Rehabilitation of Acute Vs. Chronic Patients With Spinal Cord Injury With a Neurologically Controlled Hybrid Assistive Limb Exoskeleton: Is There a Difference in Outcome?

Challenges in Translating Regenerative Therapies for Spinal Cord Injury

Regenerating the injured spinal cord is a substantial challenge with many obstacles that need to be overcome to achieve robust functional benefits. This abundance of hurdles can partly explain the limited success when applying regenerative intervention treatments in animal models and/or people. In this article, we elaborate on a few of these obstacles, starting with the applicability of animal models and how they compare to the clinical setting. We then discuss the requirement for combinatorial interventions and the associated problems in experimental design, including the addition of rehabilitative training. The article expands on differences in lesion sizes and locations between humans and common animal models, and how this difference can determine the success or failure of an intervention. An additional and frequently overlooked problem in the translation of interventions that applies beyond the field of neuroregeneration is the reporting bias and the lack of transparency in reporting findings. New data mandates are tackling this problem and will eventually result in a more balanced view of the field. Finally, we will discuss strategies to negotiate the challenging course of successful translation to facilitate successful translation of regeneration promoting interventions.

Impact of Robotic-Assisted Gait Training in Subacute Spinal Cord Injury Patients on Outcome Measure

The improvement of walking ability is a primary goal for spinal cord injury (SCI) patients. Robotic-assisted gait training (RAGT) is an innovative method for its improvement. This study evaluates the influence of RAGT vs. dynamic parapodium training (DPT) in improving gait motor functions in SCI patients. In this single-centre, single-blinded study, we enrolled 105 (39 and 64 with complete and incomplete SCI, respectively) patients. The investigated subjects received gait training with RAGT (experimental S1-group) and DPT (control S0-group), with six training sessions per week over seven weeks. The American Spinal Cord Injury Association Impairment Scale Motor Score (MS), Spinal Cord Independence Measure, version-III (SCIM-III), Walking Index for Spinal Cord Injury, version-II (WISCI-II), and Barthel Index (BI) were assessed in each patient before and after sessions. Patients with incomplete SCI assigned to the S1 rehabilitation group achieved more significant improvement in MS [2.58 (SE 1.21, p < 0.05)] and WISCI-II [3.07 (SE 1.02, p < 0.01])] scores in comparison with patients assigned to the S0 group. Despite the described improvement in the MS motor score, no progression between grades of AIS (A to B to C to D) was observed. A nonsignificant improvement between the groups for SCIM-III and BI was found. RAGT significantly improved gait functional parameters in SCI patients in comparison with conventional gait training with DPT. RAGT is a valid treatment option in SCI patients in the subacute phase. DPT should not be recommended for patients with incomplete SCI (AIS-C); in those patients, RAGT rehabilitation programs should be taken into consideration.

Mobile and wearable technologies for the analysis of Ten Meter Walk Test: A concise systematic review

Physical issues started to receive more attention due to the sedentary lifestyle prevalent in modern culture. The Ten Meter Walk Test allows measuring the person's capacity to walk along 10 m and analyzing the advancement of various medical procedures for ailments, including stroke. This systematic review is related to the use of mobile or wearable devices to measure physical parameters while administering the Ten Meter Walk Test for the analysis of the performance of the test. We applied the PRISMA methodology for searching the papers related to the Ten Meter Walk Test. Natural Language Processing (NLP) algorithms were used to automate the screening process. Various papers published in two decades from multiple scientific databases, including IEEE Xplore, Elsevier, Springer, EMBASE, SCOPUS, Multidisciplinary Digital Publishing Institute (MDPI), and PubMed Central were analyzed, focusing on various diseases, devices, features, and methods. The study reveals that chronometer and accelerometer sensors measuring spatiotemporal features are the most pertinent in the Gait characterization of most diseases. Likewise, all studies emphasized the close relation between the quality of the sensor's data obtained and the system's ultimate accuracy. In other words, calibration procedures are needed because of the body part where the sensor is worn and the type of sensor. In addition, using ambient sensors providing kinematic and kinetic features in conjunction with wearable sensors and consistently acquiring walking signals can enhance the system's performance. The most common weaknesses in the analyzed studies are the sample size and the unavailability of continuous monitoring devices for measuring the Ten Meter Walk Test.

Robotic rehabilitation therapy using Hybrid Assistive Limb (HAL) for patients with spinal cord lesions: A narrative review

Background

The Hybrid Assistive Limb (HAL) is a rehabilitation device that utilizes the "interactive biofeedback" hypothesis to facilitate the motion of the device according to the user's motion intention and appropriate sensory input evoked by HAL-supported motion. HAL has been studied extensively for its potential to promote walking function in patients with spinal cord lesions, including spinal cord injury.

Methods

We performed a narrative review of HAL rehabilitation for spinal cord lesions.

Results

Several reports have shown the effectiveness of HAL rehabilitation in the recovery of walking ability in patients with gait disturbance caused by compressive myelopathy. Clinical studies have also demonstrated potential mechanisms of action leading to clinical findings, including normalization of cortical excitability, improvement of muscle synergy, attenuation of difficulties in voluntarily initiating joint movement, and gait coordination changes.

Conclusions

However, further investigation with more sophisticated study designs is necessary to prove the true efficacy of HAL walking rehabilitation. HAL remains one of the most promising rehabilitation devices for promoting walking function in patients with spinal cord lesions.

[New technologies and robotics]

The development of increasingly more complex computer and electromotor technologies enables the increasing use and expansion of robot-assisted systems in trauma surgery rehabilitation; however, the currently available devices are rarely comprehensively applied but are often used within pilot projects and studies. Different technological approaches, such as exoskeletal systems, functional electrical stimulation, soft robotics, neurorobotics and brain-machine interfaces are used and combined to read and process the communication between, e.g., residual musculature or brain waves, to transfer them to the executing device and to enable the desired execution.Currently, the greatest amount of evidence exists for the use of exoskeletal systems with different modes of action in the context of gait and stance rehabilitation in paraplegic patients; however, their use also plays a role in the rehabilitation of fractures close to the hip joint and endoprosthetic care. So-called single joint systems are also being tested in the rehabilitation of functionally impaired extremities, e.g., after knee prosthesis implantation. At this point, however, the current data situation is still too limited to be able to make a clear statement about the use of these technologies in the trauma surgery "core business" of rehabilitation after fractures and other joint injuries.For rehabilitation after limb amputation, in addition to the further development of myoelectric prostheses, the current development of "sentient" prostheses is of great interest. The use of 3D printing also plays a role in the production of individualized devices.Due to the current progress of artificial intelligence in all fields, ground-breaking further developments and widespread application possibilities in the rehabilitation of trauma patients are to be expected.