Chronic complications of spinal cord injury

Motion tracking with automated pose estimator can enhance ankle-foot-orthoses alignment

BACKGROUND

Ankle-foot orthoses are commonly prescribed to address motor impairments in individuals with neurological disorders. Proper alignment of Ankle-foot orthoses, commonly assessed by the ground reaction force in relation to the knee joint center and the shank-to-vertical angle, is crucial for their effectiveness but is time-consuming. This study validates automated pose estimator DeepLabCut on measuring these metrics using 2D videos with force vector overlay in individuals with neurological disorders wearing ankle-foot orthoses.

METHODS

Thirty subjects with neurological disorders wearing ankle-foot orthoses participated. DeepLabCut's performance was compared to 3D gait analysis (Vicon). Subjects were randomly divided into three groups to train (20 subjects) and evaluate (10 subjects) DeepLabCut models. The number of subjects with untrackable points of interests in their videos was determined. The mean difference, root mean square error, intraclass correlation and repeatability coefficient between DeepLabCut and Vicon were computed for videos with trackable points of interest.

FINDINGS

Only two subjects for ground reaction force distance to the knee and four subjects for the shank-to-vertical angle had untrackable points of interest. Excellent agreement between DeepLabCut and Vicon was found for the ground reaction force distance to the knee (mean difference 0.1 mm, root mean square error 6.7 mm, intraclass correlation 0.99, repeatability coefficient 6.7 mm) and shank-to-vertical angle (mean difference 0.7°, root mean square error 1.8°, intraclass correlation 0.99, repeatability coefficient 1.6°).

INTERPRETATION

This study demonstrates that DeepLabCut can accurately and efficiently assess ankle-foot orthosis alignment parameters, paving the way for a simple and straightforward 2D video setup with a force-vector overlay for automated ankle-foot orthosis alignment.

Trace amine-associated receptor 1 (TAAR1): an emerging therapeutic target for neurodegenerative, neurodevelopmental, and neurotraumatic disorders

Trace amines are physiologically active amines present in all organisms. They are structurally identical to traditional monoamines and are rapidly metabolized by monoamine oxidases. The mammalian neurological system generates these molecules at rates equivalent to traditional monoamines, but because of their short half-life, they are only observable in trace quantities. Their receptors are G protein-coupled receptors present in both the CNS and peripheral locations, with trace amine-associated receptor 1 (TAAR1) being the most researched. TAAR1's capacity to regulate glutamatergic and monoaminergic neurotransmission has made it a viable therapeutic target for neuropsychiatric illnesses. Although the TAAR1 role in schizophrenia and other neuropsychiatric disorders is well established, its role in the pathology of neurodegenerative and neurotraumatic disorders recently got attention. This review discusses the role of TAAR1 in neurodegenerative, neurodevelopment, and neurotraumatic disorders and explores its potential to be a novel therapeutic target in these disorders.

Study of the Effect of Methyl Eugenol on Gastric Damage Produced by Spinal Cord Injury Model in the Rat

Traumatic spinal cord injury (SCI) is a serious medical condition that places patients at high risk of developing gastric ulceration and gastrointestinal bleeding. One preventative strategy involves the use of omeprazole; however, its chronic use is associated with adverse effects, highlighting the need for alternative therapies. This study evaluated the protective effects of methyl eugenol (ME) on gastric mucosal damage in a rat model of SCI. ME was administered orally at doses of 30, 100, and 177 mg/kg in SCI induced at the T9 level, alongside diclofenac or ketorolac (30 mg/kg each). The enzymatic activity of superoxide dismutase, catalase, and glutathione peroxidase was assessed, and the levels of total glutathione and malondialdehyde were determined using biochemical kits. Additionally, stomach histological sections were analyzed. ME exhibited dose-dependent gastroprotective effects, with maximal protection observed at 177 mg/kg in the presence of diclofenac (9.78 ± 2.16 mm2) or ketorolac (12.49 ± 2.17 mm2). A histological analysis confirmed these findings. In conclusion, methyl eugenol protects the gastric mucosa from SCI-induced damage, with glutathione peroxidase and catalase playing key roles in its mechanism of gastroprotection.

