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Malloy DC, Côté MP. Multi-session transcutaneous spinal cord stimulation prevents chloride homeostasis imbalance and the development of hyperreflexia after spinal cord injury in rat. Exp Neurol 2024; 376:114754. [PMID: 38493983 DOI: 10.1016/j.expneurol.2024.114754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 02/28/2024] [Accepted: 03/11/2024] [Indexed: 03/19/2024]
Abstract
Spasticity is a complex and multidimensional disorder that impacts nearly 75% of individuals with spinal cord injury (SCI) and currently lacks adequate treatment options. This sensorimotor condition is burdensome as hyperexcitability of reflex pathways result in exacerbated reflex responses, co-contractions of antagonistic muscles, and involuntary movements. Transcutaneous spinal cord stimulation (tSCS) has become a popular tool in the human SCI research field. The likeliness for this intervention to be successful as a noninvasive anti-spastic therapy after SCI is suggested by a mild and transitory improvement in spastic symptoms following a single stimulation session, but it remains to be determined if repeated tSCS over the course of weeks can produce more profound effects. Despite its popularity, the neuroplasticity induced by tSCS also remains widely unexplored, particularly due to the lack of suitable animal models to investigate this intervention. Thus, the basis of this work was to use tSCS over multiple sessions (multi-session tSCS) in a rat model to target spasticity after SCI and identify the long-term physiological improvements and anatomical neuroplasticity occurring in the spinal cord. Here, we show that multi-session tSCS in rats with an incomplete (severe T9 contusion) SCI (1) decreases hyperreflexia, (2) increases the low frequency-dependent modulation of the H-reflex, (3) prevents potassium-chloride cotransporter isoform 2 (KCC2) membrane downregulation in lumbar motoneurons, and (4) generally augments motor output, i.e., EMG amplitude in response to single pulses of tSCS, particularly in extensor muscles. Together, this work displays that multi-session tSCS can target and diminish spasticity after SCI as an alternative to pharmacological interventions and begins to highlight the underlying neuroplasticity contributing to its success in improving functional recovery.
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Affiliation(s)
- Dillon C Malloy
- Marion Murray Spinal Cord Research Center, Department of Neurobiology and Anatomy, Drexel University College of Medicine, Philadelphia, PA 19129, United States of America.
| | - Marie-Pascale Côté
- Marion Murray Spinal Cord Research Center, Department of Neurobiology and Anatomy, Drexel University College of Medicine, Philadelphia, PA 19129, United States of America.
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2
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Therkildsen ER, Kaster P, Nielsen JB. A scoping review on muscle cramps and spasms in upper motor neuron disorder-two sides of the same coin? Front Neurol 2024; 15:1360521. [PMID: 38497037 PMCID: PMC10940373 DOI: 10.3389/fneur.2024.1360521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Accepted: 02/20/2024] [Indexed: 03/19/2024] Open
Abstract
Background Muscle cramps are typically regarded as benign muscle overactivity in healthy individuals, whereas spasms are linked to spasticity resulting from central motor lesions. However, their striking similarities made us hypothesize that cramping is an under-recognized and potentially misidentified aspect of spasticity. Methods A systematic search on spasms and cramps in patients with Upper Motor Neuron Disorder (spinal cord injury, cerebral palsy, traumatic brain injury, and stroke) was carried out in Embase/Medline, aiming to describe the definitions, characteristics, and measures of spasms and cramps that are used in the scientific literature. Results The search identified 4,202 studies, of which 253 were reviewed: 217 studies documented only muscle spasms, 7 studies reported only cramps, and 29 encompassed both. Most studies (n = 216) lacked explicit definitions for either term. One-half omitted any description and when present, the clinical resemblance was significant. Various methods quantified cramp/spasm frequency, with self-reports being the most common approach. Conclusion Muscle cramps and spasms probably represent related symptoms with a shared pathophysiological component. When considering future treatment strategies, it is important to recognize that part of the patient's spasms may be attributed to cramps.
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Affiliation(s)
| | | | - Jens Bo Nielsen
- Department of Neuroscience, University of Copenhagen, Copenhagen, Denmark
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3
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Steele AG, Vette AH, Martin C, Masani K, Sayenko DG. Combining transcutaneous spinal stimulation and functional electrical stimulation increases force generated by lower limbs: When more is more. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.12.22.573119. [PMID: 38187778 PMCID: PMC10769419 DOI: 10.1101/2023.12.22.573119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2024]
Abstract
Background Transcutaneous Spinal Stimulation (TSS) has been shown to promote activation of the lower limb and trunk muscles and is being actively explored for improving the motor outcomes of people with neurological conditions. However, individual responses to TSS vary, and often the muscle responses are insufficient to produce enough force for self-supported standing. Functional electrical stimulation (FES) can activate individual muscles and assist in closing this functional gap, but it introduces questions regarding timing between modalities. Methods To assess the effects of TSS and FES on force generation, ten neurologically intact participants underwent (1) TSS only, (2) FES only, and (3) TSS + FES. TSS was delivered using four electrodes placed at T10-T11 through the L1-L2 intervertebral spaces simultaneously, while FES was delivered to the skin over the right knee extensors and plantarflexors. For all conditions, TSS and FES were delivered using three 0.5 ms biphasic square-wave pulses at 15 Hz. During the TSS + FES condition, timing between the two modalities was adjusted in increments of ¼ time between pulses (16.5 ms). Results When TSS preceded FES, a larger force production was observed. We also determined several changes in muscle activation amplitude at different relative stimulus intervals, which help characterize our finding and indicate the facilitating and inhibitory effects of the modalities. Conclusions Utilizing a delay ranging from 15 to 30 ms between stimuli resulted in higher mean force generation in both the knee and ankle joints, regardless of the selected FES location (Average; knee: 112.0%, ankle: 103.1%).
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Affiliation(s)
- Alexander G Steele
- Department of Neurosurgery, Center for Neuroregeneration, Houston Methodist Research Institute, 6550 Fannin Street, Houston, Texas, 77030, United States of America
| | - Albert H Vette
- Department of Mechanical Engineering, University of Alberta, Donadeo Innovation Centre for Engineering, 9211-116 Street NW, Edmonton, Alberta T6G 1H9, Canada
- Glenrose Rehabilitation Hospital, Alberta Health Services, 10230 111 Avenue NW, Edmonton, Alberta T5G 0B7, Canada
| | - Catherine Martin
- Department of Neurosurgery, Center for Neuroregeneration, Houston Methodist Research Institute, 6550 Fannin Street, Houston, Texas, 77030, United States of America
| | - Kei Masani
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON M5S 3G9, Canada
- KITE Research Institute - University Health Network, Toronto, ON M4G 3V9, Canada
| | - Dimitry G Sayenko
- Department of Neurosurgery, Center for Neuroregeneration, Houston Methodist Research Institute, 6550 Fannin Street, Houston, Texas, 77030, United States of America
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Quel de Oliveira C, Bundy A, Middleton JW, Refshauge K, Rogers K, Davis GM. Activity-Based Therapy for Mobility, Function and Quality of Life after Spinal Cord Injuries-A Mixed-Methods Case Series. J Clin Med 2023; 12:7588. [PMID: 38137657 PMCID: PMC10743935 DOI: 10.3390/jcm12247588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 12/01/2023] [Accepted: 12/05/2023] [Indexed: 12/24/2023] Open
Abstract
(1) Background: Despite inconclusive evidence on the benefits of activity-based therapies (ABTs) in people with spinal cord injuries, implementation has occurred in clinics worldwide in response to consumers' requests. We explored the clinical changes and participants' perceptions from engaging in an ABT program in the community. (2) Methods: This mixed-methods study involved a pragmatic observational multiple-baseline design and an evaluation of participants' perceptions. Fifteen participants were included. Outcome measures were balance in sitting using the Seated Reach Distance test, mobility using the Modified Rivermead Mobility Index and quality of life using the Quality of Life Index SCI version pre- and post-participation in an ABT community-based program. Linear mixed models and logistic regressions were used to analyse the effects of intervention. Semi-structured interviews explored participants' perceptions using inductive thematic analysis. (3) Results: There was an increase of 9% in the standardised reach distance (95% CI 2-16) for sitting balance, 1.33 points (95% CI: 0.81-1.85) in mobility and 1.9 points (0.17-2.1) in quality of life. Two themes emerged from the interviews: (1) reduced impact of disability and an increased sense of life as before, and (2) the program was superior to usual rehabilitation. No adverse events related to the intervention were observed. (4) Conclusion: ABT delivered in the community improved clinical outcomes in people with a chronic SCI. High levels of satisfaction with the program were reported.
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Affiliation(s)
- Camila Quel de Oliveira
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia; (A.B.); (K.R.); (G.M.D.)
- Discipline of Physiotherapy, Graduate School of Health, Faculty of Health, University of Technology Sydney, Ultimo, NSW 2007, Australia
| | - Anita Bundy
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia; (A.B.); (K.R.); (G.M.D.)
- Department of Occupational Therapy, Colorado State University, Fort Collins, CO 80524, USA
| | - James W. Middleton
- John Walsh Center for Rehabilitation Research, Kolling Institute, Northern Sydney Local Health District and Sydney Medical School Northern, The University of Sydney, Sydney, NSW 2006, Australia;
| | - Kathryn Refshauge
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia; (A.B.); (K.R.); (G.M.D.)
| | - Kris Rogers
- Graduate School of Health, Faculty of Health, University of Technology Sydney, Ultimo, NSW 2007, Australia;
| | - Glen M. Davis
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia; (A.B.); (K.R.); (G.M.D.)
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Dalin D, Wiesmeier IK, Heimbach B, Weiller C, Maurer C. Postural control deficits due to bilateral pyramidal tract lesions exemplified by hereditary spastic paraplegia (HSP) originate from increased feedback time delay and reduced long-term error corrections. Front Hum Neurosci 2023; 17:1229055. [PMID: 38116238 PMCID: PMC10728727 DOI: 10.3389/fnhum.2023.1229055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 11/13/2023] [Indexed: 12/21/2023] Open
Abstract
Pyramidal tract lesions determine the clinical syndrome of Hereditary Spastic Paraplegia (HSP). The clinical impairments of HSP are typically exemplified by their deficits in mobility, leading to falls and injuries. The first aim of this study was to identify the cause for postural abnormalities caused by pyramidal tract lesions in HSP. The second aim was to specify the effect of treadmill training for postural abnormalities. We examined nine HSP patients before and after treadmill training, as well as nine healthy control subjects during perturbed and unperturbed stance. We found that HSP was associated with larger sway amplitudes and velocities. Body excursions following platform tilts were larger, and upper body excursions showed a phase lead. Model-based analysis detected a greater time delay and a reduced long-term error correction of postural reactions in the center of mass. HSP patients performed significantly better in clinical assessments after treadmill training. In addition, treadmill training reduced sway amplitudes and body excursions, most likely by increasing positional and velocity error correction gain as a compensatory mechanism, while the time delay and long-term error correction gain remained largely unaffected. Moreover, the upper body's phase lead was reduced. We conclude that HSP leads to very specific postural impairments. While postural control generally benefits from treadmill training, the effect seems to mainly rely on compensatory mechanisms, whereas the original deficits are not affected significantly.
