1
|
Spungen AM, Dematt EJ, Biswas K, Jones KM, Mi Z, Snodgrass AJ, Morin K, Asselin PK, Cirnigliaro CM, Kirshblum S, Gorman PH, Goetz LL, Stenson K, White KT, Hon A, Sabharwal S, Kiratli BJ, Ota D, Bennett B, Berman JE, Castillo D, Lee KK, Eddy BW, Henzel MK, Trbovich M, Holmes SA, Skelton F, Priebe M, Kornfeld SL, Huang GD, Bauman WA. Exoskeletal-Assisted Walking in Veterans With Paralysis: A Randomized Clinical Trial. JAMA Netw Open 2024; 7:e2431501. [PMID: 39230903 PMCID: PMC11375472 DOI: 10.1001/jamanetworkopen.2024.31501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/05/2024] Open
Abstract
Importance Robotic exoskeletons leverage technology that assists people with spinal cord injury (SCI) to walk. The efficacy of home and community exoskeletal use has not been studied in a randomized clinical trial (RCT). Objective To examine whether use of a wheelchair plus an exoskeleton compared with use of only a wheelchair led to clinically meaningful net improvements in patient-reported outcomes for mental and physical health. Design, Setting, and Participants This RCT of veterans with SCI was conducted at 15 Veterans Affairs medical centers in the US from September 6, 2016, to September 27, 2021. Data analysis was performed from March 10, 2022, to June 20, 2024. Interventions Participants were randomized (1:1) to standard of care (SOC) wheelchair use or SOC plus at-will use of a US Food and Drug Administration (FDA)-cleared exoskeletal-assisted walking (EAW) device for 4 months in the home and community. Main Outcomes and Measures Two primary outcomes were studied: 4.0-point or greater improvement in the mental component summary score on the Veterans RAND 36-Item Health Survey (MCS/VR-36) and 10% improvement in the total T score of the Spinal Cord Injury-Quality of Life (SCI-QOL) physical and medical health domain and reported as the proportion who achieved clinically meaningful changes. The primary outcomes were measured at baseline, post randomization after advanced EAW training sessions, and at 2 months and 4 months (primary end point) in the intervention period. Device usage, reasons for not using, and adverse events were collected. Results A total of 161 veterans with SCI were randomized to the EAW (n = 78) or SOC (n = 83) group; 151 (94%) were male, the median age was 47 (IQR, 35-56) years, and median time since SCI was 7.3 (IQR, 0.5 to 46.5) years. The difference in proportion of successes between the EAW and SOC groups on the MCS/VR-36 (12 of 78 [15.4%] vs 14 of 83 [16.9%]; relative risk, 0.91; 95% CI, 0.45-1.85) and SCI-QOL physical and medical health domain (10 of 78 [12.8%] vs 11 of 83 [13.3%]; relative risk, 0.97; 95% CI, 0.44-2.15) was not statistically different. Device use was lower than expected (mean [SD] distance, 1.53 [0.02] miles per month), primarily due to the FDA-mandated companion being unavailable 43.9% of the time (177 of 403 instances). Two EAW-related foot fractures and 9 unrelated fractures (mostly during wheelchair transfers) were reported. Conclusions and Relevance In this RCT of veterans with SCI, the lack of improved outcomes with EAW device use may have been related to the relatively low device usage. Solutions for companion requirements and user-friendly technological adaptations should be considered for improved personal use of these devices. Trial Registration ClinicalTrials.gov Identifier: NCT02658656.
Collapse
Affiliation(s)
- Ann M Spungen
- Spinal Cord Damage Research Center, James J. Peters Veterans Affairs (VA) Medical Center, Bronx, New York
- Departments of Rehabilitation and Human Performance and Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ellen J Dematt
- VA Cooperative Studies Program Coordinating Center, VA Maryland Health Care System, Perry Point
| | - Kousick Biswas
- VA Cooperative Studies Program Coordinating Center, VA Maryland Health Care System, Perry Point
- Department of Epidemiology and Public Health, Division of Biostatistics School of Medicine, University of Maryland, Baltimore
| | - Karen M Jones
- VA Cooperative Studies Program Coordinating Center, VA Maryland Health Care System, Perry Point
- Now retired
| | - Zhibao Mi
- VA Cooperative Studies Program Coordinating Center, VA Maryland Health Care System, Perry Point
| | - Amanda J Snodgrass
- VA Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, New Mexico
- University of New Mexico, College of Pharmacy, Albuquerque
| | - Kel Morin
- Spinal Cord Damage Research Center, James J. Peters Veterans Affairs (VA) Medical Center, Bronx, New York
- VA Providence Healthcare System, Providence, Rhode Island
| | - Pierre K Asselin
- Spinal Cord Damage Research Center, James J. Peters Veterans Affairs (VA) Medical Center, Bronx, New York
| | - Christopher M Cirnigliaro
- Spinal Cord Damage Research Center, James J. Peters Veterans Affairs (VA) Medical Center, Bronx, New York
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark
| | - Steven Kirshblum
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark
- Kessler Institute for Rehabilitation and The Kessler Foundation, West Orange, New Jersey
| | - Peter H Gorman
- Department of Neurology, University of Maryland School of Medicine, Baltimore
| | - Lance L Goetz
- Richmond VA Medical Center, Richmond, Virginia
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University School of Medicine, Richmond
| | - Katherine Stenson
- VA St Louis Health Care System-Jefferson Barracks, St Louis, Missouri
- Departments of Orthopaedics and Neurology, Division of Physical Medicine and Rehabilitation, Washington University School of Medicine, St Louis, Missouri
| | - Kevin T White
- James A. Haley Veterans' Hospital, Tampa, Florida
- Department of Physical Medicine and Rehabilitation, University of South Florida, Tampa
| | - Alice Hon
- VA Long Beach Health Care System, Long Beach, California
- Department of Physical Medicine and Rehabilitation, University of California Irvine
| | - Sunil Sabharwal
- VA Boston Health Care System, Boston, Massachusetts
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts
| | | | - Doug Ota
- VA Palo Alto Health Care System, Palo Alto, California
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, California
| | - Bridget Bennett
- VA North Texas Health Care System, Dallas
- Department of Physical Medicine and Rehabilitation, The University of Texas Southwestern Medical Center, Dallas
| | | | - Denis Castillo
- Clement J. Zablocki VA Medical Center, Milwaukee, Wisconsin
- Department of Physical Medicine and Rehabilitation, Medical College of Wisconsin, Milwaukee
| | - Kenneth K Lee
- Clement J. Zablocki VA Medical Center, Milwaukee, Wisconsin
- Department of Physical Medicine and Rehabilitation, Medical College of Wisconsin, Milwaukee
| | - Byron W Eddy
- Minneapolis VA Health Care System, Minneapolis, Minnesota
| | - M Kristi Henzel
- Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio
- Department of Physical Medicine & Rehabilitation, Case Western Reserve School of Medicine, Cleveland, Ohio
| | - Michelle Trbovich
- South Texas Veterans Health Care System-Audie Murphy Division, San Antonio
- Department of Rehabilitation Medicine, University of Texas Health Science Center, San Antonio
| | - Sally A Holmes
- Michael E. DeBakey VA Medical Center, Houston, Texas
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas
| | - Felicia Skelton
- Michael E. DeBakey VA Medical Center, Houston, Texas
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas
| | - Michael Priebe