Relationship between functional independence and community integration of people with spinal cord injury in Bangladesh

Design

Prospective, cross-sectional study.

Objectives

To determine the functional outcome and home and social integration of people who had spinal cord injury and completed their inpatient rehabilitation.

Setting

Centre for the Rehabilitation of the Paralysed (CRP), Bangladesh.

Methods

Spinal Cord Independence Measure (SCIM) and Community Integration Questionnaire (CIQ) were used to analyse the relationship between the functional outcome and home and social integration at the end of rehabilitation. Descriptive and inferential statistics were performed to analyse the data.

Results

A total of two hundred participants (181 men and 19 women) were recruited for the study. Among the participants, 92.5% of them reported a history of trauma or accident, including road traffic accidents, falls and other injuries. Approximately 60% of participants presented with paraplegia and 62.5% of participants were categorized on the ASIA Impairment Scale (AIS) as Grade A, complete spinal cord injury. Participants with paraplegia and participants with a Grade B, incomplete injury, on the AIS were functionally more independent (p = 0.011)) compared with participants with tetraplegia and other AIS grades. Participants with paraplegia reported having a more active lifestyle (p = 0.040) in their home and social activities compared to those with tetraplegia. There was no significant association found between functional independence at pre-discharged and community integration one-month post-discharge of the people with SCI.

Conclusion

A month after discharge, there is no statistically significant relationship between community reintegration and functional independence. A measure of functional independence may not be a suitable indicator of community integration. It is proposed that to monitor a person's community integration the CIQ could be used with a measure of quality of life as this would indicate a person's contentment with their level of community integration.

of Potential Noncoding RNAs Related to Spinal Cord Injury Based on Competing Endogenous RNAs

This study aims to elucidate the key regulatory molecules, specifically messenger RNAs (mRNAs), long noncoding RNAs (lncRNAs), and microRNAs (miRNAs) and their roles in the development and progression of spinal cord injury (SCI). Expression profiles (GSE45006, GSE19890, and GSE125630) for SCI were sourced from the Gene Expression Omnibus (GEO) database. By comparing rats with SCI at various time points against those without SCI, we identified differentially expressed mRNAs (DEmRNAs), lncRNAs (DElncRNAs), and miRNAs (DEmiRNAs). The GSE45006 dataset facilitated the production of DEmRNAs, which were then clustered using Mfuzz. Subsequently, we constructed a protein-protein interaction (PPI) network and anticipated interaction pairs between miRNA-mRNA and lncRNA-mRNA. These pairs were instrumental in forming a regulatory network involving lncRNA-miRNA-mRNA interactions. Additionally, we conducted functional enrichment studies on the DEmRNAs within these gene networks. A total of 2313 DEmRNAs were identified using the GSE45006 dataset, alongside 111 DEmiRNAs from GSE19890. From GSE125630, we extracted 154 DElncRNAs and 2322 DEmRNAs. Our analysis revealed 294 up-regulated DEmRNAs, grouped into the up-cluster, and 407 down-regulated DEmRNAs, forming the down-cluster. Key hub genes in the PPI network, such as Rhof, Vav1, Lyz2, Rab3a, Lyn, Cyfip1, Gns, and Nckap1l, were identified. Additionally, the study successfully constructed a competing endogenous RNA (ceRNA) network, revealing 55 unique lncRNA-miRNA-mRNA link pairs. Our research established a ceRNA network associated with SCI, identifying several critical lncRNA-miRNA-mRNA connection pairs integral to the disease's onset and progression. Notably, significant associations, including the AABR07041411.1-miR-125a-5p-Slc4a7 and the Smg1-rno-miR-331-3p-Tlr4 pairs, were observed to exert a significant influence within this biological context.

Perceived Barriers to Leisure-Time Physical Activity Among Physically Active Individuals With Spinal Cord Injury

Objective

To investigate barriers to leisure-time physical activity (LTPA) for physically active people with spinal cord injury (SCI).

Design

Prospective cross-sectional.

Setting

General community.

Participants

One hundred and five physically active individuals with SCI.