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Affiliation(s)
- Daniela Dalin
- Department of Neurology and Neurophysiology, Medical Faculty, University Medical Center, University of Freiburg, Freiburg im Breisgau, Germany
| | - Isabella Katharina Wiesmeier
- Department of Neurology and Neurophysiology, Medical Faculty, University Medical Center, University of Freiburg, Freiburg im Breisgau, Germany
- Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Bernhard Heimbach
- Department of Neurology and Neurophysiology, Medical Faculty, University Medical Center, University of Freiburg, Freiburg im Breisgau, Germany
| | - Cornelius Weiller
- Department of Neurology and Neurophysiology, Medical Faculty, University Medical Center, University of Freiburg, Freiburg im Breisgau, Germany
| | - Christoph Maurer
- Department of Neurology and Neurophysiology, Medical Faculty, University Medical Center, University of Freiburg, Freiburg im Breisgau, Germany
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Malloy DC, Côté MP. Multi-session transcutaneous spinal cord stimulation prevents chloridehomeostasis imbalance and the development of spasticity after spinal cordinjury in rat. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.10.24.563419. [PMID: 37961233 PMCID: PMC10634766 DOI: 10.1101/2023.10.24.563419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
Spasticity is a complex and multidimensional disorder that impacts nearly 75% of individuals with spinal cord injury (SCI) and currently lacks adequate treatment options. This sensorimotor condition is burdensome as hyperexcitability of reflex pathways result in exacerbated reflex responses, co-contractions of antagonistic muscles, and involuntary movements. Transcutaneous spinal cord stimulation (tSCS) has become a popular tool in the human SCI research field. The likeliness for this intervention to be successful as a noninvasive anti-spastic therapy after SCI is suggested by a mild and transitory improvement in spastic symptoms following a single stimulation session, but it remains to be determined if repeated tSCS over the course of weeks can produce more profound effects. Despite its popularity, the neuroplasticity induced by tSCS also remains widely unexplored, particularly due to the lack of suitable animal models to investigate this intervention. Thus, the basis of this work was to use tSCS over multiple sessions (multi-session tSCS) in a rat model to target spasticity after SCI and identify the long-term physiological improvements and anatomical neuroplasticity occurring in the spinal cord. Here, we show that multi-session tSCS in rats with an incomplete (severe T9 contusion) SCI (1) decreases hyperreflexia, (2) increases the low frequency-dependent modulation of the H-reflex, (3) prevents potassium-chloride cotransporter isoform 2 (KCC2) membrane downregulation in lumbar motoneurons, and (4) generally augments motor output, i.e., EMG amplitude in response to single pulses of tSCS, particularly in extensor muscles. Together, this work displays that multi-session tSCS can target and diminish spasticity after SCI as an alternative to pharmacological interventions and begins to highlight the underlying neuroplasticity contributing to its success in improving functional recovery.
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Affiliation(s)
- Dillon C. Malloy
- Marion Murray Spinal Cord Research Center, Department of Neurobiology and Anatomy, Drexel University College of Medicine, Philadelphia, PA 19129
| | - Marie-Pascale Côté
- Marion Murray Spinal Cord Research Center, Department of Neurobiology and Anatomy, Drexel University College of Medicine, Philadelphia, PA 19129
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Shackleton C, Evans R, West S, Derman W, Albertus Y. Robotic locomotor training for spasticity, pain, and quality of life in individuals with chronic SCI: A pilot randomized controlled trial. FRONTIERS IN REHABILITATION SCIENCES 2023; 4:1003360. [PMID: 36793803 PMCID: PMC9922844 DOI: 10.3389/fresc.2023.1003360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 01/05/2023] [Indexed: 01/31/2023]
Abstract
Objective The prevention and treatment of secondary complications is a key priority for people with spinal cord injury and a fundamental goal of rehabilitation. Activity-based Training (ABT) and Robotic Locomotor Training (RLT) demonstrate promising results for reducing secondary complications associated with SCI. However, there is a need for increased evidence through randomized controlled trials. Therefore, we aimed to investigate the effect of RLT and ABT interventions on pain, spasticity, and quality of life in individuals with spinal cord injuries. Methods Participants with chronic motor incomplete tetraplegia (n = 16) were recruited. Each intervention involved 60-minute sessions, 3× per week, over 24-weeks. RLT involved walking in an Ekso GT exoskeleton. ABT involved a combination of resistance, cardiovascular and weight-bearing exercise. Outcomes of interest included the Modified Ashworth Scale, the International SCI Pain Basic Data Set Version 2, and the International SCI Quality of Life Basic Data Set. Results Neither intervention altered symptoms of spasticity. Pain intensity increased from pre-post intervention for both groups, with a mean increase of 1.55 [-0.82, 3.92] (p = 0.03) and 1.56 [-0.43, 3.55] (p = 0.02) points for the RLT and ABT group, respectively. The ABT group had an increase in pain interference scores of 100%, 50%, and 109% for the daily activity, mood, and sleep domain, respectively. The RLT group had an increase in pain interference scores of 86% and 69% for the daily activity and mood domain respectively, but no change in the sleep domain. The RLT group had increased perceptions of quality of life with changes of 2.37 [0.32, 4.41], 2.00 [0.43, 3.56] and 0.25 [-1.63, 2.13] points, p = 0.03, for the general, physical, and psychological domains, respectively. The ABT group had increased perceptions of general, physical and psychological quality of life with changes of 0.75 [-1.38, 2.88], 0.62 [-1.83, 3.07] and 0.63 [-1.87, 3.13] points, respectively. Conclusions Despite increased pain ratings and no change in symptoms of spasticity, there was an increase in perceived quality of life for both groups over 24-weeks. This dichotomy warrants additional investigation in future large-scale randomized controlled trials.
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Affiliation(s)
- Claire Shackleton
- Department of Human Biology, Physical Activity, Lifestyle and Sport Research Centre (HPALS), University of Cape Town, Cape Town, South Africa
| | - Robert Evans
- Department of Human Biology, Physical Activity, Lifestyle and Sport Research Centre (HPALS), University of Cape Town, Cape Town, South Africa
| | - Sacha West
- Department of Sport Management, Cape Peninsula University of Technology, Cape Town, Western cape, South Africa
| | - Wayne Derman
- Institute of Sport and Exercise Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Campus, Cape Town, Western cape, South Africa,International Olympic Committee Research Center, IOCResearch Center, Cape Town, South Africa
| | - Yumna Albertus
- Department of Human Biology, Physical Activity, Lifestyle and Sport Research Centre (HPALS), University of Cape Town, Cape Town, South Africa,Correspondence: Yumna Albertus
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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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Gouveia D, Cardoso A, Carvalho C, Almeida A, Gamboa Ó, Ferreira A, Martins Â. Approach to Small Animal Neurorehabilitation by Locomotor Training: An Update. Animals (Basel) 2022; 12:ani12243582. [PMID: 36552502 PMCID: PMC9774773 DOI: 10.3390/ani12243582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 12/05/2022] [Accepted: 12/15/2022] [Indexed: 12/23/2022] Open
Abstract
Neurorehabilitation has a wide range of therapies to achieve neural regeneration, reorganization, and repair (e.g., axon regeneration, remyelination, and restoration of spinal circuits and networks) to achieve ambulation for dogs and cats, especially for grade 1 (modified Frankel scale) with signs of spinal shock or grade 0 (deep pain negative), similar to humans classified with ASIA A lesions. This review aims to explain what locomotor training is, its importance, its feasibility within a clinical setting, and some possible protocols for motor recovery, achieving ambulation with coordinated and modulated movements. In addition, it cites some of the primary key points that must be present in the daily lives of veterinarians or rehabilitation nurses. These can be the guidelines to improve this exciting exercise necessary to achieve ambulation with quality of life. However, more research is essential in the future years.
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Affiliation(s)
- Débora Gouveia
- Arrábida Veterinary Hospital—Arrábida Animal Rehabilitation Center, 2925-538 Setubal, Portugal
- Superior School of Health, Protection and Animal Welfare, Polytechnic Institute of Lusophony, Campo Grande, 1950-396 Lisboa, Portugal
- Faculty of Veterinary Medicine, Lusófona University, Campo Grande, 1749-024 Lisboa, Portugal
- Correspondence:
| | - Ana Cardoso
- Arrábida Veterinary Hospital—Arrábida Animal Rehabilitation Center, 2925-538 Setubal, Portugal
| | - Carla Carvalho
- Arrábida Veterinary Hospital—Arrábida Animal Rehabilitation Center, 2925-538 Setubal, Portugal
| | - António Almeida
- Faculty of Veterinary Medicine, University of Lisbon, 1300-477 Lisboa, Portugal
| | - Óscar Gamboa
- Faculty of Veterinary Medicine, University of Lisbon, 1300-477 Lisboa, Portugal
| | - António Ferreira
- Faculty of Veterinary Medicine, University of Lisbon, 1300-477 Lisboa, Portugal
- CIISA—Centro Interdisciplinar-Investigaçāo em Saúde Animal, Faculdade de Medicina Veterinária, Av. Universi dade Técnica de Lisboa, 1300-477 Lisboa, Portugal
| | - Ângela Martins
- Arrábida Veterinary Hospital—Arrábida Animal Rehabilitation Center, 2925-538 Setubal, Portugal
- Superior School of Health, Protection and Animal Welfare, Polytechnic Institute of Lusophony, Campo Grande, 1950-396 Lisboa, Portugal
- Faculty of Veterinary Medicine, Lusófona University, Campo Grande, 1749-024 Lisboa, Portugal
- Faculty of Veterinary Medicine, University of Lisbon, 1300-477 Lisboa, Portugal
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10
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Wang S, Wang P, Yin R, Xiao M, Zhang Y, Reinhardt JD, Wang H, Xu G. Combination of repetitive transcranial magnetic stimulation and treadmill training reduces hyperreflexia by rebalancing motoneuron excitability in rats after spinal cord contusion. Neurosci Lett 2022; 775:136536. [PMID: 35183693 DOI: 10.1016/j.neulet.2022.136536] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 02/12/2022] [Accepted: 02/15/2022] [Indexed: 11/19/2022]
Abstract
Spasticity commonly emerges during the process of recovery after spinal cord injury (SCI) and critically exacerbates motor dysfunction. Given insufficient effects of individual therapies, we combined repetitive transcranial magnetic stimulation (rTMS) with treadmill training (Tr) in rats with SCI to investigate potential synergistic effects on alleviating spasticity and motor dysfunction. Animals were randomized into four groups: SCI only, rTMS, Tr, and rTMS plus Tr. At the study endpoint eight weeks after the start of interventions, the rTMS plus Tr group exhibited the largest decrease in maximal H-reflex amplitude/maximal M-wave amplitude ratio (effect size (ES): -0.082, 95% confidence interval (CI): -0.118 to -0.046, p < 0.001) as well as the greatest improvement in motor function measured with the Basso, Beattie, and Bresnahan locomotor scale (ES: 1.811, 95% CI: 1.018 to 2.603, p < 0.001; significantly different from all other groups at p < 0.01) and grid-walking test (ES: -5.1, 95% CI: -7.784 to -2.416, p < 0.001, significantly different from rTMS alone at p < 0.01). Pathological analyses demonstrated that the combined treatment facilitated the growth of serotonergic axons around the lesion site, and the upregulation of 5-hydroxytryptamine, potassium-chloride cotransporter-2, and glutamic acid decarboxylases 67 in the lumbar spinal cord distal to the injury site. All effects of combined treatment of rTMS and treadmill training were enhanced compared to treadmill training or rTMS alone. Treadmill training and rTMS intervention appear to have synergistic effects on hyperreflexia and locomotion likely related to a restored balance between facilitatory and inhibitory inputs to motoneurons.
