
Abstract
Introduction The objective of this article is to introduce the robotic platform KIINCE and
its emphasis on the potential of kinetic objectives for studying and
training human walking and standing. The device is motivated by the need to
characterize and train lower limb muscle coordination to address balance
deficits in impaired walking and standing. Methods The device measures the forces between the user and his or her environment,
particularly the force of the ground on the feet (F) that
reflects lower limb joint torque coordination. In an environment that allows
for exploration of the user’s capabilities, various forms of real-time
feedback guide neural training to produce F appropriate for
remaining upright. Control of the foot plate motion is configurable and may
be user driven or prescribed. Design choices are motivated from theory of
motor control and learning as well as empirical observations of
F during walking and standing. Results Preliminary studies of impaired individuals demonstrate the feasibility and
potential utility of patient interaction with kinetic immersive interface
for neuromuscular coordination enhancement. Conclusion Applications include study and rehabilitation of standing and walking after
injury, amputation, and neurological insult, with an initial focus on stroke
discussed here.
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Affiliation(s)
- Wendy L Boehm
- Department of Biomedical Engineering, Northwestern University, Chicago, USA
| | - Kreg G Gruben
- Department of Kinesiology, University of Wisconsin, Madison, USA.,Department of Biomedical Engineering, University of Wisconsin, Madison, USA
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Selfslagh A, Shokur S, Campos DSF, Donati ARC, Almeida S, Yamauti SY, Coelho DB, Bouri M, Nicolelis MAL. Non-invasive, Brain-controlled Functional Electrical Stimulation for Locomotion Rehabilitation in Individuals with Paraplegia. Sci Rep 2019; 9:6782. [PMID: 31043637 PMCID: PMC6494802 DOI: 10.1038/s41598-019-43041-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 04/10/2019] [Indexed: 11/19/2022] Open
Abstract
Spinal cord injury (SCI) impairs the flow of sensory and motor signals between the brain and the areas of the body located below the lesion level. Here, we describe a neurorehabilitation setup combining several approaches that were shown to have a positive effect in patients with SCI: gait training by means of non-invasive, surface functional electrical stimulation (sFES) of the lower-limbs, proprioceptive and tactile feedback, balance control through overground walking and cue-based decoding of cortical motor commands using a brain-machine interface (BMI). The central component of this new approach was the development of a novel muscle stimulation paradigm for step generation using 16 sFES channels taking all sub-phases of physiological gait into account. We also developed a new BMI protocol to identify left and right leg motor imagery that was used to trigger an sFES-generated step movement. Our system was tested and validated with two patients with chronic paraplegia. These patients were able to walk safely with 65-70% body weight support, accumulating a total of 4,580 steps with this setup. We observed cardiovascular improvements and less dependency on walking assistance, but also partial neurological recovery in both patients, with substantial rates of motor improvement for one of them.
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Affiliation(s)
- Aurelie Selfslagh
- Neurorehabilitation Laboratory, Associação Alberto Santos Dumont para Apoio à Pesquisa (AASDAP), São Paulo, 05440-000, Brazil
- STI IMT, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Solaiman Shokur
- Neurorehabilitation Laboratory, Associação Alberto Santos Dumont para Apoio à Pesquisa (AASDAP), São Paulo, 05440-000, Brazil
| | - Debora S F Campos
- Neurorehabilitation Laboratory, Associação Alberto Santos Dumont para Apoio à Pesquisa (AASDAP), São Paulo, 05440-000, Brazil
| | - Ana R C Donati
- Neurorehabilitation Laboratory, Associação Alberto Santos Dumont para Apoio à Pesquisa (AASDAP), São Paulo, 05440-000, Brazil
- Associação de Assistência à Criança Deficiente (AACD), São Paulo, 04027-000, Brazil
| | - Sabrina Almeida
- Neurorehabilitation Laboratory, Associação Alberto Santos Dumont para Apoio à Pesquisa (AASDAP), São Paulo, 05440-000, Brazil
- Associação de Assistência à Criança Deficiente (AACD), São Paulo, 04027-000, Brazil
| | - Seidi Y Yamauti
- Neurorehabilitation Laboratory, Associação Alberto Santos Dumont para Apoio à Pesquisa (AASDAP), São Paulo, 05440-000, Brazil
| | - Daniel B Coelho
- Biomedical Engineering, Federal University of ABC, São Bernardo do Campo, SP, 09606-045, Brazil
| | - Mohamed Bouri
- STI IMT, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Miguel A L Nicolelis
- Neurorehabilitation Laboratory, Associação Alberto Santos Dumont para Apoio à Pesquisa (AASDAP), São Paulo, 05440-000, Brazil.
- Department of Neurobiology, Duke University Medical Center, Durham, NC, 27710, USA.
- Duke Center for Neuroengineering, Duke University, Durham, NC, 27710, USA.
- Department of Biomedical Engineering, Duke University, Durham, NC, 27708, USA.
- Department of Neurology, Duke University, Durham, NC, 27710, USA.
- Department of Neurosurgery, Duke University, Durham, NC, 27710, USA.
- Department of Psychology and Neuroscience, Duke University, Durham, NC, 27708, USA.
- Edmond and Lily Safra International Institute of Neuroscience, Macaíba, Brazil.
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