1
|
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.
Collapse
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.
| |
Collapse
|
2
|
Tefertiller C, Wojciehowski S, Sevigny M, Ketchum JM, Rozwod M. Comparison of One-Year Postinjury Mobility Outcomes Between Locomotor Training and Usual Care After Motor Incomplete Spinal Cord Injury. Top Spinal Cord Inj Rehabil 2024; 30:87-97. [PMID: 38433742 PMCID: PMC10906373 DOI: 10.46292/sci23-00013] [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
Objectives To compare 1-year mobility outcomes of individuals with traumatic motor incomplete spinal cord injury (miSCI) who participated in standardized locomotor training (LT) within the first year of injury to those who did not. Methods This retrospective case-control analysis conducted with six US rehabilitation hospitals used SCI Model Systems (SCIMS) data comparing 1-year postinjury outcomes between individuals with miSCI who participated in standardized LT to those who received usual care (UC). Participants were matched on age, gender, injury year, mode of mobility, and rehabilitation center. The primary outcome is the FIM Total Motor score. Other outcomes include the FIM Transfer Index, FIM Stairs, and self-reported independence with household mobility, community mobility, and stairs. Results LT participants reported significantly better FIM Total Motor (difference = 2.812, 95% confidence interval [CI] = 5.896, 17.282) and FIM Transfer Index scores (difference = 0.958, 95% CI = 0.993, 4.866). No significant between-group differences were found for FIM Stairs (difference = 0.713, 95% CI = -0.104, 1.530) or self-reported household mobility (odds ratio [OR] = 5.065, CI = 1.435, 17.884), community mobility (OR = 2.933, 95% CI = 0.868, 9.910), and stairs (OR = 5.817, 95% CI = 1.424, 23.756) after controlling for multiple comparisons. Conclusion LT participants reported significantly greater improvements in primary and secondary measures of mobility and independence (FIM Total Motor score; FIM Transfer Index) compared to UC participants. Self-reported mobility outcomes were not significant between groups.
Collapse
|
3
|
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.
Collapse
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.)
| |
Collapse
|
4
|
Kaiser A, Chan K, Sessford J, McCullum S, Athanasopoulos P, Rice C, Leo J, MacRitchie I, Zariffa J, Musselman KE. Providing Insights into the Challenges of Implementing Activity-Based Therapy in Canada: A Comparative Analysis Using Focus Group Interviews with Key Interest Groups. Top Spinal Cord Inj Rehabil 2023; 29:53-74. [PMID: 38174133 PMCID: PMC10759825 DOI: 10.46292/sci23-00022s] [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: 01/05/2024]
Abstract
Background Activity-based therapy (ABT) has emerged as a therapeutic approach that may promote neurorecovery and reduce secondary complications in people living with spinal cord injury or disease (SCI/D). In spite of the numerous health benefits, adoption of ABT into practice has been limited across the Canadian care continuum. Objectives This study aimed to understand the challenges of implementing ABT in Canada for people living with SCI/D through the perspectives of key interest groups. Methods Researchers, hospital therapists, community trainers, administrators, persons living with SCI/D, and advocates, funders, and policy experts who had knowledge of and/or experience with ABT participated in focus group interviews to share their perspectives on the barriers to ABT practice. Interviews were analyzed using conventional content analysis followed by a comparative analysis across groups. Results The 48 participants identified six key challenges: (1) challenge of gaps in knowledge/training, (2) challenge of standardizing ABT, (3) challenge of determining the optimal timing of ABT, (4) challenge of defining, characterizing, and achieving high dosage and intensity, (5) challenge of funding ABT, and (6) challenge of measuring participation and performance in ABT. A comparative analysis found some challenges were emphasized by certain groups, such as the cost of ABT for persons with SCI/D, lack of education and training in ABT for therapists and trainers, minimal evidence to develop guidelines for researchers and advocates, and funding ABT programs for administrators. Conclusion Participants highlighted several challenges that limit ABT practice. Strategies to address these challenges will support successful implementation of ABT in Canada.
Collapse
Affiliation(s)
- Anita Kaiser
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Canadian Spinal Research Organization, Richmond Hill, ON, Canada
| | - Katherine Chan
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - James Sessford
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Shane McCullum
- Stan Cassidy Centre for Rehabilitation, Horizon Health Network, Fredericton, NB, Canada
| | | | - Chris Rice
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Jennifer Leo
- The Steadward Centre for Personal & Physical Achievement, University of Alberta, Edmonton, AB, Canada
| | - Iona MacRitchie
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - José Zariffa
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
- Edward S. Rogers Sr. Department of Electrical and Computer Engineering, University of Toronto, Toronto, ON, Canada
| | - Kristin E. Musselman
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
5
|
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.
Collapse
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
| |
Collapse
|
6
|
Reeves B, Smith E, Broussard M, Martin R. Activity based restorative therapy considerations for children: medical and therapeutic perspectives for the pediatric population. FRONTIERS IN REHABILITATION SCIENCES 2023; 4:1186212. [PMID: 37744428 PMCID: PMC10511641 DOI: 10.3389/fresc.2023.1186212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 08/24/2023] [Indexed: 09/26/2023]
Abstract
Well-established scientific evidence demonstrates that activity is essential for the development and repair of the central nervous system, yet traditional rehabilitation approaches target muscles only above the lesion as a means of compensation. Activity-Based Rehabilitation (ABR) represents an evolving paradigm shift in neurorehabilitation targeting activation of the neuromuscular system below the lesion. Based on activity-dependent plasticity, ABR offers high intensity activation of the nervous system to optimize the capacity for recovery, while working to offset the chronic complications that occur as a result of neurologic injury. Treatment focus shifts from compensatory training to promotion of restoration of function with special emphasis on normalizing sensory cues and movement kinematics. ABR in children carries special considerations for a developing nervous system and the focus is not just restoring functions but advancing functions in line with typical development. Application of activity-based interventions includes traditional rehabilitation strategies at higher intensity and frequency than in traditional models, including locomotor training, functional electrical stimulation, massed practice, and task specific training, applied across the continuum of care from early intervention to the chronic condition.
Collapse
Affiliation(s)
- Brooke Reeves
- International Center for Spinal Cord Injury, Kennedy Krieger Institute, Baltimore, MD, United States
| | - Emily Smith
- International Center for Spinal Cord Injury, Kennedy Krieger Institute, Baltimore, MD, United States
| | - Miranda Broussard
- International Center for Spinal Cord Injury, Kennedy Krieger Institute, Baltimore, MD, United States
| | - Rebecca Martin
- International Center for Spinal Cord Injury, Kennedy Krieger Institute, Baltimore, MD, United States
- Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, Baltimore, MD, United States
| |
Collapse
|
7
|
Noonan-Eaton K, Stout D, Goode-Roberts M, Leon Machado L, Davis M, Behrman AL. Case report: training neck and head control in children with chronic paralysis due to acute flaccid myelitis. FRONTIERS IN REHABILITATION SCIENCES 2023; 4:1063724. [PMID: 37275404 PMCID: PMC10235686 DOI: 10.3389/fresc.2023.1063724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 04/18/2023] [Indexed: 06/07/2023]
Abstract
Background Acute flaccid myelitis (AFM) occurs rarely in children and adolescents when damage to spinal motor neurons rapidly causes flaccid paralysis of limb, trunk, and neck muscles and potentially respiratory failure. When neck muscles are weakened or paralyzed, a child loses head control, severely compromising engagement with their environment. Compensation for lack of head control is achieved with external support devices attached to a wheelchair, but there is no indication in the AFM literature of therapeutic efforts to restore head control. In this case series, we explore the possibility of the recovery of head control when children with AFM received activity-based restorative therapies (ABRTs) guided by principles targeting motor control. Case description Three children, two male and one female, aged 6, 9, and 7, with a history of AFM-onset at 5, 7, and 4 years respectively, enrolled in an activity-based restorative therapies outpatient program targeting activation of the neuromuscular system below the lesion. Each of them lacked head control, was either ventilator-dependent or had a tracheostomy, and was a power wheelchair user via hand/foot control. Methods Activity-based restorative therapies were provided 5 days/week: 1.5 h of activity-based locomotor training and 1.5 h of activity-based neuromuscular electrical stimulation. Results An approach to addressing head/neck control developed iteratively across disciplines, from complete compensation with passive external head support to emerging head control during diverse tasks, e.g., sitting, reaching, driving a power chair, sit-to-stand, standing, stepping on a treadmill, and walking. Key principles identified and employed were (a) passive facilitation, (b) external head support, (c) posterior head support, (d) graded manual facilitation, and (e) independent head control. Discussion The recovery of head control in children with paralysis due to AFM may be accelerated when executing a step-wise progression to effectively target and challenge head control in parallel with activity-based restorative therapies. In treating three children with a chronic lack of head control, a therapeutic strategy was iteratively developed guided by scientific principles, e.g., segmental assessment of control, to promote recovery of head control. While this strategy is encouraging, gaps in sensitive and responsive measurement instruments and treatment technologies persist in guiding assistance, challenging, and promoting independent head control.
Collapse
Affiliation(s)
- Kathryn Noonan-Eaton
- SCI Out-Patient Program, Frazier Rehab Institute, Louisville, KY, United States
- Department of Neurological Surgery and Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, United States
| | - Danielle Stout
- SCI Out-Patient Program, Frazier Rehab Institute, Louisville, KY, United States
| | - MacKenzie Goode-Roberts
- SCI Out-Patient Program, Frazier Rehab Institute, Louisville, KY, United States
- Department of Neurological Surgery and Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, United States
| | - Laura Leon Machado
- SCI Out-Patient Program, Frazier Rehab Institute, Louisville, KY, United States
| | - Matthew Davis
- SCI Out-Patient Program, Frazier Rehab Institute, Louisville, KY, United States
| | - Andrea L. Behrman
- Department of Neurological Surgery and Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, United States
- Kosair Charities Center for Pediatric NeuroRecovery, University of Louisville, Louisville, KY, United States
| |
Collapse
|
8
|
Leon Machado L, Lucas K, Behrman AL. Activity-Based Restorative Therapy Promotes Progression from Asymmetry to Symmetry in Posture and Gait in a Child with Chronic, Incomplete Spinal Cord Injury. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10030594. [PMID: 36980152 PMCID: PMC10047088 DOI: 10.3390/children10030594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 03/03/2023] [Accepted: 03/16/2023] [Indexed: 03/30/2023]
Abstract
Incomplete spinal cord injuries (ISCI) in pediatrics and adults can lead to asymmetric motor impairments exhibiting as asymmetries of posture and gait. Recently, rehabilitation guidelines for adults with neurologic injuries have focused on gaining a functional gait pattern as measured by speed and distance, even if asymmetry deficits persist. Activity-based restorative therapies (ABRT) take advantage of activity-dependent neuroplasticity to change an individual's neuromuscular capacity. This is a report of an ambulatory child with chronic ISCI presenting with significant postural and gait asymmetries who enrolled in an ABRT program. Across 79 ABRT sessions, the child gained symmetry during sitting, standing, and walking. Even though this child was a functional ambulator at enrollment, targeting symmetry of movements via improved neuromuscular capacity further enhanced her achievement of kinematically appropriate function for participation in daily activities.