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Affiliation(s)
- Shuangyan Wang
- Department of Rehabilitation Medicine, Zhongda Hospital, Southeast University Nanjing 210024, China; Nanjing Medical University, Center of Rehabilitation Medicine, 1st affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Pei Wang
- Department of Rehabilitation Medicine, Zhongda Hospital, Southeast University Nanjing 210024, China
| | - Ruian Yin
- Department of Rehabilitation Medicine, Zhongda Hospital, Southeast University Nanjing 210024, China
| | - Ming Xiao
- Jiangsu Key Laboratory of Neurodegeneration, Nanjing Medical University, Nanjing 211166, China
| | - Yongjie Zhang
- Department of Human Anatomy, Nanjing Medical University, Nanjing 211166, China
| | - Jan D Reinhardt
- Institute for Disaster Management and Reconstruction, Sichuan University, Chengdu, China
| | - Hongxing Wang
- Department of Rehabilitation Medicine, Zhongda Hospital, Southeast University Nanjing 210024, China.
| | - Guangxu Xu
- Nanjing Medical University, Center of Rehabilitation Medicine, 1st affiliated Hospital of Nanjing Medical University, Nanjing 210029, China.
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Bohannon RW, Green MD. Neurologic and musculoskeletal effects of tilt-table standing on adults: a systematic review. J Phys Ther Sci 2021; 33:700-706. [PMID: 34539077 PMCID: PMC8436033 DOI: 10.1589/jpts.33.700] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 06/27/2021] [Indexed: 11/24/2022] Open
Abstract
[Purpose] Tilt table use is associated, most often, with the assessment of syncope. However, it also has applications for patients with neurologic and orthopedic problems. These applications do not appear to be widely applied. The purpose of this review, therefore, was to summarize the research literature addressing the use of tilt tables for treating specific musculoskeletal and neurologic impairments in adults. [Methods] Relevant literature was identified by searches of the PubMed, CINAHL, and Scopus databases and hand searches (December 2018 and October 2020). The methodological quality of the identified research articles was assessed using the PEDro scale. [Results] Of 482 unique articles identified, 20 matched the eligibility criteria of the review and were included. The studies varied widely in the populations studied, procedures used, and responses reported. The studies provide limited support for tilt table standing as an intervention. [Conclusion] However, evidence that some patients with neurologic conditions may respond positively to tilt-table standing is available. Among such individuals are those with decreased ankle range of motion, positive neurologic signs in the lower limbs, and decreased levels of consciousness.
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Effect of robotic-assisted gait training on functional status, walking and quality of life in complete spinal cord injury. Int J Rehabil Res 2021; 44:262-268. [PMID: 34356038 DOI: 10.1097/mrr.0000000000000486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The purpose of this study was to investigate the effect of robotic-assisted gait training (RAGT) on functional status and the quality of life in patients with subacute complete spinal cord injury (SCI). Thirty-seven patients with complete SCI were included in this study. All patients underwent conventional rehabilitation 5 days a week for 8 weeks. The patients were divided into two groups: those who received RAGT (group I, n = 17) and those who received only conventional rehabilitation (group II, n = 20) for 30 min twice a week for a total of 8 weeks. Evaluations were performed using the Walking Index SCI II (WISCI II) for ambulation, Functional Independence Measure (FIM) for functional status and Short Form 36 (SF-36) for the quality of life at the beginning and end of rehabilitation. The mean duration of injury was 3.5 ± 2.1 months in group I and 3.8 ± 2.6 months in group II (P > 0.05). Significant improvement was observed in both groups as per WISCI II and FIM scores (P < 0.05). However, no significant inter-group difference was noted in pre- and post-treatment FIM and WISCI II change scores (P > 0.05). In groups I and II, there was significant improvement only in physical activity scores of SF-36 compared with baseline scores (P < 0.05); however, other SF-36 subparameter scores did not differ significantly between pre- and post-treatment (P > 0.05). Treatment with RAGT has positive effects on functional independence, ambulation and the quality of life in patients with subacute complete SCI. RAGT combined with conventional therapy in patients with complete SCI may facilitate the improvement of patient condition more than conventional therapy alone.
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Do any physiotherapy interventions increase spinal cord independence measure or functional independence measure scores in people with spinal cord injuries? A systematic review. Spinal Cord 2021; 59:705-715. [PMID: 34099880 DOI: 10.1038/s41393-021-00638-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 04/14/2021] [Accepted: 04/14/2021] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Systematic review. OBJECTIVE To determine whether any physiotherapy interventions increase Spinal Cord Independence Measure or Functional Independence Measure scores (SCIM/FIM) in people with spinal cord injury (SCI), with the overall aim of determining whether any physiotherapy interventions need to be controlled for in studies examining the effects of novel experimental interventions on SCIM/FIM. METHODS A systematic review was conducted to identify all randomised controlled trials examining the effect of any physiotherapy intervention on SCIM/FIM in people with SCI. PEDro scores were used to rate risk of bias. The results of similar trials and comparisons were pooled using meta-analyses. RESULTS Thirty-three trials met the inclusion criteria but only 27 provided useable data. The median (IQR) PEDro score was 6.0 (4.0-7.0). A meta-analysis of four trials comparing robotic gait training with overground gait training that used a combination of FIM/SCIM indicated a pooled mean (95% CI) between-group difference of 0.38 standardised mean difference (SMD; 95% CI, 0.08-0.67). A second meta-analysis of two trials comparing upper limb training with and without functional electrical stimulation using FIM indicated a pooled (95% CI) between-group difference of 1.31 SMD (0.62-1.99). Another six trials examining a range of different physiotherapy interventions reported a statistically significant mean between-group difference on SCIM/FIM. CONCLUSION There is low-quality evidence to indicate that a small number of physiotherapy interventions increase SCIM/FIM. The importance of controlling for all physiotherapy interventions in studies examining the effects of novel experimental interventions on SCIM/FIM is as yet unclear.
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Clinical Benefit of Rehabilitation Training in Spinal Cord Injury: A Systematic Review and Meta-Analysis. Spine (Phila Pa 1976) 2021; 46:E398-E410. [PMID: 33620185 DOI: 10.1097/brs.0000000000003789] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A systematic review and meta-analysis. OBJECTIVE This study was performed to evaluate the effects of different rehabilitation interventions in spinal cord injury. SUMMARY OF BACKGROUND DATA Several activity-based interventions have been widely applied in spinal cord injury in the past, but the effects of these rehabilitation exercises are controversial. METHODS Publications were searched from databases (PubMed, Embase, Cochrane, the database of the U.S. National Institutes of Health and World Health Organization International Clinical Trials Registry Platform) using the searching terms like spinal cord injury, transcranial magnetic stimulation, functional electrical stimulation, activity-based therapy, and robotic-assisted locomotor training. Randomized controlled trials and controlled trials were included. The primary outcomes included functional upper/lower extremity independence, walking capacity, spasticity, and life quality of individuals with spinal cord injury. Meta-analysis was performed using Revman 5.0 software. RESULTS Thirty-one articles were included. Meta-analysis showed that transcranial magnetic stimulation improved walking speed (95% confidence interval [CI] 0.01, 0.16) and lower extremity function (95% CI 1.55, 7.27); functional electrical stimulation significantly increased upper extremity independence (95% CI 0.37, 5.48). Robotic-assisted treadmill training improved lower extremity function (95% CI 3.44, 6.56) compared with related controls. CONCLUSION Activity-based intervention like transcranial magnetic stimulation, functional electrical stimulation, and robotic-assisted treadmill training are effective in improving function in individuals with spinal cord injury.Level of Evidence: 1.
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Estes S, Zarkou A, Hope JM, Suri C, Field-Fote EC. Combined Transcutaneous Spinal Stimulation and Locomotor Training to Improve Walking Function and Reduce Spasticity in Subacute Spinal Cord Injury: A Randomized Study of Clinical Feasibility and Efficacy. J Clin Med 2021; 10:1167. [PMID: 33799508 PMCID: PMC7999894 DOI: 10.3390/jcm10061167] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 03/06/2021] [Accepted: 03/06/2021] [Indexed: 01/01/2023] Open
Abstract
Locomotor training (LT) is intended to improve walking function and can also reduce spasticity in motor-incomplete spinal cord injury (MISCI). Transcutaneous spinal stimulation (TSS) also influences these outcomes. We assessed feasibility and preliminary efficacy of combined LT + TSS during inpatient rehabilitation in a randomized, sham-controlled, pragmatic study. Eighteen individuals with subacute MISCI (2-6 months post-SCI) were enrolled and randomly assigned to the LT + TSS or the LT + TSSsham intervention group. Participants completed a 4-week program consisting of a 2-week wash-in period (LT only) then a 2-week intervention period (LT + TSS or LT + TSSsham). Before and after each 2-week period, walking (10 m walk test, 2-min walk test, step length asymmetry) and spasticity (pendulum test, clonus drop test, modified spinal cord injury-spasticity evaluation tool) were assessed. Sixteen participants completed the study. Both groups improved in walking speed and distance. While there were no significant between-groups differences, the LT + TSS group had significant improvements in walking outcomes following the intervention period; conversely, improvements in the LT + TSSsham group were not significant. Neither group had significant changes in spasticity, and the large amount of variability in spasticity may have obscured ability to observe change in these measures. TSS is a feasible adjunct to LT in the subacute stage of SCI and may have potential to augment training-related improvements in walking outcomes.
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Affiliation(s)
- Stephen Estes
- Shepherd Center, Crawford Research Institute, Atlanta, GA 30309, USA; (S.E.); (A.Z.); (J.M.H.); (C.S.)
| | - Anastasia Zarkou
- Shepherd Center, Crawford Research Institute, Atlanta, GA 30309, USA; (S.E.); (A.Z.); (J.M.H.); (C.S.)
| | - Jasmine M. Hope
- Shepherd Center, Crawford Research Institute, Atlanta, GA 30309, USA; (S.E.); (A.Z.); (J.M.H.); (C.S.)
