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Ettema S, Pennink GH, Buurke TJW, David S, van Bennekom CAM, Houdijk H. Clinical indications and protocol considerations for selecting initial body weight support levels in gait rehabilitation: a systematic review. J Neuroeng Rehabil 2024; 21:97. [PMID: 38849899 PMCID: PMC11157893 DOI: 10.1186/s12984-024-01389-8] [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: 11/22/2023] [Accepted: 05/20/2024] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND Body weight support (BWS) training devices are frequently used to improve gait in individuals with neurological impairments, but guidance in selecting an appropriate level of BWS is limited. Here, we aim to describe the initial BWS levels used during gait training, the rationale for this selection and the clinical goals aligned with BWS training for different diagnoses. METHOD A systematic literature search was conducted in PubMed, Embase and Web of Science, including terms related to the population (individuals with neurological disorders), intervention (BWS training) and outcome (gait). Information on patient characteristics, type of BWS device, BWS level and training goals was extracted from the included articles. RESULTS Thirty-three articles were included, which described outcomes using frame-based (stationary or mobile) and unidirectional ceiling-mounted devices on four diagnoses (multiple sclerosis (MS), spinal cord injury (SCI), stroke, traumatic brain injury (TBI)). The BWS levels were highest for individuals with MS (median: 75%, IQR: 6%), followed by SCI (median: 40%, IQR: 35%), stroke (median: 30%, IQR: 4.75%) and TBI (median: 15%, IQR: 0%). The included studies reported eleven different training goals. Reported BWS levels ranged between 30 and 75% for most of the training goals, without a clear relationship between BWS level, diagnosis, training goal and rationale for BWS selection. Training goals were achieved in all included studies. CONCLUSION Initial BWS levels differ considerably between studies included in this review. The underlying rationale for these differences was not clearly motivated in the included studies. Variation in study designs and populations does not allow to draw a conclusion on the effectiveness of BWS levels. Hence, it remains difficult to formulate guidelines on optimal BWS settings for different diagnoses, BWS devices and training goals. Further efforts are required to establish clinical guidelines and to experimentally investigate which initial BWS levels are optimal for specific diagnoses and training goals.
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Affiliation(s)
- Sanne Ettema
- Research and Development, Heliomare Rehabilitation, Wijk aan Zee, the Netherlands.
- Department of Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
| | - Geertje H Pennink
- Research and Development, Heliomare Rehabilitation, Wijk aan Zee, the Netherlands
- Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | - Tom J W Buurke
- Department of Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Department of Movement Sciences, KU Leuven, Leuven, Belgium
| | - Sina David
- Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | - Coen A M van Bennekom
- Research and Development, Heliomare Rehabilitation, Wijk aan Zee, the Netherlands
- Department of Public and Occupational Health, Amsterdam UMC, Amsterdam, the Netherlands
| | - Han Houdijk
- Department of Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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Dietz N, Wagers S, Harkema SJ, D'Amico JM. Intrathecal and Oral Baclofen Use in Adults With Spinal Cord Injury: A Systematic Review of Efficacy in Spasticity Reduction, Functional Changes, Dosing, and Adverse Events. Arch Phys Med Rehabil 2023; 104:119-131. [PMID: 35750207 DOI: 10.1016/j.apmr.2022.05.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 04/29/2022] [Accepted: 05/06/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To examine the efficacy, dosing, and safety profiles of intrathecal and oral baclofen in treating spasticity after spinal cord injury (SCI). DATA SOURCES PubMed and Cochrane Databases were searched from 1970-2018 with keywords baclofen, spinal cord injury, and efficacy. STUDY SELECTION The database search yielded 588 sources and 10 additional relevant publications. After removal of duplicates, 398 publications were screened. DATA EXTRACTION Data were extracted using the following population, intervention, comparator, outcomes, and study designs criteria: studies including adult patients with SCI with spasticity; the intervention could be oral or intrathecal administration of baclofen; selection was inclusive for control groups, surgical management, rehabilitation, and alternative pharmaceutical agents; outcomes were efficacy, dosing, and adverse events. Randomized controlled trials, observational studies, and case reports were included. Meta-analyses and systematic reviews were excluded. DATA SYNTHESIS A total of 98 studies were included with 1943 patients. Only 4 randomized, double-blinded, and placebo-controlled trials were reported. Thirty-nine studies examined changes in the Modified Ashworth Scale (MAS; 34 studies) and Penn Spasm scores (Penn Spasm Frequency; 19 studies), with average reductions of 1.7±1.3 and 1.6±1.4 in individuals with SCI, respectively. Of these data, a total of 6 of the 34 studies (MAS) and 2 of the 19 studies (Penn Spasm Frequency) analyzed oral baclofen. Forty-three studies addressed adverse events with muscle weakness and fatigue frequently reported. CONCLUSIONS Baclofen is the most commonly-prescribed antispasmodic after SCI. Surprisingly, there remains a significant lack of large, placebo-controlled, double-blinded clinical trials, with most efficacy data arising from small studies examining treatment across different etiologies. In the studies reviewed, baclofen effectively improved spasticity outcome measures, with increased efficacy through intrathecal administration. Few studies assessed how reduced neural excitability affected residual motor function and activities of daily living. A host of adverse events were reported that may negatively affect quality of life. Comparative randomized controlled trials of baclofen and alternative treatments are warranted because these have demonstrated promise in relieving spasticity with reduced adverse events and without negatively affecting residual motor function.
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Affiliation(s)
- Nicholas Dietz
- Department of Neurological Surgery, University of Louisville, Louisville, KY; Kentucky Spinal Cord Injury Research Center, Louisville, KY
| | - Sarah Wagers
- Department of Neurological Surgery, University of Louisville, Louisville, KY; Kentucky Spinal Cord Injury Research Center, Louisville, KY
| | - Susan J Harkema
- Department of Neurological Surgery, University of Louisville, Louisville, KY; Kentucky Spinal Cord Injury Research Center, Louisville, KY
| | - Jessica M D'Amico
- Department of Neurological Surgery, University of Louisville, Louisville, KY; Kentucky Spinal Cord Injury Research Center, Louisville, KY.
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Balbinot G, Joner Wiest M, Li G, Pakosh M, Cesar Furlan J, Kalsi-Ryan S, Zariffa J. The use of surface EMG in neurorehabilitation following traumatic spinal cord injury: a scoping review. Clin Neurophysiol 2022; 138:61-73. [DOI: 10.1016/j.clinph.2022.02.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 02/06/2022] [Accepted: 02/27/2022] [Indexed: 11/03/2022]
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The effects of virtual soccer game on balance, gait function, and kick speed in chronic incomplete spinal cord injury: a randomized controlled trial. Spinal Cord 2022; 60:504-509. [PMID: 34999726 DOI: 10.1038/s41393-021-00745-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 12/14/2021] [Accepted: 12/24/2021] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Participant-blinded comparative pre-post randomized controlled trial. OBJECTIVE To evaluate the effects of virtual soccer game on balance, gait function, and kick speed in individuals with spinal cord injuries. SETTING Forty participants with incomplete spinal cord injury (SCI) were included. METHODS The participants were randomized into either an experimental group (EG) or a control group for treatment 3 days/week over 4 weeks. The clinical outcomes included the results of the chair stand test (CST), timed up-and-go (TUG) test, and 10 m walking test (10MWT). The virtual reality (VR) content outcome measure was kick speed. RESULTS The independent t-test results indicated that the participants in the EG exhibited superior performances in the CST, TUG test, 10MWT, and kick speed test (all P < 0.05). CONCLUSIONS Our results provide novel, promising clinical evidence that VR rehabilitation improves both dynamic and static balance and reduces the risk of falls in patients with incomplete SCI of Asia impairment scale grades C-D.
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Balbinot G, Li G, Wiest MJ, Pakosh M, Furlan JC, Kalsi-Ryan S, Zariffa J. Properties of the surface electromyogram following traumatic spinal cord injury: a scoping review. J Neuroeng Rehabil 2021; 18:105. [PMID: 34187509 PMCID: PMC8244234 DOI: 10.1186/s12984-021-00888-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 05/27/2021] [Indexed: 12/23/2022] Open
Abstract
Traumatic spinal cord injury (SCI) disrupts spinal and supraspinal pathways, and this process is reflected in changes in surface electromyography (sEMG). sEMG is an informative complement to current clinical testing and can capture the residual motor command in great detail-including in muscles below the level of injury with seemingly absent motor activities. In this comprehensive review, we sought to describe how the sEMG properties are changed after SCI. We conducted a systematic literature search followed by a narrative review focusing on sEMG analysis techniques and signal properties post-SCI. We found that early reports were mostly focused on the qualitative analysis of sEMG patterns and evolved to semi-quantitative scores and a more detailed amplitude-based quantification. Nonetheless, recent studies are still constrained to an amplitude-based analysis of the sEMG, and there are opportunities to more broadly characterize the time- and frequency-domain properties of the signal as well as to take fuller advantage of high-density EMG techniques. We recommend the incorporation of a broader range of signal properties into the neurophysiological assessment post-SCI and the development of a greater understanding of the relation between these sEMG properties and underlying physiology. Enhanced sEMG analysis could contribute to a more complete description of the effects of SCI on upper and lower motor neuron function and their interactions, and also assist in understanding the mechanisms of change following neuromodulation or exercise therapy.
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Affiliation(s)
- Gustavo Balbinot
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, M5G 2A2, Canada.
| | - Guijin Li
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, M5G 2A2, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, Canada
| | - Matheus Joner Wiest
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, M5G 2A2, Canada
| | - Maureen Pakosh
- Library & Information Services, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Julio Cesar Furlan
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, M5G 2A2, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
- Department of Medicine, Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, Canada
- Division of Physical Medicine and Rehabilitation, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, Canada
| | - Sukhvinder Kalsi-Ryan
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, M5G 2A2, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
- Department of Physical Therapy, University of Toronto, Toronto, Canada
| | - Jose Zariffa
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, M5G 2A2, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
- Edward S. Rogers Sr. Department of Electrical and Computer Engineering, University of Toronto, Toronto, Canada
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Daily acute intermittent hypoxia combined with walking practice enhances walking performance but not intralimb motor coordination in persons with chronic incomplete spinal cord injury. Exp Neurol 2021; 340:113669. [PMID: 33647273 DOI: 10.1016/j.expneurol.2021.113669] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 02/14/2021] [Accepted: 02/25/2021] [Indexed: 12/15/2022]
Abstract
Persons living with incomplete spinal cord injuries (SCI) often struggle to regain independent walking due to deficits in walking mechanics. They often dedicate many weeks of gait training before benefits to emerge, with additional training needed for benefits to persist. Recent studies in humans with SCI found that daily bouts of breathing low oxygen (acute intermittent hypoxia, AIH) prior to locomotor training elicited persistent (weeks) improvement in overground walking speed and endurance. AIH-induced improvements in overground walking may result from changes in control strategies that also enhance intralimb coordination; however, this possibility remains untested. Here, we examined the extent to which daily AIH combined with walking practice (AIH + WALK) improved overground walking performance and intralimb motor coordination in persons with chronic, incomplete SCI. METHODS We recruited 11 persons with chronic (> 1 year), incomplete SCI to participate in a randomized, double-blind, balanced, crossover study. Participants first received either daily (5 consecutive days) AIH (15, 90-s episodes of 10.0% O2 with 60s intervals at 20.9% O2) or SHAM (15, 90s episodes at 20.9% O2 with 60s intervals at 20.9% O2) followed by 30-min of overground walking practice. They received the second treatment after a minimum 2-week washout period. We quantified overground walking performance, in terms of speed and endurance, using the 10-Meter Walk Test (10MWT) and 6-Minute Walk Test (6MWT), respectively. We quantified intralimb motor coordination using kinematic variability measures of foot trajectory (i.e., endpoint variability, EV) and of inter-joint coupling between the hip and knee, as well as between the knee and ankle joints (i.e., angular coefficient of correspondence, ACC). We compared the changes in walking performance relative to baseline (BL) between daily AIH + WALK and daily SHAM+WALK on treatment day 5 (T5), 1-week follow-up (F1), and 2-weeks follow-up (F2). We also compared these changes between participants who used bilateral walking aids (N = 5) and those who did not. To assess the effects of daily AIH + WALK on intralimb coordination, we compared potential treatment-induced changes in EV and ACC relative to BL at F1 and F2. RESULTS Participants improved overground walking performance (speed and endurance) after daily AIH + WALK, but not SHAM+WALK. Following daily AIH + WALK, participants decreased their 10MWT time at T5 by 28% (95% CI 0.2-10.1 s, p = 0.04), F1 by 28% (95% CI 1.1-13.5 s, p = 0.01), and F2 by 27% (95% CI 1.4-13.9 s, p = 0.01) relative to BL. The greatest decreases in the 10MWT occurred in participants who used bilateral walking aids (p < 0.05). We also found daily AIH + WALK resulted in an increase in 6MWT distance at T5 by 22% (95% CI 13.3-72.6 m, p = 0.001), F1 by 21% (95% CI 13.1-72.5 m, p = 0.001), and F2 by 16% (95% CI 2.9-62.2 m, p = 0.02). However, measures of EV and ACC during self-selected walking conditions did not change following daily AIH + WALK (all p-values >0.50). CONCLUSIONS Consistent with prior studies, daily AIH + WALK triggered improvements in walking speed and endurance that persisted for weeks after treatment. Greatest improvements in speed occurred in participants who used bilateral walking aids. No change in EV and ACC may suggest that intralimb motor coordination was not a significant gait training priority during daily AIH + WALK.