- VA Cooperative Studies Program Coordinating Center, VA Maryland Health Care System, Perry Point
- Now retired
- Charlie Norwood VA Medical Center, VA Augusta Health Care System, Augusta, Georgia
| | - Stephen L Kornfeld
- Departments of Rehabilitation and Human Performance and Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
- Spinal Cord Injury/Disorders Service, James J. Peters VA Medical Center, Bronx, New York
| | - Grant D Huang
- VA Cooperative Studies Program Central Office, VA Office of Research and Development, Washington, DC
| | - William A Bauman
- Departments of Rehabilitation and Human Performance and Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
- Now retired
| |
Collapse
|
2
|
Cooper RA, Smolinski G, Candiotti JL, Satpute S, Grindle GG, Sparling TL, Nordstrom MJ, Yuan X, Symsack A, Dae Lee C, Vitiello N, Knezevic S, Sugar TG, Schneider U, Kopp V, Holl M, Gaunaurd I, Gailey R, Bonato P, Poropatich R, Adet DJ, Clemente F, Abbas J, Pasquina PF. Current State, Needs, and Opportunities for Wearable Robots in Military Medical Rehabilitation and Force Protection. ACTUATORS 2024; 13:236. [PMID: 39246296 PMCID: PMC11378964 DOI: 10.3390/act13070236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 09/10/2024]
Abstract
Despite advances in wearable robots across various fields, there is no consensus definition or design framework for the application of this technology in rehabilitation or musculoskeletal (MSK) injury prevention. This paper aims to define wearable robots and explore their applications and challenges for military rehabilitation and force protection for MSK injury prevention. We conducted a modified Delphi method, including a steering group and 14 panelists with 10+ years of expertise in wearable robots. Panelists presented current wearable robots currently in use or in development for rehabilitation or assistance use in the military workforce and healthcare. The steering group and panelists met to obtain a consensus on the wearable robot definition applicable for rehabilitation or primary injury prevention. Panelists unanimously agreed that wearable robots can be grouped into three main applications, as follows: (1) primary and secondary MSK injury prevention, (2) enhancement of military activities and tasks, and (3) rehabilitation and reintegration. Each application was presented within the context of its target population and state-of-the-art technology currently in use or under development. Capturing expert opinions, this study defines wearable robots for military rehabilitation and MSK injury prevention, identifies health outcomes and assessment tools, and outlines design requirements for future advancements.
Collapse
Affiliation(s)
- Rory A Cooper
- Human Engineering Research Laboratories, VA Pittsburgh Healthcare System and University of Pittsburgh, Pittsburgh, PA 15026, USA
| | - George Smolinski
- Department of Physical Medicine and Rehabilitation, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Jorge L Candiotti
- Human Engineering Research Laboratories, VA Pittsburgh Healthcare System and University of Pittsburgh, Pittsburgh, PA 15026, USA
| | - Shantanu Satpute
- Human Engineering Research Laboratories, VA Pittsburgh Healthcare System and University of Pittsburgh, Pittsburgh, PA 15026, USA
| | - Garrett G Grindle
- Human Engineering Research Laboratories, VA Pittsburgh Healthcare System and University of Pittsburgh, Pittsburgh, PA 15026, USA
| | - Tawnee L Sparling
- Department of Physical Medicine and Rehabilitation, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Michelle J Nordstrom
- Department of Physical Medicine and Rehabilitation, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Xiaoning Yuan
- Department of Physical Medicine and Rehabilitation, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Allison Symsack
- Department of Physical Medicine and Rehabilitation, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Chang Dae Lee
- Department of Occupational Therapy, Indiana University Indianapolis, Indianapolis, IN 46202, USA
| | - Nicola Vitiello
- BioRobotics Institute, Scuola Superiore Sant'Anna, 56025 Pontedera, PI, Italy
| | - Steven Knezevic
- Spinal Cord Damage Research Center, James J. Peters VA Medical Center, Bronx, NY 10468, USA
| | - Thomas G Sugar
- Barrett, The Honors College, ASU Polytechnic, Mesa, AZ 85281, USA
| | - Urs Schneider
- Fraunhofer Institute for Manufacturing Engineering and Automation IPA, 70569 Stuttgart, Germany
| | - Verena Kopp
- Fraunhofer Institute for Manufacturing Engineering and Automation IPA, 70569 Stuttgart, Germany
| | - Mirjam Holl
- Fraunhofer Institute for Manufacturing Engineering and Automation IPA, 70569 Stuttgart, Germany
| | - Ignacio Gaunaurd
- Department of Physical Therapy, University of Miami Miller School of Medicine, Coral Gables, FL 33146, USA
- Bruce W. Carter VA Medical Center, Miami, FL 33125, USA
| | - Robert Gailey
- Department of Physical Therapy, University of Miami Miller School of Medicine, Coral Gables, FL 33146, USA
| | - Paolo Bonato
- Harvard School of Medicine, Boston, MA 02115, USA
| | - Ron Poropatich
- Center for Military Medicine Research, University of Pittsburgh, Pittsburgh, PA 15219, USA
| | - David J Adet
- U.S. Army Combat Capabilities Development Command Soldier Center, Natick, MA 01760, USA
| | | | - James Abbas
- Institute for Integrative and Innovative Research (I3R) and the Department of Biomedical Engineering, University of Arkansas, Fayetteville, AR 72701, USA
| | - Paul F Pasquina
- Department of Physical Medicine and Rehabilitation, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| |
Collapse
|
3
|
Rigoli A, Francis L, Nicholson M, Weber G, Redhead J, Iyer P. A systematic review of the effects of robotic exoskeleton training on energy expenditure and body composition in adults with spinal cord injury. Int J Rehabil Res 2024; 47:64-74. [PMID: 38616768 DOI: 10.1097/mrr.0000000000000626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2024]
Abstract
Metabolic diseases disproportionately affect people with spinal cord injury (SCI). Increasing energy expenditure and remodeling body composition may offset deleterious consequences of SCI to improve cardiometabolic health. Evidence is emerging that robotic exoskeleton use increases physical activity in SCI, but little is known about its effects on energy expenditure and body composition. This study therefore aimed to evaluate the impact of robotic exoskeleton training on body composition and energy expenditure in adults with SCI. A systematic literature review was performed according to the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. Five databases were searched to retrieve studies meeting pre-set eligibility criteria: adults with SCI, interventions evaluating the effects of robotic exoskeleton devices on body composition or energy expenditure. The PEDro scale guided quality assessments with findings described narratively. Of 2163 records, 10 studies were included. Robotic exoskeleton training does not significantly improve energy expenditure compared to other exercise interventions. Significant changes ( P < 0.05) in body composition, particularly reduced fat mass, however, were reported. High variability seen with the interventions was coupled with poor quality of the studies. While robotic exoskeleton interventions may propose modest cardiometabolic benefits in adults with SCI, further robust trials in larger samples are needed to strengthen these findings.