Collapse
Affiliation(s)
- Laura Leon Machado
- Frazier Rehabilitation Institute, UofL Health, Louisville, KY 40202, USA
| | - Kathryn Lucas
- Department of Neurosurgery, University of Louisville, Louisville, KY 40202, USA
- Kentucky Spinal Cord Injury Research Center, Louisville, KY 40202, USA
- Kosair Charities Center for Pediatric NeuroRecovery, Louisville, KY 40202, USA
| | - Andrea L Behrman
- Department of Neurosurgery, University of Louisville, Louisville, KY 40202, USA
- Kentucky Spinal Cord Injury Research Center, Louisville, KY 40202, USA
- Kosair Charities Center for Pediatric NeuroRecovery, Louisville, KY 40202, USA
| |
Collapse
|
9
|
Tefertiller C, Rozwod M, Wojciehowski S, Sevigny M, Charlifue S, Ketchum JM, Berliner J, Taylor HB, Behrman AL, Harkema S, Forrest G, Schmidt Read M, Basso M. A comparison of one year outcomes between standardized locomotor training and usual care after motor incomplete spinal cord injury: Community participation, quality of life and re-hospitalization. J Spinal Cord Med 2023; 46:35-44. [PMID: 34612793 PMCID: PMC9897794 DOI: 10.1080/10790268.2021.1977060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
CONTEXT/OBJECTIVE Spinal cord injury (SCI) often results in a significant loss of mobility and independence coinciding with reports of decreased quality of life (QOL), community participation, and medical complications often requiring re-hospitalization. Locomotor training (LT), the repetition of stepping-like patterning has shown beneficial effects for improving walking ability after motor incomplete SCI, but the potential impact of LT on psychosocial outcomes has not been well-established. The purpose of this study was to evaluate one year QOL, community participation and re-hospitalization outcomes between individuals who participated in a standardized LT program and those who received usual care (UC). DESIGN/SETTING/PARTICIPANTS A retrospective (nested case/control) analysis was completed using SCI Model Systems (SCIMS) data comparing one year post-injury outcomes between individuals with traumatic motor incomplete SCI who participated in standardized LT to those who received UC. OUTCOME MEASURES Outcomes compared include the following: Satisfaction with Life Scale (SWLS™), Craig Handicap Assessment and Reporting Technique-Short Form (CHART-SF™), and whether or not an individual was re-hospitalized during the first year of injury. RESULTS Statistically significant improvements for the LT group were found in the following outcomes: SWLS (P = 0.019); and CHART subscales [mobility (P = <0.001)]; occupation (P = 0.028); with small to medium effects sizes. CONCLUSION Individuals who completed a standardized LT intervention reported greater improvements in satisfaction with life, community participation, and fewer re-hospitalizations at one year post-injury in comparison to those who received UC. Future randomized controlled trials are needed to verify these findings.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Heather B Taylor
- The Institute for Rehabilitation and Research (TIRR) Memorial Hermann, Houston, Texas, USA
| | - Andrea L Behrman
- Department of Neurological Surgery, Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky, USA
| | - Susan Harkema
- Department of Neurological Surgery, Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky, USA
| | - Gail Forrest
- Kessler Institute of Rehabilitation, West Orange, New Jersey, USA
| | - Mary Schmidt Read
- Magee Rehabilitation/Jefferson Health, Philadelphia, Pennsylvania, USA
| | | |
Collapse
|
10
|
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.
Collapse
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
| |
Collapse
|
11
|
A Scoping Review of the Characteristics of Activity-based Therapy Interventions Across the Continuum of Care for People Living With Spinal Cord Injury or Disease. Arch Rehabil Res Clin Transl 2022; 4:100218. [PMID: 36545530 PMCID: PMC9761266 DOI: 10.1016/j.arrct.2022.100218] [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: 12/24/2022] Open
Abstract
Objective To identify the characteristics of activity-based therapy (ABT) that individuals with spinal cord injury and disease (SCI/D) participate in across the continuum of care. Data Sources A search of 8 databases was conducted from inception to 4 March 2020: Medline, CINAHL, Embase, Emcare, PEDro, APA PsycINFO, Cochrane Database of Systematic Reviews, and the CENTRAL. The search strategy used terms identifying the population (SCI/D) and concept (ABT). Study Selection Original studies involving individuals with SCI/D ≥16 years of age participating in ABT interventions for >1 session were included in the review. The Joanna Briggs Institute guidelines for scoping reviews were followed. The initial search produced 2306 records. Title, abstract, and full-text screening by 2 independent reviewers yielded 140 articles. Data Extraction Data extraction was conducted by 3 independent reviewers and charted according to key themes. Data fields included participant demographics, ABT interventions, exercises, parameters, technology, and setting. Data synthesis included frequency counts and descriptive analysis of key themes. Data Synthesis Eighty percent of participants were male. Eighty-seven percent of studies included individuals with tetraplegia (26% exclusive). Fifty-six percent of studies occurred in a research lab. Fifty-four percent of studies were single modality interventions encompassing the whole body (71%). Sixteen main types of ABT exercises were identified. The most common were treadmill training (59%), muscle strengthening (36%), and overground walking (33%). Electrical stimulation (50%) and virtual reality (6%) were used in combination with an ABT exercise. Eighty-four types of parameters were identified. Six were general intervention parameters and 78 were specific to the type of ABT exercise. Sixteen main categories of technology were reported. The most common were motorized treadmills (47%) and transcutaneous electrical stimulation (44%). Conclusions The characteristics of ABT are diverse in scope. The results will inform the content to include in tools that track ABT participation and performance.
Collapse
|
12
|
Cardoso LRL, Bochkezanian V, Forner-Cordero A, Melendez-Calderon A, Bo APL. Soft robotics and functional electrical stimulation advances for restoring hand function in people with SCI: a narrative review, clinical guidelines and future directions. J Neuroeng Rehabil 2022; 19:66. [PMID: 35773733 PMCID: PMC9245887 DOI: 10.1186/s12984-022-01043-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 06/02/2022] [Indexed: 11/10/2022] Open
Abstract
Background Recovery of hand function is crucial for the independence of people with spinal cord injury (SCI). Wearable devices based on soft robotics (SR) or functional electrical stimulation (FES) have been employed to assist the recovery of hand function both during activities of daily living (ADLs) and during therapy. However, the implementation of these wearable devices has not been compiled in a review focusing on the functional outcomes they can activate/elicit/stimulate/potentiate. This narrative review aims at providing a guide both for engineers to help in the development of new technologies and for clinicians to serve as clinical guidelines based on the available technology in order to assist and/or recover hand function in people with SCI. Methods A literature search was performed in Scopus, Pubmed and IEEE Xplore for articles involving SR devices or FES systems designed for hand therapy or assistance, published since 2010. Only studies that reported functional outcomes from individuals with SCI were selected. The final collections of both groups (SR and FES) were analysed based on the technical aspects and reported functional outcomes. Results A total of 37 out of 1101 articles were selected, 12 regarding SR and 25 involving FES devices. Most studies were limited to research prototypes, designed either for assistance or therapy. From an engineering perspective, technological improvements for home-based use such as portability, donning/doffing and the time spent with calibration were identified. From the clinician point of view, the most suitable technical features (e.g., user intent detection) and assessment tools should be determined according to the particular patient condition. A wide range of functional assessment tests were adopted, moreover, most studies used non-standardized tests. Conclusion SR and FES wearable devices are promising technologies to support hand function recovery in subjects with SCI. Technical improvements in aspects such as the user intent detection, portability or calibration as well as consistent assessment of functional outcomes were the main identified limitations. These limitations seem to be be preventing the translation into clinical practice of these technological devices created in the laboratory.
Collapse
Affiliation(s)
- Lucas R L Cardoso
- Biomedical Engineering, School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, Australia.
| | - Vanesa Bochkezanian
- College of Health Sciences, School of Health, Medical and Applied Sciences, Central Queensland University, North Rockhampton, Australia
| | - Arturo Forner-Cordero
- Biomechatronics Laboratory, Escola Politecnica, University of São Paulo, São Paulo, Brazil
| | - Alejandro Melendez-Calderon
- Biomedical Engineering, School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, Australia.,School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia.,Jamieson Trauma Institute, Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Brisbane, Australia
| | - Antonio P L Bo
- Biomedical Engineering, School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, Australia
| |
Collapse
|
13
|
Liu M, Shafiq M, Sun B, Wu J, Wang W, El-Newehy M, El-Hamshary H, Morsi Y, Ali O, Khan AUR, Mo X. Composite Superelastic Aerogel Scaffolds Containing Flexible SiO 2 Nanofibers Promote Bone Regeneration. Adv Healthc Mater 2022; 11:e2200499. [PMID: 35670086 DOI: 10.1002/adhm.202200499] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 04/25/2022] [Indexed: 11/08/2022]
Abstract
Repairing irregular-shaped bone defects poses enormous challenges. Scaffolds that can fully fit the defect site and simultaneously induce osteogenesis and angiogenesis hold great promise for bone defect healing. This study aimed to produce superelastic organic/inorganic composite aerogel scaffolds by blending silica nanofibers (SiO2 ) and poly (lactic acid)/gelatin (PLA/gel) nanofibers; the content of SiO2 nanofibers were varied from 0-60 wt% (e.g., PLA/gel, PLA/gel/SiO2 -L, PLA/gel/SiO2 -M, and PLA/gel/SiO2 -H for 0%, 20%, 40%, and 60% of SiO2 nanofibers, respectively) to produce a range of scaffolds. The PLA/gel/SiO2 -M scaffold had excellent elasticity and good mechanical properties. In vitro experiments demonstrated that the silicon ions released from PLA/gel/SiO2 -M scaffolds could promote the differentiation of rat bone marrow-derived mesenchymal stem cells (rBMSCs) into osteoblasts, thereby enhancing alkaline phosphatase activity and bone-related genes expressions. Meanwhile, the released silicon ions also promoted the proliferation of human umbilical vein endothelial cells (HUVECs) and the expression of vascular endothelial growth factors, thereby promoting angiogenesis. The assessment of these scaffolds in a calvarial defect model in rats showed good potential of PLA/gel/SiO2 -M to induce bone regeneration as well as promote osteogenesis and angiogenesis. Overall, these superelastic scaffolds containing flexible SiO2 nanofibers can simultaneously induce osteogenesis and angiogenesis, which may have broad applications for tissue engineering applications. This article is protected by copyright. All rights reserved.
Collapse
Affiliation(s)
- Mingyue Liu
- Shanghai Engineering Research Center of Nano-Biomaterials and Regenerative Medicine, College of Chemistry, Chemical Engineering and Biotechnology, Donghua University, Shanghai, 201620, P. R. China
| | - Muhammad Shafiq
- Shanghai Engineering Research Center of Nano-Biomaterials and Regenerative Medicine, College of Chemistry, Chemical Engineering and Biotechnology, Donghua University, Shanghai, 201620, P. R. China
| | - Binbin Sun
- Shanghai Engineering Research Center of Nano-Biomaterials and Regenerative Medicine, College of Chemistry, Chemical Engineering and Biotechnology, Donghua University, Shanghai, 201620, P. R. China
| | - Jinglei Wu
- Shanghai Engineering Research Center of Nano-Biomaterials and Regenerative Medicine, College of Chemistry, Chemical Engineering and Biotechnology, Donghua University, Shanghai, 201620, P. R. China
| | - Wei Wang
- Shanghai Engineering Research Center of Nano-Biomaterials and Regenerative Medicine, College of Chemistry, Chemical Engineering and Biotechnology, Donghua University, Shanghai, 201620, P. R. China
| | - Mohamed El-Newehy
- Department of Chemistry, College of Science, King Saud University, P.O. Box 2455, Riyadh, 11451, Saudi Arabia
| | - Hany El-Hamshary
- Department of Chemistry, College of Science, King Saud University, P.O. Box 2455, Riyadh, 11451, Saudi Arabia
| | - Yosry Morsi
- Faculty of Engineering and Industrial Sciences, Swinburne University of Technology, Boroondara, VIC, 3122, Australia
| | - Onaza Ali
- School of Chemistry and Chemical Engineering, Tiangong University, Tianjin, 300387, China
| | - Atta Ur Rehman Khan
- Department of Biotechnology, The University of Azad Jammu & Kashmir, Muzaffarabad, Pakistan
| | - Xiumei Mo
- Shanghai Engineering Research Center of Nano-Biomaterials and Regenerative Medicine, College of Chemistry, Chemical Engineering and Biotechnology, Donghua University, Shanghai, 201620, P. R. China
| |
Collapse
|
14
|
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: 0] [Impact Index Per Article: 0] [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.
