Gait Rehabilitation Techniques In Incomplete Cervical Spinal Cord Injuries
Keywords:
Incomplete Spinal Cord Injury, Gait Training, Rehabilitation, ExoskeletonAbstract
Incomplete cervical spinal cord injuries can lead to severe functional loss, with mobility deficits of the lower limbs and motor control. Contemporary gait rehabilitation techniques focus on the motor reprogramming of neuronic circuits. This systematic review aims to compare the results of different rehabilitation techniques, ranging from robotic exoskeleton systems, to new and improves weight- bearing systems, and other methods including virtual reality, on their ability to achieve measurable therapeutic goals.
Three electronic databases (MEDLINE, PEDro and Google Scholar) were systematically searched for clinical trials, up until May 2022. The following search terms were used: “Incomplete Cervical Spinal Cord Injury” AND “Gait Training” OR “Rehabilitation” OR “Exoskeletal assisted walking” OR “Lokomat” OR “Robot- assisted gait training”.
Of the initial 2.411 papers, 54 were selected to be review for eligibility to this systematic review, leading to the final 20 that were included. The most common evaluation tools were 6MWT, 10MWT, TUG, LEMS and WISCI-II. In all 20 papers significant or very significant changes were noted between the time of the first assessment and the last. 13 of them noted statistically significant differences between the control groups and the intervention groups at the end of the trial period, regardless of the method used. In this systematic review, 409 patients were recruited for trials on robotic exoskeletons, 70 participated in Weight- Bearing trials, and another 55 completed trials on interventions including WBV, OLT and GRAIL. In regards to the use of a robotic exoskeleton system, 10 out of 13 trials noted statistical significant differences between groups, a result shared by 2 out of 3 trials on weight-bearing systems. Contemporary interventions using the latest technological advances, whether they be robotic exoskeletons, advanced weight-bearing systems or enhanced virtual reality, may contribute to a faster and more efficient gait rehabilitation of patients suffering from incomplete cervical spinal cord injuries.
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References
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4. Μ????? ?. ???????????? ?????? ?? ????? ? ?????? ???????? ??????: ??? ??? ????? ?? ??? ?????????? (????? ?). ?????: ???????????????? ???????????? 2012
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6. In T., Jung K., Lee MG, et al. Whole-body vibrations improves ankle spasticity, balance, and walking ability in individuals with incomplete cervical spinal cord injury. Neurorehabilitation 2018;42(4):491-97
7. Mazwi NL. Traumatic Spinal Cord Injury: Recovery, Rehabilitation, and Prognosis.Current Trauma Reports, Springer International Publishing, 2015:182- 92
8. Alizadeh A, Dyck SM and Karimi-Abdolrezaee S. Traumatic Spinal Cord Injury: An Overview of Pathophysiology, Models and Acute Injury Mechanisms.?Front. Neurol.?2019;10:282. doi: 10.3389/fneur.2019.00282
9. Hwang S, Kim HR, Han ZA, et al. Improved gait speed after robot- assisted gait training in patients with motor incomplete spinal cord injury: a preliminary study. Ann Rehabil Medπάκας Ε. Αποκατάσταση Ασθενή με Βλάβη ή Κάκωση Νωτιαίου Μυελού: Από την Βλάβη ως την Επανένταξη (τόμος Ι). Αθήνα: ΙατρικέςΕκδόσεις Κωνσταντάρας 2012
10. NCSCI. Spinal Cord Injuries. Facts and Figures at a glance. 2019 [online] Available at: https://www.nscisc.uab.edu/Public/Facts%20and%20Figures%202019%20-%20Final.pdf
11. In T., Jung K., Lee MG, et al. Whole-body vibrations improves ankle spasticity, balance, and walking ability in individuals with incomplete cervical spinal cord injury. Neurorehabilitation 2018;42(4):491-97
12. Mazwi NL. Traumatic Spinal Cord Injury: Recovery, Rehabilitation, and Prognosis.Current Trauma Reports, Springer International Publishing, 2015:182- 92
13. Alizadeh A, Dyck SM and Karimi-Abdolrezaee S. Traumatic Spinal Cord Injury: An Overview of Pathophysiology, Models and Acute Injury Mechanisms. Front. Neurol. 2019;10:282. doi: 10.3389/fneur.2019.00282
14. Hwang S, Kim HR, Han ZA, et al. Improved gait speed after robot- assisted gait training in patients with motor incomplete spinal cord injury: a preliminary study. Ann Rehabil Med 2017; 42(1):32-41
15. Tester NJ, Howland DR, Day KV et al. Device use, locomotor training and the presence of arm swing during treadmill walking after spinal cord injury. Spinal Cord 2011;49(3):451-56
16. Hasegawa T., Uchiyama Y., Uemura K, et al. Physical impairment and walking function required for community ambulation with cervical incomplete spinal cord injury. Spinal Cord 2014; 52(5):396-99
17. Gollie JM., Guccione AA., Panza GS et al. Effects of overground locomotor training on walking performance in chronic cervical motor incomplete spinal cord injury: A pilot study. Arch Phys Med Rehabil. 2016;98(6):1119-25
18. Panza GS, Herrick JE, Chin LM, et al. Effect of overground locomotor training on ventilator kinetics and rate of perceived exertion in persons with cervical motor- incomplete spinal cord injury. Spinal Cord Ser Cases 2019;26:5:80
19. Senthilvelkumar T, Magimairaj H, Fletcher J, et al. Comparison of body weight-supported treadmill training versus body weight- supported overground training in people with incomplete tetraplegia: a pilot randomized trial. Clin Rehabil 2015; 29(1):42-9
20. Walker, J. R., &Detloff, M. R. (2021). Plasticity in Cervical Motor Circuits following Spinal Cord Injury and Rehabilitation. Biology, 2021;10(10): 976.