Interventions

Semi-structured interviews and surveys.

Main Outcome Measure

Participants were surveyed and interviewed to determine barriers and determinants of LTPA participation. SCI-specific physical activity (PA) guideline adherence was documented. Barriers were categorized using the capability, opportunity, motivation, and behavior model, and regression statistics were used to determine relationships between LTPA volume and barriers.

Results

Health problems, costs of equipment and programs, pain, and a lack of energy were the most common capability barriers, and a lack of accessible facilities, confidence in the knowledge and skill of a health professional, and a lack of time were common opportunity barriers. Motivation barriers pertained to self-consciousness in a fitness center and a lack of interest. Believing LTPA to be too difficult, uninteresting, and unable to improve health emerged as significant barriers to SCI-specific PA guideline adherence.

Conclusion

SCI-specific PA guideline adherence was below 50% in physically active individuals. There are still numerous capability and opportunity barriers that physically active people with SCI must overcome when engaging in LTPA. Motivational barriers such as feeling self-conscious in a fitness center significantly influence PA guideline compliance in this population. Service providers should emphasize the benefit of LTPA to people with SCI while providing LTPA options that facilitate enjoyment, interest, and inclusivity, particularly for those who do not meet PA guideline recommendations.

Neurogenic Aging After Spinal Cord Injury: Highlighting the Unique Characteristics of Aging After Spinal Cord Injury

Emanating from several decades of study into the effects of the aging process after spinal cord injury (SCI), "accelerated aging" has become a common expression as the SCI accelerates the onset of age-related pathologies. However, the aging process follows a distinct trajectory, characterized by unique patterns of decline that differ from those observed in the general population without SCI. Aging brings significant changes to muscles, bones, and hormones, impacting overall physical function. Muscle mass and strength begin to decrease with a reduction in muscle fibers and impaired repair mechanisms. Bones become susceptible to fractures as bone density decreases. Hormonal changes combined with decreased physical activity accelerate the reduction of muscle mass and increase in body fat. Muscle atrophy and skeletal muscle fiber type transformation occur rapidly and in a unique pattern after SCI. Bone loss develops more rapidly and results in an increased risk of fractures in body regions unique to individuals with SCI. Other factors, such as excessive adiposity, decreased testosterone and human growth hormone, and increased systemic inflammation, contribute to a higher risk of neuropathically driven obesity, dyslipidemia, glucose intolerance, insulin resistance, and increasing cardiovascular disease risk. Cardiorespiratory changes after SCI result in lower exercise heart rates, decreased oxygenation, and mitochondrial dysfunction. While it is important to acknowledge the accelerated aging processes after SCI, it is essential to recognize the distinct differences in the aging process between individuals without physical disabilities and those with SCI. These differences, influenced by neuropathology, indicate that it may be more accurate to describe the aging process in individuals with chronic SCI as neurogenic accelerated aging (NAA). Research should continue to address conditions associated with NAA and how to ameliorate the accelerated rate of premature age-related conditions. This review focuses on the NAA processes and the differences between them and the aging process in those without SCI. Recommendations are provided to help slow the development of premature aging conditions.

Safety and feasibility of paired vagus nerve stimulation with rehabilitation for improving upper extremity function in people with cervical spinal cord injury: study protocol for a pilot randomized controlled trial

Introduction

Pairing vagus nerve stimulation with traditional rehabilitation therapies results in improved motor recovery in people with stroke. However, this approach has not yet been studied in people with spinal cord injury (SCI). Motor recovery continues to be challenging after SCI, and there is a need for innovative research strategies to enhance motor recovery after SCI. Hence, this pilot randomized controlled trial aims to evaluate the safety, feasibility, and potential efficacy of pairing vagus nerve stimulation (VNS) with rehabilitation therapy to restore the motor function of the paretic upper limbs in people with cervical SCI.