Collapse
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
| |
Collapse
|
15
|
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: 0] [Impact Index Per Article: 0] [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.
Collapse
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
| |
Collapse
|
16
|
van der Scheer JW, Goosey-Tolfrey VL, Valentino SE, Davis GM, Ho CH. Functional electrical stimulation cycling exercise after spinal cord injury: a systematic review of health and fitness-related outcomes. J Neuroeng Rehabil 2021; 18:99. [PMID: 34118958 PMCID: PMC8196442 DOI: 10.1186/s12984-021-00882-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 05/19/2021] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES The objective of this review was to summarize and appraise evidence on functional electrical stimulation (FES) cycling exercise after spinal cord injury (SCI), in order to inform the development of evidence-based clinical practice guidelines. METHODS PubMed, the Cochrane Central Register of Controlled Trials, EMBASE, SPORTDiscus, and CINAHL were searched up to April 2021 to identify FES cycling exercise intervention studies including adults with SCI. In order to capture the widest array of evidence available, any outcome measure employed in such studies was considered eligible. Two independent reviewers conducted study eligibility screening, data extraction, and quality appraisal using Cochranes' Risk of Bias or Downs and Black tools. Each study was designated as a Level 1, 2, 3 or 4 study, dependent on study design and quality appraisal scores. The certainty of the evidence for each outcome was assessed using GRADE ratings ('High', 'Moderate', 'Low', or 'Very low'). RESULTS Ninety-two studies met the eligibility criteria, comprising 999 adults with SCI representing all age, sex, time since injury, lesion level and lesion completeness strata. For muscle health (e.g., muscle mass, fiber type composition), significant improvements were found in 3 out of 4 Level 1-2 studies, and 27 out of 32 Level 3-4 studies (GRADE rating: 'High'). Although lacking Level 1-2 studies, significant improvements were also found in nearly all of 35 Level 3-4 studies on power output and aerobic fitness (e.g., peak power and oxygen uptake during an FES cycling test) (GRADE ratings: 'Low'). CONCLUSION Current evidence indicates that FES cycling exercise improves lower-body muscle health of adults with SCI, and may increase power output and aerobic fitness. The evidence summarized and appraised in this review can inform the development of the first international, evidence-based clinical practice guidelines for the use of FES cycling exercise in clinical and community settings of adults with SCI. Registration review protocol: CRD42018108940 (PROSPERO).
Collapse
Affiliation(s)
- Jan W van der Scheer
- Peter Harrison Centre for Disability Sport, School for Sport, Exercise and Health Sciences, Loughborough University, Epinal Way, Loughborough, LE11 3TU, UK
- The Healthcare Improvement Studies (THIS) Institute, Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge, Cambridge Biomedical Campus, Clifford Allbutt Building, Cambridge, CB2 OAH, UK
| | - Victoria L Goosey-Tolfrey
- Peter Harrison Centre for Disability Sport, School for Sport, Exercise and Health Sciences, Loughborough University, Epinal Way, Loughborough, LE11 3TU, UK
| | - Sydney E Valentino
- Department of Kinesiology, McMaster University, Room IWC EG115, 1280 Main St. W., Hamilton, ON, L8S 4K1, Canada
| | - Glen M Davis
- Discipline of Exercise and Sport Sciences, Faculty of Medicine and Health, Sydney School of Health Sciences, University of Sydney, Sydney, NSW, 2006, Australia
| | - Chester H Ho
- Division of Physical Medicine & Rehabilitation, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, T6G 2R3, Canada.
| |
Collapse
|
17
|
Cajigas I, Vedantam A. Brain-Computer Interface, Neuromodulation, and Neurorehabilitation Strategies for Spinal Cord Injury. Neurosurg Clin N Am 2021; 32:407-417. [PMID: 34053728 DOI: 10.1016/j.nec.2021.03.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
As neural bypass interfacing, neuromodulation, and neurorehabilitation continue to evolve, there is growing recognition that combination therapies may achieve superior results. This article briefly introduces these broad areas of active research and lays out some of the current evidence for their use for patients with spinal cord injury.
Collapse
Affiliation(s)
- Iahn Cajigas
- Department of Neurosurgery, University of Miami, 1095 Northwest 14th Terrace (D4-6), Miami, FL 33136, USA.
| | - Aditya Vedantam
- Department of Neurosurgery, University of Miami, 1095 Northwest 14th Terrace (D4-6), Miami, FL 33136, USA
| |
Collapse
|
18
|
Hagen K, Porter C, Martin R, Dean J, Salorio C, Sadowsky C. Improvements in Function Following Inpatient Activity-Based Therapy for Children With Acute Flaccid Myelitis. Top Spinal Cord Inj Rehabil 2021; 26:275-282. [PMID: 33536733 PMCID: PMC7831282 DOI: 10.46292/sci20-00010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Acute flaccid myelitis (AFM) is an illness defined by rapid onset of flaccid paralysis in one or more limbs or bulbar muscles, with MRI findings of predominantly spinal cord gray matter abnormalities spanning one or more spinal segments following a viral illness. Individuals with AFM may require rehabilitation to promote recovery. Activity-based restorative therapy (ABRT) has previously been shown to result in positive outcomes in children with neurologic deficits related to AFM. OBJECTIVES This study examined functional changes in a group of children with AFM who participated in ABRT in an inpatient setting. METHODS Retrospective chart review of children with AFM admitted to a single inpatient rehabilitation unit from 2014 to 2018. Children were assessed using the Functional Independence Measure for Children (WeeFIM), Manual Muscle Testing (MMT), Spinal Cord Independence Measure (SCIM), and the Physical Abilities and Mobility Scale (PAMS) as part of routine clinical care; the Modified Rankin Scale for Neurologic Disability was completed retrospectively. RESULTS Children showed significant improvements across all outcome measures, with effect sizes ranging from moderate to large. Significant change was also seen across all muscle groups on MMT, with effect sizes ranging from small to large. Consistent with previous reports, children demonstrated better function in distal than proximal muscle groups at both admission and discharge. CONCLUSION Children with AFM who participated in ABRT increased muscle strength and made functional gains across all outcome measures. These results support the utility of rehabilitation in the long-term care of children with AFM and residual neurologic deficit.
Collapse
Affiliation(s)
- Kaitlin Hagen
- International Center for Spinal Cord Injury, Kennedy Krieger Institute, Baltimore, Maryland
| | - Courtney Porter
- International Center for Spinal Cord Injury, Kennedy Krieger Institute, Baltimore, Maryland
| | - Rebecca Martin
- International Center for Spinal Cord Injury, Kennedy Krieger Institute, Baltimore, Maryland
- Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Janet Dean
- International Center for Spinal Cord Injury, Kennedy Krieger Institute, Baltimore, Maryland
| | - Cynthia Salorio
- International Center for Spinal Cord Injury, Kennedy Krieger Institute, Baltimore, Maryland
- Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Cristina Sadowsky
- International Center for Spinal Cord Injury, Kennedy Krieger Institute, Baltimore, Maryland
- Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, Baltimore, Maryland
| |
Collapse
|
19
|
Wang C, Yue H, Liu J, Zhao Q, He Z, Li K, Lu B, Huang W, Wei Y, Tang Y, Wang M. Advanced reconfigurable scaffolds fabricated by 4D printing for treating critical-size bone defects of irregular shapes. Biofabrication 2020; 12:045025. [PMID: 32736373 DOI: 10.1088/1758-5090/abab5b] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
While scaffold-based tissue engineering has been widely used to treat bone critical-size defects, challenges such as implantation of scaffolds in defects with irregular shapes and implantation of scaffolds through minimally invasive surgery remain in the tissue engineering field. Customized bioactive bone tissue engineering scaffolds with reconfigurable capability for both easy scaffold implantation and perfect shape fitting in irregularly shaped bone defects are therefore needed. Herein, applying 4D printing, photothermal-responsive shape memory bone tissue engineering scaffolds are constructed by incorporating black phosphorus nanosheets and osteogenic peptide into β-tricalcium phosphate/poly(lactic acid-co-trimethylene carbonate) (TCP/P(DLLA-TMC)) nanocomposite scaffolds. When near-infrared irradiation is applied to customized scaffolds on-demand, scaffold temperature rapidly increases to 45 °C, enabling scaffold shape reconfiguration for easy scaffold implantation and precise fitting in irregular bone defects. Once the implantation is finished, scaffold temperature rapidly decreases to 37 °C and scaffolds display mechanical properties comparable to those of human cancellous bone. The improved osteogenesis in bone defect sites is then initiated through pulsed peptide release from scaffolds. Compact integration of reconfigurable scaffolds in rat cranial bone defects and improved new bone formation are demonstrated through micro-computed tomography and histochemical analyses. This study shows a facile method to clinically treat bone defects of irregular shapes.
Collapse
Affiliation(s)
- Chong Wang
- School of Mechanical Engineering, Dongguan University of Technology, Dongguan, Guangdong, People's Republic of China. Contributed equally. Author to whom any correspondence should be addressed
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Kaiser A, Chan K, Pakosh M, Musselman KE. Characteristics of activity-based therapy interventions for people living with spinal cord injury or disease across the continuum of care: a scoping review protocol. BMJ Open 2020; 10:e040014. [PMID: 32709658 PMCID: PMC7380728 DOI: 10.1136/bmjopen-2020-040014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 06/11/2020] [Accepted: 06/18/2020] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Individuals living with spinal cord injury and disease (SCI/D) experience sensory and motor impairments below their neurological level of injury. Activity-based therapies (ABT) are interventions that provide activation of the neuromuscular system below the level of lesion with the goal of retraining the nervous system to recover a specific motor task. ABT can lead to increased function and improved quality of life; however, research and clinical settings currently lack tools to track participation in ABT. As a first step towards developing such a tool, a scoping review will be conducted with the objective of identifying the characteristics of ABT that individuals with SCI/D participate in across the continuum of care. METHODS AND ANALYSIS The review will follow the Joanna Briggs Institute scoping review framework. Studies that involve at least two sessions of ABT for individuals with SCI/D aged ≥16 years will be included. Seven databases were searched from their inception to 4 March 2020: Medline, Embase, Emcare, Cumulative Index to Nursing and Allied Health Literature, APA PsycINFO, Physiotherapy Evidence Database, Cochrane Database of Systematic Reviews and the Cochrane Central Register of Controlled Trials. The search will be rerun in November 2020 prior to manuscript submission. Screening of titles and abstracts will be followed by a review of full texts to identify articles meeting inclusion criteria. Stakeholders will be consulted for the creation of the data extraction table. The Downs and Black Checklist or the Mixed Methods Appraisal Tool will be used to assess article quality. Results will be reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews checklist. ETHICS AND DISSEMINATION Ethical approval is not required for this scoping review. Study findings will be shared with key stakeholder groups through academic, clinical and public venues.
