The effectiveness of robotic-assisted upper limb rehabilitation to improve upper limb function in patients with cervical spinal cord injuries: a systematic literature review

Comparative efficacy of robotic exoskeleton and conventional gait training in patients with spinal cord injury: a meta-analysis of randomized controlled trials

OBJECTIVE

The purpose of this meta-analysis was to investigate the effects of Robotic exoskeleton gait training (REGT) on lower limb mobility, walking balance, functional scores and respiratory function in patients with spinal cord injury (SCI).

DATA SOURCES

The PubMed, Embase, Cochrane Library databases were systematically searched from inception until December 24, 2024.

STUDY SELECTION

Eligible randomized controlled trials contained information on the population (SCI), intervention (REGT), and outcomes (walking speed and distance, walking balance, functional scores for SCI rehabilitation, respiratory function). Participants in the REGT intervention group were compared with those in conventional physical gait training (CPT) groups. Two independent researchers conducted the research,screened the articles, and assessed their eligibility.

DATA EXTRACTION

Two independent researchers extracted key information from each eligible study. The authors' names, year of publication, setting, total sample size, REGT, CPT training schedule, baseline/mean difference (MD), and 95% confidence interval (CI) were extracted using a standardized form, and the methodological quality was assessed using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) system.

DATA SYNTHESIS

Of 595 studies identified, 15 randomized controlled trials (n = 579) were included for meta-analysis. Compared with conventional physical gait training (CPT), REGT showed no significant efficacy in walking speed (10-Meter Walk Test, WMD (95%CI) = - 0.03 (- 0.06, 0.00) m/s, P = 0.08) and walking distance, (6-Minute Walk Test, WMD (95% CI) = -1.83 (- 14.48, 10.83) meters, P = 0.78). REGT showed statistically significant efficacy in walking stability (Timed Up and Go, WMD (95%CI) = 6.62 (0.35, 12.88) s, P = 0.04) and functional scores such as Walking Index for Spinal Cord Injury Version II (WMD (95%CI) = 2.17 (1.05, 3.29), P = 0.0001) and Lower Extremity Motor Score (WMD (95%CI) = 1.33 (0.58, 2.07), P = 0.0005). Additional Significant efficacy was also found in terms of respiratory function (forced expiratory volume in one second, WMD (95%CI) = 0.60 (0.05, 1.16) L, P = 0.03).

CONCLUSIONS

This meta-analysis discovered the evidence that robotic exoskeleton gait training can improve the walking balance, strength of lower limbs, functional scores and respiratory function in the patients with spinal cord injury (SCI) compared to conventional gait training (CPT). No obvious evidence showed that REGT has more advantages than CPT in improving walking speed and distance. REGT combined with CPT are more recommended in the discovery of walking speed and distance of patients above 6 months after SCI.

Effectiveness of virtual reality rehabilitation for cervical spinal cord injury: A systematic review and meta-analysis

This systematic review and meta-analysis evaluated the effectiveness of virtual reality (VR) rehabilitation in improving functional performance for patients with cervical spinal cord injury (CSCI), which affects both upper and lower limb function. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, electronic databases including PubMed, Medline, Embase, Scopus, and Cochrane Library were searched. Meta-analysis was conducted on studies reporting common functional outcomes, with standardized mean difference (SMD) used to quantify effect sizes. Nine studies were included in the systematic review, and seven were analyzed in the meta-analysis. Three studies focused on upper limb outcomes, and six on lower limb function. Of the seven studies, four included only CSCI patients, while three had mixed injury cohorts (cervical and thoracic). Meta-analysis revealed no statistically significant improvements in function for mixed injury cohorts across various outcomes: Timed-Up and Go test (SMD 0.94 [-0.21, 2.09]), Berg Balance Scale (-0.83 [-1.72, 0.07]), Walking Index for Spinal Cord Injury II (-0.38 [-0.86, 0.09]), Spinal Cord Independence Measure (-0.41 [-0.92, 0.10]), and 10 Meter Walk Test (-1.43 [-3.58, -0.73]). However, the Timed-Up and Go test showed significant results favoring VR-based rehabilitation when excluding mixed cohorts (SMD 2.02 [1.24, 2.79]). VR rehabilitation shows promise for improving lower limb function in CSCI patients, but overall evidence remains inconclusive due to study variability. Standardizing outcome measures and further research on upper limb rehabilitation are essential to enhance the impact of VR-based interventions for CSCI.

Case report: Movement-related neuroplasticity in a patient after spinal cord injury in response to task-oriented bimanual training

Background

Bimanual motor training is an effective neurological rehabilitation strategy. However, its use has rarely been investigated in patients with paralysis caused by spinal cord injury (SCI). Therefore, we conducted a case study to investigate the effects of robot-assisted task-oriented bimanual training (RBMT) on upper limb function, activities of daily living, and movement-related sensorimotor activity in a patient with SCI.

Methods

A patient with bilateral upper limb paresis due to incomplete cervical SCI underwent 20 sessions of RBMT. Functional recovery was measured using clinical scales for upper limb motor function and activities of daily living. Training-induced neuroplasticity was evaluated using event-related desynchronization (ERD) induced by movement of the right hand (the more affected side), recorded on the electroencephalogram (EEG).

Results

RBMT improved the patient's upper limb motor function and activity independence. At baseline, our EEG paradigm demonstrated an ipsilateral predominance of movement-related ERD responses over the sensorimotor cortex (SMC) in relation to the moving hand. Following the RBMT, the ERD pattern shifted from being predominantly ipsilateral to a contralateral allocation.

Conclusion

The present case study provides preliminary evidence to support the therapeutic use of RBMT to restore upper limb function in patients with incomplete SCI. The recovery of function following SCI might be related to the rebalancing of sensorimotor activation.

Artificial Intelligence and Machine Learning in Neuroregeneration: A Systematic Review

Artificial intelligence (AI) and machine learning (ML) show promise in various medical domains, including medical imaging, precise diagnoses, and pharmaceutical research. In neuroscience and neurosurgery, AI/ML advancements enhance brain-computer interfaces, neuroprosthetics, and surgical planning. They are poised to revolutionize neuroregeneration by unraveling the nervous system's complexities. However, research on AI/ML in neuroregeneration is fragmented, necessitating a comprehensive review. Adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations, 19 English-language papers focusing on AI/ML in neuroregeneration were selected from a total of 247. Two researchers independently conducted data extraction and quality assessment using the Mixed Methods Appraisal Tool (MMAT) 2018. Eight studies were deemed high quality, 10 moderate, and four low. Primary goals included diagnosing neurological disorders (35%), robotic rehabilitation (18%), and drug discovery (12% each). Methods ranged from analyzing imaging data (24%) to animal models (24%) and electronic health records (12%). Deep learning accounted for 41% of AI/ML techniques, while standard ML algorithms constituted 29%. The review underscores the growing interest in AI/ML for neuroregenerative medicine, with increasing publications. These technologies aid in diagnosing diseases and facilitating functional recovery through robotics and targeted stimulation. AI-driven drug discovery holds promise for identifying neuroregenerative therapies. Nonetheless, addressing existing limitations remains crucial in this rapidly evolving field.