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Fenrich KK, Hallworth BW, Vavrek R, Raposo PJF, Misiaszek JE, Bennett DJ, Fouad K, Torres-Espin A. Self-directed rehabilitation training intensity thresholds for efficient recovery of skilled forelimb function in rats with cervical spinal cord injury. Exp Neurol 2020; 339:113543. [PMID: 33290776 DOI: 10.1016/j.expneurol.2020.113543] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 11/18/2020] [Accepted: 12/02/2020] [Indexed: 01/01/2023]
Abstract
Task specific rehabilitation training is commonly used to treat motor dysfunction after neurological injures such as spinal cord injury (SCI), yet the use of task specific training in preclinical animal studies of SCI is not common. This is due in part to the difficulty in training animals to perform specific motor tasks, but also due to the lack of knowledge about optimal rehabilitation training parameters to maximize recovery. The single pellet reaching, grasping and retrieval (SPRGR) task (a.k.a. single pellet reaching task or Whishaw task) is a skilled forelimb motor task used to provide rehabilitation training and test motor recovery in rodents with cervical SCI. However, the relationships between the amount, duration, intensity, and timing of training remain poorly understood. In this study, using automated robots that allow rats with cervical SCI ad libitum access to self-directed SPRGR rehabilitation training, we show clear relationships between the total amount of rehabilitation training, the intensity of training (i.e., number of attempts/h), and performance in the task. Specifically, we found that rats naturally segregate into High and Low performance groups based on training strategy and performance in the task. Analysis of the different training strategies showed that more training (i.e., increased number of attempts in the SPRGR task throughout rehabilitation training) at higher intensities (i.e., number of attempts per hour) increased performance in the task, and that improved performance in the SPRGR task was linked to differences in corticospinal tract axon collateral densities in the injured spinal cords. Importantly, however, our data also indicate that rehabilitation training becomes progressively less efficient (i.e., less recovery for each attempt) as both the amount and intensity of rehabilitation training increases. Finally, we found that Low performing animals could increase their training intensity and transition to High performing animals in chronic SCI. These results highlight the rehabilitation training strategies that are most effective to regain skilled forelimb motor function after SCI, which will facilitate pre-clinical rehabilitation studies using animal models and could be beneficial in the development of more efficient clinical rehabilitation training strategies.
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Affiliation(s)
- Keith K Fenrich
- Faculty of Rehabilitation Medicine and Neuroscience and Mental Health Institute, University of Alberta, Edmonton, Alberta T6G 2E1, Canada.
| | - Ben W Hallworth
- Faculty of Rehabilitation Medicine and Neuroscience and Mental Health Institute, University of Alberta, Edmonton, Alberta T6G 2E1, Canada
| | - Romana Vavrek
- Faculty of Rehabilitation Medicine and Neuroscience and Mental Health Institute, University of Alberta, Edmonton, Alberta T6G 2E1, Canada
| | - Pamela J F Raposo
- Faculty of Rehabilitation Medicine and Neuroscience and Mental Health Institute, University of Alberta, Edmonton, Alberta T6G 2E1, Canada
| | - John E Misiaszek
- Faculty of Rehabilitation Medicine and Neuroscience and Mental Health Institute, University of Alberta, Edmonton, Alberta T6G 2E1, Canada
| | - David J Bennett
- Faculty of Rehabilitation Medicine and Neuroscience and Mental Health Institute, University of Alberta, Edmonton, Alberta T6G 2E1, Canada
| | - Karim Fouad
- Faculty of Rehabilitation Medicine and Neuroscience and Mental Health Institute, University of Alberta, Edmonton, Alberta T6G 2E1, Canada
| | - Abel Torres-Espin
- Faculty of Rehabilitation Medicine and Neuroscience and Mental Health Institute, University of Alberta, Edmonton, Alberta T6G 2E1, Canada; Brain and Spinal Injury Center (BASIC), Department of Neurosurgery, University of California San Francisco, San Francisco 94110, USA.
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Tan AQ, Barth S, Trumbower RD. Acute intermittent hypoxia as a potential adjuvant to improve walking following spinal cord injury: evidence, challenges, and future directions. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2020; 8:188-198. [PMID: 33738145 DOI: 10.1007/s40141-020-00270-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Purpose of Review The reacquisition and preservation of walking ability are highly valued goals in spinal cord injury (SCI) rehabilitation. Recurrent episodes of breathing low oxygen (i.e., acute intermittent hypoxia, AIH) is a potential therapy to promote walking recovery after incomplete SCI via endogenous mechanisms of neuroplasticity. Here, we report on the progress of AIH, alone or paired with other treatments, on walking recovery in persons with incomplete SCI. We evaluate the evidence of AIH as a therapy ready for clinical and home use and the real and perceived challenges that may interfere with this possibility. Recent Findings Repetitive AIH is a safe and an efficacious treatment to enhance strength, walking speed and endurance, as well as, dynamic balance in persons with chronic, incomplete SCI. Summary The potential for AIH as a treatment for SCI remains high, but further research is necessary to understand treatment targets and effectiveness in a large cohort of persons with SCI.
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Affiliation(s)
- Andrew Quesada Tan
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA. USA
- Spaulding Rehabilitation Hospital, Boston MA
| | - Stella Barth
- Spaulding Rehabilitation Hospital, Boston MA
- Harvard University, Cambridge MA
| | - Randy D Trumbower
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA. USA
- Spaulding Rehabilitation Hospital, Boston MA
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Mikicin M, Mróz A, Karczewska-Lindinger M, Malinowska K, Mastalerz A, Kowalczyk M. Effect of the Neurofeedback-EEG Training During Physical Exercise on the Range of Mental Work Performance and Individual Physiological Parameters in Swimmers. Appl Psychophysiol Biofeedback 2020; 45:49-55. [PMID: 32232604 PMCID: PMC7250807 DOI: 10.1007/s10484-020-09456-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The aim of the study was to demonstrate the effects of the Neurofeedback-EEG training during physical exercise on the improvements in mental work performance and physiological parameters. The study examined seven swimmers based on the following anthropometric measurements: body height, body mass and body composition. The Kraepelin's work curve test, EEG and EMG during physical exercise were also performed. The athletes followed 20 Neurofeedback-EEG training sessions on the swimming ergometer for 4 months. Most mean indices of partial measures of the work curve were significantly modified (p < 0.05) following the Neurofeedback-EEG training. Mean level of maximal oxygen uptake in study participants was over 55 ml/kg/min, with statistically significant differences documented between the first and the second measurements. No significant differences were found in the fatigue rate between the measurements 1 and 2. The improved mental work performance following the Neurofeedback-EEG training facilitates optimization of psychomotor activities.
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Affiliation(s)
- Mirosław Mikicin
- Józef Piłsudski University of Physical Education, Marymoncka 34, 00-968, Warsaw, Poland.
| | - Anna Mróz
- Józef Piłsudski University of Physical Education, Marymoncka 34, 00-968, Warsaw, Poland
| | - Magdalena Karczewska-Lindinger
- Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.,Center for Health and Performance, Department of Food and Nutrition and Sport Science, University of Gothenburg, Gothenburg, Sweden
| | - Karolina Malinowska
- Józef Piłsudski University of Physical Education, Marymoncka 34, 00-968, Warsaw, Poland
| | - Andrzej Mastalerz
- Józef Piłsudski University of Physical Education, Marymoncka 34, 00-968, Warsaw, Poland
| | - Marek Kowalczyk
- Józef Piłsudski University of Physical Education, Marymoncka 34, 00-968, Warsaw, Poland
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Korupolu R, Stampas A, Singh M, Zhou P, Francisco G. Electrophysiological Outcome Measures in Spinal Cord Injury Clinical Trials: A Systematic Review. Top Spinal Cord Inj Rehabil 2020; 25:340-354. [PMID: 31844386 DOI: 10.1310/sci2504-340] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background: Electrophysiological measures are being increasingly utilized due to their ability to provide objective measurements with minimal bias and to detect subtle changes with quantitative data on neural function. Heterogeneous reporting of trial outcomes limits effective interstudy comparison and optimization of treatment. Objective: The objective of this systematic review is to describe the reporting of electrophysiological outcome measures in spinal cord injury (SCI) clinical trials in order to inform a subsequent consensus study. Methods: A systematic search of PubMed and EMBASE databases was conducted according to PRISMA guidelines. Adult human SCI clinical trials published in English between January 1, 2008 and September 15, 2018 with at least one electrophysiological outcome measure were eligible. Findings were reviewed by all authors to create a synthesis narrative describing each outcome measure. Results: Sixty-four SCI clinical trials were included in this review. Identified electrophysiological outcomes included electromyography activity (44%), motor evoked potentials (33%), somatosensory evoked potentials (33%), H-reflex (20%), reflex electromyography activity (11%), nerve conduction studies (9%), silent period (3%), contact heat evoked potentials (2%), and sympathetic skin response (2%). Heterogeneity was present in regard to both methods of measurement and reporting of electrophysiological outcome measures. Conclusion: This review demonstrates need for the development of a standardized reporting set for electrophysiological outcome measures. Limitations of this review include exclusion of non-English publications, studies more than 10 years old, and an inability to assess methodological quality of primary studies due to a lack of guidelines on reporting of systematic reviews of outcome measures.
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Affiliation(s)
- Radha Korupolu
- Department of Physical Medicine and Rehabilitation, University of Texas John P and Katherine G McGovern Medical School, Houston, Texas
| | - Argyrios Stampas
- Department of Physical Medicine and Rehabilitation, University of Texas John P and Katherine G McGovern Medical School, Houston, Texas
| | - Mani Singh
- Department of Physical Medicine and Rehabilitation, University of Texas John P and Katherine G McGovern Medical School, Houston, Texas
| | - Ping Zhou
- Department of Physical Medicine and Rehabilitation, University of Texas John P and Katherine G McGovern Medical School, Houston, Texas
| | - Gerard Francisco
- Department of Physical Medicine and Rehabilitation, University of Texas John P and Katherine G McGovern Medical School, Houston, Texas
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Lee SSM, Lam T, Pauhl K, Wakeling JM. Quantifying muscle coactivation in individuals with incomplete spinal cord injury using wavelets. Clin Biomech (Bristol, Avon) 2020; 73:101-107. [PMID: 31958701 DOI: 10.1016/j.clinbiomech.2020.01.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 02/11/2019] [Accepted: 01/03/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Individuals with incomplete spinal cord injury often have decreased gait function and coactivation of antagonistic muscle pairs. Common ways of quantifying coactivation using electromyographic signals do not consider frequency information in the signal. As electromyographic signals from different motor unit types have different frequency components and muscle fiber type can change in individuals with spinal cord injury, it may be beneficial to consider frequency components. The aims were to demonstrate the utility of using a method which considers temporal and frequency components of the electromyographical signal to quantify coactivation in lower extremity muscles in individuals with incomplete spinal cord injury through 1) comparison with able-bodied individuals and 2) comparison before and after body weight supported treadmill training. METHODS Frequency decomposition techniques were applied to electromyographical signals to consider the temporal and frequency components of the electromyographical signals to quantify coactivation over a range of frequencies. RESULTS Our main findings show that correlation coefficients between total EMG intensities of rectus femoris-biceps femoris and medial gastrocnemius-tibialis anterior were significantly different between able-bodied individuals and those with incomplete spinal cord injury (p = 0006, p = 0.01). The correlation spectra of medial gastrocnemius-tibialis anterior of the spinal cord injury group were substantially different than those the able-bodied group, while the EMG normalcy score was significantly different (p = 0.002). We also found that there was a change in coactivation of ankle muscles after body weight supported treadmill training. INTERPRETATION Our findings indicate that there may be frequency specific differences in muscle coactivation between able-bodied individuals and those with incomplete spinal cord injury. Changes in coactivation were also observed before and after body weight supported treadmill training. These differences may reflect the changes in recruitment patterns of different motor unit types.