Collapse
Affiliation(s)
- Anita Kaiser
- KITE, Toronto Rehab-University Health Network, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
- Canadian Spinal Research Organization, Toronto, Ontario, Canada
| | - Katherine Chan
- KITE, Toronto Rehab-University Health Network, Toronto, Ontario, Canada
| | - Maureen Pakosh
- KITE, Toronto Rehab-University Health Network, Toronto, Ontario, Canada
| | - Kristin E Musselman
- KITE, Toronto Rehab-University Health Network, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
21
|
Dionne TP, Lenker JA, Hennessy P, Sullivan JE. Use of Electrical Stimulation for People With Spinal Cord Injury: A Survey of Occupational Therapy Practitioners. Am J Occup Ther 2020; 74:7403205110p1-7403205110p7. [PMID: 32365317 DOI: 10.5014/ajot.2020.035584] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE When working with clients who have experienced spinal cord injury (SCI), occupational therapy practitioners can face challenges in achieving desired results during functional activity when using electrical stimulation (ES) interventions. In an effort to understand current practice, a survey study was conducted. OBJECTIVE For people with SCI, ES elicits positive physiological effects; however, no implementation guidelines exist for upper extremity application of ES for this population. Therefore, we surveyed occupational therapy practitioners about their use of ES with clients who have cervical-level SCI. DESIGN A 33-item, 20-min online survey was used. PARTICIPANTS AND SETTING We queried 57 occupational therapy practitioners with active caseloads in regional rehabilitation centers specializing in SCI, both outpatient and inpatient. RESULTS For clients with SCI, occupational therapy practitioners used ES most often for grasp-and-release, reaching, and grip or pinch activities using a broad range of parameter settings. Among respondents, 43% did not use a specific treatment protocol; 27% used research evidence to guide selection of parameters. CONCLUSIONS AND RELEVANCE Findings suggest that ES treatment parameters are not uniformly applied, introducing potential unknown effects on client outcomes and undermining treatment fidelity. WHAT THIS ARTICLE ADDS Our survey of occupational therapy practitioners regarding their practice and use of ES interventions with this population revealed variation in application of ES treatment parameters. Understanding different treatment approaches and justification used when applying ES to clients with SCI is an important first step in unifying and promoting best practice and maximizing patient outcomes.
Collapse
Affiliation(s)
- Timothy P Dionne
- Timothy P. Dionne, PhD, OTR/L, is Assistant Professor, Occupational Therapy Graduate Program, School of Medicine, The University of New Mexico, Albuquerque;
| | - James A Lenker
- James A. Lenker, PhD, OTR/L, FAOTA, is Associate Professor, Department of Rehabilitation Science, University at Buffalo, Buffalo, NY
| | - Patrick Hennessy
- Patrick Hennessy, PT, MPT, NCS, is Clinical Knowledge Broker, Infinity Rehab, Wilsonville, OR
| | - Jane E Sullivan
- Jane E. Sullivan, PT, DHS, MS, is Professor, Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago
| |
Collapse
|
22
|
Argetsinger LC, Singh G, Bickel SG, Calvery ML, Behrman AL. Spinal cord injury in infancy: activity-based therapy impact on health, function, and quality of life in chronic injury. Spinal Cord Ser Cases 2020; 6:13. [PMID: 32157078 PMCID: PMC7064539 DOI: 10.1038/s41394-020-0261-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 01/29/2020] [Accepted: 01/29/2020] [Indexed: 02/07/2023] Open
Abstract
Introduction Spinal cord injury (SCI) in infancy magnifies the complexity of a devastating diagnosis. Children injured so young have high incidences of scoliosis, hip dysplasia, and respiratory complications leading to poor health and outcomes. We report the medical history, progression of rehabilitation, usual care and activity-based therapy, and outcomes for a child injured in infancy. Activity-based therapy (ABT) aims to activate the neuromuscular system above and below the lesion through daily, task-specific training to improve the neuromuscular capacity, and outcomes for children with acquired SCI. Case presentation A 3-month-old infant suffered a cervical SCI from a surgical complication with resultant tetraplegia. Until age 3, her medical complications included scoliosis, kyphosis, and pneumonia. Even with extensive physical and occupational therapy, she was fully dependent on caregivers for mobility and unable to roll, come to sit, sit, stand or walk. She initiated ABT at ~3 years old, participating for 8 months. The child’s overall neuromuscular capacity improved significantly, especially for head and trunk control, contributing to major advances in respiratory health, novel engagement with her environment, and improved physical abilities. Discussion From injury during infancy until 3 years old, this child’s health, abilities, and complications were consistent with the predicted path of early-onset SCI. Due to her age at injury, severity and chronicity of injury, she demonstrated unexpected, meaningful changes in her neuromuscular capacity during and post-ABT associated with improved health, function and quality of life for herself and her caregivers.
Collapse
Affiliation(s)
- Laura C Argetsinger
- Frazier Rehab Institute, Pediatric NeuroRecovery Program, Louisville, KY, USA
| | - Goutam Singh
- Kosair Charities Center for Pediatric NeuroRecovery, University of Louisville, Louisville, KY, USA.,Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, USA.,Department of Neurological Surgery, University of Louisville, Louisville, KY, USA
| | - Scott G Bickel
- Department of Pediatrics, University of Louisville, Louisville, KY, USA
| | | | - Andrea L Behrman
- Kosair Charities Center for Pediatric NeuroRecovery, University of Louisville, Louisville, KY, USA. .,Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, USA. .,Department of Neurological Surgery, University of Louisville, Louisville, KY, USA.
| |
Collapse
|
23
|
Duffell LD, Paddison S, Alahmary AF, Donaldson N, Burridge J. The effects of FES cycling combined with virtual reality racing biofeedback on voluntary function after incomplete SCI: a pilot study. J Neuroeng Rehabil 2019; 16:149. [PMID: 31771600 PMCID: PMC6880599 DOI: 10.1186/s12984-019-0619-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 11/06/2019] [Indexed: 11/20/2022] Open
Abstract
Background Functional Electrical Stimulation (FES) cycling can benefit health and may lead to neuroplastic changes following incomplete spinal cord injury (SCI). Our theory is that greater neurological recovery occurs when electrical stimulation of peripheral nerves is combined with voluntary effort. In this pilot study, we investigated the effects of a one-month training programme using a novel device, the iCycle, in which voluntary effort is encouraged by virtual reality biofeedback during FES cycling. Methods Eleven participants (C1-T12) with incomplete SCI (5 sub-acute; 6 chronic) were recruited and completed 12-sessions of iCycle training. Function was assessed before and after training using the bilateral International Standards for Neurological Classification of SCI (ISNC-SCI) motor score, Oxford power grading, Modified Ashworth Score, Spinal Cord Independence Measure, the Walking Index for Spinal Cord Injury and 10 m-walk test. Power output (PO) was measured during all training sessions. Results Two of the 6 participants with chronic injuries, and 4 of the 5 participants with sub-acute injuries, showed improvements in ISNC-SCI motor score > 8 points. Median (IQR) improvements were 3.5 (6.8) points for participants with a chronic SCI, and 8.0 (6.0) points for those with sub-acute SCI. Improvements were unrelated to other measured variables (age, time since injury, baseline ISNC-SCI motor score, baseline voluntary PO, time spent training and stimulation amplitude; p > 0.05 for all variables). Five out of 11 participants showed moderate improvements in voluntary cycling PO, which did not correlate with changes in ISNC-SCI motor score. Improvement in PO during cycling was positively correlated with baseline voluntary PO (R2 = 0.50; p < 0.05), but was unrelated to all other variables (p > 0.05). The iCycle was not suitable for participants who were too weak to generate a detectable voluntary torque or whose effort resulted in a negative torque. Conclusions Improved ISNC-SCI motor scores in chronic participants may be attributable to the iCycle training. In sub-acute participants, early spontaneous recovery and changes due to iCycle training could not be distinguished. The iCycle is an innovative progression from existing FES cycling systems, and positive results should be verified in an adequately powered controlled trial. Trial registration ClinicalTrials.gov, NCT03834324. Registered 06 February 2019 - Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT03834324. Protocol V03, dated 06.08.2015.
Collapse
Affiliation(s)
- Lynsey D Duffell
- Department of Medical Physics & Biomedical Engineering, University College London, Malet Place Engineering Building, Gower Street, London, WC1E 6BT, UK.
| | - Sue Paddison
- London Spinal Cord Injury Centre, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Ahmad F Alahmary
- Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Nick Donaldson
- Department of Medical Physics & Biomedical Engineering, University College London, Malet Place Engineering Building, Gower Street, London, WC1E 6BT, UK
| | - Jane Burridge
- Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| |
Collapse
|
24
|
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] [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.
Collapse
|
25
|
Vova JA, Eggebrecht EM. Utilizing Functional Electrical Stimulation and Exoskeletons in Pediatrics: a Closer Look at Their Roles in Gait and Functional Changes in Cerebral Palsy. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2019. [DOI: 10.1007/s40141-019-00215-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
26
|
Melicosta ME, Dean J, Hagen K, Oppenheimer K, Porter C, Rybczynski S, Salorio C, Sadowsky C. Acute flaccid myelitis: Rehabilitation challenges and outcomes in a pediatric cohort. J Pediatr Rehabil Med 2019; 12:245-253. [PMID: 31476175 DOI: 10.3233/prm-180549] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE To describe one institution's experience in the rehabilitation of children with acute flaccid myelitis (AFM). This study reviews the medical and rehabilitative course and functional outcomes of a cohort of children who underwent Activity Based Restorative Therapy (ABRT) at a single center. METHODS Children with AFM presenting for rehabilitation between March 2005 and January 2017 were identified and a retrospective chart review was conducted. Changes in medical and functional status were assessed using multiple standardized instruments, as well as a chart review of medical progress. RESULTS Thirty-one children with AFM treated at our institution in the study time period were identified. Of these, seventeen received inpatient treatment, and fourteen received solely outpatient interventions. Their medical and functional outcomes are described with use of standardized measures when available. CONCLUSIONS Children with flaccid paralysis due to AFM undergoing structured, comprehensive rehabilitation interventions, even when these are initiated long after paralysis onset, can make significant neurologic and functional gains. Recovery of function and prevention of comorbidities are the main therapeutic targets for interventions in this population.