- Graduate Division of Biological and Biomedical Sciences, Laney Graduate School, Emory University, Atlanta, GA 30322, USA
| | - Cazmon Suri
- Shepherd Center, Crawford Research Institute, Atlanta, GA 30309, USA; (S.E.); (A.Z.); (J.M.H.); (C.S.)
| | - Edelle C. Field-Fote
- Shepherd Center, Crawford Research Institute, Atlanta, GA 30309, USA; (S.E.); (A.Z.); (J.M.H.); (C.S.)
- Division of Physical Therapy, Emory University School of Medicine, Atlanta, GA 30322, USA
- Program in Biomedical Sciences, Georgia Institute of Technology, Atlanta, GA 30332, USA
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Physiotherapy interventions for the treatment of spasticity in people with spinal cord injury: a systematic review. Spinal Cord 2021; 59:236-247. [PMID: 33564117 DOI: 10.1038/s41393-020-00610-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 12/20/2020] [Accepted: 12/21/2020] [Indexed: 11/08/2022]
Abstract
STUDY DESIGN Systematic review. OBJECTIVE To determine the effectiveness of physiotherapy interventions for the treatment of spasticity in people with spinal cord injuries. SETTING Not applicable. METHODS A comprehensive search was undertaken to identify all randomised controlled trials of physiotherapy interventions that included an assessor-reported (objective) or participant-reported (subjective) measure of spasticity. Only trials that provided a physiotherapy intervention on more than one occasion were included. The susceptibility to bias of each trial was rated on the PEDro scale. Data were extracted to derive mean between-group differences (95% CI) for each trial. RESULTS Twenty-eight trials were identified but only 17 provided useable data. Seven trials compared a physiotherapy intervention to no intervention (or a sham intervention) and 10 trials compared one physiotherapy intervention to another physiotherapy intervention. The median (IQR) PEDro score of the 17 trials was 6/10 (6-8). The most commonly used assessor- and participant-reported measures of spasticity were the Ashworth scale and Spinal Cord Injury Spasticity Evaluation Tool, respectively. Only one trial demonstrated a treatment effect. This trial compared continuous passive motion of the ankle to no treatment on the Ashworth scale. The remaining 16 trials were either inconclusive or indicated that the treatment was ineffective for reducing spasticity. CONCLUSIONS There is no high-quality evidence to indicate that physiotherapy interventions decrease spasticity but this may reflect a lack of research on the topic. Future trials should focus on participant-reported measures of spasticity that distinguish between the immediate, short-term and long-term effects of any physiotherapy intervention.
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Hou J, Nelson R, Mohammad N, Mustafa G, Plant D, Thompson FJ, Bose P. Effect of Simultaneous Combined Treadmill Training and Magnetic Stimulation on Spasticity and Gait Impairments after Cervical Spinal Cord Injury. J Neurotrauma 2020; 37:1999-2013. [DOI: 10.1089/neu.2019.6961] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Affiliation(s)
- Jiamei Hou
- Department of Physiological Sciences, University of Florida, Gainesville, Florida, USA
- BRRC, North Florida/South Georgia Veterans Health System, Gainesville, Florida, USA
| | - Rachel Nelson
- BRRC, North Florida/South Georgia Veterans Health System, Gainesville, Florida, USA
| | - Naweed Mohammad
- BRRC, North Florida/South Georgia Veterans Health System, Gainesville, Florida, USA
| | - Golam Mustafa
- Department of Physiological Sciences, University of Florida, Gainesville, Florida, USA
- BRRC, North Florida/South Georgia Veterans Health System, Gainesville, Florida, USA
| | - Daniel Plant
- Research Service, North Florida/South Georgia Veterans Health System, Gainesville, Florida, USA
| | - Floyd J. Thompson
- Department of Physiological Sciences, University of Florida, Gainesville, Florida, USA
- BRRC, North Florida/South Georgia Veterans Health System, Gainesville, Florida, USA
- Department of Neuroscience, University of Florida, Gainesville, Florida, USA
| | - Prodip Bose
- Department of Physiological Sciences, University of Florida, Gainesville, Florida, USA
- BRRC, North Florida/South Georgia Veterans Health System, Gainesville, Florida, USA
- Department of Anesthesiology, University of Florida, Gainesville, Florida, USA
- Department of Neurology, University of Florida, Gainesville, Florida, USA
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Delgado AD, Escalon MX, Bryce TN, Weinrauch W, Suarez SJ, Kozlowski AJ. Safety and feasibility of exoskeleton-assisted walking during acute/sub-acute SCI in an inpatient rehabilitation facility: A single-group preliminary study. J Spinal Cord Med 2020; 43:657-666. [PMID: 31603395 PMCID: PMC7534310 DOI: 10.1080/10790268.2019.1671076] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Context/objective: Information on the safety and feasibility of lower extremity powered exoskeletons for persons with acute/sub-acute spinal cord injury (SCI) is limited. Understanding the safety and feasibility of employing powered exoskeletons in acute/sub-acute (<6 months post injury) at a SCI acute inpatient rehabilitation (SCI-AIR) facility could guide clinical practice and provide a basis for larger clinical trials on efficacy and effectiveness. Design: Single group observational study. Setting: SCI-AIR. Participants: Participants (n = 12; age: 28-71 years; 58% AIS D; 58% male) with neurological levels of injuries ranging from C2 to L3. Interventions: Up to 90 min of exoskeleton-assisted locomotor training was provided up to three times per week during SCI-AIR. Outcome measures: Safety of device use during inpatient locomotor training was quantified as the number of adverse events (AE) per device exposure hour. Feasibility of device use was defined in terms of protocol compliance, intensity, and proficiency. Results: Concerning safety, symptomatic hypotension was the most common AE reported at 111-events/exoskeleton-hours. Protocol compliance had a mean (SD) of 54% (30%). For intensity, 77% of participants incorporated variable assistance into at least 1 walking session; 70% of participants' sessions were completed with a higher RPE than the physical therapist. In proficiency, 58% achieved at least minimal assistance when walking with the device. Conclusion: Exoskeleton training in SCI-AIR can be safe and feasible for newly injured individuals with SCI who have clinically defined ambulatory goals. Nonetheless, sufficient controls to minimize risks for AEs, such as hypotensive events, are required.
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Affiliation(s)
- Andrew D. Delgado
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York City, New York, USA,The Graduate School, Icahn School of Medicine at Mount Sinai, New York City, New York, USA,Correspondence to: Andrew D. Delgado, Department of Rehabilitation Medicine and Human Performance, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, New York10029, USA; Ph: 212-241-9478.
| | - Miguel X. Escalon
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Thomas N. Bryce
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - William Weinrauch
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Stephanie J. Suarez
- Sports Therapy and Rehabilitation Services (STARS), Northwell Health, East Meadow, New York, USA
| | - Allan J. Kozlowski
- Department of Epidemiology and Biostatistics, Michigan State University, Grand Rapids, Michigan, USA,John F. Butzer Center for Research & Innovation, Mary Free Bed Rehabilitation Hospital, Grand Rapids, Michigan, USA
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19
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Hon AJ, Kraus P. Spasticity Management After Spinal Cord Injury. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2020. [DOI: 10.1007/s40141-020-00280-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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20
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Hope JM, Koter RZ, Estes SP, Field-Fote EC. Disrupted Ankle Control and Spasticity in Persons With Spinal Cord Injury: The Association Between Neurophysiologic Measures and Function. A Scoping Review. Front Neurol 2020; 11:166. [PMID: 32218765 PMCID: PMC7078326 DOI: 10.3389/fneur.2020.00166] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 02/21/2020] [Indexed: 12/03/2022] Open
Abstract
Control of muscles about the ankle joint is an important component of locomotion and balance that is negatively impacted by spinal cord injury (SCI). Volitional control of the ankle dorsiflexors (DF) is impaired by damage to pathways descending from supraspinal centers. Concurrently, spasticity arising from disrupted organization of spinal reflex circuits, further erodes control. The association between neurophysiological changes (corticospinal and spinal) with volitional ankle control (VAC) and spasticity remains unclear. The goal of this scoping review was to synthesize what is known about how changes in corticospinal transmission and spinal reflex excitability contribute to disrupted ankle control after SCI. We followed published guidelines for conducting a scoping review, appraising studies that contained a measure of corticospinal transmission and/or spinal reflex excitability paired with a measure of VAC and/or spasticity. We examined studies for evidence of a relationship between neurophysiological measures (either corticospinal tract transmission or spinal reflex excitability) with VAC and/or spasticity. Of 1,538 records identified, 17 studies were included in the review. Ten of 17 studies investigated spinal reflex excitability, while 7/17 assessed corticospinal tract transmission. Four of the 10 spinal reflex studies examined VAC, while 9/10 examined ankle spasticity. The corticospinal tract transmission studies examined only VAC. While current evidence suggests there is a relationship between neurophysiological measures and ankle function after SCI, more studies are needed. Understanding the relationship between neurophysiology and ankle function is important for advancing therapeutic outcomes after SCI. Future studies to capture an array of corticospinal, spinal, and functional measures are warranted.
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Affiliation(s)
- Jasmine M Hope
- Shepherd Center, Crawford Research Institute, Atlanta, GA, United States.,Graduate Division of Biological and Biomedical Sciences, Laney Graduate School, Emory University, Atlanta, GA, United States
| | - Ryan Z Koter
- Shepherd Center, Crawford Research Institute, Atlanta, GA, United States
| | - Stephen P Estes
- Shepherd Center, Crawford Research Institute, Atlanta, GA, United States
| | - Edelle C Field-Fote
- Shepherd Center, Crawford Research Institute, Atlanta, GA, United States.,Graduate Division of Biological and Biomedical Sciences, Laney Graduate School, Emory University, Atlanta, GA, United States.,Division of Physical Therapy, School of Medicine, Emory University, Atlanta, GA, United States.,Georgia Institute of Technology, School of Biological Sciences, Program in Applied Physiology, Atlanta, GA, United States
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21
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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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Quality of life and psychological outcomes of body-weight supported locomotor training in spinal cord injured persons with long-standing incomplete lesions. Spinal Cord 2019; 58:560-569. [DOI: 10.1038/s41393-019-0401-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 11/26/2019] [Accepted: 11/27/2019] [Indexed: 11/08/2022]
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Audet O, Bui HT, Allisse M, Comtois AS, Leone M. Assessment of the impact of an exercise program on the physical and functional capacity in patients with autosomal recessive spastic ataxia of Charlevoix-Saguenay: An exploratory study. Intractable Rare Dis Res 2018; 7:164-171. [PMID: 30181935 PMCID: PMC6119673 DOI: 10.5582/irdr.2018.01060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Autosomal recessive spastic ataxia of Charlevoix-Saguenay (ARSACS) is a neuromuscular disorder caused by the mutation of the SACS gene. Clinical symptoms of this disease include progressive ataxia, spasticity, and peripheral neuropathy. Similar to other neuromuscular disorders, these patients are prone to physical deconditioning which may lead to a loss of functional capacity. This paper aims to evaluate the impact of a training program on the physical fitness and the functional capacity of ARSACS patients. Twelve patients (age: 28.1 ± 8.2 years) participated in this study. They followed an eight-week training program including physical activities, strength-power and aerobic training. Compared to the initial evaluation, measures of physical fitness and functional capacity were significantly improved (p ≤ 0.05) for 11 of the 12 tests. Positive gains were also observed for fall frequency and for upper-limb incoordination. This paper supports the importance of a training program for ARSACS patients in order to improve their quality of life. Through these types of interventions, it may be possible to slow down the progression of the disease and help maintain functional capacity.
