Potential impact of orthotic gait exercise on natural killer cell activities in thoracic level of spinal cord-injured patients

The efficacy of powered orthoses on walking in persons with paraplegia

BACKGROUND

Powered orthoses are a new generation of assistive devices for people with spinal cord injury, which are designed to induce motion to paralyzed lower limb joints using external power via electric motors or pneumatic or hydraulic actuators.

OBJECTIVE

Powered gait orthoses provide activated movement of lower limb joints to limit the forces applied through the upper limb joints and trunk muscles during ambulation due to the need to use an external walking aid, while simultaneously improving the kinetics and kinematics of walking in subjects with spinal cord injury. This article reviews their walking efficacy when used by people with paraplegia.

STUDY DESIGN

Literature review.

METHOD

A literature search was performed in ISI Web of Knowledge, PubMed, Google Scholar, ScienceDirect, and Scopus databases.

RESULTS

Efficacy was demonstrated in producing activated motion of lower limb joints. Powered gait orthoses have a beneficial effect on the kinetics, kinematics, and temporal-spatial parameters of gait, but their effect on muscle activity in individuals with spinal cord injury is still unclear.

CONCLUSIONS

Further research is needed regarding the design and construction of powered gait orthoses using significant power application to the ankle joints and their effect on lower limb muscle activity and gait patterns in spinal cord injury subjects.

CLINICAL RELEVANCE

Powered orthoses is a new generation of orthotic intervention that could potentially be significant in assisting in improving the walking parameters and energy consumption of spinal cord injury subjects.

Infertility in men with spinal cord injury: research and treatment

Spinal cord injury (SCI) occurs most often to young men. Following SCI, most men are infertile due to a combination of erectile dysfunction, ejaculatory dysfunction and semen abnormalities. Erectile dysfunction may be treated by the same therapies that are used in the general population. Similarly, the same treatments that are effective to assist conception in couples with non-SCI male factor patients are effective in assisting conception in SCI male-factor patients. The most apparent differences in male-factor symptoms between SCI and non-SCI patients are the high occurrences of anejaculation and atypical semen profiles in men with SCI. Methods available to assist ejaculation in men with SCI include penile vibratory stimulation and EEJ. Use of surgical sperm retrieval as the first line of treatment for anejaculation in men with SCI is controversial. Most men with SCI have a unique semen profile characterized by normal sperm concentration, but abnormally low sperm motility. Toxic substances in the semen contribute to this problem. Despite impaired sperm parameters, pregnancy outcomes using sperm from men with SCI are similar to pregnancy outcomes using sperm from non-SCI men. Future studies should focus on improving natural ejaculation and improving semen quality in these men.

[Complications of chronic spinal cord injury]

BACKGROUND

A spinal cord injury changes body composition and metabolism over time. The main purpose of this article is to provide an overview of what is known about these changes and the consequences of those in the chronic phase, long after the acute injury.

MATERIAL AND METHODS

The article is based on own research and clinical experience, as well as a non-systematic search in the PubMed database.

RESULTS

The following has been documented for people with spinal cord injury: reduced bone and muscle mass, altered composition of muscle fibre, marked increase of body fat, decreased sensitivity to insulin and leptin and an increased activity in inflammatory signalling pathways. Changes are also demonstrated in hemostatic mechanisms and immune system.

INTERPRETATION

Changes in metabolism and hormonal regulation in people with spinal cord injury, may increase the risk of osteoporosis, obesity, cardiovascular disease and type 2 diabetes. Changed body composition and inflammatory activity may contribute to the higher incidence of cardiovascular disease and diabetes/metabolic syndrome, although other important risk factors (such as obesity and high blood pressure) may be absent. It has not been documented that changes in haemostatic mechanisms and the immune system are associated with the increased incidence of thromboembolic complications, severe infections or certain types of cancer.

Effect of lesion level on the orthotic gait performance in individuals with complete paraplegia

STUDY DESIGN

Cross-sectional, experimental research.

OBJECTIVES

To clarify the effect of lesion level on cardio-respiratory responses and biomechanical characteristics of walking with a reciprocating gait orthosis in complete paraplegia with spinal cord injury (SCI).

SETTING

National Rehabilitation Center for Persons with Disabilities, Japan.

METHODS

Ten SCI individuals (age: 20-34 years, injured level: Th5-12) who experienced orthotic gait training at least for 10 weeks participated in two experiments: (1) measurement of the cardiorespiratory responses during 20 min of orthotic gait exercise; and (2) three-dimensional motion analysis and ground reaction force measurement using the VICON system. We calculated the following parameters: pulmonary ventilation, oxygen consumption (VO(2)), heart rate (HR), gait speed, cadence, stride length, crutch force (CF), hip range of motion (ROM), and hip angular velocity (VEL). Further, energy consumption and energy cost were calculated using the steady-state value of VO(2) and gait speed.

RESULTS

The steady-state value of the VO(2) (18.2 +/- 3.80 ml/kg) and HR (133.0 +/- 21.63 b/min) tended to be larger in higher thoracic SCI subjects. There were strong positive correlations between the lesion level and walking speed (r = 0.74), energy cost (r = 0.85), and hip ROM (r = 0.78). On the other hand, negative correlation between the lesion level and peak CF (r = -0.78) was clarified.

CONCLUSIONS

The physiological intensity of the orthotic gait strongly depended on the level of lesion. It seems likely that a limited hip range of motion and excess upper limb load result in the low energy cost of orthotic gait for the higher thoracic level of paraplegic patients.