Collapse
Affiliation(s)
- Michelle E Melicosta
- Department of Pediatric Rehabilitation, Kennedy Krieger Institute, Baltimore, MD, USA.,Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Janet Dean
- International Center for Spinal Cord Injury, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Kaitlin Hagen
- Speech and Language Department, Kennedy Krieger Institute, Baltimore, MD, USA
| | | | - Courtney Porter
- International Center for Spinal Cord Injury, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Suzanne Rybczynski
- Department of Pediatric Rehabilitation, Kennedy Krieger Institute, Baltimore, MD, USA.,Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Cynthia Salorio
- Department of Pediatric Rehabilitation, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Cristina Sadowsky
- International Center for Spinal Cord Injury, Kennedy Krieger Institute, Baltimore, MD, USA
| |
Collapse
|
27
|
Behrman AL, Argetsinger LC, Roberts MT, Stout D, Thompson J, Ugiliweneza B, Trimble SA. Activity-Based Therapy Targeting Neuromuscular Capacity After Pediatric-Onset Spinal Cord Injury. Top Spinal Cord Inj Rehabil 2019; 25:132-149. [PMID: 31068745 PMCID: PMC6496965 DOI: 10.1310/sci2502-132] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background: Activity-based therapies aim to improve neuromuscular capacity after spinal cord injury (SCI). Objective: The purpose of this prospective study was to report the impact of Activity-based Locomotor Training (AB-LT) on neuromuscular capacity in pediatric patients with SCI. Methods: Participants were enrolled for their first episode of AB-LT for a minimum of 60 daily, 1.5-hour sessions. The Segmental Assessment of Trunk Control (SATCo) and the Pediatric Neuromuscular Recovery Scale (Pediatric NRS) were assessed initially, every 20 sessions, and post 60 sessions. Results: Twenty-six consecutive patients, mean age 5 years (SD = 3), completed a mean 55 sessions (SD = 4) within 63 weekdays (SD = 9). The Pediatric NRS total score improved significantly, adjusted mean 11.4, from initial to post-60 sessions (p < .05) with an average adjusted evaluation-to-evaluation 3.7 change. SATCo scores improved significantly across 60 sessions, mean change 5.2, an estimated 1.7 change between evaluations (p < .05). Age at enrollment and chronicity had no effect; however, initial neuromuscular capacity scores were negatively correlated with change scores (p < .05). Conclusion: Sixty AB-LT sessions significantly improved trunk and neuromuscular capacity in children with SCI, regardless of age or chronicity at enrollment. Patients with lower initial scores made greater improvements than patients with higher initial neuromuscular capacity. Anecdotal parent reports of their child's functional change in the home and community highlight the synergy between quantitative change in neuromuscular capacity and meaningful, improved quality of life and the need for formal investigation of this relationship.
Collapse
Affiliation(s)
- Andrea L. Behrman
- Department of Neurological Surgery, Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky
| | - Laura C. Argetsinger
- Pediatric NeuroRecovery Program, Spinal Cord Injury Outpatient Program, Frazier Rehab Institute, Louisville, Kentucky
| | - MacKenzie T. Roberts
- Pediatric NeuroRecovery Program, Spinal Cord Injury Outpatient Program, Frazier Rehab Institute, Louisville, Kentucky
| | - Danielle Stout
- Pediatric NeuroRecovery Program, Spinal Cord Injury Outpatient Program, Frazier Rehab Institute, Louisville, Kentucky
| | - Jennifer Thompson
- Department of Pediatrics, University of Louisville, Louisville, Kentucky
| | - Beatrice Ugiliweneza
- Department of Neurological Surgery, Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky
| | - Shelley A. Trimble
- Pediatric NeuroRecovery Program, Spinal Cord Injury Outpatient Program, Frazier Rehab Institute, Louisville, Kentucky
| |
Collapse
|
28
|
Hwang DH, Park HH, Shin HY, Cui Y, Kim BG. Insulin-like Growth Factor-1 Receptor Dictates Beneficial Effects of Treadmill Training by Regulating Survival and Migration of Neural Stem Cell Grafts in the Injured Spinal Cord. Exp Neurobiol 2018; 27:489-507. [PMID: 30636901 PMCID: PMC6318559 DOI: 10.5607/en.2018.27.6.489] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 12/13/2018] [Accepted: 12/14/2018] [Indexed: 02/06/2023] Open
Abstract
Survival and migration of transplanted neural stem cells (NSCs) are prerequisites for therapeutic benefits in spinal cord injury. We have shown that survival of NSC grafts declines after transplantation into the injured spinal cord, and that combining treadmill training (TMT) enhances NSC survival via insulin-like growth factor-1 (IGF-1). Here, we aimed to obtain genetic evidence that IGF-1 signaling in the transplanted NSCs determines the beneficial effects of TMT. We transplanted NSCs heterozygous (+/-) for Igf1r, the gene encoding IGF-1 receptor, into the mouse spinal cord after injury, with or without combining TMT. We analyzed the influence of genotype and TMT on locomotor recovery and survival and migration of NSC grafts. In vitro experiments were performed to examine the potential roles of IGF-1 signaling in the migratory ability of NSCs. Mice receiving +/- NSC grafts showed impaired locomotor recovery compared with those receiving wild-type (+/+) NSCs. Locomotor improvement by TMT was more pronounced with +/+ grafts. Deficiency of one allele of Igf1r significantly reduced survival and migration of the transplanted NSCs. Although TMT did not significantly influence NSC survival, it substantially enhanced the extent of migration for only +/+ NSCs. Cultured neurospheres exhibited dynamic motility with cytoplasmic protrusions, which was regulated by IGF-1 signaling. IGF-1 signaling in transplanted NSCs may be essential in regulating their survival and migration. Furthermore, TMT may promote NSC graft-mediated locomotor recovery via activation of IGF-1 signaling in transplanted NSCs. Dynamic NSC motility via IGF-1 signaling may be the cellular basis for the TMT-induced enhancement of migration.
Collapse
Affiliation(s)
- Dong Hoon Hwang
- Department of Brain Science, Ajou University School of Medicine, Suwon 16499, Korea
| | - Hee Hwan Park
- Department of Brain Science, Ajou University School of Medicine, Suwon 16499, Korea.,Neuroscience Graduate Program, Department of Biomedical Sciences, Ajou University School of Medicine, Suwon 16499, Korea
| | - Hae Young Shin
- Department of Brain Science, Ajou University School of Medicine, Suwon 16499, Korea.,Logos Biosystems, Anyang 14055, Korea
| | - Yuexian Cui
- Department of Brain Science, Ajou University School of Medicine, Suwon 16499, Korea.,Department of Neurology, Yanbian University Hospital, Yanji 133000, Jilin, China
| | - Byung Gon Kim
- Department of Brain Science, Ajou University School of Medicine, Suwon 16499, Korea.,Department of Neurology, Ajou University School of Medicine, Suwon 16499, Korea.,Neuroscience Graduate Program, Department of Biomedical Sciences, Ajou University School of Medicine, Suwon 16499, Korea
| |
Collapse
|
29
|
Morais MPD, Rodrigues GM. Strategies to teach swimming to people with Spinal Cord Injury (SCI). MOTRIZ: REVISTA DE EDUCACAO FISICA 2018. [DOI: 10.1590/s1980-6574201800040006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
|
30
|
Dean JM, Onders RP, Elmo MJ. Diaphragm Pacers in Pediatric Patients with Cervical Spinal Cord Injury: a Review and Implications for Inpatient Rehabilitation. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2018. [DOI: 10.1007/s40141-018-0200-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
31
|
Theriault ER, Huang V, Whiteneck G, Dijkers MP, Harel NY. Antispasmodic medications may be associated with reduced recovery during inpatient rehabilitation after traumatic spinal cord injury. J Spinal Cord Med 2018; 41:63-71. [PMID: 27841095 PMCID: PMC5810808 DOI: 10.1080/10790268.2016.1245010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE To determine whether antispasmodic medications are associated with neurological and functional outcomes during the first year after traumatic spinal cord injury (SCI). DESIGN/METHODS Retrospective analysis of prospectively collected data from six inpatient SCI rehabilitation centers. Baseline-adjusted outcomes at discharge and one-year follow-up were compared using analysis of covariance between patients who received antispasmodic medication on at least 5 days during inpatient rehabilitation and patients who did not. OUTCOME MEASURES Rasch-transformed motor subscore of the Functional Independence Measure (FIM); International Standards for Neurological Classification of Spinal Cord Injury motor scores, grade, and level. RESULTS Of 1,259 patients, 59.8%, 35.4%, and 4.8% were injured at the cervical, thoracic, and lumbosacral levels, respectively. 65.6% had motor complete injury. Rasch-transformed motor FIM score at admission averaged 23.3 (95% confidence interval (CI) 22.4-24.2). Total motor score averaged 39.2 (95% CI 37.8-40.6). 685 patients (54.4%) received one or more antispasmodic medications on at least 5 days. After controlling for demographic and injury variables at admission, Rasch-transformed motor FIM scores at discharge were significantly lower (P = 0.018) in patients receiving antispasmodic medications than in those who did not. This trend persisted in secondary analyses for cervical, thoracic, and lumbosacral subgroups. Multivariate regression showed that receiving antispasmodic medication significantly contributed to discharge motor FIM outcome. At one-year follow-up, no outcomes significantly differed between patients ON or OFF antispasmodics. CONCLUSIONS Antispasmodic medications may be associated with decreased functional recovery at discharge from inpatient traumatic SCI rehabilitation. Randomized prospective studies are needed to directly evaluate the effects of antispasmodic medication on recovery.
Collapse
Affiliation(s)
- Eric R. Theriault
- New York Institute of Technology, Department of Physical Therapy, Old Westbury, NY, USA
| | - Vincent Huang
- Icahn School of Medicine at Mount Sinai, Department of Rehabilitation Medicine, New York, NY, USA
| | | | - Marcel P. Dijkers
- Icahn School of Medicine at Mount Sinai, Department of Rehabilitation Medicine, New York, NY, USA,Department of Physical Medicine and Rehabilitation, Wayne State University, Detroit, MI, USA
| | - Noam Y. Harel
- Icahn School of Medicine at Mount Sinai, Department of Rehabilitation Medicine, New York, NY, USA,James J. Peters VA Medical Center, Spinal Cord Damage Research Center, Bronx, NY, USA,Correspondence to: Noam Y. Harel, James J. Peters VA Medical Center, 130 West Kingsbridge Road, 7A-13G, Bronx, NY, 10468; 718-584-9000 x1742.
| |
Collapse
|
32
|
Pediatric Spinal Cord Injury Due to Acute Flaccid Myelitis: Epidemiology, Clinical Management, and Implications for Rehabilitation. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2017. [DOI: 10.1007/s40141-017-0159-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
33
|
Felter CE, Bentley JA, Sadowsky CL, Wegener ST. Characteristics of individuals seeking activity-based restorative therapy following spinal cord injury: A focus on hope. NeuroRehabilitation 2017; 41:237-240. [PMID: 28505997 DOI: 10.3233/nre-171476] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND There is a lack of evidence regarding the psychosocial characteristics of individuals with spinal cord injury (SCI) undergoing activity-based restorative therapy (ABRT) treatment. OBJECTIVES This study seeks to describe the hopefulness of a sample of ABRT participants and describe the relationship between hopefulness and level of rehabilitation engagement. METHODS A prospective cross-sectional cohort study was conducted using a convenience sample of 73 individuals with SCI (mean time since injury = 66.6 months) seeking out-patient, post-acute rehabilitation at a metropolitan ABRT center. Outcome measures included a demographic survey, The Hope Scale, the Patient Health Questionare-9 and the Hopkins Rehabilitation Engagement Rating Scale. RESULTS The ABRT group reported higher levels of hope (M = 54.78, SD = 7.13) than have been reported in a sample of individuals with SCI seeking traditional rehabilitation in the acute (M = 24.58, SD = 4.06) setting. Rehabilitation engagement was not related to hopefulness in the ABRT group. CONCLUSIONS The ABRT group demonstrated high levels of hopefulness. The difference in hopefulness noted between this group and previous studies could be due to the time elapsed since injury, the presence of choice in the rehabilitation process, or the possibility that individuals who chose to participate in ABRT may have inherently different hopefulness characteristics than the broader SCI population.