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Affiliation(s)
- Olivier Audet
- Deparment of Kinesiology, Université Laval, Québec, Canada
| | - Hung Tien Bui
- Department of Applied Sciences, Université du Québec à Chicoutimi, Saguenay, Canada
| | - Maxime Allisse
- Department of Health Sciences, Université du Québec à Chicoutimi, Saguenay, Canada
| | - Alain-Steve Comtois
- Department of Exercise Sciences, Université du Québec à Montréal, Montréal, Canada
| | - Mario Leone
- Department of Health Sciences, Université du Québec à Chicoutimi, Saguenay, Canada
- Address correspondence to:Dr. Mario Leone, Department of Health, Kinesiology Division, Université du Québec à Chicoutimi, 555 boulevard de l'Université, Saguenay (Québec), G7H 2B1, Canada. E-mail:
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Audet O, Bui HT, Allisse M, Comtois AS, Leone M. WITHDRAWN: Assessment of the impact of an exercise program on the physical and functional capacity in patients with autosomal recessive spastic ataxia of Charlevoix-Saguenay: An exploratory study. Biosci Trends 2018. [PMID: 30012892 DOI: 10.5582/bst.2018.01060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Ahead of Print article withdrawn by publisher. This withdrawal is for above article due to the misoperation of advance online publication.
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Affiliation(s)
| | - Hung Tien Bui
- Department of Applied Sciences, Université du Québec à Chicoutimi
| | - Maxime Allisse
- Department of Health Sciences, Université du Québec à Chicoutimi
| | | | - Mario Leone
- Department of Health Sciences, Université du Québec à Chicoutimi
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Mekki M, Delgado AD, Fry A, Putrino D, Huang V. Robotic Rehabilitation and Spinal Cord Injury: a Narrative Review. Neurotherapeutics 2018; 15:604-617. [PMID: 29987763 PMCID: PMC6095795 DOI: 10.1007/s13311-018-0642-3] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Mobility after spinal cord injury (SCI) is among the top goals of recovery and improvement in quality of life. Those with tetraplegia rank hand function as the most important area of recovery in their lives, and those with paraplegia, walking. Without hand function, emphasis in rehabilitation is placed on accessing one's environment through technology. However, there is still much reliance on caretakers for many activities of daily living. For those with paraplegia, if incomplete, orthoses exist to augment walking function, but they require a significant amount of baseline strength and significant energy expenditure to use. Options for those with motor complete paraplegia have traditionally been limited to the wheelchair. While wheelchairs provide a modified level of independence, wheelchair users continue to face difficulties in access and mobility. In the past decade, research in SCI rehabilitation has expanded to include external motorized or robotic devices that initiate or augment movement. These robotic devices are used with 2 goals: to enhance recovery through repetitive, functional movement and increased neural plasticity and to act as a mobility aid beyond orthoses and wheelchairs. In addition, lower extremity exoskeletons have been shown to provide benefits to the secondary medical conditions after SCI such as pain, spasticity, decreased bone density, and neurogenic bowel. In this review, we discuss advances in robot-guided rehabilitation after SCI for the upper and lower extremities, as well as potential adjuncts to robotics.
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Affiliation(s)
- Marwa Mekki
- Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Andrew D Delgado
- Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Adam Fry
- Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - David Putrino
- Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Vincent Huang
- Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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Ryu Y, Ogata T, Nagao M, Sawada Y, Nishimura R, Fujita N. Effects of Treadmill Training Combined with Serotonergic Interventions on Spasticity after Contusive Spinal Cord Injury. J Neurotrauma 2018; 35:1358-1366. [PMID: 29336209 DOI: 10.1089/neu.2017.5400] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Spasticity usually emerges during the course of recovery from spinal cord injury (SCI). While medications and physical rehabilitation are prescribed to alleviate spastic symptoms, the insufficiency of their effects remains an important problem to be addressed. Given the challenges associated with increasing the dose of medication, we hypothesized that a combination therapy with medication and physical rehabilitation can be effective. Therefore, we examined the effects of treadmill training (TMT) along with serotonergic medication using a spastic rat model after contusive injury. Spasticity-strong SCI rats were selected 4 weeks after SCI and received one of the following interventions for 2 weeks: only TMT, TMT with fluoxetine (a selective serotonin re-uptake inhibitor), TMT with cyproheptadine (a 5-HT2 receptor antagonist), only fluoxetine, or only cyproheptadine. We performed the swimming test to quantify the frequency of spastic behaviors. We also evaluated hindlimb locomotor functions every week. At the end of the intervention, we examined the Hoffman reflex from the plantar muscle and the immunoreactivity of the 5-HT2A receptor in spinal cord tissues. While the TMT group and cyproheptadine-treated groups showed decreased spastic behaviors and reduction in spinal hyperreflexia, the fluoxetine-treated group showed the opposite effect, even with TMT. Moreover, TMT suppressed the expression of the 5-HT2A receptor in the lumbar spinal motor neurons, while cyproheptadine treatment did not change it. We did not observe any differences in locomotor functions between the groups. Taken together, our findings indicate that TMT and cyproheptadine significantly alleviated spastic symptoms, but did not show synergistic or additive effects.
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Affiliation(s)
- Youngjae Ryu
- 1 Department of Veterinary Surgery, Graduate School of Agricultural and Life Sciences, The University of Tokyo , Tokyo, Japan .,2 Department of Rehabilitation for the Movement Functions, Research Institute , National Rehabilitation Center, Saitama, Japan
| | - Toru Ogata
- 2 Department of Rehabilitation for the Movement Functions, Research Institute , National Rehabilitation Center, Saitama, Japan
| | - Motoshi Nagao
- 2 Department of Rehabilitation for the Movement Functions, Research Institute , National Rehabilitation Center, Saitama, Japan
| | - Yasuhiro Sawada
- 2 Department of Rehabilitation for the Movement Functions, Research Institute , National Rehabilitation Center, Saitama, Japan
| | - Ryohei Nishimura
- 1 Department of Veterinary Surgery, Graduate School of Agricultural and Life Sciences, The University of Tokyo , Tokyo, Japan
| | - Naoki Fujita
- 1 Department of Veterinary Surgery, Graduate School of Agricultural and Life Sciences, The University of Tokyo , Tokyo, Japan
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Zamani H, Dadgoo M, Ebrahimi Takamjani I, Hajouj E, Jamshidi Khorneh AA. The Effects of Two Months Body Weight Supported Treadmill Training on Balance and Quality of Life of Patients With Incomplete Spinal Cord Injury. JOURNAL OF REHABILITATION 2018. [DOI: 10.21859/jrehab.18.4.7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Gant KL, Nagle KG, Cowan RE, Field-Fote EC, Nash MS, Kressler J, Thomas CK, Castellanos M, Widerström-Noga E, Anderson KD. Body System Effects of a Multi-Modal Training Program Targeting Chronic, Motor Complete Thoracic Spinal Cord Injury. J Neurotrauma 2017; 35:411-423. [PMID: 28795657 DOI: 10.1089/neu.2017.5105] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
The safety and efficacy of pharmacological and cellular transplantation strategies are currently being evaluated in people with spinal cord injury (SCI). In studies of people with chronic SCIs, it is thought that functional recovery will be best achieved when drug or cell therapies are combined with rehabilitation protocols. However, any functional recovery attributed to the therapy may be confounded by the conditioned state of the body and by training-induced effects on neuroplasticity. For this reason, we sought to investigate the effects of a multi-modal training program on several body systems. The training program included body-weight-supported treadmill training for locomotion, circuit resistance training for upper body conditioning, functional electrical stimulation for activation of sublesional muscles, and wheelchair skills training for overall mobility. Eight participants with chronic, thoracic-level, motor-complete SCI completed the 12-week training program. After 12 weeks, upper extremity muscular strength improved significantly for all participants, and some participants experienced improvements in function, which may be explained by increased strength. Neurological function did not change. Changes in pain and spasticity were highly variable between participants. This is the first demonstration of the effect of this combination of four training modalities. However, balancing participant and study-site burden with capturing meaningful outcome measures is also an important consideration.