Methods and analysis

In this triple-blind, randomized, sham-controlled pilot study, 8 adults with chronic incomplete SCI will be implanted with a VNS device and randomly assigned to either active VNS (0.8 mA) control VNS (0.0 mA) paired with upper limb rehabilitation. Each participant will undergo 18 in-clinic therapy sessions over 6 weeks, each lasting 120 min and delivered three times per week. Following the in-clinic phase, participants will continue with a 90-day home exercise program. Participants in both groups will receive similar goal-directed and intense upper limb rehabilitation. The therapy is focused on active movements, task specificity, high number repetitions, variable practice, and active participant engagement. Post-treatment assessment will occur immediately after in-clinic therapy and at 30 and 90 days of follow-up. After completion of blinding at 90 days follow-up, participants in the control group will be offered 6 weeks of in-clinic active VNS (0.8 mA) paired with rehabilitation. The safety of pairing VNS with rehabilitation will be assessed by the occurrence of adverse events in each group, and feasibility by the number of treatment sessions and follow-up visits attended and the number of dropouts. Potential efficacy will be assessed by measuring the change in Graded Redefined Assessment of Strength, Sensibility and Prehension (GRASSP) performance from baseline to immediately after in-clinic therapy and to 90 days. Secondary clinical outcome measures are the Toronto Rehabilitation Institute Hand Function Test, Capabilities of Upper Extremity Questionnaire, Spinal Cord Injury Independence Measure-III self-care subscore, and Spinal Cord Injury-Quality of Life scale.

Ethics and dissemination

The trial protocol was approved by the Institutional Review Board of UTHealth (HSC-MS-22-0579). We anticipate publishing the results in a peer-reviewed journal within 1 year of study completion.

Clinical trial registration

ClinicalTrials.gov, NCT05601661.

Epidemiological investigation of traumatic spinal cord injury caused by object strike in China: strategies for workplace safety improvement

OBJECTIVE

Being struck by an object is a major cause of traumatic spinal cord injury in China. This study aims to investigate epidemiological characteristics of spinal cord injury caused by object strike.

METHODS

This research analysed data from 435 cases of strike-induced spinal cord injury from 2013 to 2022. The collected information encompassed gender, age, level of neurological injury, surgical interventions, expense, occupation, and other relevant factors. χ2tests and Mann-Whitney U test were used with a statistical significance level of 0.05.

RESULTS

The male-to-female ratio was 11.8:1. The 30-44 age group was more likely to suffer from complete spinal cord injuries (70.5%). The predominant occupations were workers (58.9%) and farmers (15.2%). Manual labourers are usually injured in the workplace (89.4%) with a high surgical rate (95.3%).

CONCLUSION

Young and middle-aged males engaged in manual work constitute the primary demographic for strike-induced spinal cord injury. Safety education in workplaces such as construction sites and mines should be emphasized to reduce the occurrence of spinal cord injuries caused by object strikes.

A deep learning approach for cervical cord injury severity determination through axial and sagittal magnetic resonance imaging segmentation and classification

STUDY DESIGN

Cross-sectional Database Study.

OBJECTIVE

While the American Spinal Injury Association (ASIA) Impairment Scale is the standard for assessing spinal cord injuries (SCI), it has limitations due to subjectivity and impracticality. Advances in machine learning (ML) and image recognition have spurred research into their use for outcome prediction. This study aims to analyze deep learning techniques for identifying and classifying cervical SCI severity from MRI scans.

METHODS

The study included patients with traumatic and nontraumatic cervical SCI admitted from 2019 to 2022. MRI images were labeled by two senior resident physicians. A deep convolutional neural network was trained using axial and sagittal cervical MRI images from the dataset. Model performance was assessed using Dice Score and IoU to measure segmentation accuracy by comparing predicted and ground truth masks. Classification accuracy was evaluated with the F1 Score, balancing false positives and negatives.

RESULT

In the axial spinal cord segmentation, we achieved a Dice score of 0.94 for and IoU score of 0.89. In the sagittal spinal cord segmentation, we obtained Dice score up to 0.9201 and IoU scores up to 0.8541. The model for axial image score classification gave a satisfactory result with an F1 score of 0.72 and AUC of 0.79.

CONCLUSION

Our models successfully identified cervical SCI on T2-weighted MR images with satisfactory performance. Further research is needed to develop more advanced models for predicting patient outcomes in SCI cases.