Collapse
Affiliation(s)
- Cara E Felter
- Department of Physical Therapy and Rehabilitation Science, University of Maryland, Baltimore, School of Medicine, Baltimore, MD, USA
| | - Jacob A Bentley
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Cristina L Sadowsky
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,International Center for Spinal Cord Injury, Hugo W. Moser Research Institute at Kennedy Krieger Institute, Baltimore, MD, USA
| | - Stephen T Wegener
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| |
Collapse
|
34
|
Is the Routine Use of a Functional Electrical Stimulation Cycle for Lower Limb Movement Standard of Care for Acute Spinal Cord Injury Rehabilitation? PM R 2017; 9:521-528. [DOI: 10.1016/j.pmrj.2017.03.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Accepted: 03/18/2017] [Indexed: 11/20/2022]
|
35
|
Quel de Oliveira C, Refshauge K, Middleton J, de Jong L, Davis GM. Effects of Activity-Based Therapy Interventions on Mobility, Independence, and Quality of Life for People with Spinal Cord Injuries: A Systematic Review and Meta-Analysis. J Neurotrauma 2017; 34:1726-1743. [PMID: 27809702 DOI: 10.1089/neu.2016.4558] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
The aim of this study was to review the literature about the effects of activity-based therapy (ABT) interventions on mobility, functional independence, and quality of life for people with a spinal cord injury (SCI). A systematic review with meta-analysis of randomized and non-randomized trials was performed, including adults with a non-progressive SCI at any level. The intervention of interest was ABT, defined as any intervention that sought to improve muscle activation or sensory function below the level of injury in the spinal cord and does not rely on compensatory mechanisms for improving function. The comparison was either no intervention or conventional physical interventions targeted to regions above the level of injury. The outcome measures were quality-of-life questionnaires, mobility assessments, and functional independence scales. Nineteen trials were included in this systematic review. Three compared ABT to no intervention and 16 to conventional physical rehabilitation. The methodological quality of the trials was assessed using the PEDro scale as moderate. Six studies investigated the effects of ABT interventions for the upper limbs, 11 investigated gait-related interventions, and two applied multi-modal interventions. Compared with no intervention, the meta-analysis found that ABT was not more effective for improving independence or lower limb mobility, but conferred a large positive effect on upper limb function. Compared with conventional physical interventions, there was no significant effect of ABT on lower limb mobility, independence, or quality of life; however, it had positive effects on upper limbs. In conclusion, there is evidence that ABT can improve independence and functional ability when applied to the upper limbs in people with SCI. However, it is not superior to conventional physical interventions when applied to the lower limbs.
Collapse
Affiliation(s)
| | - Kathryn Refshauge
- 1 Faculty of Health Sciences, The University of Sydney , Sydney, Australia
| | - James Middleton
- 2 John Walsh Center for Rehabilitation Research, Kolling Institute, Northern Sydney Local Health District and Sydney Medical School Northern, The University of Sydney , Sydney, Australia
| | - Lysanne de Jong
- 1 Faculty of Health Sciences, The University of Sydney , Sydney, Australia
- 3 Radboud University Nijmegen , Nijmegen, the Netherlands
| | - Glen M Davis
- 1 Faculty of Health Sciences, The University of Sydney , Sydney, Australia
| |
Collapse
|
36
|
Hoffman H, Sierro T, Niu T, Sarino ME, Sarrafzadeh M, McArthur D, Edgerton VR, Lu DC. Rehabilitation of hand function after spinal cord injury using a novel handgrip device: a pilot study. J Neuroeng Rehabil 2017; 14:22. [PMID: 28327161 PMCID: PMC5361778 DOI: 10.1186/s12984-017-0234-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2016] [Accepted: 03/14/2017] [Indexed: 01/21/2023] Open
Abstract
Background Activity-based therapy (ABT) for patients with spinal cord injury (SCI), which consists of repetitive use of muscles above and below the spinal lesion, improves locomotion and arm strength. Less data has been published regarding its effects on hand function. We sought to evaluate the effects of a weekly hand-focused therapy program using a novel handgrip device on grip strength and hand function in a SCI cohort. Methods Patients with SCI were enrolled in a weekly program that involved activities with the MediSens (Los Angeles, CA) handgrip. These included maximum voluntary contraction (MVC) and a tracking task that required each subject to adjust his/her grip strength according to a pattern displayed on a computer screen. For the latter, performance was measured as mean absolute accuracy (MAA). The Spinal Cord Independence Measure (SCIM) was used to measure each subject’s independence prior to and after therapy. Results Seventeen patients completed the program with average participation duration of 21.3 weeks. The cohort included patients with American Spinal Injury Association (ASIA) Impairment Scale (AIS) A (n = 12), AIS B (n = 1), AIS C (n = 2), and AIS D (n = 2) injuries. The average MVC for the cohort increased from 4.1 N to 21.2 N over 20 weeks, but did not reach statistical significance. The average MAA for the cohort increased from 9.01 to 21.7% at the end of the study (p = .02). The cohort’s average SCIM at the end of the study was unchanged compared to baseline. Conclusions A weekly handgrip-based ABT program is feasible and efficacious at increasing hand task performance in subjects with SCI.
Collapse
Affiliation(s)
- Haydn Hoffman
- Department of Neurosurgery, University of California, Los Angeles, 300 Stein Plaza, Ste. 536, Los Angeles, CA, 90095-6901, USA
| | - Tiffany Sierro
- Department of Neurosurgery, University of California, Los Angeles, 300 Stein Plaza, Ste. 536, Los Angeles, CA, 90095-6901, USA
| | - Tianyi Niu
- Department of Neurosurgery, University of California, Los Angeles, 300 Stein Plaza, Ste. 536, Los Angeles, CA, 90095-6901, USA
| | - Melanie E Sarino
- Rancho Los Amigos National Rehabilitation Center, Downey, CA, 90242, USA
| | - Majid Sarrafzadeh
- Wireless Health Institute, University of California Los Angeles, Los Angeles, CA, USA.,Department of Computer Science, University of California Los Angeles, Los Angeles, CA, USA
| | - David McArthur
- Department of Neurosurgery, University of California, Los Angeles, 300 Stein Plaza, Ste. 536, Los Angeles, CA, 90095-6901, USA
| | - V Reggie Edgerton
- Department of Neurosurgery, University of California, Los Angeles, 300 Stein Plaza, Ste. 536, Los Angeles, CA, 90095-6901, USA.,Brain Research Institute, University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Daniel C Lu
- Department of Neurosurgery, University of California, Los Angeles, 300 Stein Plaza, Ste. 536, Los Angeles, CA, 90095-6901, USA. .,Department of Orthopedic Surgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, 90095, USA. .,Neuromotor Recovery and Rehabilitation Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, 90095, USA. .,Brain Research Institute, University of California, Los Angeles, Los Angeles, CA, 90095, USA.
| |
Collapse
|
37
|
Yozbatiran N, Keser Z, Davis M, Stampas A, O'Malley MK, Cooper-Hay C, Frontera J, Fregni F, Francisco GE. Transcranial direct current stimulation (tDCS) of the primary motor cortex and robot-assisted arm training in chronic incomplete cervical spinal cord injury: A proof of concept sham-randomized clinical study. NeuroRehabilitation 2017; 39:401-11. [PMID: 27589510 DOI: 10.3233/nre-161371] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND After cervical spinal cord injury, current options for treatment of upper extremity motor functions have been limited to traditional approaches. However, there is a substantial need to explore more rigorous alternative treatments to facilitate motor recovery. OBJECTIVE To demonstrate whether anodal-primary motor cortex (M1) excitability enhancement (with cathodal-supra orbital area) (atDCS) combined with robot-assisted arm training (R-AAT) will provide greater improvement in contralateral arm and hand motor functions compared to sham stimulation (stDCS) and R-AAT in patients with chronic, incomplete cervical spinal cord injury (iCSCI). METHODS In this parallel-group, double-blinded, randomized and sham-controlled trial, nine participants with chronic iCSCI (AIS C and D level) were randomized to receive 10 sessions of atDCS or stDSC combined with R-AAT. Feasibility and tolerability was assessed with attrition rate and occurrence of adverse events, Changes in arm and hand function were assessed with Jebson Taylor Hand Function Test (JTHFT). Amount of Use Scale of Motor Activity Log (AOU-MAL), American Spinal Injury Association Upper Extremity Motor Score and Modified Ashworth Scale (MAS) at baseline, after treatment, and at two-month follow-up. RESULTS None of the participants missed a treatment session or dropped-out due to adverse events related to the treatment protocol. Participants tended to perform better in JTHFT and AOU-MAL after treatment. Active group at post-treatment and two-month follow-up demonstrated better arm and hand performance compared to sham group. CONCLUSION These preliminary findings support that modulating excitatory input of the corticospinal tracts on spinal circuits may be a promising strategy in improving arm and hand functions in persons with incomplete tetraplegia. Further study is needed to explore the underlying mechanisms of recovery.
Collapse
Affiliation(s)
- Nuray Yozbatiran
- Department of Physical Medicine and Rehabilitation and The Institute for Rehabilitation and Research (TIRR) Memorial Hermann Neurorecovery Research Center, University of Texas Health Science Center at Houston, TX, USA
| | - Zafer Keser
- Department of Physical Medicine and Rehabilitation and The Institute for Rehabilitation and Research (TIRR) Memorial Hermann Neurorecovery Research Center, University of Texas Health Science Center at Houston, TX, USA
| | - Matthew Davis
- Department of Physical Medicine and Rehabilitation and The Institute for Rehabilitation and Research (TIRR) Memorial Hermann Neurorecovery Research Center, University of Texas Health Science Center at Houston, TX, USA
| | - Argyrios Stampas
- Department of Physical Medicine and Rehabilitation and The Institute for Rehabilitation and Research (TIRR) Memorial Hermann Neurorecovery Research Center, University of Texas Health Science Center at Houston, TX, USA
| | - Marcia K O'Malley
- Department of Mechanical Engineering, Rice University, Houston, TX, USA
| | - Catherine Cooper-Hay
- Department of Physical Medicine and Rehabilitation and The Institute for Rehabilitation and Research (TIRR) Memorial Hermann Neurorecovery Research Center, University of Texas Health Science Center at Houston, TX, USA
| | - Joel Frontera
- Department of Physical Medicine and Rehabilitation and The Institute for Rehabilitation and Research (TIRR) Memorial Hermann Neurorecovery Research Center, University of Texas Health Science Center at Houston, TX, USA
| | - Felipe Fregni
- Spaulding Neuromodulation Center, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Gerard E Francisco
- Department of Physical Medicine and Rehabilitation and The Institute for Rehabilitation and Research (TIRR) Memorial Hermann Neurorecovery Research Center, University of Texas Health Science Center at Houston, TX, USA
| |
Collapse
|
38
|
Scivoletto G, Miscusi M, Forcato S, Ricciardi L, Serrao M, Bellitti R, Raco A. The Rehabilitation of Spinal Cord Injury Patients in Europe. ACTA NEUROCHIRURGICA SUPPLEMENT 2017; 124:203-210. [DOI: 10.1007/978-3-319-39546-3_31] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
|
39
|
Brogioli M, Schneider S, Popp WL, Albisser U, Brust AK, Velstra IM, Gassert R, Curt A, Starkey ML. Monitoring Upper Limb Recovery after Cervical Spinal Cord Injury: Insights beyond Assessment Scores. Front Neurol 2016; 7:142. [PMID: 27630612 PMCID: PMC5005421 DOI: 10.3389/fneur.2016.00142] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 08/18/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Preclinical investigations in animal models demonstrate that enhanced upper limb (UL) activity during rehabilitation promotes motor recovery following spinal cord injury (SCI). Despite this, following SCI in humans, no commonly applied training protocols exist, and therefore, activity-based rehabilitative therapies (ABRT) vary in frequency, duration, and intensity. Quantification of UL recovery is limited to subjective questionnaires or scattered measures of muscle function and movement tasks. OBJECTIVE To objectively measure changes in UL activity during acute SCI rehabilitation and to assess the value of wearable sensors as novel measurement tools that are complimentary to standard clinical assessments tools. METHODS The overall amount of UL activity and kinematics of wheeling were measured longitudinally with wearable sensors in 12 thoracic and 19 cervical acute SCI patients (complete and incomplete). The measurements were performed for up to seven consecutive days, and simultaneously, SCI-specific assessments were made during rehabilitation sessions 1, 3, and 6 months after injury. Changes in UL activity and function over time were analyzed using linear mixed models. RESULTS During acute rehabilitation, the overall amount of UL activity and the active distance wheeled significantly increased in tetraplegic patients, but remained constant in paraplegic patients. The same tendency was shown in clinical scores with the exception of those for independence, which showed improvements at the beginning of the rehabilitation period, even in paraplegic subjects. In the later stages of acute rehabilitation, the quantity of UL activity in tetraplegic individuals matched that of their paraplegic counterparts, despite their greater motor impairments. Both subject groups showed higher UL activity during therapy time compared to the time outside of therapy time. CONCLUSION Tracking day-to-day UL activity is necessary to gain insights into the real impact of a patient's impairments on their UL movements during therapy and during their leisure time. In the future, this novel methodology may be used to reliably control and adjust ABRT and to evaluate the progress of UL rehabilitation in clinical trials.