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Affiliation(s)
- Katie L Gant
- 1 The Miami Project to Cure Paralysis, The University of Miami Miller School of Medicine , Miami, Florida.,2 The Department of Neurological Surgery, The University of Miami Miller School of Medicine , Miami, Florida
| | | | - Rachel E Cowan
- 1 The Miami Project to Cure Paralysis, The University of Miami Miller School of Medicine , Miami, Florida.,2 The Department of Neurological Surgery, The University of Miami Miller School of Medicine , Miami, Florida
| | - Edelle C Field-Fote
- 5 Shepherd Center , Atlanta, Georgia .,6 Division of Physical Therapy, Emory University School of Medicine , Atlanta, Georgia .,7 Georgia Institute of Technology , Atlanta, Georgia
| | - Mark S Nash
- 1 The Miami Project to Cure Paralysis, The University of Miami Miller School of Medicine , Miami, Florida.,2 The Department of Neurological Surgery, The University of Miami Miller School of Medicine , Miami, Florida.,3 The Department of Physical Medicine and Rehabilitation, The University of Miami Miller School of Medicine , Miami, Florida
| | - Jochen Kressler
- 8 The Department of Exercise and Nutritional Sciences, San Diego State University , San Diego, California
| | - Christine K Thomas
- 1 The Miami Project to Cure Paralysis, The University of Miami Miller School of Medicine , Miami, Florida.,2 The Department of Neurological Surgery, The University of Miami Miller School of Medicine , Miami, Florida
| | - Mabelin Castellanos
- 1 The Miami Project to Cure Paralysis, The University of Miami Miller School of Medicine , Miami, Florida.,2 The Department of Neurological Surgery, The University of Miami Miller School of Medicine , Miami, Florida
| | - Eva Widerström-Noga
- 1 The Miami Project to Cure Paralysis, The University of Miami Miller School of Medicine , Miami, Florida.,2 The Department of Neurological Surgery, The University of Miami Miller School of Medicine , Miami, Florida.,9 Bruce W. Carter Department of Veterans Affairs Medical Center , Miami, Florida
| | - Kimberly D Anderson
- 1 The Miami Project to Cure Paralysis, The University of Miami Miller School of Medicine , Miami, Florida.,2 The Department of Neurological Surgery, The University of Miami Miller School of Medicine , Miami, Florida
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Bhatnagar T, Ben Mortensen W, Mattie J, Wolff J, Parker C, Borisoff J. A survey of stakeholder perspectives on a proposed combined exoskeleton-wheelchair technology. IEEE Int Conf Rehabil Robot 2017; 2017:1574-1579. [PMID: 28814044 DOI: 10.1109/icorr.2017.8009472] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Exoskeleton technology has potential benefits for wheelchair users' health and mobility. However, there are practical barriers to their everyday use as a mobility device. In particular, challenges related to travelling longer distances and transitioning between using a wheelchair and exoskeleton walking may present significant deterrents to regular exoskeleton use. In an effort to remove these barriers, a combined exoskeleton-wheelchair concept ('COMBO') has been proposed, which aims to achieve the benefits of both these mobility technologies. Given the inherent importance of including user-stakeholder opinions when designing an assistive technology solution, a study was undertaken to explore the perspectives of wheelchair users and healthcare professionals on the proposed conceptual design of the COMBO. METHODS An online survey with quantitative and qualitative components was conducted with wheelchair users and healthcare professionals working directly with individuals with mobility impairments. Respondents rated whether they would use or recommend a COMBO for four potential reasons. Nine design features were rated and compared in terms of their importance. Content analysis was used to analyze data from an open-ended question regarding additional perceptions about using or recommending a COMBO. RESULTS A total of 481 survey responses were analyzed, 354 from wheelchair users and 127 from healthcare professionals. Potential health benefits was the most highly rated reason for potential use or recommendation of a COMBO. Of the 9 design features, 2 had a median rating of very important: inclusion of a fall-protection mechanism, and the ability for the operator to use their hands while standing. Qualitative findings indicated that health and physical benefits, use for daily life activities, and psychosocial benefits were important considerations in whether to use or recommend the COMBO. CONCLUSIONS This study captures the opinions and perspectives of two stakeholder groups for an exoskeleton-wheelchair hybrid device. It also emphasizes the importance of fall-protection, hand-use capabilities and enabling functional activities. Findings from this study can be utilized to provide insight for the refinement of the COMBO concept, as well as to guide more general mobility device research and development.
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Ansari NN, Kashi M, Naghdi S. The Spinal Cord Injury Spasticity Evaluation Tool: A Persian adaptation and validation study. J Spinal Cord Med 2017; 40:380-388. [PMID: 27579622 PMCID: PMC5537954 DOI: 10.1080/10790268.2016.1195941] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVE To adapt the Spinal Cord Injury Spasticity Evaluation Tool (SCI-SET) into the Persian language (SCI-SETp) and to examine the reliability and validity of the SCI-SETp in patients with spinal cord injury (SCI). DESIGN A cross-sectional and prospective cohort validation study. SETTING University Neurological Physiotherapy Clinic. PARTICIPANTS Adult patients with SCI. MAIN OUTCOME MEASURES SCI-SET. RESULTS There was no missing data. No floor or ceiling effect was observed. Cronbach's α coefficient was 0.862. Factor analysis suggested 1 factor structure (Eigenvalue = 8.49) explained 24.27% of the total variance. The ICCagreement for test-retest reliability was 0.84. The standard error of measurement and the smallest detectable change was 0.30 and 0.82, respectively. The divergent relationships demonstrated the SCI-SETp uniqueness construct. CONCLUSION The results support the reliability and validity of the SCI-SETp for assessing the impact of spasticity on daily life of patients with SCI.
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Affiliation(s)
- Noureddin Nakhostin Ansari
- Correspondence to: Noureddin Nakhostin Ansari, Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Enghelab Ave, Pitch-e-shemiran, Zip: 11489, Tehran, Iran.
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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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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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Pompa A, Morone G, Iosa M, Pace L, Catani S, Casillo P, Clemenzi A, Troisi E, Tonini A, Paolucci S, Grasso MG. Does robot-assisted gait training improve ambulation in highly disabled multiple sclerosis people? A pilot randomized control trial. Mult Scler 2016; 23:696-703. [PMID: 27486219 DOI: 10.1177/1352458516663033] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Robotic training is commonly used to assist walking training in patients affected by multiple sclerosis (MS) with non-conclusive results. OBJECTIVE To compare the effect of robot-assisted gait training (RAGT) with that of conventional walking training (CWT) on gait competencies, global ability, fatigue and spasticity in a group of severely affected patients with MS. METHODS A pilot, single-blind randomized controlled trial was conducted in 43 severe (Expanded Disability Status Scale (EDSS) score of 6-7.5) and non-autonomous ambulant in-patients with MS. Experimental group performed 12 sessions of RAGT, whereas control group performed the same amount of CWT. Primary outcome measures were gait ability assessed by 2 minutes walking test and Functional Ambulatory Category; secondary outcomes were global ability (modified Barthel Index), global mobility (Rivermead Mobility Index), severity of disease (EDSS) and subjectively perceived fatigue (Fatigue Severity Scale). RESULTS The number of subjects who achieved a clinical significant improvement was significantly higher in RAGT than in CWT ( p < 0.05 for both primary outcome measures). RAGT also led to an improvement in all the other clinical parameters (global ability: p < 0.001, global mobility: p < 0.001, EDSS: p = 0.014 and fatigue: p = 0.001). CONCLUSIONS RAGT improved the walking competencies in non-autonomous ambulant patients with MS, with benefits in terms of perceived fatigue.
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Affiliation(s)
- Alessandra Pompa
- Multiple Sclerosis Unit, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Giovanni Morone
- Clinical Laboratory of Experimental Neurorehabilitation, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Marco Iosa
- Clinical Laboratory of Experimental Neurorehabilitation, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Luca Pace
- Multiple Sclerosis Unit, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Sheila Catani
- Multiple Sclerosis Unit, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Paolo Casillo
- Multiple Sclerosis Unit, IRCCS Santa Lucia Foundation, Rome, Italy
| | | | - Elio Troisi
- Multiple Sclerosis Unit, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Angelo Tonini
- Multiple Sclerosis Unit, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Stefano Paolucci
- Clinical Laboratory of Experimental Neurorehabilitation, IRCCS Santa Lucia Foundation, Rome, Italy
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Paleg G, Livingstone R. Systematic review and clinical recommendations for dosage of supported home-based standing programs for adults with stroke, spinal cord injury and other neurological conditions. BMC Musculoskelet Disord 2015; 16:358. [PMID: 26576548 PMCID: PMC4650310 DOI: 10.1186/s12891-015-0813-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 11/12/2015] [Indexed: 11/19/2022] Open
Abstract
Background Sitting for more than 8 h a day has been shown to negatively impact health and mortality while standing is the recommended healthier alternative. Home-based standing programs are commonly recommended for adults who cannot stand and/or walk independently. The aim of this systematic review is to review effectiveness of home-based standing programs for adults with neurological conditions including stroke and spinal cord injury; and to provide dosage guidelines to address body structure and function, activity and participation outcomes. Methods Eight electronic databases were searched, including Cochrane Library databases, MEDLINE, CINAHL and EMBASE. From 376 articles, 36 studies addressing impact of a standing intervention on adults with sub-acute or chronic neurological conditions and published between 1980 and September 2015 were included. Two reviewers independently screened titles, reviewed abstracts, evaluated full-text articles and rated quality and strength of evidence. Evidence level was rated using Oxford Centre for Evidence Based Medicine Levels and quality evaluated using a domain-based risk-of-bias rating. Outcomes were divided according to ICF components, diagnoses and dosage amounts from individual studies. GRADE and the Evidence-Alert Traffic-Lighting system were used to determine strength of recommendation and adjusted in accordance with risk-of-bias rating. Results Stronger evidence supports the impact of home-based supported standing programs on range of motion and activity, primarily for individuals with stroke or spinal cord injury while mixed evidence supports impact on bone mineral density. Evidence for other outcomes and populations is weak or very weak. Conclusions Standing should occur 30 min 5 times a week for a positive impact on most outcomes while 60 min daily is suggested for mental function and bone mineral density. Electronic supplementary material The online version of this article (doi:10.1186/s12891-015-0813-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ginny Paleg
- Montgomery County Infants and Toddlers Program, Rockville, MD, USA.
| | - Roslyn Livingstone
- Sunny Hill Health Centre for Children, Vancouver, British Columbia, Canada
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Sadeghi M, Mclvor J, Finlayson H, Sawatzky B. Static standing, dynamic standing and spasticity in individuals with spinal cord injury. Spinal Cord 2015; 54:376-82. [PMID: 26391189 DOI: 10.1038/sc.2015.160] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Revised: 07/22/2015] [Accepted: 08/10/2015] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN This was a cross-over efficacy study design. OBJECTIVE To determine spasticity differences between static and dynamic standing training in individuals with spinal cord injury (SCI). SETTING Vancouver, Canada. METHODS Ten individuals with SCI who could stand with or without bracing or supports participated in both dynamic and static standing training (one session each, 2 days apart) using a Segway. The primary outcome was spasticity as measured by Visual Analog Scale (VAS), Modified Ashworth Scale (MAS) and electromyography (EMG) of the quadriceps, hamstrings, adductors and gastrocnemius. RESULTS There was no statistically detectable difference in spasticity between dynamic and static standing training in individuals with SCI as measured by VAS, MAS or EMG, although there was a trend towards decreased spasticity after the dynamic training. CONCLUSION There is no significant difference in spasticity outcomes between static and dynamic standing training on a Segway for individuals with SCI. SPONSORSHIP This research was funded by Natural Sciences and Engineering Research Council of Canada and International Collaboration on Repair Discoveries.
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Affiliation(s)
- M Sadeghi
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,International Collaboration on Repair Discoveries, Vancouver, British Columbia, Canada
| | - J Mclvor
- Department of Mechanical Engineering, University of British Columbia, Vancouver, British Columbia, Canada
| | - H Finlayson
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - B Sawatzky
- International Collaboration on Repair Discoveries, Vancouver, British Columbia, Canada.,Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
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Dolbow DR, Gorgey AS, Recio AC, Stiens SA, Curry AC, Sadowsky CL, Gater DR, Martin R, McDonald JW. Activity-Based Restorative Therapies after Spinal Cord Injury: Inter-institutional conceptions and perceptions. Aging Dis 2015; 6:254-61. [PMID: 26236547 DOI: 10.14336/ad.2014.1105] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Revised: 10/12/2014] [Accepted: 11/05/2014] [Indexed: 11/01/2022] Open
Abstract
This manuscript is a review of the theoretical and clinical concepts provided during an inter-institutional training program on Activity-Based Restorative Therapies (ABRT) and the perceptions of those in attendance. ABRT is a relatively recent high volume and intensity approach toward the restoration of neurological deficits and decreasing the risk of secondary conditions associated with paralysis after spinal cord injury (SCI). ABRT is guided by the principle of neuroplasticity and the belief that even those with chronic SCI can benefit from repeated activation of the spinal cord pathways located both above and below the level of injury. ABRT can be defined as repetitive-task specific training using weight-bearing and external facilitation of neuromuscular activation. The five key components of ABRT are weight-bearing activities, functional electrical stimulation, task-specific practice, massed practice and locomotor training which includes body weight supported treadmill walking and water treadmill training. The various components of ABRT have been shown to improve functional mobility, and reverse negative body composition changes after SCI leading to the reduction of cardiovascular and other metabolic disease risk factors. The consensus of those who received the ABRT training was that ABRT has much potential for enhancement of recovery of those with SCI. Although various institutions have their own strengths and challenges, each institution was able to initiate a modified ABRT program.