Collapse
Affiliation(s)
- Alessandra Rigoli
- The University of Sydney, Nutrition and Dietetics Group, Susan Wakil School of Nursing and Midwifery, The Charles Perkins Centre
| | - Lucinda Francis
- The University of Sydney, Nutrition and Dietetics Group, Susan Wakil School of Nursing and Midwifery, The Charles Perkins Centre
| | - Margaret Nicholson
- The University of Sydney, Nutrition and Dietetics Group, Susan Wakil School of Nursing and Midwifery, The Charles Perkins Centre
| | | | | | - Priya Iyer
- The University of Sydney, Nutrition and Dietetics Group, Susan Wakil School of Nursing and Midwifery, The Charles Perkins Centre
- Royal Rehab, Sydney, New South Wales, Australia
| |
Collapse
|
4
|
Nepomuceno P, Souza WH, Pakosh M, Musselman KE, Craven BC. Exoskeleton-based exercises for overground gait and balance rehabilitation in spinal cord injury: a systematic review of dose and dosage parameters. J Neuroeng Rehabil 2024; 21:73. [PMID: 38705999 PMCID: PMC11070073 DOI: 10.1186/s12984-024-01365-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 04/22/2024] [Indexed: 05/07/2024] Open
Abstract
BACKGROUND Exoskeletons are increasingly applied during overground gait and balance rehabilitation following neurological impairment, although optimal parameters for specific indications are yet to be established. OBJECTIVE This systematic review aimed to identify dose and dosage of exoskeleton-based therapy protocols for overground locomotor training in spinal cord injury/disease. METHODS A systematic review was conducted in accordance with the Preferred Reporting Items Systematic Reviews and Meta-Analyses guidelines. A literature search was performed using the CINAHL Complete, Embase, Emcare Nursing, Medline ALL, and Web of Science databases. Studies in adults with subacute and/or chronic spinal cord injury/disease were included if they reported (1) dose (e.g., single session duration and total number of sessions) and dosage (e.g., frequency of sessions/week and total duration of intervention) parameters, and (2) at least one gait and/or balance outcome measure. RESULTS Of 2,108 studies identified, after removing duplicates and filtering for inclusion, 19 were selected and dose, dosage and efficacy were abstracted. Data revealed a great heterogeneity in dose, dosage, and indications, with overall recommendation of 60-min sessions delivered 3 times a week, for 9 weeks in 27 sessions. Specific protocols were also identified for functional restoration (60-min, 3 times a week, for 8 weeks/24 sessions) and cardiorespiratory rehabilitation (60-min, 3 times a week, for 12 weeks/36 sessions). CONCLUSION This review provides evidence-based best practice recommendations for overground exoskeleton training among individuals with spinal cord injury/disease based on individual therapeutic goals - functional restoration or cardiorespiratory rehabilitation. There is a need for structured exoskeleton clinical translation studies based on standardized methods and common therapeutic outcomes.
Collapse
Affiliation(s)
- Patrik Nepomuceno
- KITE Research Institute, University Health Network, Toronto, ON, Canada
- Graduate Program in Health Promotion, Department of Health Sciences, University of Santa Cruz do Sul, Santa Cruz do Sul, RS, Brazil
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Canada
| | - Wagner H Souza
- KITE Research Institute, University Health Network, Toronto, ON, Canada
| | - Maureen Pakosh
- KITE Research Institute, University Health Network, Toronto, ON, Canada
| | - Kristin E Musselman
- KITE Research Institute, University Health Network, Toronto, ON, Canada
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - B Catharine Craven
- KITE Research Institute, University Health Network, Toronto, ON, Canada.
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Canada.
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada.
| |
Collapse
|
5
|
Mahon J, Nolan L, O'Sullivan D, Curtin M, Devitt A, Murphy CG. Bilateral tibial fractures associated with powered exoskeleton use in complete spinal cord injury - a case report & literature review. Spinal Cord Ser Cases 2024; 10:22. [PMID: 38627367 PMCID: PMC11021521 DOI: 10.1038/s41394-024-00635-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 03/31/2024] [Accepted: 04/05/2024] [Indexed: 04/19/2024] Open
Abstract
INTRODUCTION Powered robotic exoskeleton (PRE) physiotherapy programmes are a relatively novel frontier which allow patients with reduced mobility to engage in supported walking. Research is ongoing regarding their utility, risks, and benefits. This article describes the case of two fractures occurring in one patient using a PRE. CASE We report the case of a 54 year old man who sustained bilateral tibial fractures while using a PRE, on a background of T10 AIS A SCI. The initial session was discontinued due to acute severe bilateral knee swelling after approximately 15 min. The patient attended their local hospital the following day, where radiographs demonstrated bilateral proximal tibial fractures. The patient was treated with manipulation under anaesthetic and long-leg casting for five weeks, at which point he was stepped down to hinged knee braces which were weaned gradually while he remained non-weight bearing for 12 weeks. The patient was investigated with DEXA scan and was diagnosed with osteoporosis. He was liaised with rheumatology services and bone protection was initiated. Fracture healing was achieved and weight-bearing precautions were discontinued, however this period of immobilisation led to significant spasticity. The patient was discharged from orthopaedic services, with ongoing rehabilitation and physiotherapy follow-up. CONCLUSION PRE assisted physiotherapy programmes are a promising concept in terms of rehabilitation and independence, however they are not without risk and it is important that both providers and patients are aware of this. Furthermore, SCI patients are at increased risk for osteoporosis and should be monitored and considered for bone protection.