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Affiliation(s)
- Sabrina S M Lee
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, 8888 University Drive, Burnaby, BC V5A 1S6, Canada; Department of Physical Therapy and Human Movement Sciences, Northwestern University, 645 N Michigan Avenue, Chicago, IL, USA.
| | - Tania Lam
- School of Kinesiology, The University of British Columbia, 210-6081 University Boulevard, Vancouver, BC V6T 1Z1, Canada; International Collaboration on Repair Discoveries, 818 W. 10th Ave., Vancouver V5Z 1M9, Canada
| | - Katherine Pauhl
- School of Kinesiology, The University of British Columbia, 210-6081 University Boulevard, Vancouver, BC V6T 1Z1, Canada; International Collaboration on Repair Discoveries, 818 W. 10th Ave., Vancouver V5Z 1M9, Canada
| | - James M Wakeling
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, 645 N Michigan Avenue, Chicago, IL, USA
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Modulation of soleus stretch reflexes during walking in people with chronic incomplete spinal cord injury. Exp Brain Res 2019; 237:2461-2479. [PMID: 31309252 PMCID: PMC6751142 DOI: 10.1007/s00221-019-05603-1] [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: 04/05/2019] [Accepted: 07/08/2019] [Indexed: 12/28/2022]
Abstract
In people with spasticity due to chronic incomplete spinal cord injury (SCI), it has been presumed that the abnormal stretch reflex activity impairs gait. However, locomotor stretch reflexes across all phases of walking have not been investigated in people with SCI. Thus, to understand modulation of stretch reflex excitability during spastic gait, we investigated soleus stretch reflexes across the entire gait cycle in nine neurologically normal participants and nine participants with spasticity due to chronic incomplete SCI (2.5–11 year post-injury). While the participant walked on the treadmill at his/her preferred speed, unexpected ankle dorsiflexion perturbations (6° at 250°/s) were imposed every 4–6 steps. The soleus H-reflex was also examined. In participants without SCI, spinal short-latency “M1”, spinal medium latency “M2”, and long-latency “M3” were clearly modulated throughout the step cycle; the responses were largest in the mid-stance and almost completely suppressed during the stance-swing transition and swing phases. In participants with SCI, M1 and M2 were abnormally large in the mid–late-swing phase, while M3 modulation was similar to that in participants without SCI. The H-reflex was also large in the mid–late-swing phase. Elicitation of H-reflex and stretch reflexes in the late swing often triggered clonus and affected the soleus activity in the following stance. In individuals without SCI, moderate positive correlation was found between H-reflex and stretch reflex sizes across the step cycle, whereas in participants with SCI, such correlation was weak to non-existing, suggesting that H-reflex investigation would not substitute for stretch reflex investigation in individuals after SCI.
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Onushko T, Mahtani GB, Brazg G, Hornby TG, Schmit BD. Exercise-Induced Alterations in Sympathetic-Somatomotor Coupling in Incomplete Spinal Cord Injury. J Neurotrauma 2019; 36:2688-2697. [PMID: 30696387 DOI: 10.1089/neu.2018.5719] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The aim of this study was to understand how high- and low-intensity locomotor training (LT) affects sympathetic-somatomotor (SS) coupling in people with incomplete spinal cord injury (SCI). Proper coupling between sympathetic and somatomotor systems allows controlled regulation of cardiovascular responses to exercise. In people with SCI, altered connectivity between descending pathways and spinal segments impairs sympathetic and somatomotor coordination, which may have deleterious effects during exercise and limit rehabilitation outcomes. We postulated that high-intensity LT, which repeatedly engages SS systems, would alter SS coupling. Thirteen individuals (50 ± 7.2 years) with motor incomplete spinal cord injuries (American Spinal Injury Association Impairment Scale C or D; injury level >T6) participated in a locomotor treadmill training program. Patients were randomized into either a high-intensity (high-LT; 70-85% of maximum predicted heart rate; n = 6) group or a low-intensity (low-LT; 50-65% of maximum predicted heart rate; n = 7) group and completed up to 20 LT training sessions over 4-6 weeks, 3-5 days/week. Before and after taining, we tested SS coupling by eliciting reflexive sympathetic activity through a cold stimulation, noxious stimulation, and a mental math task while we measured tendon reflexes, blood pressure, and heart rate. Participants who completed high- versus low-LT exhibited significant decreases in reflex torques during triggered sympathetic activity (cold: -83 vs. 13%, p < 0.01; pain: -65 vs. 54%, p < 0.05; mental math: -43 vs. 41%; p < 0.05). Mean arterial pressure responses to sympathetic stimuli were slightly higher following high- versus low-LT (cold: 30 vs. -1.5%; pain: 6 vs. -12%; mental math: 5 vs. 7%), although differences were not statistically significant. These results suggest that high-LT may be advantageous to low-LT to improve SS coupling in people with incomplete SCI.
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Affiliation(s)
- Tanya Onushko
- Department of Biomedical Engineering, Marquette University, Milwaukee, Wisconsin
| | - Gordhan B Mahtani
- Department of Orthopaedic Surgery, Stanford University, Stanford, California
| | | | - T George Hornby
- Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, Indianapolis, Indiana
| | - Brian D Schmit
- Department of Biomedical Engineering, Marquette University, Milwaukee, Wisconsin
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14
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Özyurt MG, Piotrkiewicz M, Topkara B, Weisskircher HW, Türker KS. Motor units as tools to evaluate profile of human Renshaw inhibition. J Physiol 2019; 597:2185-2199. [PMID: 30673125 DOI: 10.1113/jp277129] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 12/14/2018] [Indexed: 11/08/2022] Open
Abstract
KEY POINTS To uncover the synaptic profile of Renshaw inhibition on motoneurons, we stimulated thick motor axons and recorded from voluntarily-activated motor units. Stimuli generated a direct motor response on the whole muscle and an inhibitory response in active motor units. We have estimated the profile of Renshaw inhibition indirectly using the response of motor unit discharge rates to the stimulus. We have put forward a method of extrapolation that may be used to determine genuine synaptic potentials as they develop on motoneurons. These optimized techniques can be used in research and in clinics to fully appreciate Renshaw cell function in various neurological disorders. ABSTRACT Although Renshaw inhibition (RI) has been extensively studied for decades, its precise role in motor control is yet to be discovered. One of the main handicaps is a lack of reliable methods for studying RI in conscious human subjects. We stimulated the lowest electrical threshold motor axons (thickest axons) in the tibial nerve and analysed the stimulus-correlated changes in discharge of voluntarily recruited low-threshold single motor units (SMUs) from the soleus muscle. In total, 54 distinct SMUs from 12 subjects were analysed. Stimuli that generated only the direct motor response (M-only) on surface electromyography induced an inhibitory response in the low-threshold SMUs. Because the properties of RI had to be estimated indirectly using the background discharge rate of SMUs, its profile varied with the discharge rate of the SMU. The duration of RI was found to be inversely proportional to the discharge rate of SMUs. Using this important finding, we have developed a method of extrapolation for estimating RI as it develops on motoneurons in the spinal cord. The frequency methods indicated that the duration of RI was between 30 and 40 ms depending on the background firing rate of the units, and the extrapolation indicated that RI on silent motoneurons was ∼55 ms. The present study establishes a novel methodology for studying RI in human subjects and hence may serve as a tool for improving our understanding of the involvement of RI in human motor control.
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Affiliation(s)
| | - Maria Piotrkiewicz
- Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Warsaw, Poland
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15
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Locomotor Training Promotes Time-dependent Functional Recovery after Experimental Spinal Cord Contusion. Neuroscience 2018; 392:258-269. [DOI: 10.1016/j.neuroscience.2018.08.033] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 08/28/2018] [Accepted: 08/29/2018] [Indexed: 12/13/2022]
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16
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Otzel DM, Lee J, Ye F, Borst SE, Yarrow JF. Activity-Based Physical Rehabilitation with Adjuvant Testosterone to Promote Neuromuscular Recovery after Spinal Cord Injury. Int J Mol Sci 2018; 19:ijms19061701. [PMID: 29880749 PMCID: PMC6032131 DOI: 10.3390/ijms19061701] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Revised: 05/31/2018] [Accepted: 06/01/2018] [Indexed: 12/22/2022] Open
Abstract
Neuromuscular impairment and reduced musculoskeletal integrity are hallmarks of spinal cord injury (SCI) that hinder locomotor recovery. These impairments are precipitated by the neurological insult and resulting disuse, which has stimulated interest in activity-based physical rehabilitation therapies (ABTs) that promote neuromuscular plasticity after SCI. However, ABT efficacy declines as SCI severity increases. Additionally, many men with SCI exhibit low testosterone, which may exacerbate neuromusculoskeletal impairment. Incorporating testosterone adjuvant to ABTs may improve musculoskeletal recovery and neuroplasticity because androgens attenuate muscle loss and the slow-to-fast muscle fiber-type transition after SCI, in a manner independent from mechanical strain, and promote motoneuron survival. These neuromusculoskeletal benefits are promising, although testosterone alone produces only limited functional improvement in rodent SCI models. In this review, we discuss the (1) molecular deficits underlying muscle loss after SCI; (2) independent influences of testosterone and locomotor training on neuromuscular function and musculoskeletal integrity post-SCI; (3) hormonal and molecular mechanisms underlying the therapeutic efficacy of these strategies; and (4) evidence supporting a multimodal strategy involving ABT with adjuvant testosterone, as a potential means to promote more comprehensive neuromusculoskeletal recovery than either strategy alone.
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Affiliation(s)
- Dana M Otzel
- Brain Rehabilitation Research Center, Malcom Randall Veterans Affairs Medical Center, North Florida/South Georgia Veterans Health System, Gainesville, FL 32608, USA.
| | - Jimmy Lee
- Research Service, Malcom Randall Veterans Affairs Medical Center, North Florida/South Georgia Veterans Health System, Gainesville, FL 32608, USA.
| | - Fan Ye
- Research Service, Malcom Randall Veterans Affairs Medical Center, North Florida/South Georgia Veterans Health System, Gainesville, FL 32608, USA.
| | - Stephen E Borst
- Department of Applied Physiology, Kinesiology and University of Florida College of Health and Human Performance, Gainesville, FL 32603, USA.
| | - Joshua F Yarrow
- Research Service, Malcom Randall Veterans Affairs Medical Center, North Florida/South Georgia Veterans Health System, Gainesville, FL 32608, USA.
- Division of Endocrinology, Diabetes and Metabolism, University of Florida College of Medicine, Gainesville, FL 32610, USA.