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Affiliation(s)
- David R Dolbow
- University of Southern Mississippi, College of Health, Human Performance and Recreation, Hattiesburg, MS 39406, USA
| | - Ashraf S Gorgey
- Hunter Holmes McGuire VA Medical Center, Spinal Cord Injury and Disorders Center, Richmond, VA 23224, USA. ; Virginia Commonwealth University, School of Medicine, Richmond, VA 23298, USA
| | - Albert C Recio
- Kennedy Krieger Institute, International Center for Spinal Cord Injury, Baltimore MD 21205, USA. ; Johns Hopkins University School of Medicine, Baltimore MD 21205, USA
| | | | - Amanda C Curry
- VA Boston Healthcare System, Physical Medicine and Rehabilitation, West Roxbury, MA 02132, USA
| | - Cristina L Sadowsky
- Kennedy Krieger Institute, International Center for Spinal Cord Injury, Baltimore MD 21205, USA. ; Johns Hopkins University School of Medicine, Baltimore MD 21205, USA
| | - David R Gater
- Penn State Hershey Medical Center and Health System, Hershey, PA 17033, USA. ; Penn State College of Medicine, Hershey, PA 17033
| | - Rebecca Martin
- Kennedy Krieger Institute, International Center for Spinal Cord Injury, Baltimore MD 21205, USA
| | - John W McDonald
- Kennedy Krieger Institute, International Center for Spinal Cord Injury, Baltimore MD 21205, USA. ; Johns Hopkins University School of Medicine, Baltimore MD 21205, USA
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Kozlowski AJ, Bryce TN, Dijkers MP. Time and Effort Required by Persons with Spinal Cord Injury to Learn to Use a Powered Exoskeleton for Assisted Walking. Top Spinal Cord Inj Rehabil 2015; 21:110-21. [PMID: 26364280 DOI: 10.1310/sci2102-110] [Citation(s) in RCA: 97] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Powered exoskeletons have been demonstrated as being safe for persons with spinal cord injury (SCI), but little is known about how users learn to manage these devices. OBJECTIVE To quantify the time and effort required by persons with SCI to learn to use an exoskeleton for assisted walking. METHODS A convenience sample was enrolled to learn to use the first-generation Ekso powered exoskeleton to walk. Participants were given up to 24 weekly sessions of instruction. Data were collected on assistance level, walking distance and speed, heart rate, perceived exertion, and adverse events. Time and effort was quantified by the number of sessions required for participants to stand up, walk for 30 minutes, and sit down, initially with minimal and subsequently with contact guard assistance. RESULTS Of 22 enrolled participants, 9 screen-failed, and 7 had complete data. All of these 7 were men; 2 had tetraplegia and 5 had motor-complete injuries. Of these, 5 participants could stand, walk, and sit with contact guard or close supervision assistance, and 2 required minimal to moderate assistance. Walk times ranged from 28 to 94 minutes with average speeds ranging from 0.11 to 0.21 m/s. For all participants, heart rate changes and reported perceived exertion were consistent with light to moderate exercise. CONCLUSIONS This study provides preliminary evidence that persons with neurological weakness due to SCI can learn to walk with little or no assistance and light to somewhat hard perceived exertion using a powered exoskeleton. Persons with different severities of injury, including those with motor complete C7 tetraplegia and motor incomplete C4 tetraplegia, may be able to learn to use this device.
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Affiliation(s)
- Allan J Kozlowski
- Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, New York New York
| | - Thomas N Bryce
- Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, New York New York
| | - Marcel P Dijkers
- Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, New York New York
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Wolff J, Parker C, Borisoff J, Mortenson WB, Mattie J. A survey of stakeholder perspectives on exoskeleton technology. J Neuroeng Rehabil 2014; 11:169. [PMID: 25523497 PMCID: PMC4320449 DOI: 10.1186/1743-0003-11-169] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2014] [Accepted: 12/12/2014] [Indexed: 11/17/2022] Open
Abstract
Background Exoskeleton technology has potential benefits for wheelchair users’ health and mobility. However, there are practical barriers to their everyday use as a mobility device. To further understand potential exoskeleton use, and facilitate the development of new technologies, a study was undertaken to explore perspectives of wheelchair users and healthcare professionals on reasons for use of exoskeleton technology, and the importance of a variety of device characteristics. Methods An online survey with quantitative and qualitative components was conducted with wheelchair users and healthcare professionals working directly with individuals with mobility impairments. Respondents rated whether they would use or recommend an exoskeleton for four potential reasons. Seventeen design features were rated and compared in terms of their importance. An exploratory factor analysis was conducted to categorize the 17 design features into meaningful groupings. Content analysis was used to identify themes for the open ended questions regarding reasons for use of an exoskeleton. Results 481 survey responses were analyzed, 354 from wheelchair users and 127 from healthcare professionals. The most highly rated reason for potential use or recommendation of an exoskeleton was health benefits. Of the design features, 4 had a median rating of very important: minimization of falls risk, comfort, putting on/taking off the device, and purchase cost. Factor analysis identified two main categories of design features: Functional Activities and Technology Characteristics. Qualitative findings indicated that health and physical benefits, use for activity and access reasons, and psychosocial benefits were important considerations in whether to use or recommend an exoskeleton. Conclusions This study emphasizes the importance of developing future exoskeletons that are comfortable, affordable, minimize fall risk, and enable functional activities. Findings from this study can be utilized to inform the priorities for future development of this technology. Electronic supplementary material The online version of this article (doi:10.1186/1743-0003-11-169) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | | | - Jaimie Borisoff
- Occupational Science and Occupational Therapy, University of British Columbia, (T325 - 2211 Wesbrook Mall), Vancouver (V6T 2B5), Canada.
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Balioussis C, Hitzig SL, Flett H, Noreau L, Craven BC. Identifying and classifying quality of life tools for assessing spasticity after spinal cord injury. Top Spinal Cord Inj Rehabil 2014; 20:208-24. [PMID: 25484567 DOI: 10.1310/sci2003-208] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To identify and classify tools for assessing the influence of spasticity on quality of life (QOL) after spinal cord injury (SCI). METHODS Electronic databases (MEDLINE/PubMed CINAHL and PsycInfo) were searched for studies published between 1975 and 2012. Dijkers's theoretical framework on QOL was used to classify tools as either objective or subjective measures of QOL. RESULTS Sixteen studies met the inclusion criteria. Identified objective measures that were used to assess the influence of spasticity on QOL included the Short Form-36 (SF-36) the Sickness Impact Profile (SIP) and the Health Utilities Index-III (HUI-III). Subjective measures included the Quality of Life Index-SCI Version III (QLI-SCI) Life Situation Questionnaire-Revised (LSQ-R) Reciprocal Support Scale (RSS) Profile of Mood States (POMS) Spinal Cord Injury Spasticity Evaluation Tool (SCI-SET) and the Patient Reported Impact of Spasticity Measure (PRISM). A number of tools proved either to be insensitive to the presence of spasticity (QLI-SCI) or yielded mixed (SF-36) or weak (RSS LSQ-R) results. Tools that were sensitive to spasticity had limited psychometric data for use in the SCI population (HUI-III SIP POMS) although 2 were developed specifically for assessing spasticity on daily life post SCI (SCI-SET PRISM). CONCLUSIONS Two condition-specific subjective measures the SCI-SET and PRISM emerged as the most promising tools for the assessment of spasticity impact on QOL after SCI. Further research should focus on establishing the psychometric properties of these measures for use in the SCI population.Key words: outcome measurement quality of life spasticity spinal cord injury.
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Affiliation(s)
- Christina Balioussis
- Lyndhurst Centre, Toronto Rehabilitation Institute - University Health Network , Toronto, Ontario , Canada
| | - Sander L Hitzig
- Institute for Life Course and Aging, Faculty of Medicine, University of Toronto , Toronto, Ontario , Canada
| | - Heather Flett
- Lyndhurst Centre, Toronto Rehabilitation Institute - University Health Network , Toronto, Ontario , Canada
| | - Luc Noreau
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale (CIRRIS) , Québec, Québec , Canada ; Départment de réadaptation,Faculté de Médecine, Université Laval , Québec, Québec , Canada
| | - B Catharine Craven
- Lyndhurst Centre, Toronto Rehabilitation Institute - University Health Network , Toronto, Ontario , Canada ; Department of Medicine, Division of Physiatry, University of Toronto , Toronto, Ontario , Canada
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Harvey LA, Glinsky JV, Bowden JL, Arora M. How well do randomised controlled trials of physical interventions for people with spinal cord injury adhere to the CONSORT guidelines? An analysis of trials published over a 10-year period. Spinal Cord 2014; 52:795-802. [PMID: 25179652 DOI: 10.1038/sc.2014.152] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Revised: 07/29/2014] [Accepted: 08/01/2014] [Indexed: 12/20/2022]
Abstract
STUDY DESIGN Cross-sectional descriptive study of randomised controlled trials involving physical interventions for people with spinal cord injury (SCI) published between 2003 and 2013. OBJECTIVES To determine how well randomised controlled trials of physical interventions for people with SCI adhere to the CONSORT (Consolidated Standards of Reporting Trials) guidelines. SETTING University of Sydney, Sydney, NSW, Australia. METHODS A search was conducted for randomised controlled trials designed to determine the effectiveness of physical interventions for people with SCI published between 2003 and 2013. The CONSORT checklist for the reporting of randomised controlled trials was used to determine how well each trial adhered to the guidelines. Two independent reviewers rated each trial on each of the 37 items on the CONSORT checklist using the following criteria: 'fully reported', 'partially reported', 'not reported', 'not relevant' or 'not reported but unable to determine if relevant/done'. RESULTS Fifty-three trials were retrieved. None of the trials 'fully reported' all items of the CONSORT guidelines. The median (IQR) number of items that was 'fully reported' was 11/37 (7-20). The median (IQR) number of items that was either 'fully reported' or 'not relevant' or 'not reported but unable to determine if relevant' was 20/37 items (17-27). CONCLUSION The reporting of randomised controlled trials in SCI is only partially adhering to the CONSORT guidelines. Journals can help lift standards by encouraging authors of randomised controlled trials to adhere to the CONSORT guidelines.