Collapse
Affiliation(s)
- John Mahon
- University Hospital Galway, Newcastle Road, Galway, Ireland.
| | - Lily Nolan
- University Hospital Galway, Newcastle Road, Galway, Ireland
| | | | - Mark Curtin
- University Hospital Galway, Newcastle Road, Galway, Ireland
| | - Aiden Devitt
- University Hospital Galway, Newcastle Road, Galway, Ireland
| | - Colin G Murphy
- University Hospital Galway, Newcastle Road, Galway, Ireland
| |
Collapse
|
6
|
LeBlanc M, Soucy M, Moustafa-Bayoumi M, Soto D, Nessler J. Effect of robotic gait training on muscle and bone characteristics in spinal cord transected rats. J Orthop Res 2024. [PMID: 38374812 DOI: 10.1002/jor.25810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 12/23/2023] [Accepted: 02/02/2024] [Indexed: 02/21/2024]
Abstract
Osteoporosis and loss of muscle mass are secondary issues with spinal cord injury. Robotic gait training has provided evidence of increasing bone density and muscle mass, but its effect on bone strength is undetermined. The purpose of this study was to determine the effect of a 6-week robotic locomotion training program on skeletal muscle mass and bone characteristics. Twelve female Sprague-Dawley rats received a mid-thoracic spinal cord transection at 5 days old and at 3 weeks old were assigned to a Control or Trained Group. The Trained Group performed 5-min sessions on the Rat Stepper 5 days a week for 6 weeks with 90% of body weight supported. At the end of the 6 weeks, body mass was obtained and right femurs and four lower extremity muscles were harvested. Femur bone mineral density was measured with DXA and mechanical characteristics of the femur were determined via 3-point bending testing. Independent t-tests, effects sizes and percent differences were computed between the two groups (p < 0.05). The Trained Group had significantly larger normalized femur mass (p = 0.007) and normalized soleus muscle mass (p = 0.033) when compared to the Control Group. There was a medium or large effect size with the Trained Groups' femurs having larger mass, bone mineral density, rupture loads, cortical wall thickness, shaft cross sectional area, soleus mass, normalized gastrocnemius mass, and smaller shaft inner diameters compared to the Control Group. These changes may contribute to decreasing osteoporosis and fracture risk in those with spinal cord injuries.
Collapse
Affiliation(s)
- Michele LeBlanc
- Exercise Science Department, California Lutheran University, Thousand Oaks, California, USA
| | - Michael Soucy
- Exercise Science Department, California Lutheran University, Thousand Oaks, California, USA
| | | | - Dalziel Soto
- Department of Kinesiology, California State University, San Marcos, USA
| | - Jeff Nessler
- Department of Kinesiology, California State University, San Marcos, USA
| |
Collapse
|
7
|
Ibitoye MO, Hamzaid NA, Ahmed YK. Effectiveness of FES-supported leg exercise for promotion of paralysed lower limb muscle and bone health-a systematic review. BIOMED ENG-BIOMED TE 2023:bmt-2021-0195. [PMID: 36852605 DOI: 10.1515/bmt-2021-0195] [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: 06/17/2021] [Accepted: 02/07/2023] [Indexed: 03/01/2023]
Abstract
Leg exercises through standing, cycling and walking with/without FES may be used to preserve lower limb muscle and bone health in persons with physical disability due to SCI. This study sought to examine the effectiveness of leg exercises on bone mineral density and muscle cross-sectional area based on their clinical efficacy in persons with SCI. Several literature databases were searched for potential eligible studies from the earliest return date to January 2022. The primary outcome targeted was the change in muscle mass/volume and bone mineral density as measured by CT, MRI and similar devices. Relevant studies indicated that persons with SCI that undertook FES- and frame-supported leg exercise exhibited better improvement in muscle and bone health preservation in comparison to those who were confined to frame-assisted leg exercise only. However, this observation is only valid for exercise initiated early (i.e., within 3 months after injury) and for ≥30 min/day for ≥ thrice a week and for up to 24 months or as long as desired and/or tolerable. Consequently, apart from the positive psychological effects on the users, leg exercise may reduce fracture rate and its effectiveness may be improved if augmented with FES.
Collapse
Affiliation(s)
- Morufu Olusola Ibitoye
- Department of Biomedical Engineering, Faculty of Engineering and Technology, University of Ilorin, Ilorin, Nigeria
| | - Nur Azah Hamzaid
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur Malaysia
| | - Yusuf Kola Ahmed
- Department of Biomedical Engineering, Faculty of Engineering and Technology, University of Ilorin, Ilorin, Nigeria
| |
Collapse
|
8
|
Cirnigliaro CM, La Fountaine MF, Parrott JS, Kirshblum SC, Sauer SJ, Shapses SA, McClure IA, Bauman WA. Loss of lower extremity bone mineral density 1 year after denosumab is discontinued in persons with subacute spinal cord injury. Osteoporos Int 2023; 34:741-748. [PMID: 36735054 DOI: 10.1007/s00198-023-06679-w] [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] [Received: 10/28/2022] [Accepted: 01/17/2023] [Indexed: 02/04/2023]
Abstract
UNLABELLED Twelve months following discontinuation of denosumab, the percent decrease in mean bone mineral density (BMD) values at the hip and knee regions were similar between both the denosumab and placebo groups. These findings emphasize the need for additional trials to understand the effect of continued administration of denosumab after subacute spinal cord injury (SCI) to avoid this demineralization. OBJECTIVE To determine changes in BMD 1 year after denosumab was discontinued in participants with subacute SCI who had drug treatment initiated within 90 days post SCI and continued for 1 year. METHODS Fourteen participants who completed a randomized, double-blinded, placebo-controlled drug trial (parent study: denosumab 60 mg (Prolia, Amgen Inc., n = 8) or placebo (n = 6); administered at baseline, 6, and 12 months) were followed 12 months after the 18 months from baseline primary end point was completed. The BMD of skeletal regions below the SCI at higher risk of fracture was measured [total hip, distal femur epiphysis (DFE), distal femur metaphysis (DFM), and proximal tibia epiphysis (PTE)] by dual energy X-ray absorptiometry. RESULTS The percent decreases in mean BMD values at all regions of the hip and knee from 18 to 30 months were similar in both the denosumab and placebo groups. However, at 30 months, the absolute values for mean BMD remained significantly higher in the drug treatment than that of the placebo group at the DFM (p = 0.03), DFE (p = 0.04), and PTE (p = 0.05). CONCLUSIONS In persons with SCI who initiated denosumab treatment during the subacute injury phase and maintained treatment for 1 year, the discontinuation of drug resulted in percent loss of mean BMD similar to that of the placebo group, with absolute mean BMD values at the knee regions at the 12-month follow-up visit significantly higher in the drug treatment than those in the placebo group. These data underscore the need to study continued administration of denosumab after subacute SCI to avoid marked demineralization in the sublesional skeleton upon discontinuation of this agent.