Collapse
Affiliation(s)
- Michael Brogioli
- Spinal Cord Injury Center, Balgrist University Hospital , Zurich , Switzerland
| | - Sophie Schneider
- Spinal Cord Injury Center, Balgrist University Hospital , Zurich , Switzerland
| | - Werner L Popp
- Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland; Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Urs Albisser
- Spinal Cord Injury Center, Balgrist University Hospital , Zurich , Switzerland
| | - Anne K Brust
- Clinical Trial Unit, Swiss Paraplegic Centre , Nottwil , Switzerland
| | | | - Roger Gassert
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zurich , Zurich , Switzerland
| | - Armin Curt
- Spinal Cord Injury Center, Balgrist University Hospital , Zurich , Switzerland
| | - Michelle L Starkey
- Spinal Cord Injury Center, Balgrist University Hospital , Zurich , Switzerland
| |
Collapse
|
40
|
Upper Extremity Assessment in Tetraplegia: The Importance of Differentiating Between Upper and Lower Motor Neuron Paralysis. Arch Phys Med Rehabil 2016; 97:S97-S104. [DOI: 10.1016/j.apmr.2015.11.021] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Revised: 10/06/2015] [Accepted: 11/02/2015] [Indexed: 12/25/2022]
|
41
|
Padula N, Costa M, Batista A, Gaspar R, Motta C, Palma G, Torriani-Pasin C. Long-term effects of an intensive interventional training program based on activities for individuals with spinal cord injury: a pilot study. Physiother Theory Pract 2015; 31:568-74. [PMID: 26467667 DOI: 10.3109/09593985.2015.1070938] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To investigate the long-term effects of a rehabilitation program using activity-based therapies in daily activities and the participation of individuals with spinal cord injury (SCI). METHOD A descriptive study of case reports assessing the performance of daily activities and quality of life as a dependent variable, using the Functional Independence Measure (FIM) and the Short-Form Health Survey (SF-36), respectively. Seven individuals were included in the intervention composed of a multimodal intensive therapies program based on activities (activity-based therapy, ABT) conducted for 18 months. RESULTS It was possible to descriptively observe that the individual with the shortest time of injury and previous training obtained the largest variation in the FIM score. But no statistically significant difference was found in the assessments. CONCLUSION For trained individuals with chronic SCIs, classified "A" according to the American Spinal Injury Association (ASIA), an ABT program did not significantly affect the scores of the scales used to assess quality of life (SF-36) and functional independence (FIM).
Collapse
Affiliation(s)
- Natalia Padula
- a Acreditando Recovery Centre - Neuromotor Recovery, Health and Well-Being , São Paulo , Brazil and.,b School of Physical Education and Sport (EEFE), University of São Paulo (USP) , São Paulo , Brazil
| | - Mariana Costa
- b School of Physical Education and Sport (EEFE), University of São Paulo (USP) , São Paulo , Brazil
| | - Alexsandro Batista
- b School of Physical Education and Sport (EEFE), University of São Paulo (USP) , São Paulo , Brazil
| | - Roberta Gaspar
- a Acreditando Recovery Centre - Neuromotor Recovery, Health and Well-Being , São Paulo , Brazil and.,b School of Physical Education and Sport (EEFE), University of São Paulo (USP) , São Paulo , Brazil
| | - Camilo Motta
- a Acreditando Recovery Centre - Neuromotor Recovery, Health and Well-Being , São Paulo , Brazil and
| | - Gisele Palma
- b School of Physical Education and Sport (EEFE), University of São Paulo (USP) , São Paulo , Brazil
| | - Camila Torriani-Pasin
- b School of Physical Education and Sport (EEFE), University of São Paulo (USP) , São Paulo , Brazil
| |
Collapse
|
42
|
Bonetti LV, Ilha J, Schneider APK, Barbosa S, Faccioni-Heuser MC. Balance and coordination training, but not endurance training, enhances synaptophysin and neurotrophin-3 immunoreactivity in the lumbar spinal cord after sciatic nerve crush. Muscle Nerve 2015; 53:617-25. [PMID: 26316168 DOI: 10.1002/mus.24889] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Revised: 08/19/2015] [Accepted: 08/25/2015] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Numerous rehabilitation treatments have been shown to be useful for peripheral and central restoration after (PNI). METHODS After sciatic nerve crush, we investigated 4 weeks of endurance training (ET) and balance and coordination training (BCT) with sciatic function index, hind-paw stride length, and spinal cord dorsal horn synaptophysin and neurotrophin-3 immunoreactivity. RESULTS Our results demonstrated no significant differences between the non-trained (NT), ET, and BCT groups in sciatic functional index, and in stride-length analysis, but the ET showed higher values compared with the NT group. Synaptophysin immunoreactivity was higher in the BCT group compared with the NT group, and neurotrophin-3 immunoreactivity in the BCT group was greater compared with the other groups. CONCLUSION BCT can positively affect spinal cord plasticity after a (PNI), and these modifications are important in the rehabilitation process.
Collapse
Affiliation(s)
- Leandro Viçosa Bonetti
- Programa de Pós-Graduação em Neurociências, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil.,Laboratório de Histofisiologia Comparada, Departamento de Ciências Morfológicas, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Sarmento Leite 500, CEP 90050-170, Porto Alegre, Rio Grande do Sul, Brazil
| | - Jocemar Ilha
- Laboratório de Pesquisa Experimental, Departamento de Fisioterapia, Universidade do Estado de Santa Catarina, Santa Catarina, Brazil
| | - Ana Paula Krauthein Schneider
- Laboratório de Histofisiologia Comparada, Departamento de Ciências Morfológicas, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Sarmento Leite 500, CEP 90050-170, Porto Alegre, Rio Grande do Sul, Brazil
| | - Silvia Barbosa
- Laboratório de Histofisiologia Comparada, Departamento de Ciências Morfológicas, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Sarmento Leite 500, CEP 90050-170, Porto Alegre, Rio Grande do Sul, Brazil
| | - Maria Cristina Faccioni-Heuser
- Programa de Pós-Graduação em Neurociências, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil.,Laboratório de Histofisiologia Comparada, Departamento de Ciências Morfológicas, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Sarmento Leite 500, CEP 90050-170, Porto Alegre, Rio Grande do Sul, Brazil
| |
Collapse
|
43
|
Astorino TA, Harness ET, Witzke KA. Chronic activity-based therapy does not improve body composition, insulin-like growth factor-I, adiponectin, or myostatin in persons with spinal cord injury. J Spinal Cord Med 2015; 38:615-25. [PMID: 25130192 PMCID: PMC4535804 DOI: 10.1179/2045772314y.0000000236] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
UNLABELLED Spinal cord injury (SCI) induces dramatic changes in body composition including reductions in fat-free mass (FFM) and increases in fat mass (FM). OBJECTIVE To examine changes in body composition in response to chronic activity-based therapy (ABT) in persons with SCI. DESIGN Longitudinal exercise intervention. METHODS Seventeen men and women with SCI (mean age=36.1±11.5 years) completed 6 months of supervised ABT consisting of load bearing, resistance training, locomotor training, and functional electrical stimulation. At baseline and after 3 and 6 months of ABT, body weight, body fat, and FFM were assessed using dual-energy X-ray absorptiometry, and fasting blood samples were obtained to assess changes in insulin-like growth factor-I (IGF-I), adiponectin, and myostatin. RESULTS Across all subjects, there was no change (P>0.05) in body weight, percent body fat, or FFM of the leg, arm, or trunk, whereas whole-body FFM declined (P=0.02, 50.4±8.4 to 49.2±7.4 kg). No changes (P=0.21-0.41) were demonstrated in IGF-I, adiponectin, or myostatin during the study. CONCLUSIONS Chronic ABT focusing on the lower extremity does not slow muscle atrophy or alter body fat, body mass, or regional depots of FFM in persons with SCI. Further, it does not induce beneficial changes in adiponectin, myostatin, or IGF-I. Alternative exercise-based therapies are needed in SCI to reverse muscle atrophy and minimize the onset of related health risks.
Collapse
Affiliation(s)
- Todd A. Astorino
- Department of Kinesiology, California State University San Marcos, College of Arts and Sciences, San Marcos, CA, USA,Correspondence to: Todd A. Astorino, Kinesiology California State University San Marcos, College of Arts and Sciences, San Marcos, CA 92096-0001, USA.
| | - Eric T. Harness
- Project Walk® Spinal Cord Injury Recovery Center, Carlsbad, CA, USA
| | - Kara A. Witzke
- Department of Nutrition and Exercise Science, Oregon State University, Cascades, OR, USA
| |
Collapse
|
44
|
Dolbow DR, Gorgey AS, Recio AC, Stiens SA, Curry AC, Sadowsky CL, Gater DR, Martin R, McDonald JW. Activity-Based Restorative Therapies after Spinal Cord Injury: Inter-institutional conceptions and perceptions. Aging Dis 2015; 6:254-61. [PMID: 26236547 DOI: 10.14336/ad.2014.1105] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Revised: 10/12/2014] [Accepted: 11/05/2014] [Indexed: 11/01/2022] Open
Abstract
This manuscript is a review of the theoretical and clinical concepts provided during an inter-institutional training program on Activity-Based Restorative Therapies (ABRT) and the perceptions of those in attendance. ABRT is a relatively recent high volume and intensity approach toward the restoration of neurological deficits and decreasing the risk of secondary conditions associated with paralysis after spinal cord injury (SCI). ABRT is guided by the principle of neuroplasticity and the belief that even those with chronic SCI can benefit from repeated activation of the spinal cord pathways located both above and below the level of injury. ABRT can be defined as repetitive-task specific training using weight-bearing and external facilitation of neuromuscular activation. The five key components of ABRT are weight-bearing activities, functional electrical stimulation, task-specific practice, massed practice and locomotor training which includes body weight supported treadmill walking and water treadmill training. The various components of ABRT have been shown to improve functional mobility, and reverse negative body composition changes after SCI leading to the reduction of cardiovascular and other metabolic disease risk factors. The consensus of those who received the ABRT training was that ABRT has much potential for enhancement of recovery of those with SCI. Although various institutions have their own strengths and challenges, each institution was able to initiate a modified ABRT program.