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17
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Sohn WJ, Tan AQ, Hayes HB, Pochiraju S, Deffeyes J, Trumbower RD. Variability of Leg Kinematics during Overground Walking in Persons with Chronic Incomplete Spinal Cord Injury. J Neurotrauma 2018; 35:2519-2529. [PMID: 29648987 DOI: 10.1089/neu.2017.5538] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Incomplete spinal cord injury (iSCI) often leads to partial disruption of spinal pathways that are important for motor control of walking. Persons with iSCI present with deficits in walking ability in part because of inconsistent leg kinematics during stepping. Although kinematic variability is important for normal walking, growing evidence indicates that excessive variability may limit walking ability and increase reliance on assistive devices (AD) after iSCI. The purpose of this study was to assess the effects of iSCI-induced impairments on kinematic variability during overground walking. We hypothesized that iSCI results in greater variability of foot and joint displacement during overground walking compared with controls. We further hypothesized that variability is larger in persons with limited walking speed and greater reliance on ADs. To test these hypotheses, iSCI and control subjects walked overground. Kinematic variability was quantified as step-to-step foot placement variability (end-point), and variability in hip-knee, hip-ankle, and knee-ankle joint space (angular coefficient of correspondence [ACC]). We characterized sensitivity of kinematic variability to cadence, auditory cue, and AD. Supporting our hypothesis, persons with iSCI exhibited greater kinematic variability than controls, which scaled with deficits in overground walking speed (p < 0.01). Significant correlation between ACC and end-point variability, and with walking speed, indicates that both are markers of walking performance. Moreover, hip-knee and hip-ankle ACC discriminated AD use, indicating that ACC may capture AD-specific control strategies. We conclude that increased variability of foot and joint displacement are indicative of motor impairment severity and may serve as therapeutic targets to restore walking after iSCI.
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Affiliation(s)
- Won Joon Sohn
- 1 Department of Biology, Northeastern University , Boston, Massachusetts
| | - Andrew Q Tan
- 2 Department of Physical Medicine and Rehabilitation, Harvard Medical School , Boston, Massachusetts.,3 Spaulding Rehabilitation Hospital , Charlestown, Massachusetts
| | | | | | - Joan Deffeyes
- 6 Rehabilitation Medicine, Emory University , Atlanta, Georgia
| | - Randy D Trumbower
- 2 Department of Physical Medicine and Rehabilitation, Harvard Medical School , Boston, Massachusetts.,3 Spaulding Rehabilitation Hospital , Charlestown, Massachusetts
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18
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Slow Versus Fast Robot-Assisted Locomotor Training After Severe Stroke: A Randomized Controlled Trial. Am J Phys Med Rehabil 2017; 96:S165-S170. [PMID: 28796648 DOI: 10.1097/phm.0000000000000810] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND PURPOSE Robot-assisted locomotor training on a bodyweight-supported treadmill is a rehabilitation intervention that compels repetitive practice of gait movements. Standard treadmill speed may elicit rhythmic movements generated primarily by spinal circuits. Slower-than-standard treadmill speed may elicit discrete movements, which are more complex than rhythmic movements and involve cortical areas. OBJECTIVE Compare effects of fast (i.e., rhythmic) versus slow (i.e., discrete) robot-assisted locomotor training on a bodyweight-supported treadmill in subjects with chronic, severe gait deficit after stroke. METHODS Subjects (N = 18) were randomized to receive 30 sessions (5 d/wk) of either fast or slow robot-assisted locomotor training on a bodyweight-supported treadmill in an inpatient setting. Functional ambulation category, time up and go, 6-min walk test, 10-m walk test, Berg Balance Scale, and Fugl-Meyer Assessment were administered at baseline and postintervention. RESULTS The slow group had statistically significant improvement on functional ambulation category (first quartile-third quartile, P = 0.004), 6-min walk test (95% confidence interval [CI] = 1.8 to 49.0, P = 0.040), Berg Balance Scale (95% CI = 7.4 to 14.8, P < 0.0001), time up and go (95% CI = -79.1 to 5.0, P < 0.0030), and Fugl-Meyer Assessment (95% CI = 24.1 to 45.1, P < 0.0001). The fast group had statistically significant improvement on Berg Balance Scale (95% CI = 1.5 to 10.5, P = 0.02). CONCLUSIONS In initial stages of robot-assisted locomotor training on a bodyweight-supported treadmill after severe stroke, slow training targeting discrete movement may yield greater benefit than fast training.
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19
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Chen YW, Gregory C, Ye F, Harafuji N, Lott D, Lai SH, Mathur S, Scarborough M, Gibbs P, Baligand C, Vandenborne K. Molecular signatures of differential responses to exercise trainings during rehabilitation. ACTA ACUST UNITED AC 2017; 2. [PMID: 28845464 PMCID: PMC5568829 DOI: 10.15761/bgg.1000127] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The loss and recovery of muscle mass and function following injury and during rehabilitation varies among individuals. While recent expression profiling studies have illustrated transcriptomic responses to muscle disuse and remodeling, how these changes contribute to the physiological responses are not clear. In this study, we quantified the effects of immobilization and subsequent rehabilitation training on muscle size and identified molecular pathways associated with muscle responsiveness in an orthopaedic patient cohort study. The injured leg of 16 individuals with ankle injury was immobilized for a minimum of 4 weeks, followed by a 6-week rehabilitation program. The maximal cross-sectional area (CSA) of the medial gastrocnemius muscle of the immobilized and control legs were determined by T1-weighted axial MRI images. Genome-wide mRNA profiling data were used to identify molecular signatures that distinguish the patients who responded to immobilization and rehabilitation and those who were considered minimal responders. RESULTS: Using 6% change as the threshold to define responsiveness, a greater degree of changes in muscle size was noted in high responders (−14.9 ± 3.6%) compared to low responders (0.1 ± 0.0%) during immobilization. In addition, a greater degree of changes in muscle size was observed in high responders (20.5 ± 3.2%) compared to low responders (2.5 ± 0.9%) at 6-week rehabilitation. Microarray analysis showed a higher number of genes differentially expressed in the responders compared to low responders in general; with more expression changes observed at the acute stage of rehabilitation in both groups. Pathways analysis revealed top molecular pathways differentially affected in the groups, including genes involved in mitochondrial function, protein turn over, integrin signaling and inflammation. This study confirmed the extent of muscle atrophy due to immobilization and recovery by exercise training is associated with distinct remodeling signature, which can potentially be used for evaluating and predicting clinical outcomes.
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Affiliation(s)
- Yi-Wen Chen
- Research Center for Genetic Medicine, Children's National Medical Center, Washington DC, USA.,Department of Integrative Systems Biology, George Washington University, Washington DC, USA
| | - Chris Gregory
- Department of Health Sciences and Research, Medical University of South Carolina, Charleston, SC, USA
| | - Fan Ye
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, USA
| | - Naoe Harafuji
- Research Center for Genetic Medicine, Children's National Medical Center, Washington DC, USA
| | - Donovan Lott
- Department of Physical Therapy, University of Florida, Gainesville, FL, USA
| | - San-Huei Lai
- Research Center for Genetic Medicine, Children's National Medical Center, Washington DC, USA
| | - Sunita Mathur
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, USA
| | - Mark Scarborough
- Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL, USA
| | - Parker Gibbs
- Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL, USA
| | - Celine Baligand
- Department of Physiology and Functional Genomics, University of Florida, Gainesville, FL, USA
| | - Krista Vandenborne
- Department of Physical Therapy, University of Florida, Gainesville, FL, USA
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20
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Pericytes impair capillary blood flow and motor function after chronic spinal cord injury. Nat Med 2017; 23:733-741. [PMID: 28459438 PMCID: PMC5716958 DOI: 10.1038/nm.4331] [Citation(s) in RCA: 111] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 03/28/2017] [Indexed: 12/19/2022]
Abstract
Blood vessels in the central nervous system (CNS) are controlled by neuronal activity. For example, widespread vessel constriction (vessel tone) is induced by brainstem neurons that release the monoamines serotonin and noradrenaline, and local vessel dilation is induced by glutamatergic neuron activity. Here we examined how vessel tone adapts to the loss of neuron-derived monoamines after spinal cord injury (SCI) in rats. We find that, months after the imposition of SCI, the spinal cord below the site of injury is in a chronic state of hypoxia owing to paradoxical excess activity of monoamine receptors (5-HT1) on pericytes, despite the absence of monoamines. This monoamine-receptor activity causes pericytes to locally constrict capillaries, which reduces blood flow to ischemic levels. Receptor activation in the absence of monoamines results from the production of trace amines (such as tryptamine) by pericytes that ectopically express the enzyme aromatic L-amino acid decarboxylase (AADC), which synthesizes trace amines directly from dietary amino acids (such as tryptophan). Inhibition of monoamine receptors or of AADC, or even an increase in inhaled oxygen, produces substantial relief from hypoxia and improves motoneuron and locomotor function after SCI.
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21
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Gandhi P, Chan K, Verrier MC, Pakosh M, Musselman KE. Training to Improve Walking after Pediatric Spinal Cord Injury: A Systematic Review of Parameters and Walking Outcomes. J Neurotrauma 2017; 34:1713-1725. [PMID: 27869534 DOI: 10.1089/neu.2016.4501] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Walking or locomotor training is often initiated following pediatric spinal cord injury (SCI). There is no synthesis of the literature on interventions targeting walking for pediatric SCI, although this would assist future clinical trials and interventions. To address this need, we completed a systematic review to summarize the who, what, when, and how of walking interventions in children with SCI. Participant characteristics, training parameters, and walking outcomes with training in pediatric SCI were identified and compared with training parameters and outcomes in adults with SCI. The PubMed, Medline, AMED, Embase, PsycInfo, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and CINAHL databases were searched for studies that included participants aged 1-17 years with a SCI acquired post-birth, physical interventions, and pre- and post-training walking measures. Two researchers evaluated each study's risk of bias using a domain-based approach. Training parameters and walking outcomes were extracted. Total training duration (duration × frequency × number of weeks) was calculated. Thirteen pediatric studies (n = 43 children) were included; all but one were case series/reports. Risk of bias was high in the pediatric studies. A 2012 adult review was updated (11 studies added). As with adults, the training durations, frequencies, and modes used with the children varied; however, overground walking practice was included in 10/13 pediatric studies. Improvements in walking capacity, speed, and distance were comparable between children and adults. There was a trend for greater gains with greater total training durations. There is a paucity of high-quality research examining interventions targeting walking after pediatric SCI; however, intensive training, including practice overground, results in notable improvements.
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Affiliation(s)
- Payal Gandhi
- 1 Toronto Rehabilitation Institute-University Health Network , Toronto, Ontario, Canada
| | - Katherine Chan
- 1 Toronto Rehabilitation Institute-University Health Network , Toronto, Ontario, Canada
| | - Mary C Verrier
- 1 Toronto Rehabilitation Institute-University Health Network , Toronto, Ontario, Canada
- 2 Department of Physical Therapy, Rehabilitation Sciences Institute, University of Toronto , Toronto, Ontario, Canada
| | - Maureen Pakosh
- 1 Toronto Rehabilitation Institute-University Health Network , Toronto, Ontario, Canada
| | - Kristin E Musselman
- 1 Toronto Rehabilitation Institute-University Health Network , Toronto, Ontario, Canada
- 2 Department of Physical Therapy, Rehabilitation Sciences Institute, University of Toronto , Toronto, Ontario, Canada
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22
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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.
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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
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Field-Fote EC, Yang JF, Basso DM, Gorassini MA. Supraspinal Control Predicts Locomotor Function and Forecasts Responsiveness to Training after Spinal Cord Injury. J Neurotrauma 2016; 34:1813-1825. [PMID: 27673569 DOI: 10.1089/neu.2016.4565] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Restoration of walking ability is an area of great interest in the rehabilitation of persons with spinal cord injury. Because many cortical, subcortical, and spinal neural centers contribute to locomotor function, it is important that intervention strategies be designed to target neural elements at all levels of the neuraxis that are important for walking ability. While to date most strategies have focused on activation of spinal circuits, more recent studies are investigating the value of engaging supraspinal circuits. Despite the apparent potential of pharmacological, biological, and genetic approaches, as yet none has proved more effective than physical therapeutic rehabilitation strategies. By making optimal use of the potential of the nervous system to respond to training, strategies can be developed that meet the unique needs of each person. To complement the development of optimal training interventions, it is valuable to have the ability to predict future walking function based on early clinical presentation, and to forecast responsiveness to training. A number of clinical prediction rules and association models based on common clinical measures have been developed with the intent, respectively, to predict future walking function based on early clinical presentation, and to delineate characteristics associated with responsiveness to training. Further, a number of variables that are correlated with walking function have been identified. Not surprisingly, most of these prediction rules, association models, and correlated variables incorporate measures of volitional lower extremity strength, illustrating the important influence of supraspinal centers in the production of walking behavior in humans.