Collapse
Affiliation(s)
- Christopher M Cirnigliaro
- Department of Veterans Affairs Rehabilitation Research and Development Service National Center for the Medical Consequences of Spinal Cord Injury, James J. Peters Veterans Affairs Medical Center, 130 West Kingsbridge Road, Bronx, NY, 10468, USA.
| | - Michael F La Fountaine
- Department of Veterans Affairs Rehabilitation Research and Development Service National Center for the Medical Consequences of Spinal Cord Injury, James J. Peters Veterans Affairs Medical Center, 130 West Kingsbridge Road, Bronx, NY, 10468, USA
- Department of Physical Therapy, School of Health and Medical Sciences, Seton Hall University, South Orange, NJ, USA
- Departments of Medical Sciences and Neurology, Hackensack Meridian School of Medicine, Nutley, NJ, USA
| | - J Scott Parrott
- Department of Interdisciplinary Studies, School of Health Professions, Rutgers Biomedical and Health Sciences, Newark, NJ, USA
| | - Steven C Kirshblum
- Kessler Institute for Rehabilitation, West Orange, NJ, USA
- Kessler Foundation Research Center, West Orange, NJ, USA
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Susan J Sauer
- Kessler Institute for Rehabilitation, West Orange, NJ, USA
| | - Sue A Shapses
- Department of Nutritional Sciences, Rutgers University, New Brunswick, NJ, USA
- Department of Medicine, Rutgers-Robert Wood Johnson Medical School, NJ, New Brunswick, USA
| | | | - William A Bauman
- Departments of Medicine and Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| |
Collapse
|
9
|
Pinto D, Heinemann AW, Chang SH, Charlifue S, Field-Fote EC, Furbish CL, Jayaraman A, Tefertiller C, Taylor HB, French DD. Cost-effectiveness analysis of overground robotic training versus conventional locomotor training in people with spinal cord injury. J Neuroeng Rehabil 2023; 20:10. [PMID: 36681852 PMCID: PMC9867867 DOI: 10.1186/s12984-023-01134-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 01/10/2023] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Few, if any estimates of cost-effectiveness for locomotor training strategies following spinal cord injury (SCI) are available. The purpose of this study was to estimate the cost-effectiveness of locomotor training strategies following spinal cord injury (overground robotic locomotor training versus conventional locomotor training) by injury status (complete versus incomplete) using a practice-based cohort. METHODS A probabilistic cost-effectiveness analysis was conducted using a prospective, practice-based cohort from four participating Spinal Cord Injury Model System sites. Conventional locomotor training strategies (conventional training) were compared to overground robotic locomotor training (overground robotic training). Conventional locomotor training included treadmill-based training with body weight support, overground training, and stationary robotic systems. The outcome measures included the calculation of quality adjusted life years (QALYs) using the EQ-5D and therapy costs. We estimate cost-effectiveness using the incremental cost utility ratio and present results on the cost-effectiveness plane and on cost-effectiveness acceptability curves. RESULTS Participants in the prospective, practice-based cohort with complete EQ-5D data (n = 99) qualified for the analysis. Both conventional training and overground robotic training experienced an improvement in QALYs. Only people with incomplete SCI improved with conventional locomotor training, 0.045 (SD 0.28), and only people with complete SCI improved with overground robotic training, 0.097 (SD 0.20). Costs were lower for conventional training, $1758 (SD $1697) versus overground robotic training $3952 (SD $3989), and lower for those with incomplete versus complete injury. Conventional overground training was more effective and cost less than robotic therapy for people with incomplete SCI. Overground robotic training was more effective and cost more than conventional training for people with complete SCI. The incremental cost utility ratio for overground robotic training for people with complete spinal cord injury was $12,353/QALY. CONCLUSIONS The most cost-effective locomotor training strategy for people with SCI differed based on injury completeness. Conventional training was more cost-effective than overground robotic training for people with incomplete SCI. Overground robotic training was more cost-effective than conventional training for people with complete SCI. The effect estimates may be subject to limitations associated with small sample sizes and practice-based evidence methodology. These estimates provide a baseline for future research.
Collapse
Affiliation(s)
- Daniel Pinto
- Department of Physical Therapy, College of Health Sciences, Marquette University, Milwaukee, USA.
- World Health Organization Collaborating Center for the Epidemiology of Musculoskeletal Health and Aging, University of Liege, Liege, Belgium.
| | - Allen W Heinemann
- Center for Rehabilitation Outcomes Research, Shirley Ryan AbilityLab, Chicago, USA
- Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Shuo-Hsiu Chang
- Neurorecovery Research Center, TIRR Memorial Hermann, Houston, USA
- Department of Physical Medicine and Rehabilitation, University of Texas Health Science Center at Houston, Houston, USA
| | | | - Edelle C Field-Fote
- Spinal Cord Injury, Shepherd Center, Atlanta, Georgia
- Division of Physical Therapy, Emory University, Atlanta, USA
| | | | - Arun Jayaraman
- Max Näder Center for Rehabilitation Technologies and Outcomes Research and Outcomes Research, Shirley Ryan AbilityLab, Chicago, USA
- Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | | | - Heather B Taylor
- Spinal Cord Injury and Disability Research, TIRR Memorial Hermann, Houston, USA
- Department of Physical Medicine and Rehabilitation, University of Texas Health Science Center at Houston, Houston, USA
| | - Dustin D French
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, USA
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, USA
- Center for Health Services and Outcomes Research, Feinberg School of Medicine, Northwestern University, Chicago, USA
- Health Services Research and Development Service, US Department of Veterans Affairs, Chicago, USA
| |
Collapse
|
10
|
Prevalence of Sarcopenic Obesity and Factors Influencing Body Composition in Persons with Spinal Cord Injury in Japan. Nutrients 2023; 15:nu15020473. [PMID: 36678344 PMCID: PMC9863685 DOI: 10.3390/nu15020473] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 01/10/2023] [Accepted: 01/14/2023] [Indexed: 01/18/2023] Open
Abstract
This study aims to investigate the prevalence of sarcopenic obesity and factors influencing body composition in persons with spinal cord injury (SCI) in Japan. Adults with SCI aged ≥ 20 years who underwent whole-body dual-energy X-ray absorptiometry between 2016 and 2022 were retrospectively analyzed. Data from 97 patients were examined. The primary outcome was appendicular skeletal muscle mass (ASM). Multiple linear regression analysis was conducted to assess factors influencing the lean and adipose indices in persons with SCI. Sarcopenia, obesity, and sarcopenic obesity were prevalent in 76%, 85%, and 64% of patients, respectively. Multivariate linear regression analysis revealed that sex (β = 0.34, p < 0.001), lesion level (β = 0.25, p = 0.007), severity (β = 0.20, p = 0.043), and ability to walk (β = 0.29, p = 0.006) were independently associated with ASM. Sex (β = −0.63, p < 0.001) was independently associated with percent body fat. In conclusion, sarcopenia, obesity, and sarcopenic obesity were prevalent among patients with SCI in Japan. Female sex, tetraplegia, motor-complete injury, and inability to walk were risk factors for sarcopenia, whereas female sex was a risk factor for obesity in persons with SCI. A routine monitoring of body composition is necessary, especially among those with multiple risk factors, to identify individuals in need of preventive and therapeutic interventions.