Collapse
Affiliation(s)
- David R Dolbow
- University of Southern Mississippi, College of Health, Human Performance and Recreation, Hattiesburg, MS 39406, USA
| | - Ashraf S Gorgey
- Hunter Holmes McGuire VA Medical Center, Spinal Cord Injury and Disorders Center, Richmond, VA 23224, USA. ; Virginia Commonwealth University, School of Medicine, Richmond, VA 23298, USA
| | - Albert C Recio
- Kennedy Krieger Institute, International Center for Spinal Cord Injury, Baltimore MD 21205, USA. ; Johns Hopkins University School of Medicine, Baltimore MD 21205, USA
| | | | - Amanda C Curry
- VA Boston Healthcare System, Physical Medicine and Rehabilitation, West Roxbury, MA 02132, USA
| | - Cristina L Sadowsky
- Kennedy Krieger Institute, International Center for Spinal Cord Injury, Baltimore MD 21205, USA. ; Johns Hopkins University School of Medicine, Baltimore MD 21205, USA
| | - David R Gater
- Penn State Hershey Medical Center and Health System, Hershey, PA 17033, USA. ; Penn State College of Medicine, Hershey, PA 17033
| | - Rebecca Martin
- Kennedy Krieger Institute, International Center for Spinal Cord Injury, Baltimore MD 21205, USA
| | - John W McDonald
- Kennedy Krieger Institute, International Center for Spinal Cord Injury, Baltimore MD 21205, USA. ; Johns Hopkins University School of Medicine, Baltimore MD 21205, USA
| |
Collapse
|
45
|
Dugan EA, Sagen J. An Intensive Locomotor Training Paradigm Improves Neuropathic Pain following Spinal Cord Compression Injury in Rats. J Neurotrauma 2015; 32:622-32. [DOI: 10.1089/neu.2014.3692] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
|
46
|
Smith E, Brosnan M, Comiskey C, Synnott K. Road collisions as a cause of traumatic spinal cord injury in ireland, 2001-2010. Top Spinal Cord Inj Rehabil 2014; 20:158-65. [PMID: 25477738 DOI: 10.1310/sci2002-147] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Road collisions remain the leading cause of traumatic spinal cord injury (TSCI) in the world. Half of all TSCIs in Ireland in 2000 were caused by road collisions. Since then, there has been a downward trend in road fatalities coincident with implemented road safety strategies. OBJECTIVE To examine the incidence of TSCI resulting from road collisions from 2001 to 2010. METHOD This is a retrospective study using the hospital inpatient enquiry database of the tertiary referral center, which houses the national spinal injuries unit. Information retrieved included total numbers of patients with TSCI and number of TSCIs due to road collisions from 2001 through 2010, age groups affected, and the gender balance. RESULTS Over the 10-year period studied, the incidence rate of TSCI due to road collisions declined, although this did not reach statistical significance. The largest numbers of all TSCIs and TSCIs due to road collisions were in the 20- to 29-year age category and the male gender. CONCLUSIONS As mortality due to road collisions declined, so did the number of TSCIs from the same etiology. An impactful road safety campaign is likely to have influenced these trends.
Collapse
Affiliation(s)
- Eimear Smith
- Spinal Cord System of Care, National Rehabilitation Hospital, Dun Laoghaire , Co. Dublin , Ireland
| | | | - Catherine Comiskey
- Centre for Practice & Healthcare Innovation, School of Nursing & Midwifery, Trinity College Dublin , Dublin , Ireland
| | - Keith Synnott
- Department of Spinal & Orthopaedic Surgery, Mater Misericordiae University Hospital , Dublin , Ireland
| |
Collapse
|
47
|
Bonetti LV, Schneider APK, Barbosa S, Ilha J, Faccioni-Heuser MC. Balance and coordination training and endurance training after nerve injury. Muscle Nerve 2014; 51:83-91. [PMID: 24752648 DOI: 10.1002/mus.24268] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2014] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Different rehabilitation treatments have proven useful in accelerating regeneration. METHODS After sciatic nerve crush in rats, we tested balance and coordination training (BCT) and endurance training (ET) through sensorimotor tests and analyzed nerve and muscle morphology. RESULTS After BCT and ET, rats performed better in sensorimotor tests than did non-trained animals. However, only BCT maintained sensorimotor function during training. Furthermore, BCT and ET produced significantly larger muscle area than in non-trained animals. CONCLUSIONS These findings indicate that BCT and ET, when initiated in the early phase after sciatic nerve injury, improve morphological properties of the soleus muscle and sciatic nerve, but only the task-oriented BCT maintained sensorimotor function. The success of rehabilitative strategies appears to be highly task-specific, and strategies that stimulate sensory pathways are the most effective in improving balance and/or coordination parameters.
Collapse
Affiliation(s)
- Leandro Viçosa Bonetti
- Programa de Pós-Graduação em Neurociências, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Rio Grande do Sul, Brazil; Laboratório de Histofisiologia Comparada, Departamento de Ciências Morfológicas, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Sarmento Leite 500, CEP: 90050-170, Porto Alegre, Rio Grande do Sul, Brazil
| | | | | | | | | |
Collapse
|
48
|
Jones ML, Evans N, Tefertiller C, Backus D, Sweatman M, Tansey K, Morrison S. Activity-based therapy for recovery of walking in individuals with chronic spinal cord injury: results from a randomized clinical trial. Arch Phys Med Rehabil 2014; 95:2239-46.e2. [PMID: 25102384 DOI: 10.1016/j.apmr.2014.07.400] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Revised: 07/03/2014] [Accepted: 07/12/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To examine the effects of activity-based therapy (ABT) on neurologic function, walking ability, functional independence, metabolic health, and community participation. DESIGN Randomized controlled trial with delayed treatment design. SETTING Outpatient program in a private, nonprofit rehabilitation hospital. PARTICIPANTS Volunteer sample of adults (N=48; 37 men and 11 women; age, 18-66y) with chronic (≥12mo postinjury), motor-incomplete (ASIA Impairment Scale grade C or D) spinal cord injury (SCI). INTERVENTIONS A total of 9h/wk of ABT for 24 weeks including developmental sequencing; resistance training; repetitive, patterned motor activity; and task-specific locomotor training. Algorithms were used to guide group allocation, functional electrical stimulation utilization, and locomotor training progression. MAIN OUTCOME MEASURES Neurologic function (International Standards for Neurological Classification of Spinal Cord Injury); walking speed and endurance (10-meter walk test, 6-minute walk test, and Timed Up and Go test); community participation (Spinal Cord Independence Measure, version III, and Reintegration to Normal Living Index); and metabolic function (weight, body mass index, and Quantitative Insulin Sensitivity Check). RESULTS Significant improvements in neurologic function were noted for experimental versus control groups (International Standards for Neurological Classification of Spinal Cord Injury total motor score [5.1±6.3 vs 0.9±5.0; P=.024] and lower extremity motor score [4.2±5.2 vs -0.6±4.2; P=.004]). Significant differences between experimental and control groups were observed for 10-meter walk test speed (0.096±0.14m/s vs 0.027±0.10m/s; P=.036) and 6-minute walk test total distance (35.97±48.2m vs 3.0±25.5m; P=.002). CONCLUSIONS ABT has the potential to promote neurologic recovery and enhance walking ability in individuals with chronic, motor-incomplete SCI. However, further analysis is needed to determine for whom ABT is going to lead to meaningful clinical benefits.
Collapse
Affiliation(s)
- Michael L Jones
- Virginia C. Crawford Research Institute, Shepherd Center, Atlanta, GA.
| | - Nicholas Evans
- Virginia C. Crawford Research Institute, Shepherd Center, Atlanta, GA
| | | | - Deborah Backus
- Virginia C. Crawford Research Institute, Shepherd Center, Atlanta, GA
| | - Mark Sweatman
- Virginia C. Crawford Research Institute, Shepherd Center, Atlanta, GA
| | - Keith Tansey
- Virginia C. Crawford Research Institute, Shepherd Center, Atlanta, GA
| | - Sarah Morrison
- Virginia C. Crawford Research Institute, Shepherd Center, Atlanta, GA
| |
Collapse
|
49
|
Dolbow DR, Holcomb WR, Gorgey AS. Improving the Efficiency of Electrical Stimulation Activities After Spinal Cord Injury. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2014; 2:169-175. [PMID: 29503764 PMCID: PMC5832057 DOI: 10.1007/s40141-014-0053-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
In order to enhance spinal cord injury (SCI) rehabilitation programs using neuromuscular electrical stimulation (NMES) and functional electrical stimulation (FES) it is important to examine the manner in which muscle fibers are recruited and the dose-response relationship. A review of the literature suggests that premature force decline and early fatigue with NMES and FES activities may be alleviated with decreased current frequency and increased current intensity. Dose-response relationships with NMES and FES are dependent on the goals of interest as reversing muscle atrophy can be achieved with activities 2-3 times per week for 6 or more weeks while increasing bone mass is more limited and requires more intense activity with greater exercise frequency and duration, e.g., 3-5 days per week for at least 6-12 months. The best known protocol to elicit neurological improvement is massed practice activities-based restorative therapies (ABRT) (3-5 h per day for several weeks).
Collapse
Affiliation(s)
- David R Dolbow
- Human Performance and Recreation Department, University of Southern Mississippi, 118 College Drive, Box 5142, Hattiesburg, MS 39406, USA
| | - William R Holcomb
- Human Performance and Recreation Department, University of Southern Mississippi, 118 College Drive, Box 5142, Hattiesburg, MS 39406, USA
| | - Ashraf S Gorgey
- Spinal Cord Injury Research, McGuire VA Medical Center, 1201 Broad Rock Blvd, Richmond, VA 23224, USA
| |
Collapse
|
50
|
Rastogi S. Rehabilitative potential of Ayurveda for neurological deficits caused by traumatic spinal cord injury. J Ayurveda Integr Med 2014; 5:56-9. [PMID: 24812477 PMCID: PMC4012364 DOI: 10.4103/0975-9476.128868] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Revised: 06/12/2013] [Accepted: 06/13/2013] [Indexed: 11/04/2022] Open
Abstract
Spinal cord injury (SCI) is associated with worst outcomes and requires a prolonged rehabilitation. Ayurvedic indigenous methods of rehabilitation are often utilized to treat such conditions. A case of SCI was followed up for 3 months upon an Ayurvedic composite intervention and subsequently reported. The composite treatment plan involved Ayurvedic oral medications as well as a few selected external and internal pancha karma procedures. A substantial clinical and patient centered outcome improvement in existing neurological deficits and quality of life was observed after 3 months of the Ayurvedic treatment given to this case.
Collapse
Affiliation(s)
- Sanjeev Rastogi
- Department of Pancha karma, State Ayurvedic College and Hospital, Lucknow University, Lucknow, Uttar Pradesh, India
| |
Collapse
|