Effectiveness of interventions to increase physical activity in adults with SCI: a systematic review and meta-analysis

PURPOSE

To determine the effectiveness of interventions to increase physical activity (PA) in people with spinal cord injury (SCI).

METHOD

Online databases PubMed, Medline, AMED and CINAHL were searched from the earliest date available to July 2022. Randomised controlled trials (RCT) exploring the effect of interventions on physical activity in people with SCI were eligible. The search identified 1191 studies, after screening 16 reports of 15 RCT's were included. Data were extracted on participant characteristics, intervention characteristics and physical activity outcomes. Methodological quality was assessed using the PEDro Scale and certainty of evidence assessed using GRADE. Post intervention means and standard deviations were pooled in meta-analyses to calculate standardised mean differences or mean differences and 95% confidence intervals.

RESULTS

Fifteen trials with 693 participants (mean age 41-52) were included. There was moderate certainty evidence that exercise interventions had no effect on subjectively or objectively measured PA. There was moderate to high certainty evidence that behavioural interventions and combined behavioural and exercise interventions increased subjectively, but not objectively measured physical activity.

CONCLUSION

Behaviour change techniques are an important intervention component for increasing PA in people with SCI.

Exploring and prioritizing content to include in a medication self-management toolkit for persons with spinal cord injury/dysfunction: A concept mapping approach

BACKGROUND

Adults with spinal cord injury/dysfunction (SCI/D) face challenges with medications they take to manage their secondary conditions (e.g., pain, urinary tract infections, autonomic dysreflexia). With many healthcare providers typically involved in care, there are additional challenges with care fragmentation and self-management. Prior research emphasized the desire for more support with medication self-management among this population.

OBJECTIVE

To explore what content should be included in a medication self-management resource (i.e., toolkit) for adults with SCI/D, as well as considerations for delivery from the perspectives of adults with SCI/D, caregivers, healthcare providers, and representatives from community organizations.

METHODS

A concept mapping study was conducted. Participants took part in one or more of three activities: brainstorming; sorting and rating; and mapping. Participants generated ideas about the content to include in a medication self-management toolkit. Participants sorted the statements into conceptual piles and assigned a name to each. All statements were rated on a five-point Likert-type scale on importance and realistic to include in the toolkit. Participants decided on the final cluster map, rearranged statements, and assigned a name to each cluster to create visual representations of the data.

RESULTS

Forty-four participants took part in this study. The final map contained eight clusters: 1) information-sharing and communication; 2) healthcare provider interactions and involvement; 3) peer and community connections; 4) supports and services for accessing prescription medications and medication information; 5) information on non-prescription medication and medication supplies; 6) safety and lifestyle considerations; 7) general medication information; and 8) practical information and strategies related to medication-taking. Safety and lifestyle considerations was rated as the most important and realistic to include in the toolkit.

CONCLUSIONS

Given the limited tools to help adults with SCI/D with managing their medications, there is great potential to better support this population across all areas of medication self-management.

Wheelchair Repairs: Delays, Causes, and Associated Outcomes

OBJECTIVE

To examine the length of time to complete wheelchair repairs and the relationship between negative outcomes and the factors that prevented or determined who performed the repairs.

DESIGN

Survey, cross-sectional.

SETTING

Nine spinal cord injury (SCI) Model Systems Centers.

PARTICIPANTS

Wheelchair users with SCI reporting at least 1 repair (N=301).

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Prevalence of adverse consequences associated with wheelchair repairs, repairs completed of those needed, and time elapsed before wheelchair repair.

RESULTS

Of the participants, 76% reported all necessary repairs were completed, 7% indicated that some repairs were addressed, and 14% reported none of the repairs were completed. The most common reason for incomplete repairs (30%) was the vendor's failure to complete the repair after being contacted. Among the repairs that were successfully completed, 56% were performed by vendors. The median time elapsed before repair was 14 days, with no significant difference observed in the time taken for repairs across different components. The most common consequences were being forced to use a backup wheelchair or being confined at home. A greater percentage of participants experienced each type of consequence, except injury, for repairs completed by vendors.