Collapse
|
11
|
Stampacchia G, Gazzotti V, Olivieri M, Andrenelli E, Bonaiuti D, Calabro RS, Carmignano SM, Cassio A, Fundaro C, Companini I, Mazzoli D, Cerulli S, Chisari C, Colombo V, Dalise S, Mazzoleni D, Melegari C, Merlo A, Boldrini P, Mazzoleni S, Posteraro F, Mazzucchelli M, Benanti P, Castelli E, Draicchio F, Falabella V, Galeri S, Gimigliano F, Grigioni M, Mazzon S, Molteni F, Morone G, Petrarca M, Picelli A, Senatore M, Turchetti G, Bizzarrini E. Gait robot-assisted rehabilitation in persons with spinal cord injury: A scoping review. NeuroRehabilitation 2022; 51:609-647. [PMID: 36502343 DOI: 10.3233/nre-220061] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Many robots are available for gait rehabilitation (BWSTRT and ORET) and their application in persons with SCI allowed an improvement of walking function. OBJECTIVE The aim of the study is to compare the effects of different robotic exoskeletons gait training in persons with different SCI level and severity. METHODS Sixty-two studies were included in this systematic review; the study quality was assessed according to GRADE and PEDro's scale. RESULTS Quality assessment of included studies (n = 62) demonstrated a prevalence of evidence level 2; the quality of the studies was higher for BWSTRT (excellent and good) than for ORET (fair and good). Almost all persons recruited for BWSTRT had an incomplete SCI; both complete and incomplete SCI were recruited for ORET. The SCI lesion level in the persons recruited for BWSTRT are from cervical to sacral; mainly from thoracic to sacral for ORET; a high representation of AIS D lesion resulted both for BWSTRT (30%) and for ORET (45%). The walking performance, tested with 10MWT, 6MWT, TUG and WISCI, improved after exoskeleton training in persons with incomplete SCI lesions, when at least 20 sessions were applied. Persons with complete SCI lesions improved the dexterity in walking with exoskeleton, but did not recover independent walking function; symptoms such as spasticity, pain and cardiovascular endurance improved. CONCLUSION Different exoskeletons are available for walking rehabilitation in persons with SCI. The choice about the kind of robotic gait training should be addressed on the basis of the lesion severity and the possible comorbidities.
Collapse
Affiliation(s)
| | - Valeria Gazzotti
- Centro Protesi Vigorso di Budrio, Istituto Nazionale Assicurazione Infortuni sul Lavoro (INAIL), Bologna, Italy
| | | | - Elisa Andrenelli
- Department of Experimental and Clinical Medicine, Università Politecnica delle Marche, Ancona, Italy
| | | | | | - Simona Maria Carmignano
- Rehabilitation Therapeutic Center (CTR), Potenza, Italy.,University of Salerno, Salerno, Italy
| | - Anna Cassio
- Spinal Cord Unit and Intensive Rehabilitation Medicine, Ospedale di Fiorenzuola d'Arda, AUSL Piacenza, Piacenza, Italy
| | - Cira Fundaro
- Neurophysiopathology Unit, Istituti Clinici Scientifici Maugeri, IRCCS Montescano, Pavia, Italy
| | - Isabella Companini
- Department of Neuromotor and Rehabilitation, LAM-Motion Analysis Laboratory, San Sebastiano Hospital, AUSL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - David Mazzoli
- Gait and Motion Analysis Laboratory, Sol et Salus Ospedale Privato Accreditato, Rimini, Italy
| | - Simona Cerulli
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Carmelo Chisari
- Department of Translational Research and New Technologies in Medicine and Surgery, Neurorehabiltation Section, University of Pisa, Pisa, Italy
| | | | - Stefania Dalise
- Department of Translational Research and New Technologies in Medicine and Surgery, Neurorehabiltation Section, University of Pisa, Pisa, Italy
| | - Daniele Mazzoleni
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | | | - Andrea Merlo
- Gait and Motion Analysis Laboratory, Sol et Salus Ospedale Privato Accreditato, Rimini, Italy
| | - Paolo Boldrini
- Italian Society of Physical Medicine and Rehabilitation (SIMFER), Rome, Italy
| | - Stefano Mazzoleni
- Department of Electrical and Information Engineering, Politecnico di Bari, Bari, Italy
| | - Federico Posteraro
- Department of Rehabilitation, Versilia Hospital - AUSL12, Viareggio, Italy
| | | | | | - Enrico Castelli
- Department of Paediatric Neurorehabilitation, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - Francesco Draicchio
- Department of Occupational and Environmental Medicine Epidemiology and Hygiene, INAIL, Rome, Italy
| | - Vincenzo Falabella
- Italian Federation of Persons with Spinal Cord Injuries (FAIP Onlus), Rome, Italy
| | | | - Francesca Gimigliano
- Department of Mental, Physical Health and Preventive Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Mauro Grigioni
- National Center for Innovative Technologies in Public Health, Italian National Institute of Health, Rome, Italy
| | - Stefano Mazzon
- Rehabilitation Unit, ULSS (Local Health Authority) Euganea, Camposampiero Hospital, Padua, Italy
| | - Franco Molteni
- Department of Rehabilitation Medicine, Villa Beretta Rehabilitation Center, Valduce Hospital, Lecco, Italy
| | | | - Maurizio Petrarca
- Movement Analysis and Robotics Laboratory (MARlab), IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - Alessandro Picelli
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Michele Senatore
- Associazione Italiana dei Terapisti Occupazionali (AITO), Rome, Italy
| | | | - Emiliana Bizzarrini
- Department of Rehabilitation Medicine, Spinal Cord Unit, Gervasutta Hospital, Azienda Sanitaria Universitaria Friuli Centrale (ASU FC), Udine, Italy
| |
Collapse
|
12
|
Fenton JM, King JA, Hoekstra SP, Valentino SE, Phillips SM, Goosey-Tolfrey VL. Protocols aiming to increase muscle mass in persons with motor complete spinal cord injury: a systematic review. Disabil Rehabil 2022; 45:1433-1443. [PMID: 35465798 DOI: 10.1080/09638288.2022.2063420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE The purpose of this review was to compare all intervention modalities aimed at increasing skeletal muscle mass (SMM) in the paralysed limbs of persons with chronic (>1-year post-injury), motor complete spinal cord injury (SCI). MATERIALS AND METHODS A systematic review of EMBASE, MEDLINE, Scopus, and SPORTDiscus databases was conducted from inception until December 2021. Published intervention studies aimed to increase SMM (measured by magnetic resonance imaging, computed tomography, ultrasound, muscle biopsy, or lean soft tissue mass by dual X-ray absorptiometry) in the paralysed limbs of adults (>18 years) with SCI were included. RESULTS Fifty articles were included that, overall, demonstrated a high risk of bias. Studies were categorised into six groups: neuromuscular electrical stimulation (NMES) with and without external resistance, functional electrical stimulation cycling, walking- and standing-based interventions, pharmacological treatments, and studies that compared or combined