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Affiliation(s)
- L A Harvey
- Rehabilitation Studies Unit, Kolling Institute, Sydney Medical School/Northern, Faculty of Medicine, University of Sydney, C/O Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - J V Glinsky
- Rehabilitation Studies Unit, Kolling Institute, Sydney Medical School/Northern, Faculty of Medicine, University of Sydney, C/O Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - J L Bowden
- Rehabilitation Studies Unit, Kolling Institute, Sydney Medical School/Northern, Faculty of Medicine, University of Sydney, C/O Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - M Arora
- Rehabilitation Studies Unit, Kolling Institute, Sydney Medical School/Northern, Faculty of Medicine, University of Sydney, C/O Royal North Shore Hospital, St Leonards, New South Wales, Australia
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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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Hou J, Nelson R, Nissim N, Parmer R, Thompson FJ, Bose P. Effect of combined treadmill training and magnetic stimulation on spasticity and gait impairments after cervical spinal cord injury. J Neurotrauma 2014; 31:1088-106. [PMID: 24552465 DOI: 10.1089/neu.2013.3096] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Spasticity and gait impairments are two common disabilities after cervical spinal cord injury (C-SCI). In this study, we tested the therapeutic effects of early treadmill locomotor training (Tm) initiated at postoperative (PO) day 8 and continued for 6 weeks with injury site transcranial magnetic stimulation (TMSsc) on spasticity and gait impairments after low C6/7 moderate contusion C-SCI in a rat model. The combined treatment group (Tm+TMSsc) showed the most robust decreases in velocity-dependent ankle torques and triceps surae electromyography burst amplitudes that were time locked to the initial phase of lengthening, as well as the most improvement in limb coordination quantitated using three-dimensional kinematics and CatWalk gait analyses, compared to the control or single-treatment groups. These significant treatment-associated decreases in measures of spasticity and gait impairment were also accompanied by marked treatment-associated up-regulation of dopamine beta-hydroxylase, glutamic acid decarboxylase 67, gamma-aminobutyric acid B receptor, and brain-derived neurotrophic factor in the lumbar spinal cord (SC) segments of the treatment groups, compared to tissues from the C-SCI nontreated animals. We propose that the treatment-induced up-regulation of these systems enhanced the adaptive plasticity in the SC, in part through enhanced expression of pre- and postsynaptic reflex regulatory processes. Further, we propose that locomotor exercise in the setting of C-SCI may decrease aspects of the spontaneous maladaptive segmental and descending plasticity. Accordingly, TMSsc treatment is characterized as an adjuvant stimulation that may further enhance this capacity. These data are the first to suggest that a combination of Tm and TMSsc across the injury site can be an effective treatment modality for C-SCI-induced spasticity and gait impairments and provided a pre-clinical demonstration for feasibility and efficacy of early TMSsc intervention after C-SCI.
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Affiliation(s)
- Jiamei Hou
- 1 Department of Physiological Sciences, University of Florida , Gainesville, Florida
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Shin HY, Kim H, Kwon MJ, Hwang DH, Lee K, Kim BG. Molecular and cellular changes in the lumbar spinal cord following thoracic injury: regulation by treadmill locomotor training. PLoS One 2014; 9:e88215. [PMID: 24520355 PMCID: PMC3919755 DOI: 10.1371/journal.pone.0088215] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Accepted: 01/03/2014] [Indexed: 11/18/2022] Open
Abstract
Traumatic spinal cord injury (SCI) often leads to debilitating loss of locomotor function. Neuroplasticity of spinal circuitry underlies some functional recovery and therefore represents a therapeutic target to improve locomotor function following SCI. However, the cellular and molecular mechanisms mediating neuroplasticity below the lesion level are not fully understood. The present study performed a gene expression profiling in the rat lumbar spinal cord at 1 and 3 weeks after contusive SCI at T9. Another group of rats received treadmill locomotor training (TMT) until 3 weeks, and gene expression profiles were compared between animals with and without TMT. Microarray analysis showed that many inflammation-related genes were robustly upregulated in the lumbar spinal cord at both 1 and 3 weeks after thoracic injury. Notably, several components involved in an early complement activation pathway were concurrently upregulated. In line with the microarray finding, the number of microglia substantially increased not only in the white matter but also in the gray matter. C3 and complement receptor 3 were intensely expressed in the ventral horn after injury. Furthermore, synaptic puncta near ventral motor neurons were frequently colocalized with microglia after injury, implicating complement activation and microglial cells in synaptic remodeling in the lumbar locomotor circuitry after SCI. Interestingly, TMT did not influence the injury-induced upregulation of inflammation-related genes. Instead, TMT restored pre-injury expression patterns of several genes that were downregulated by injury. Notably, TMT increased the expression of genes involved in neuroplasticity (Arc, Nrcam) and angiogenesis (Adam8, Tie1), suggesting that TMT may improve locomotor function in part by promoting neurovascular remodeling in the lumbar motor circuitry.
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Affiliation(s)
- Hae Young Shin
- Department of Brain Science, Ajou University School of Medicine, Suwon, Republic of Korea
- Neuroscience Graduate Program, Department of Biomedical Sciences, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Hyosil Kim
- Neuroscience Graduate Program, Department of Biomedical Sciences, Ajou University School of Medicine, Suwon, Republic of Korea
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Min Jung Kwon
- Department of Brain Science, Ajou University School of Medicine, Suwon, Republic of Korea
- Neuroscience Graduate Program, Department of Biomedical Sciences, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Dong Hoon Hwang
- Department of Brain Science, Ajou University School of Medicine, Suwon, Republic of Korea
- Neuroscience Graduate Program, Department of Biomedical Sciences, Ajou University School of Medicine, Suwon, Republic of Korea
| | - KiYoung Lee
- Neuroscience Graduate Program, Department of Biomedical Sciences, Ajou University School of Medicine, Suwon, Republic of Korea
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, Republic of Korea
- * E-mail: (KYL); (BGK)
| | - Byung Gon Kim
- Department of Brain Science, Ajou University School of Medicine, Suwon, Republic of Korea
- Neuroscience Graduate Program, Department of Biomedical Sciences, Ajou University School of Medicine, Suwon, Republic of Korea
- Department of Neurology, Ajou University School of Medicine, Suwon, Republic of Korea
- * E-mail: (KYL); (BGK)
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Nery MB, Driver S, Vanderbom KA. Systematic framework to classify the status of research on spinal cord injury and physical activity. Arch Phys Med Rehabil 2013; 94:2027-31. [PMID: 23643686 DOI: 10.1016/j.apmr.2013.04.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Revised: 04/11/2013] [Accepted: 04/22/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To systematically classify the physical activity research for individuals with a spinal cord injury by using the behavioral epidemiologic framework; and to identify where the physical activity research for individuals with a spinal cord injury has focused between 2000 and 2012. DESIGN Relevant research was identified and then categorized into 1 of 5 phases by following the coding rules of the behavioral epidemiology framework. Phase 1 studies link physical activity and health outcomes, phase 2 studies validate or develop measures of physical activity, phase 3 studies identify factors that influence behavior or examine explanatory theories of behavior, phase 4 studies evaluate interventions, and phase 5 studies disseminate health promotion programs or policies and translate research into practice. SETTING Specific keywords were identified and then searched through EBSCOhost, PubMed, and Google Scholar. PARTICIPANTS Not applicable. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Not applicable. RESULTS One hundred and thirteen articles met the criteria. Of the articles, 55% were categorized as phase 1, 12% as phase 2, 24% as phase 3, 5% as phase 4, and 4% as phase 5. CONCLUSIONS Most studies were categorized as phase 1, 2, or 3, which implies that this field is still in the early stages of development and research should focus on intervention development and dissemination.
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Affiliation(s)
- Mara B Nery
- Department of Exercise and Sport Science, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR.
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Abstract
BACKGROUND A traumatic spinal cord injury (SCI) is a lesion of neural elements of the spinal cord that can result in any degree of sensory and motor deficit, autonomic or bowel dysfunction. Improvement of locomotor function is one of the primary goals for people with SCI. Locomotor training for walking is therefore used in rehabilitation after SCI and might help to improve a person's ability to walk. However, a systematic review of the evidence is required to assess the effects and acceptability of locomotor training after SCI. OBJECTIVES To assess the effects of locomotor training on improvement in walking for people with traumatic SCI. SEARCH METHODS We searched the Cochrane Injuries Group's Specialised Register (searched November 2011); the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 4); MEDLINE (Ovid) (1966 to November 2011); EMBASE (Ovid) (1980 to November 2011); CINAHL (1982 to November 2011); AMED (Allied and Complementary Medicine Database) (1985 to November 2011); SPORTDiscus (1949 to November 2011); PEDro (the Physiotherapy Evidence database) (searched November 2011); COMPENDEX (engineering databases) (1972 to November 2011); and INSPEC (1969 to November 2011). We also searched the online trials databases Current Controlled Trials (www.controlled-trials.com/isrctn) and Clinical Trials (www.clinicaltrials.gov). We handsearched relevant conference proceedings, checked reference lists of relevant published papers and contacted study authors in an effort to identify published, unpublished and ongoing trials. SELECTION CRITERIA We included randomised controlled trials (RCTs) involving people with SCI that compared locomotor training to a control of any other exercise or no treatment. DATA COLLECTION AND ANALYSIS Two review authors independently selected trials for inclusion, assessed trial quality and extracted data. The primary outcomes were the speed of walking and walking capacity at final follow-up. MAIN RESULTS Five RCTs involving 309 people are included in this review. Overall, the results were inconclusive. There was no statistically significant superior effect of any locomotor training approach on walking function after SCI compared with any other kind of physical rehabilitation. The use of bodyweight supported treadmill training as locomotor training for people after SCI did not significantly increase walking velocity (0.03 m/sec with a 95% confidence interval (CI) -0.05 to 0.11; P = 0.52; I(2) = 22%) nor did it increase walking capacity (-1.3 metres (95% CI -41 to 40); P = 0.95; I(2) = 62%). However, in one study involving 74 people the group receiving robotic-assisted locomotor training had reduced walking capacity compared with people receiving any other intervention, a finding which needs further investigation. In all five studies there were no differences in adverse events or drop-outs between study groups. AUTHORS' CONCLUSIONS There is insufficient evidence from RCTs to conclude that any one locomotor training strategy improves walking function more than another for people with SCI. The effects especially of robotic-assisted locomotor training are not clear, therefore research in the form of large RCTs, particularly for robotic training, is needed. Specific questions about which type of locomotor training might be most effective in improving walking function for people with SCI need to be explored.
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Affiliation(s)
- Jan Mehrholz
- Head, Insitute of Science, Private European Medical Academy of the Klinik Bavaria Kreischa, Kreischa,
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Newman M, Barker K. The effect of supported standing in adults with upper motor neurone disorders: a systematic review. Clin Rehabil 2012; 26:1059-77. [DOI: 10.1177/0269215512443373] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Meredith Newman
- Physiotherapy Research Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Karen Barker
- Physiotherapy Research Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Oxford, UK
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