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Affiliation(s)
- Edelle C Field-Fote
- 1 Shepherd Center, Crawford Research Institute and Division of Physical Therapy, Emory University , Atlanta, Georgia
| | - Jaynie F Yang
- 2 Department of Physical Therapy, Faculty of Rehabilitation Medicine and Neuroscience and Mental Health Institute, Faculty of Medicine & Dentistry, University of Alberta , Edmonton, Alberta, Canada
| | - D Michele Basso
- 3 School of Health and Rehabilitation Sciences, The Ohio State University , Columbus, Ohio
| | - Monica A Gorassini
- 4 Department of Biomedical Engineering, Neuroscience and Mental Health Institute, Faculty of Medicine and Dentistry, University of Alberta , Edmonton, Alberta, Canada
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Côté MP, Murray M, Lemay MA. Rehabilitation Strategies after Spinal Cord Injury: Inquiry into the Mechanisms of Success and Failure. J Neurotrauma 2016; 34:1841-1857. [PMID: 27762657 DOI: 10.1089/neu.2016.4577] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Body-weight supported locomotor training (BWST) promotes recovery of load-bearing stepping in lower mammals, but its efficacy in individuals with a spinal cord injury (SCI) is limited and highly dependent on injury severity. While animal models with complete spinal transections recover stepping with step-training, motor complete SCI individuals do not, despite similarly intensive training. In this review, we examine the significant differences between humans and animal models that may explain this discrepancy in the results obtained with BWST. We also summarize the known effects of SCI and locomotor training on the muscular, motoneuronal, interneuronal, and supraspinal systems in human and non-human models of SCI and address the potential causes for failure to translate to the clinic. The evidence points to a deficiency in neuronal activation as the mechanism of failure, rather than muscular insufficiency. While motoneuronal and interneuronal systems cannot be directly probed in humans, the changes brought upon by step-training in SCI animal models suggest a beneficial re-organization of the systems' responsiveness to descending and afferent feedback that support locomotor recovery. The literature on partial lesions in humans and animal models clearly demonstrate a greater dependency on supraspinal input to the lumbar cord in humans than in non-human mammals for locomotion. Recent results with epidural stimulation that activates the lumbar interneuronal networks and/or increases the overall excitability of the locomotor centers suggest that these centers are much more dependent on the supraspinal tonic drive in humans. Sensory feedback shapes the locomotor output in animal models but does not appear to be sufficient to drive it in humans.
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Affiliation(s)
- Marie-Pascale Côté
- 1 Department of Neurobiology and Anatomy, Drexel University College of Medicine , Philadelphia, Pennsylvania
| | - Marion Murray
- 1 Department of Neurobiology and Anatomy, Drexel University College of Medicine , Philadelphia, Pennsylvania
| | - Michel A Lemay
- 2 Department of Bioengineering, Temple University , Philadelphia, Pennsylvania
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25
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Battistuzzo CR, Rank MM, Flynn JR, Morgan DL, Callister R, Callister RJ, Galea MP. Effects Of treadmill training on hindlimb muscles of spinal cord-injured mice. Muscle Nerve 2016; 55:232-242. [PMID: 27273462 PMCID: PMC5324672 DOI: 10.1002/mus.25211] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2016] [Indexed: 01/18/2023]
Abstract
Introduction: Treadmill training is known to prevent muscle atrophy after spinal cord injury (SCI), but the training duration required to optimize recovery has not been investigated. Methods: Hemisected mice were randomized to 3, 6, or 9 weeks of training or no training. Muscle fiber type composition and fiber cross‐sectional area (CSA) of medial gastrocnemius (MG), soleus (SOL), and tibialis anterior (TA) were assessed using ATPase histochemistry. Results: Muscle fiber type composition of SCI animals did not change with training. However, 9 weeks of training increased the CSA of type IIB and IIX fibers in TA and MG muscles. Conclusions: Nine weeks of training after incomplete SCI was effective in preventing atrophy of fast‐twitch muscles, but there were limited effects on slow‐twitch muscles and muscle fiber type composition. These data provide important evidence of the benefits of exercising paralyzed limbs after SCI. Muscle Nerve, 2016 Muscle Nerve55: 232–242, 2017
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Affiliation(s)
- Camila R Battistuzzo
- Department of Medicine (Royal Melbourne Hospital), The University of Melbourne, Parkville, Victoria, 3010, Australia
| | - Michelle M Rank
- School of Medical Sciences, RMIT University, Melbourne, Victoria, Australia.,Faculty of Health and Medicine, School of Biomedical Sciences and Pharmacy, The University of Newcastle, Newcastle, New South Wales, Australia
| | - Jamie R Flynn
- Faculty of Health and Medicine, School of Biomedical Sciences and Pharmacy, The University of Newcastle, Newcastle, New South Wales, Australia
| | - David L Morgan
- Department of Medicine (Royal Melbourne Hospital), The University of Melbourne, Parkville, Victoria, 3010, Australia
| | - Robin Callister
- Faculty of Health and Medicine, School of Biomedical Sciences and Pharmacy, The University of Newcastle, Newcastle, New South Wales, Australia
| | - Robert J Callister
- Faculty of Health and Medicine, School of Biomedical Sciences and Pharmacy, The University of Newcastle, Newcastle, New South Wales, Australia
| | - Mary P Galea
- Department of Medicine (Royal Melbourne Hospital), The University of Melbourne, Parkville, Victoria, 3010, Australia
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Reduced high-frequency motor neuron firing, EMG fractionation, and gait variability in awake walking ALS mice. Proc Natl Acad Sci U S A 2016; 113:E7600-E7609. [PMID: 27821773 DOI: 10.1073/pnas.1616832113] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Amyotrophic lateral sclerosis (ALS) is a lethal neurodegenerative disease prominently featuring motor neuron (MN) loss and paralysis. A recent study using whole-cell patch clamp recording of MNs in acute spinal cord slices from symptomatic adult ALS mice showed that the fastest firing MNs are preferentially lost. To measure the in vivo effects of such loss, awake symptomatic-stage ALS mice performing self-initiated walking on a wheel were studied. Both single-unit extracellular recordings within spinal cord MN pools for lower leg flexor and extensor muscles and the electromyograms (EMGs) of the corresponding muscles were recorded. In the ALS mice, we observed absent or truncated high-frequency firing of MNs at the appropriate time in the step cycle and step-to-step variability of the EMG, as well as flexor-extensor coactivation. In turn, kinematic analysis of walking showed step-to-step variability of gait. At the MN level, the higher frequencies absent from recordings from mutant mice corresponded with the upper range of frequencies observed for fast-firing MNs in earlier slice measurements. These results suggest that, in SOD1-linked ALS mice, symptoms are a product of abnormal MN firing due at least in part to loss of neurons that fire at high frequency, associated with altered EMG patterns and hindlimb kinematics during gait.
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Training-Specific Neural Plasticity in Spinal Reflexes after Incomplete Spinal Cord Injury. Neural Plast 2016; 2016:6718763. [PMID: 27725887 PMCID: PMC5048024 DOI: 10.1155/2016/6718763] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 07/27/2016] [Accepted: 08/03/2016] [Indexed: 11/17/2022] Open
Abstract
The neural plasticity of spinal reflexes after two contrasting forms of walking training was determined in individuals with chronic, motor-incomplete spinal cord injury (SCI). Endurance Training involved treadmill walking for as long as possible, and Precision Training involved walking precisely over obstacles and onto targets overground. Twenty participants started either Endurance or Precision Training for 2 months and then crossed over after a 2-month rest period to the other form of training for 2 months. Measures were taken before and after each phase of training and rest. The cutaneomuscular reflex (CMR) during walking was evoked in the soleus (SOL) and tibialis anterior muscles by stimulating the posterior tibial nerve at the ankle. Clonus was estimated from the EMG power in the SOL during unperturbed walking. The inhibitory component of the SOL CMR was enhanced after Endurance but not Precision Training. Clonus did not change after either form of training. Participants with lower reflex excitability tended to be better walkers (i.e., faster walking speeds) prior to training, and the reduction in clonus was significantly correlated with the improvement in walking speed and distance. Thus, reflex excitability responded in a training-specific way, with the reduction in reflex excitability related to improvements in walking function. Trial registration number is NCT01765153.
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Smith AC, Knikou M. A Review on Locomotor Training after Spinal Cord Injury: Reorganization of Spinal Neuronal Circuits and Recovery of Motor Function. Neural Plast 2016; 2016:1216258. [PMID: 27293901 PMCID: PMC4879237 DOI: 10.1155/2016/1216258] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 04/20/2016] [Indexed: 01/01/2023] Open
Abstract
Locomotor training is a classic rehabilitation approach utilized with the aim of improving sensorimotor function and walking ability in people with spinal cord injury (SCI). Recent studies have provided strong evidence that locomotor training of persons with clinically complete, motor complete, or motor incomplete SCI induces functional reorganization of spinal neuronal networks at multisegmental levels at rest and during assisted stepping. This neuronal reorganization coincides with improvements in motor function and decreased muscle cocontractions. In this review, we will discuss the manner in which spinal neuronal circuits are impaired and the evidence surrounding plasticity of neuronal activity after locomotor training in people with SCI. We conclude that we need to better understand the physiological changes underlying locomotor training, use physiological signals to probe recovery over the course of training, and utilize established and contemporary interventions simultaneously in larger scale research studies. Furthermore, the focus of our research questions needs to change from feasibility and efficacy to the following: what are the physiological mechanisms that make it work and for whom? The aforementioned will enable the scientific and clinical community to develop more effective rehabilitation protocols maximizing sensorimotor function recovery in people with SCI.
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Affiliation(s)
- Andrew C. Smith
- Interdepartmental Neuroscience Program, Northwestern University, Chicago, IL 60611, USA
| | - Maria Knikou
- The Graduate Center, City University of New York, New York, NY 10016, USA
- Department of Physical Therapy, College of Staten Island, City University of New York, Staten Island, NY 10314, USA
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Moriello G, Proper D, Cool S, Fink S, Schock S, Mayack J. Yoga therapy in an individual with spinal cord injury: A case report. J Bodyw Mov Ther 2015; 19:581-91. [PMID: 26592214 DOI: 10.1016/j.jbmt.2014.08.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Revised: 07/28/2014] [Accepted: 08/03/2014] [Indexed: 12/01/2022]
Abstract
No known research addresses the effects of yoga in those with spinal cord injury (SCI), yet yoga has the potential to improve many impairments commonly associated with SCI. This case report documents the outcomes of a yoga program in an individual with an SCI. The participant was a 59-year-old male who sustained an incomplete C3-C6 SCI. He practiced Hatha yoga for 60-min sessions, twice per week for 12 weeks and despite neurological injury, was able to complete a yoga program with modifications. Improvements were noted in balance; endurance; flexibility; posture; muscle strength of the hip extensors, hip abductors and knee extensors; and in performance of functional goals. No changes were noted in gait velocity, satisfaction in performance of goals or in overall quality of life. The participant was able to practice yoga even though he used an assistive device to walk.