CONCLUSIONS

The high percentage of uncompleted wheelchair repairs poses a significant risk to users, and this risk is compounded by prolonged time taken by vendors to address breakdowns. Unsatisfactory vendor service was common, with a significantly larger proportion of participants experiencing consequences for repairs that required a vendor. This seems to indicate structural inadequacies within the repair process and the need for interventions to address these issues.

The effect of intra spinal administration of cerium oxide nanoparticles on central pain mechanism: An experimental study

This study investigated Cerium oxide nanoparticles (CeONPs) effect on central neuropathic pain (CNP). The compressive method of spinal cord injury (SCI) model was used for pain induction. Three groups were formed by a random allocation of 24 rats. In the treatment group, CeONPs were injected above and below the lesion site immediately after inducing SCI. pain symptoms were evaluated using acetone, Radian Heat, and Von Frey tests weekly for six weeks. Finally, we counted fibroblasts using H&E staining. We evaluated the expression of Cx43, GAD65 and HDAC2 proteins using the western blot method. The analysis of results was done by PRISM software. At the end of the study, we found that CeONPs reduced pain symptoms to levels similar to those observed in normal animals. CeONPs also increased the expression of GAD65 and Cx43 proteins but did not affect HDAC2 inhibition. CeONPs probably have a pain-relieving effect on chronic pain by potentially preserving GAD65 and Cx43 protein expression and hindering fibroblast infiltration.

A robust paradigm for studying regeneration after traumatic spinal cord injury in zebrafish

BACKGROUND

Zebrafish are vertebrates with a high potential of regeneration after injury in the central nervous system. Therefore, they have emerged as a useful model system for studying traumatic spinal cord injuries.

NEW METHOD

Using larval zebrafish, we have developed a robust paradigm to model the effects of anterior spinal cord injury, which correspond to the debilitating injuries of the cervical and thoracic regions in humans. Our new paradigm consists of a more anterior injury location compared to previous studies, a modified behavioral assessment using the visual motor response, and a new data analysis code.

RESULTS

Our approach enables a spinal cord injury closer to the hindbrain with more functional impact compared to previous studies using a more posterior injury location. Results reported in this work reveal recovery over seven days following spinal cord injury.

COMPARING WITH EXISTING METHODS

The present work describes a modified paradigm for the in vivo study of spinal cord regeneration after injury using larval zebrafish, including an anterior injury location, a robust behavioral assessment, and a new data analysis software.

CONCLUSIONS

Our findings lay the foundation for applying this paradigm to study the effects of drugs, nutrition, and other treatments to improve the regeneration process.

Development of a rocking chair for use by children with spinal cord injuries

PURPOSE

Activity-based locomotor training improves intrinsic trunk control in children with spinal cord injury (SCI). To reinforce these improvements, there is a need to develop community integration activities to allow a patient to apply the retrained nervous system at home. One activity that has been explored is rocking in a rocking chair. This paper describes the design, fabrication, and evaluation of a rocking chair for children with SCI.

MATERIALS AND METHODS

The Quality Function Deployment (QFD) design process was used. Fundamental needs and features for the rocking chair were defined in a focus group with experienced therapists, and needs were then rated for importance. A House of Quality (HOQ) matrix was developed to correlate needs with design features, and a prototype design was generated. Virtual motion studies and finite element analysis (FEA) were utilized to assess the design. The chair was fabricated and physical testing was performed, including tipping and static and dynamic load assessments.

RESULTS AND CONCLUSIONS

The needs identified through the QFD process were categorized into (1) safety, (2) therapeutic, (3) practical and aesthetic, and (4) data to track chair use. Features selected to meet these needs include safety stops, padding, straps, a stable base, armrests, adjustable footrest, and sensors to capture rocking data. FEA showed a factor of safety (FOS) > 5. Physical testing confirmed physical integrity, load-bearing capacity, and stability of the prototype glider rocking chair. The prototype provides a safe tool for further investigation of rocking for promotion of trunk muscle activation in children with SCI.