intervention modalities. Resistance training (RT) using NMES on the quadriceps produced the largest and most consistent increases in SMM of all intervention modalities. CONCLUSIONS Current evidence suggests that clinical practise aiming to increase SMM in the paralysed limbs of persons with motor complete SCI should perform NMES-RT. However, more high-quality randomised control trials are needed to determine how training variables, such as exercise volume and intensity, can be optimised for increasing SMM. Implications for rehabilitationPersons with spinal cord injury (SCI) experience severe reductions in skeletal muscle mass (SMM) post-injury, which may exacerbate their risk of obesity and metabolic disease.Out of all exercise and non-exercise-based interventions, this systematic review shows that neuromuscular electrical stimulation-based resistance training demonstrates the most robust and consistent evidence for increasing skeletal muscle mass in the paralysed limbs of adults with motor complete spinal cord injury.The findings from this review can be used to inform evidence-based practise for exercise practitioners, as well as direct future research focused on increasing muscle mass in this population.
Collapse
Affiliation(s)
- Jordan M. Fenton
- National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
- Peter Harrison Centre for Disability Sport, Loughborough University, Loughborough, UK
| | - James A. King
- National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
- National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust and University of Leicester, Leicester, UK
| | - Sven P. Hoekstra
- National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
- Peter Harrison Centre for Disability Sport, Loughborough University, Loughborough, UK
| | | | - Stuart M. Phillips
- Department of Kinesiology, McMaster University, Hamilton, Ontario, Canada
| | - Victoria L. Goosey-Tolfrey
- National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
- Peter Harrison Centre for Disability Sport, Loughborough University, Loughborough, UK
| |
Collapse
|
13
|
Zhang L, Lin F, Sun L, Chen C. Comparison of Efficacy of Lokomat and Wearable Exoskeleton-Assisted Gait Training in People With Spinal Cord Injury: A Systematic Review and Network Meta-Analysis. Front Neurol 2022; 13:772660. [PMID: 35493806 PMCID: PMC9044921 DOI: 10.3389/fneur.2022.772660] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 03/04/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveLokomat and wearable exoskeleton-assisted walking (EAW) have not been directly compared previously. To conduct a network meta-analysis of randomized and non-randomized controlled trials to assess locomotor abilities achieved with two different types of robotic-assisted gait training (RAGT) program in persons with spinal cord injury (SCI).MethodsThree electronic databases, namely, PubMed, Embase, and the Cochrane Library, were systematically searched for randomized and non-randomized controlled trials published before August 2021, which assessed locomotor abilities after RAGT.ResultsOf 319 studies identified for this review, 12 studies were eligible and included in our analysis. Studies from 2013 to 2021 were covered and contained 353 valid data points (N-353) on patients with SCI receiving wearable EWA and Lokomat training. In the case of wearable EAW, the 10-m walk test (10-MWT) distance and speed scores significantly increased [distance: 0.85 (95% CI = 0.35, 1.34); speed: −1.76 (95% CI = −2.79, −0.73)]. The 6-min walk test (6-MWT) distance [−1.39 (95% CI = −2.01, −0.77)] and the timed up and go (TUG) test significantly increased [(1.19 (95% CI = 0.74, 1.64)], but no significant difference was observed in the walking index for spinal cord injury (WISCI-II) [−0.33 (95% CI = −0.79, 0.13)]. Among the patients using Lokomat, the 10-MWT-distance score significantly increased [−0.08 (95% CI = −0.14, −0.03)] and a significant increase in the WISCI-II was found [1.77 (95% CI = 0.23, 3.31)]. The result of network meta-analysis showed that the probability of wearable EAW to rank first and that of Lokomat to rank second was 89 and 47%, respectively, in the 10-MWT speed score, while that of Lokomat to rank first and wearable EAW to rank second was 73 and 63% in the WISCI-II scores.ConclusionLokomat and wearable EAW had effects on the performance of locomotion abilities, namely, distance, speed, and function. Wearable EAW might lead to better outcomes in walking speed compared with that in the case of Lokomat.
Collapse
Affiliation(s)
- Lingjie Zhang
- School of Health, Fujian Medical University, Fuzhou, China
| | - Fabin Lin
- Department of Neurosurgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Lei Sun
- School of Health, Fujian Medical University, Fuzhou, China
- Lei Sun
| | - Chunmei Chen
- Department of Neurosurgery, Fujian Medical University Union Hospital, Fuzhou, China
- *Correspondence: Chunmei Chen
| |
Collapse
|
14
|
Yip CCH, Lam CY, Cheung KMC, Wong YW, Koljonen PA. Knowledge Gaps in Biophysical Changes After Powered Robotic Exoskeleton Walking by Individuals With Spinal Cord Injury—A Scoping Review. Front Neurol 2022; 13:792295. [PMID: 35359657 PMCID: PMC8960715 DOI: 10.3389/fneur.2022.792295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 02/07/2022] [Indexed: 11/13/2022] Open
Abstract
In addition to helping individuals with spinal cord injury (SCI) regain the ability to ambulate, the rapidly evolving capabilities of robotic exoskeletons provide an array of secondary biophysical benefits which can reduce the complications resulting from prolonged immobilization. The proposed benefits of increased life-long over-ground walking capacity include improved upper body muscular fitness, improved circulatory response, improved bowel movement regularity, and reduced pain and spasticity. Beyond the positive changes related to physical and biological function, exoskeletons have been suggested to improve SCI individuals' quality of life (QOL) by allowing increased participation in day-to-day activities. Most of the currently available studies that have reported on the impact of exoskeletons on the QOL and prevention of secondary health complications on individuals with SCI, are of small scale and are heterogeneous in nature. Moreover, few meta-analyses and reviews have attempted to consolidate the dispersed data to reach more definitive conclusions of the effects of exoskeleton use. This scoping review seeks to provide an overview on the known effects of overground exoskeleton use, on the prevention of secondary health complications, changes to the QOL, and their effect on the independence of SCI individuals in the community settings. Moreover, the intent of the review is to identify gaps in the literature currently available, and to make recommendations on focus study areas and methods for future investigations.