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Affiliation(s)
| | - Dacia Proper
- St. Peters Health Partners, Albany, NY 12208, USA
| | | | | | | | - Jennifer Mayack
- Living Resources Certified Home Health Agency, Schenectady, NY 12309, USA
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Duffell LD, Brown GL, Mirbagheri MM. Facilitatory effects of anti-spastic medication on robotic locomotor training in people with chronic incomplete spinal cord injury. J Neuroeng Rehabil 2015; 12:29. [PMID: 25881322 PMCID: PMC4376342 DOI: 10.1186/s12984-015-0018-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 02/19/2015] [Indexed: 12/23/2022] Open
Abstract
Background The objective of this study was to investigate whether an anti-spasticity medication can facilitate the effects of robotic locomotor treadmill training (LTT) to improve gait function in people with incomplete spinal cord injury (SCI). Methods Individuals with chronic incomplete SCI were recruited and carried out a 4 week intervention of either locomotor treadmill training (LTT) alone (n = 26) or LTT combined with Tizanidine (TizLTT), an anti-spasticity medication (n = 22). Gait function was evaluated using clinical outcome measures of gait, speed and endurance. To better understand the underlying mechanisms of the therapeutic effects, maximal strength, active range of motion (AROM) and peak velocity (Vp) of ankle dorsi- and planter-flexor muscles were also measured. Differences were assessed using two-way mixed design analysis of variance. The number of subjects that achieved the minimal important difference (MID) for clinical scores was also measured for each group, and the results of those that did attain the MID were compared with those that did not. Results Both LTT and TizLTT resulted in significant improvements in walking speed and dorsiflexion maximum strength, with no significant differences between them, using group-averaging analysis. However, using the MID analysis, a higher proportion of subjects in the TizLTT group achieved the MID for walking speed (40%) compared with LTT alone (13%). Those that achieved the MID for walking speed were significantly higher functioning at baseline than those that did not in the TizLTT group, and the change in walking speed was associated with the change in dorsiflexion peak velocity (R2 = 0.40; P < 0.05). Conclusion Tizanidine appears to facilitate the effects of LTT on gait function in individuals with chronic SCI that are higher functioning at baseline. We speculate that this may be due to restoration of inhibitory mechanisms by Tizanidine, resulting in greater stretch in the planterflexor muscles during the LTT.
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Affiliation(s)
- Lynsey D Duffell
- Department of Physical Medicine and Rehabilitation, Northwestern University, 345 E Superior Street, Chicago, USA.
| | - Geoffrey L Brown
- Sensory Motor Performance Program, Rehabilitation Institute of Chicago, 345 E Superior Street, Chicago, USA.
| | - Mehdi M Mirbagheri
- Department of Physical Medicine and Rehabilitation, Northwestern University, 345 E Superior Street, Chicago, USA. .,Sensory Motor Performance Program, Rehabilitation Institute of Chicago, 345 E Superior Street, Chicago, USA.
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Facilitation of descending excitatory and spinal inhibitory networks from training of endurance and precision walking in participants with incomplete spinal cord injury. PROGRESS IN BRAIN RESEARCH 2015; 218:127-55. [DOI: 10.1016/bs.pbr.2014.12.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Frigon A. Responders and non-responders in motor control research: A framework to study physiological mechanisms of inter-individual variability. Clin Neurophysiol 2014; 126:1284-5. [PMID: 25468235 DOI: 10.1016/j.clinph.2014.10.143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2014] [Accepted: 10/21/2014] [Indexed: 11/19/2022]
Affiliation(s)
- Alain Frigon
- Department of Physiology and Biophysics, Faculty of Medicine and Health Sciences, Centre de Recherche du CHUS, Université de Sherbrooke, 3001, 12e Avenue Nord, Sherbrooke, Quebec J1H 5N4, Canada.
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Meyns P, Van de Crommert HWAA, Rijken H, van Kuppevelt DHJM, Duysens J. Locomotor training with body weight support in SCI: EMG improvement is more optimally expressed at a low testing speed. Spinal Cord 2014; 52:887-93. [PMID: 25311847 DOI: 10.1038/sc.2014.172] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Revised: 07/24/2014] [Accepted: 09/06/2014] [Indexed: 01/13/2023]
Abstract
STUDY DESIGN Case series. OBJECTIVES To determine the optimal testing speed at which the recovery of the EMG (electromyographic) activity should be assessed during and after body weight supported (BWS) locomotor training. SETTING Tertiary hospital, Sint Maartenskliniek, Nijmegen, The Netherlands. METHODS Four participants with incomplete chronic SCI were included for BWS locomotor training; one AIS-C and three AIS-D (according to the ASIA (American Spinal Injury Association) Impairment Scale or AIS). All were at least 5 years after injury. The SCI participants were trained three times a week for a period of 6 weeks. They improved their locomotor function in terms of higher walking speed, less BWS and less assistance needed. To investigate which treadmill speed for EMG assessment reflects the functional improvement most adequately, all participants were assessed weekly using the same two speeds (0.5 and 1.5 km h(-1), referred to as low and high speed, respectively) for 6 weeks. The change in root mean square EMG (RMS EMG) was assessed in four leg muscles; biceps femoris, rectus femoris, gastrocnemius medialis and tibialis anterior. RESULTS The changes in RMS EMG occurred at similar phases of the step cycle for both walking conditions, but these changes were larger when the treadmill was set at a low speed (0.5 km h(-1)). CONCLUSION Improvement in gait is feasible with BWS treadmill training even long after injury. The EMG changes after treadmill training are more optimally expressed using a low rather than a high testing treadmill speed.
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Affiliation(s)
- P Meyns
- Movement control and Neuroplasticity, Department of Kinesiology, Faculty of Kinesiology and Rehabilitation Sciences, KU Leuven, Heverlee, Belgium
| | - H W A A Van de Crommert
- 1] Department of Research, Development and Education, Sint Maartenskliniek, Nijmegen, The Netherlands [2] Institute of Human Movement Sciences, University of Groningen, Groningen, The Netherlands
| | - H Rijken
- Department of Research, Development and Education, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - D H J M van Kuppevelt
- Department of Research, Development and Education, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - J Duysens
- 1] Department of Research, Development and Education, Sint Maartenskliniek, Nijmegen, The Netherlands [2] Motor Control Laboratory, Movement Control and Neuroplasticity, Department of Kinesiology, Faculty of Kinesiology and Rehabilitation Sciences, KU Leuven, Heverlee, Belgium
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Mari S, Serrao M, Casali C, Conte C, Martino G, Ranavolo A, Coppola G, Draicchio F, Padua L, Sandrini G, Pierelli F. Lower limb antagonist muscle co-activation and its relationship with gait parameters in cerebellar ataxia. THE CEREBELLUM 2014; 13:226-36. [PMID: 24170572 DOI: 10.1007/s12311-013-0533-4] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Increased antagonist muscle co-activation, seen in motor-impaired individuals, is an attempt by the neuromuscular system to provide mechanical stability by stiffening joints. The aim of this study was to investigate the co-activation pattern of the antagonist muscles of the ankle and knee joints during walking in patients with cerebellar ataxia, a neurological disease that strongly affects stability. Kinematic and electromyographic parameters of gait were recorded in 17 patients and 17 controls. Ankle and knee antagonist muscle co-activation indexes were measured throughout the gait cycle and during the sub-phases of gait. The indexes of ataxic patients were compared with those of controls and correlated with clinical and gait variables. Patients showed increased co-activity indexes of both ankle and knee muscles during the gait cycle as well as during the gait sub-phases. Both knee and ankle muscle co-activation indexes were positively correlated with disease severity, while ankle muscle co-activation was also positively correlated with stance and swing duration variability. Significant negative correlations were observed between the number of self-reported falls per year and knee muscle co-activation. The increased co-activation observed in these cerebellar ataxia patients may represent a compensatory strategy serving to reduce gait instability. Indeed, this mechanism allows patients to reduce the occurrence of falls. The need for this strategy, which results in excessive muscle co-contraction, increased metabolic costs and cartilage degeneration processes, could conceivably be overcome through the use of supportive braces specially designed to provide greater joint stability.
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Anwer S, Equebal A, Palekar TJ, Nezamuddin M, Neyaz O, Alghadir A. Effect of locomotor training on motor recovery and walking ability in patients with incomplete spinal cord injury: a case series. J Phys Ther Sci 2014; 26:951-3. [PMID: 25013303 PMCID: PMC4085228 DOI: 10.1589/jpts.26.951] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Accepted: 01/08/2014] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The aim of this study was to describe the effect of locomotor training on a
treadmill for three individuals who have an incomplete spinal cord injury (SCI). [Subjects
and Methods] Three indivduals (2 males, 1 female) with incomplete paraplegia participated
in this prospective case series. All subjects participated in locomotor training for a
maximum of 20 minutes on a motorized treadmill without elevation at a comfortable walking
speed three days a week for four weeks as an adjunct to a conventional physiotherapy
program. The lower extremity strength and walking capabilities were used as the outcome
measures of this study. Lower extremity strength was measured by lower extremity motor
score (LEMS). Walking capability was assessed using the Walking Index for Spinal Cord
Injury (WISCI II). [Results] An increase in lower extremity motor score and walking
capabilities at the end of training program was found. [Conclusion] Gait training on a
treadmill can enhance motor recovery and walking capabilities in subjects with incomplete
SCI. Further research is needed to generalize these findings and to identify which
patients might benefit from locomotor training.
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Affiliation(s)
- Shahnawaz Anwer
- Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, KSA ; Padmashree Dr. D. Y. Patil College of Physiotherapy, Dr. D. Y. Patil Vidyapeeth India
| | - Ameed Equebal
- National Institute for the Orthopedically Handicapped (NIOH), India
| | - Tushar J Palekar
- Padmashree Dr. D. Y. Patil College of Physiotherapy, Dr. D. Y. Patil Vidyapeeth India
| | - M Nezamuddin
- National Institute for the Orthopedically Handicapped (NIOH), India
| | - Osama Neyaz
- National Institute for the Orthopedically Handicapped (NIOH), India
| | - Ahmad Alghadir
- Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, KSA
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Metabolic demand and muscle activation during different forms of bodyweight supported locomotion in men with incomplete SCI. BIOMED RESEARCH INTERNATIONAL 2014; 2014:632765. [PMID: 24971340 PMCID: PMC4055602 DOI: 10.1155/2014/632765] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Revised: 04/18/2014] [Accepted: 04/23/2014] [Indexed: 12/02/2022]
Abstract
Body weight supported locomotor training uses neuroplasticity principles to improve recovery following a spinal cord injury (SCI). Steady state locomotion using the same body weight support (BWS) percent was compared in 7 males (42.6 ± 4.29 years) with incomplete SCI and matched (gender, age) noninjured controls (42.7 ± 5.4 years) using the Lokomat, Manual Treadmill, and ZeroG. The VO2000, Polar Heart Rate (HR) Monitor, and lower limb electromyography (EMG) electrodes were worn during the 2-minute sessions. Oxygen uptake (VO2) and HR were expressed as percentage of peak values obtained using progressive arm ergometry; VO2 was also expressed relative to resting metabolic equivalents (METS). Filtered EMG signals from tibialis anterior (TA), rectus femoris (RF), biceps femoris (BF), and medial gastrocnemius (MG) were normalized to ZeroG stepping. The Lokomat required 30% of VO2 peak (2METS) compared to ~54% (3METS) for Manual Treadmill and ZeroG sessions. HR was 67% of peak during Lokomat sessions compared to ~83% for Manual Treadmill and ZeroG. Muscle activation was higher in treadmill conditions compared to the ZeroG primarily due to increased BF activity. At the same level of BWS, locomotion using the Manual Treadmill or the ZeroG is more aerobically demanding than the Lokomat. Treadmill modalities encourage greater hip extensor activation compared to overground locomotion.
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D'Amico JM, Condliffe EG, Martins KJB, Bennett DJ, Gorassini MA. Recovery of neuronal and network excitability after spinal cord injury and implications for spasticity. Front Integr Neurosci 2014; 8:36. [PMID: 24860447 PMCID: PMC4026713 DOI: 10.3389/fnint.2014.00036] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Accepted: 04/17/2014] [Indexed: 01/08/2023] Open
Abstract
The state of areflexia and muscle weakness that immediately follows a spinal cord injury (SCI) is gradually replaced by the recovery of neuronal and network excitability, leading to both improvements in residual motor function and the development of spasticity. In this review we summarize recent animal and human studies that describe how motoneurons and their activation by sensory pathways become hyperexcitable to compensate for the reduction of functional activation of the spinal cord and the eventual impact on the muscle. Specifically, decreases in the inhibitory control of sensory transmission and increases in intrinsic motoneuron excitability are described. We present the idea that replacing lost patterned activation of the spinal cord by activating synaptic inputs via assisted movements, pharmacology or electrical stimulation may help to recover lost spinal inhibition. This may lead to a reduction of uncontrolled activation of the spinal cord and thus, improve its controlled activation by synaptic inputs to ultimately normalize circuit function. Increasing the excitation of the spinal cord with spared descending and/or peripheral inputs by facilitating movement, instead of suppressing it pharmacologically, may provide the best avenue to improve residual motor function and manage spasticity after SCI.