Psychosocial factors associated with athlete adaptation to spinal cord injury: a systematic review

PURPOSE

To review existing research on psychosocial factors associated with athlete adaptation to acquired spinal cord injury (SCI).

METHODS

A systematic review was conducted in February 2023. MEDLINE (Pubmed), PsycINFO, and SPORTDiscus databases were used, and peer-reviewed academic journal entries fully retrievable from the researcher's institution library or online were considered for inclusion. Publications were identified according to predetermined eligibility criteria, and 18 publications were included in the review.

RESULTS

The results identified many psychosocial factors associated with adaptation to acquired SCI, including self-identity, emotions, coping strategies, sport involvement, social support, narratives, pain, participation, activity, self-efficacy, and sociability.

CONCLUSIONS

This review highlights the need for innovative methodologies and diverse perspectives and sampling in future investigations. Rehabilitation and sport and performance psychology practitioners working with athletes with acquired SCI are encouraged to gain a better understanding of the narratives framing and constraining athletes' life stories and rehabilitation experiences and consider using strategies such as narrative ambushing (Frank, 2010) to help athletes develop new ways of thinking about acquired SCI. Rehabilitation practitioners are also encouraged to discuss and facilitate opportunities to get involved in adaptive sports for athletes with acquired SCI as part of their rehabilitation plan.

Axonal Regeneration after Spinal Cord Injury: Molecular Mechanisms, Regulatory Pathways, and Novel Strategies

Axonal regeneration in the spinal cord after traumatic injuries presents a challenge for researchers, primarily due to the nature of adult neurons and the inhibitory environment that obstructs neuronal regrowth. Here, we review current knowledge of the intricate network of molecular and cellular mechanisms that hinder axonal regeneration, with a focus on myelin-associated inhibitors (MAIs) and other inhibitory guidance molecules, as well as the pivotal pathways implicated in both inhibiting and facilitating axonal regrowth, such as PKA/AMP, PI3K/Akt/mTOR, and Trk, alongside the regulatory roles of neurotrophins and axonal guidance cues. We also examine current insights into gene therapy, tissue engineering, and pharmacological interventions that show promise in overcoming barriers to axonal regrowth.

Effect of a soft exosuit on daily life gait performance in people with incomplete spinal cord injury: study protocol for a randomized controlled trial

BACKGROUND

People with incomplete spinal cord injury (iSCI) often have gait impairments that negatively affect daily life gait performance (i.e., ambulation in the home and community setting) and quality of life. They may benefit from light-weight lower extremity exosuits that assist in walking, such as the Myosuit (MyoSwiss AG, Zurich, Switzerland). A previous pilot study showed that participants with various gait disorders increased their gait speed with the Myosuit in a standardized environment. However, the effect of a soft exosuit on daily life gait performance in people with iSCI has not yet been evaluated.

OBJECTIVE

The primary study objective is to test the effect of a soft exosuit (Myosuit) on daily life gait performance in people with iSCI. Second, the effect of Myosuit use on gait capacity and the usability of the Myosuit in the home and community setting will be investigated. Finally, short-term impact on both costs and effects will be evaluated.

METHODS

This is a two-armed, open label, randomized controlled trial (RCT). Participants will be randomized (1:1) to the intervention group (receiving the Myosuit program) or control group (initially receiving the conventional program). Thirty-four people with chronic iSCI will be included. The Myosuit program consists of five gait training sessions with the Myosuit at the Sint Maartenskliniek. Thereafter, participants will have access to the Myosuit for home use during 6 weeks. The conventional program consists of four gait training sessions, followed by a 6-week home period. After completing the conventional program, participants in the control group will subsequently receive the Myosuit program. The primary outcome is walking time per day as assessed with an activity monitor at baseline and during the first, third, and sixth week of the home periods. Secondary outcomes are gait capacity (10MWT, 6MWT, and SCI-FAP), usability (D-SUS and D-QUEST questionnaires), and costs and effects (EQ-5D-5L).

DISCUSSION

This is the first RCT to investigate the effect of the Myosuit on daily life gait performance in people with iSCI.

TRIAL REGISTRATION

Clinicaltrials.gov NCT05605912. Registered on November 2, 2022.