Collapse
Affiliation(s)
- Christopher C. H. Yip
- Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Chor-Yin Lam
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Kenneth M. C. Cheung
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Yat Wa Wong
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
- Department of Orthopaedics and Traumatology, Maclehose Medical Rehabilitation Centre, Hong Kong West Cluster, Hospital Authority, Kowloon, Hong Kong SAR, China
| | - Paul A. Koljonen
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
- Department of Orthopaedics and Traumatology, Maclehose Medical Rehabilitation Centre, Hong Kong West Cluster, Hospital Authority, Kowloon, Hong Kong SAR, China
- *Correspondence: Paul A. Koljonen
| |
Collapse
|
15
|
Hook MA, Falck A, Dundumulla R, Terminel M, Cunningham R, Sefiani A, Callaway K, Gaddy D, Geoffroy CG. Osteopenia in a Mouse Model of Spinal Cord Injury: Effects of Age, Sex and Motor Function. BIOLOGY 2022; 11:biology11020189. [PMID: 35205056 PMCID: PMC8869334 DOI: 10.3390/biology11020189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 01/20/2022] [Accepted: 01/22/2022] [Indexed: 11/16/2022]
Abstract
Simple Summary In the first two years following spinal cord injury, people lose up to 50% of bone below the injury. This injury-induced bone loss significantly affects rehabilitation and leaves people vulnerable to fractures and post-fracture complications, including lung and urinary tract infections, blood clots in the veins, and depression. Unfortunately, little is known about the factors driving this bone loss. In fact, even though we know that injury, age, and sex independently increase bone loss, there have been no studies looking at the cumulative effects of these variables. People with spinal injury are aging, and the age at which injuries occur is increasing. It is essential to know whether these factors together will further compromise bone. To examine this, we assessed bone loss in young and old, male and female mice after spinal injury. As expected, we found that aging alone decreased motor activity and bone volume. Spinal injury also reduced bone volume, but it did not worsen the effects of age. Instead, injury effects appeared related to reduced rearing activity. The data suggest that although partial weight-bearing does not reduce bone loss after spinal cord injury, therapies that put full weight on the legs may be clinically effective. Abstract After spinal cord injury (SCI), 80% of individuals are diagnosed with osteopenia or osteoporosis. The dramatic loss of bone after SCI increases the potential for fractures 100-fold, with post-fracture complications occurring in 54% of cases. With the age of new SCI injuries increasing, we hypothesized that a SCI-induced reduction in weight bearing could further exacerbate age-induced bone loss. To test this, young (2–3 months) and old (20–30 months) male and female mice were given a moderate spinal contusion injury (T9–T10), and recovery was assessed for 28 days (BMS, rearing counts, distance traveled). Tibial trabecular bone volume was measured after 28 days with ex vivo microCT. While BMS scores did not differ across groups, older subjects travelled less in the open field and there was a decrease in rearing with age and SCI. As expected, aging decreased trabecular bone volume and cortical thickness in both old male and female mice. SCI alone also reduced trabecular bone volume in young mice, but did not have an additional effect beyond the age-dependent decrease in trabecular and cortical bone volume seen in both sexes. Interestingly, both rearing and total activity correlated with decreased bone volume. These data underscore the importance of load and use on bone mass. While partial weight-bearing does not stabilize/reverse bone loss in humans, our data suggest that therapies that simulate complete loading may be effective after SCI.
Collapse
Affiliation(s)
- Michelle A. Hook
- Department of Neuroscience and Experimental Therapeutics, College of Medicine, Texas A&M Health Science Center, Bryan, TX 77807, USA; (R.D.); (M.T.); (R.C.); (A.S.); (K.C.); (C.G.G.)
- Correspondence: ; Tel.: +1-979-436-0568
| | - Alyssa Falck
- Veterinary Integrative Biosciences, College of Veterinary Medicine and Biomedical Sciences, College Station, TX 77843, USA; (A.F.); (D.G.)
| | - Ravali Dundumulla
- Department of Neuroscience and Experimental Therapeutics, College of Medicine, Texas A&M Health Science Center, Bryan, TX 77807, USA; (R.D.); (M.T.); (R.C.); (A.S.); (K.C.); (C.G.G.)
| | - Mabel Terminel
- Department of Neuroscience and Experimental Therapeutics, College of Medicine, Texas A&M Health Science Center, Bryan, TX 77807, USA; (R.D.); (M.T.); (R.C.); (A.S.); (K.C.); (C.G.G.)
| | - Rachel Cunningham
- Department of Neuroscience and Experimental Therapeutics, College of Medicine, Texas A&M Health Science Center, Bryan, TX 77807, USA; (R.D.); (M.T.); (R.C.); (A.S.); (K.C.); (C.G.G.)
| | - Arthur Sefiani
- Department of Neuroscience and Experimental Therapeutics, College of Medicine, Texas A&M Health Science Center, Bryan, TX 77807, USA; (R.D.); (M.T.); (R.C.); (A.S.); (K.C.); (C.G.G.)
| | - Kayla Callaway
- Department of Neuroscience and Experimental Therapeutics, College of Medicine, Texas A&M Health Science Center, Bryan, TX 77807, USA; (R.D.); (M.T.); (R.C.); (A.S.); (K.C.); (C.G.G.)
| | - Dana Gaddy
- Veterinary Integrative Biosciences, College of Veterinary Medicine and Biomedical Sciences, College Station, TX 77843, USA; (A.F.); (D.G.)
| | - Cédric G. Geoffroy
- Department of Neuroscience and Experimental Therapeutics, College of Medicine, Texas A&M Health Science Center, Bryan, TX 77807, USA; (R.D.); (M.T.); (R.C.); (A.S.); (K.C.); (C.G.G.)
| |
Collapse
|