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Affiliation(s)
- Jessica M D'Amico
- Centre for Neuroscience, University of Alberta Edmonton, AB, Canada ; Faculty of Medicine and Dentistry, University of Alberta Edmonton, AB, Canada
| | - Elizabeth G Condliffe
- Centre for Neuroscience, University of Alberta Edmonton, AB, Canada ; Faculty of Medicine and Dentistry, University of Alberta Edmonton, AB, Canada ; Department of Biomedical Engineering, University of Alberta Edmonton, AB, Canada ; Division of Physical Medicine and Rehabilitation, University of Alberta Edmonton, AB, Canada
| | - Karen J B Martins
- Centre for Neuroscience, University of Alberta Edmonton, AB, Canada ; Faculty of Physical Education and Recreation, University of Alberta Edmonton, AB, Canada
| | - David J Bennett
- Centre for Neuroscience, University of Alberta Edmonton, AB, Canada ; Faculty of Rehabilitation Medicine, University of Alberta Edmonton, AB, Canada
| | - Monica A Gorassini
- Centre for Neuroscience, University of Alberta Edmonton, AB, Canada ; Faculty of Medicine and Dentistry, University of Alberta Edmonton, AB, Canada ; Department of Biomedical Engineering, University of Alberta Edmonton, AB, Canada
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Hayes HB, Chvatal SA, French MA, Ting LH, Trumbower RD. Neuromuscular constraints on muscle coordination during overground walking in persons with chronic incomplete spinal cord injury. Clin Neurophysiol 2014; 125:2024-35. [PMID: 24618214 DOI: 10.1016/j.clinph.2014.02.001] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Revised: 01/11/2014] [Accepted: 02/03/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Incomplete spinal cord injury (iSCI) disrupts motor control and limits the ability to coordinate muscles for overground walking. Inappropriate muscle activity has been proposed as a source of clinically observed walking deficits after iSCI. We hypothesized that persons with iSCI exhibit lower locomotor complexity compared to able-body (AB) controls as reflected by fewer motor modules, as well as, altered module composition and activation. METHODS Eight persons with iSCI and eight age-matched AB controls walked overground at prescribed cadences. Electromyograms of fourteen single leg muscles were recorded. Non-negative matrix factorization was used to identify the composition and activation of motor modules, which represent groups of consistently co-activated muscles that accounted for 90% of variability in muscle activity. RESULTS Motor module number, composition, and activation were significantly altered in persons with iSCI as compared to AB controls during overground walking at self-selected cadences. However, there was no significant difference in module number between persons with iSCI and AB controls when cadence and assistive device were matched. CONCLUSIONS Muscle coordination during overground walking is impaired after chronic iSCI. SIGNIFICANCE Our results are indicative of neuromuscular constraints on muscle coordination after iSCI. Altered muscle coordination contributes to person-specific gait deficits during overground walking.
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Affiliation(s)
- Heather B Hayes
- Dept. of Rehabilitation Medicine, Emory University, Atlanta, GA, USA
| | - Stacie A Chvatal
- Dept. of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - Margaret A French
- Dept. of Rehabilitation Medicine, Emory University, Atlanta, GA, USA
| | - Lena H Ting
- Dept. of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - Randy D Trumbower
- Dept. of Rehabilitation Medicine, Emory University, Atlanta, GA, USA; Dept. of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, USA.
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Siedziewski L, Schaaf RC, Mount J. Use of robotics in spinal cord injury: a case report. Am J Occup Ther 2013; 66:51-8. [PMID: 22389939 DOI: 10.5014/ajot.2012.000943] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE We examined the use of robotics to treat upper-extremity (UE) dysfunction in tetraplegic patients with spinal cord injury (SCI). METHOD a 51-yr-old man with incomplete SCI participated in an occupational therapy program that combined traditional occupational therapy with Reo Go®, a comprehensive therapy platform that includes a robotic guide featuring a telescopic arm to enable high repetitions of functionally relevant UE exercises. RESULTS The participant demonstrated measurable improvements in active range of motion, muscle strength as measured through manual muscle testing, perceived right UE function, and self-care performance as measured by the FIM™. CONCLUSION The findings from this case are promising and demonstrate the Reo Go's utility in combination with traditional occupational therapy. However, more research and specific protocols that are easily reproducible with robots such as the Reo Go are needed to validate this evolving treatment area.
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Affiliation(s)
- Lori Siedziewski
- Spinal Cord Injury Unit, Moss Rehab Hospital, 60 Township Road, Elkins Park, PA 19027, USA.
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Dutra CMR, Dutra CMR, Moser ADDL, Manffra EF. Treino locomotor com suporte parcial de peso corporal na reabilitação da lesão medular: revisão da literatura. FISIOTERAPIA EM MOVIMENTO 2013. [DOI: 10.1590/s0103-51502013000400019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUÇÃO: O treino locomotor com suporte de peso corporal (TLSP) é utilizado há aproximadamente 20 anos no campo da reabilitação em pacientes que sofrem de patologias neurológicas. O TLSP favorece melhoras osteomusculares, cardiovasculares e psicológicas, pois desenvolve ao máximo o potencial residual do organismo, proporcionando a reintegração na convivência familiar, profissional e social. OBJETIVO: Identificar as principais modalidades de TLSP e seus parâmetros de avaliação com a finalidade de contribuir com o estabelecimento de evidências confiáveis para as práticas reabilitativas de pessoas com lesão medular. MATERIAIS E MÉTODOS: Foram analisados artigos originais, publicados entre 2000 e 2011, que envolvessem treino de marcha após a lesão medular, com ou sem suporte parcial de peso corporal, e tecnologias na assistência do treino, como biofeedback e estimulação elétrica funcional, entre outras. RESULTADOS: A maioria dos participantes dos estudos era do sexo masculino; os níveis de lesão variavam de C3 a L3; ASIA teve pontuações de A a D; os tempos de lesão variaram entre 0,3 meses a 33 anos. Também se verificou que não há consenso em relação ao protocolo de TLSP. CONCLUSÃO: O treino locomotor com suporte de peso corporal mostra-se viável na reabilitação de pacientes que sofrem de uma patologia neurológica como a lesão medular. Independentemente do protocolo de treino utilizado, os benefícios referentes ao aumento da força muscular, manutenção ou aumento da densidade óssea, diminuição da frequência cardíaca e aumento do condicionamento físico estão presentes
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Harkema SJ, Hillyer J, Schmidt-Read M, Ardolino E, Sisto SA, Behrman AL. Locomotor training: as a treatment of spinal cord injury and in the progression of neurologic rehabilitation. Arch Phys Med Rehabil 2012; 93:1588-97. [PMID: 22920456 DOI: 10.1016/j.apmr.2012.04.032] [Citation(s) in RCA: 107] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2012] [Revised: 03/28/2012] [Accepted: 04/12/2012] [Indexed: 12/14/2022]
Abstract
Scientists, clinicians, administrators, individuals with spinal cord injury (SCI), and caregivers seek a common goal: to improve the outlook and general expectations of the adults and children living with neurologic injury. Important strides have already been accomplished; in fact, some have labeled the changes in neurologic rehabilitation a "paradigm shift." Not only do we recognize the potential of the damaged nervous system, but we also see that "recovery" can and should be valued and defined broadly. Quality-of-life measures and the individual's sense of accomplishment and well-being are now considered important factors. The ongoing challenge from research to clinical translation is the fine line between scientific uncertainty (ie, the tenet that nothing is ever proven) and the necessary burden of proof required by the clinical community. We review the current state of a specific SCI rehabilitation intervention (locomotor training), which has been shown to be efficacious although thoroughly debated, and summarize the findings from a multicenter collaboration, the Christopher and Dana Reeve Foundation's NeuroRecovery Network.
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Affiliation(s)
- Susan J Harkema
- Department of Neurological Surgery, Kentucky Spinal Cord Research Center, University of Louisville, Louisville, KY, USA.
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Yang JF, Musselman KE. Training to achieve over ground walking after spinal cord injury: a review of who, what, when, and how. J Spinal Cord Med 2012; 35:293-304. [PMID: 23031166 PMCID: PMC3459558 DOI: 10.1179/2045772312y.0000000036] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
OBJECTIVES (1) To provide clinicians with the best evidence for effective retraining of walking after spinal cord injury (SCI) to achieve over ground walking. (2) To identify gaps in our knowledge to guide future research. METHODS Articles that addressed the retraining of walking in adults with SCI and reported outcome measures of over ground walking ability were identified through a non-systematic search of the PubMed, Scopus, and CINAHL databases. No restriction was applied to the method of training. Selected articles were appraised using the Physiotherapy Evidence Database scale. Information was synthesized to answer who best responds to what type of treatment, how that treatment should be delivered, and at what stage after injury. RESULTS Individuals with motor incomplete SCI (American Spinal Injury Association (ASIA) Impairment scale (AIS) C and D) are most likely to regain walking over ground. The effective methods of training all involved a substantial component of walking in the training, and if assistance was provided, partial assistance was more effective than total assistance. Walking training resulted in a change in over ground walking speed of 0.06-0.77 m/s, and 6 minute walk distance of 24-357 m. The effective training schedules ranged from 10 to 130 sessions, with a density of sessions ranging from 2 per week to 5 per week. Earlier training led to superior results both in the subacute (<6 months) and chronic phases (>6 months) after injury, but even individuals with chronic injuries of long duration can improve. CONCLUSIONS Frequent, early treatment for individuals with motor incomplete SCI using walking as the active ingredient whether on the treadmill or over ground, generally leads to improved walking over ground. Much work remains for the future, including better quantification of treatment intensity, better outcome measures to quantify a broader range of walking skills, and better ways to retrain individuals with more severe lesions (AIS A and B).
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Affiliation(s)
- Jaynie F Yang
- Department of Physical Therapy and Centre for Neuroscience, University of Alberta, Edmonton, AB, Canada.
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Spiess MR, Jaramillo JP, Behrman AL, Teraoka JK, Patten C. Unexpected Recovery After Robotic Locomotor Training at Physiologic Stepping Speed: A Single-Case Design. Arch Phys Med Rehabil 2012; 93:1476-84. [DOI: 10.1016/j.apmr.2012.02.030] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2011] [Revised: 02/21/2012] [Accepted: 02/25/2012] [Indexed: 01/10/2023]
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Domingo A, Al-Yahya AA, Asiri Y, Eng JJ, Lam T. A systematic review of the effects of pharmacological agents on walking function in people with spinal cord injury. J Neurotrauma 2012; 29:865-79. [PMID: 22142289 PMCID: PMC4496059 DOI: 10.1089/neu.2011.2052] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Studies of spinalized animals indicate that some pharmacological agents may act on receptors in the spinal cord, helping to produce coordinated locomotor movement. Other drugs may help to ameliorate the neuropathological changes resulting from spinal cord injury (SCI), such as spasticity or demyelination, to improve walking. The purpose of this study was to systematically review the effects of pharmacological agents on gait in people with SCI. A keyword literature search of articles that evaluated the effects of drugs on walking after SCI was performed using the databases MEDLINE/PubMed, CINAHL, EMBASE, PsycINFO, and hand searching. Two reviewers independently evaluated each study, using the Physiotherapy Evidence Database (PEDro) tool for randomized clinical trials (RCTs), and the modified Downs & Black scale for all other studies. Results were tabulated and levels of evidence were assigned. Eleven studies met the inclusion criteria. One RCT provided Level 1 evidence that GM-1 ganglioside in combination with physical therapy improved motor scores, walking velocity, and distance better than placebo and physical therapy in persons with incomplete SCI. Multiple studies (levels of evidence 1-5) showed that clonidine and cyproheptadine may improve locomotor function and walking speed in severely impaired individuals with incomplete SCI. Gains in walking speed associated with GM-1, cyproheptadine, and clonidine are low compared to those seen with locomotor training. There was also Level 1 evidence that 4-aminopyridine and L-dopa were no better than placebo in helping to improve gait. Two Level 5 studies showed that baclofen had little to no effect on improving walking in persons with incomplete SCI. There is limited evidence that pharmacological agents tested so far would facilitate the recovery of walking after SCI. More studies are needed to better understand the effects of drugs combined with gait training on walking outcomes in people with SCI.
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Affiliation(s)
- Antoinette Domingo
- School of Kinesiology, University of British Columbia, Vancouver, British Columbia, Canada.
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Piotrkiewicz M, Kudina L. Analysis of motoneuron responses to composite synaptic volleys (computer simulation study). Exp Brain Res 2012; 217:209-21. [PMID: 22198533 PMCID: PMC3282905 DOI: 10.1007/s00221-011-2987-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2011] [Accepted: 12/09/2011] [Indexed: 01/07/2023]
Abstract
This paper deals with the analysis of changes in motoneuron (MN) firing evoked by repetitively applied stimuli aimed toward extracting information about the underlying synaptic volleys. Spike trains were obtained from computer simulations based on a threshold-crossing model of tonically firing MN, subjected to stimulation producing postsynaptic potentials (PSPs) of various parameters. These trains were analyzed as experimental results, using the output measures that were previously shown to be most effective for this purpose: peristimulus time histogram, raster plot and peristimulus time intervalgram. The analysis started from the effects of single excitatory and inhibitory PSPs (EPSPs and IPSPs). The conclusions drawn from this analysis allowed the explanation of the results of more complex synaptic volleys, i.e., combinations of EPSPs and IPSPs, and the formulation of directions for decoding the results of human neurophysiological experiments in which the responses of tonically firing MNs to nerve stimulation are analyzed.
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Affiliation(s)
- Maria Piotrkiewicz
- Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Warsaw, Poland.
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Nadeau S, Duclos C, Bouyer L, Richards CL. Guiding task-oriented gait training after stroke or spinal cord injury by means of a biomechanical gait analysis. PROGRESS IN BRAIN RESEARCH 2011; 192:161-80. [PMID: 21763525 DOI: 10.1016/b978-0-444-53355-5.00011-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
To recover the ability to walk is one of the most important goals of persons recovering from a stroke or spinal cord injury (SCI). While a task-oriented approach to gait training is recommended, randomized controlled trials or meta-analyses comparing different methods of delivering training have failed in general to demonstrate the superiority of one approach over the other. The large variations in the mean outcome gait measures reported in these studies reflect, at least in part, the heterogeneity of the sensorimotor impairments underlying the gait disability as well as variations in the therapeutic response. The purpose of this chapter is to demonstrate that biomechanical gait analysis can reveal information pertinent to the selection of a task-oriented approach to enhance gait training as well as the therapeutic response that clinical evaluations alone cannot provide. We first briefly review locomotor impairments underlying the gait disability after stroke and SCI as well as the effects of selected technological task-oriented gait training interventions. We then give examples that demonstrate the use of gait analysis to pinpoint underlying impairments that can guide the choice of sensorimotor therapy and then immediately identify responders to the intervention. Such an individualized approach should promote therapeutic efficacy while leading over time to the identification of clinical indices to guide therapy when gait analysis is not feasible. Given the requirements of a gait analysis laboratory and the qualified personnel to capture and interpret the data, future studies will need to demonstrate the feasibility of the technological proposed approach and assess the costs and benefits for the health care system.
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Affiliation(s)
- Sylvie Nadeau
- Pathokinesiology Laboratory, Centre for Interdisciplinary Research in Rehabilitation, Institut de réadaptation Gingras-Lindsay-de-Montréal, Montréal, Québec, Canada.
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Alexeeva N, Sames C, Jacobs PL, Hobday L, Distasio MM, Mitchell SA, Calancie B. Comparison of training methods to improve walking in persons with chronic spinal cord injury: a randomized clinical trial. J Spinal Cord Med 2011; 34:362-79. [PMID: 21903010 PMCID: PMC3152808 DOI: 10.1179/2045772311y.0000000018] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
OBJECTIVE To compare two forms of device-specific training - body-weight-supported (BWS) ambulation on a fixed track (TRK) and BWS ambulation on a treadmill (TM) - to comprehensive physical therapy (PT) for improving walking speed in persons with chronic, motor-incomplete spinal cord injury (SCI). METHODS Thirty-five adult subjects with a history of chronic SCI (>1 year; AIS 'C' or 'D') participated in a 13-week (1 hour/day; 3 days per week) training program. Subjects were randomized into one of the three training groups. Subjects in the two BWS groups trained without the benefit of additional input from a physical therapist or gait expert. For each training session, performance values and heart rate were monitored. Pre- and post-training maximal 10-m walking speed, balance, muscle strength, fitness, and quality of life were assessed in each subject. RESULTS All three training groups showed significant improvement in maximal walking speed, muscle strength, and psychological well-being. A significant improvement in balance was seen for PT and TRK groups but not for subjects in the TM group. In all groups, post-training measures of fitness, functional independence, and perceived health and vitality were unchanged. CONCLUSIONS Our results demonstrate that persons with chronic, motor-incomplete SCI can improve walking ability and psychological well-being following a concentrated period of ambulation therapy, regardless of training method. Improvement in walking speed was associated with improved balance and muscle strength. In spite of the fact that we withheld any formal input of a physical therapist or gait expert from subjects in the device-specific training groups, these subjects did just as well as subjects receiving comprehensive PT for improving walking speed and strength. It is likely that further modest benefits would accrue to those subjects receiving a combination of device-specific training with input from a physical therapist or gait expert to guide that training.
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Murray KC, Stephens MJ, Rank M, D'Amico J, Gorassini MA, Bennett DJ. Polysynaptic excitatory postsynaptic potentials that trigger spasms after spinal cord injury in rats are inhibited by 5-HT1B and 5-HT1F receptors. J Neurophysiol 2011; 106:925-43. [PMID: 21653728 PMCID: PMC3154834 DOI: 10.1152/jn.01011.2010] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2010] [Accepted: 05/26/2011] [Indexed: 02/07/2023] Open
Abstract
Sensory afferent transmission and associated spinal reflexes are normally inhibited by serotonin (5-HT) derived from the brain stem. Spinal cord injury (SCI) that eliminates this 5-HT innervation leads to a disinhibition of sensory transmission and a consequent emergence of unusually long polysynaptic excitatory postsynaptic potentials (EPSPs) in motoneurons. These EPSPs play a critical role in triggering long polysynaptic reflexes (LPRs) that initiate muscles spasms. In the present study we examined which 5-HT receptors modulate the EPSPs and whether these receptors adapt to a loss of 5-HT after chronic spinal transection in rats. The EPSPs and associated LPRs recorded in vitro in spinal cords from chronic spinal rats were consistently inhibited by 5-HT(1B) or 5-HT(1F) receptor agonists, including zolmitriptan (5-HT(1B/1D/1F)) and LY344864 (5-HT(1F)), with a sigmoidal dose-response relation, from which we computed the 50% inhibition (EC(50)) and potency (-log EC(50)). The potencies of 5-HT receptor agonists were highly correlated with their binding affinity to 5-HT(1B) and 5-HT(1F) receptors, and not to other 5-HT receptors. Zolmitriptan also inhibited the LPRs and general muscle spasms recorded in vivo in the awake chronic spinal rat. The 5-HT(1B) receptor antagonists SB216641 and GR127935 and the inverse agonist SB224289 reduced the inhibition of LPRs by 5-HT(1B) agonists (zolmitriptan). However, when applied alone, SB224289, SB216641, and GR127935 had no effect on the LPRs, indicating that 5-HT(1B) receptors do not adapt to chronic injury, remaining silent, without constitutive activity. The reduction in EPSPs with zolmitriptan unmasked a large glycine-mediated inhibitory postsynaptic current (IPSC) after SCI. This IPSC and associated chloride current reversed at -73 mV, slightly below the resting membrane potential. Zolmitriptan did not change motoneuron properties. Our results demonstrate that 5-HT(1B/1F) agonists, such as zolmitriptan, can restore inhibition of sensory transmission after SCI without affecting general motoneuron function and thus may serve as a novel class of antispastic drugs.
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Affiliation(s)
- Katherine C Murray
- Centre for Neuroscience, University of Alberta, Edmonton, Alberta, Canada
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Harkema SJ, Schmidt-Read M, Lorenz DJ, Edgerton VR, Behrman AL. Balance and ambulation improvements in individuals with chronic incomplete spinal cord injury using locomotor training-based rehabilitation. Arch Phys Med Rehabil 2011; 93:1508-17. [PMID: 21777905 DOI: 10.1016/j.apmr.2011.01.024] [Citation(s) in RCA: 142] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2010] [Revised: 12/08/2010] [Accepted: 01/06/2011] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate the effects of intensive locomotor training on balance and ambulatory function at enrollment and discharge during outpatient rehabilitation after incomplete SCI. DESIGN Prospective observational cohort. SETTING Seven outpatient rehabilitation centers from the Christopher and Dana Reeve Foundation NeuroRecovery Network (NRN). PARTICIPANTS Patients (N=196) with American Spinal Injury Association Impairment Scale (AIS) grade C or D SCI who received at least 20 locomotor training treatment sessions in the NRN. INTERVENTIONS Intensive locomotor training, including step training using body-weight support and manual facilitation on a treadmill followed by overground assessment and community integration. MAIN OUTCOME MEASURES Berg Balance Scale; Six-Minute Walk Test; 10-Meter Walk Test. RESULTS Outcome measures at enrollment showed high variability between patients with AIS grades C and D. Significant improvement from enrollment to final evaluation was observed in balance and walking measures for patients with AIS grades C and D. The magnitude of improvement significantly differed between AIS groups for all measures. Time since SCI was not associated significantly with outcome measures at enrollment, but was related inversely to levels of improvement. CONCLUSIONS Significant variability in baseline values of functional outcome measures is evident after SCI in individuals with AIS grades C and D and significant functional recovery can continue to occur even years after injury when provided with locomotor training. These results indicate that rehabilitation, which provides intensive activity-based therapy, can result in functional improvements in individuals with chronic incomplete SCI.
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Affiliation(s)
- Susan J Harkema
- Department of Neurological Surgery, Kentucky Spinal Cord Research Center, University of Louisville, Louisville, KY, USA.
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Volitional muscle strength in the legs predicts changes in walking speed following locomotor training in people with chronic spinal cord injury. Phys Ther 2011; 91:931-43. [PMID: 21511993 PMCID: PMC3107440 DOI: 10.2522/ptj.20100163] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND It is unclear which individuals with incomplete spinal cord injury best respond to body-weight-supported treadmill training. OBJECTIVE The purpose of this study was to determine the factors that predict whether a person with motor incomplete spinal cord injury will respond to body-weight-supported treadmill training. DESIGN This was a prognostic study with a one-group pretest-posttest design. METHODS Demographic, clinical, and electrophysiological measurements taken prior to training were examined to determine which measures best predicted improvements in walking speed in 19 individuals with chronic (>7 months postinjury), motor-incomplete spinal cord injuries (ASIA Impairment Scale categories C and D, levels C1-L1). RESULTS Two initial measures correlated significantly with improvements in walking speed: (1) the ability to volitionally contract a muscle, as measured by the lower-extremity manual muscle test (LE MMT) (r=.72), and (2) the peak locomotor electromyographic (EMG) amplitude in the legs (r=.56). None of the demographics (time since injury, age, body mass index) were significantly related to improvements in walking speed, nor was the clinical measure of balance (Berg Balance Scale). Further analysis of LE MMT scores showed 4 key muscle groups were significantly related to improvements in walking speed: knee extensors, knee flexors, ankle plantar flexors, and hip abductors (r=.82). Prediction using the summed MMT scores from those muscles and peak EMG amplitude in a multivariable regression indicated that peak locomotor EMG amplitude did not add significantly to the prediction provided by the LE MMT alone. Change in total LE MMT scores from the beginning to the end of training was not correlated with a change in walking speed over the same period. LIMITATIONS The sample size was limited, so the results should be considered exploratory. CONCLUSIONS The results suggest that preserved muscle strength in the legs after incomplete spinal cord injury, as measured by MMT, allows for improvements in walking speed induced by locomotor training.
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