21. Chihaya S.J., Quiros-Molina D., Tamashiro-Orrego A.D., Houle J.D., Detloff M.R. Exercise-Induced Changes to the Macrophage Response in the Dorsal Root Ganglia Prevent Neuropathic Pain after Spinal Cord Injury. J. Neurotraum. 2019;36:877–90
22. Tran A.P., Warren P.M., Silver J. New insights into glial scar formation after spinal cord injury. Cell Tissue Res. 2021
23. O’Shea, T. M., Burda, J. E., &Sofroniew, M.V. Cell biology of spinal cord injury and repair. The Journal of clinical investigation, 2017;127(9), 3259-70.
24. Jackman S.L., Regehr W.G. The Mechanisms and Functions of Synaptic Facilitation. Neuron. 2017;94:447-64.
25. Herring B.E., Nicoll R.A. Long-Term Potentiation: From CaMKII to AMPA Receptor Trafficking. Annu. Rev. Physiol. 2016;78:351-65.
26. Field-Fote E.C. Exciting recovery: Augmenting practice with stimulation to optimize outcomes after spinal cord injury. Prog. Brain Res. 2015;218:103-26.
27. Yang JF, Musselman KE, Livingstone D, Brunton K, Hendricks G, Hill D, et al. Repetitive mass practice or focused precise practice for retraining walking after incomplete spinal cord injury? A pilot randomized clinical trial. Neurorehabil Neural Repair 2014;28:314-24
28. Takeoka A, Vollenweider I, Courtine G, Arber S. Muscle spindle feedback directs locomotor recovery and circuit reorganization after spinal cord injury. Cell. 2014;159:1626-39.
29. Arpin DJ, Ugiliweneza B, Forrest G, Harkema SJ, Rejc E. Optimizing neuromuscular electrical stimulation pulse width and amplitude to promote central activation in individuals with severe spinal cord injury. Front. Physiol. 2019;10:1310.
30. Wagner FB, et al. Targeted neurotechnology restores walking in humans with spinal cord injury. Nature. 2018;563:65-71.
31. Côté MP, Murray M, Lemay MA. Rehabilitation Strategies after Spinal Cord Injury: Inquiry into the Mechanisms of Success and Failure. J Neurotrauma. 2017;34(10):1841-57. doi: 10.1089/neu.2016.4577. Epub 2016 Nov 21. PMID: 27762657; PMCID: PMC5444418
32. Guo LY, Lozinski B, Yong VW. Exercise in multiple sclerosis and its models: focus on the central nervous system outcomes. J. Neurosci. Res. 2020;98:509-23.
33. Asboth L, et al. Cortico-reticulo-spinal circuit reorganization enables functional recovery after severe spinal cord contusion. Nat. Neurosci. 2018;21:576-88.
34. Fu J, Wang H, Deng L et al.. Exercise training promotes functional recovery after spinal cord injury. Neural Plast. 2016;2016:4039580 [online]
35. Nas K, Yazmalar L, Sah V et al. Rehabilitation of spinal cord injuries. World J Orthop 2015;6(1):8-16
36. Marinho- Buzelli AR, Barela AMF, Craven BC et al. Effects of water immersion on gait initiation: part II of a case series after incomplete spinal cord injury. Spinal Cord Ser Cases. 2019;16:6:84
37. Zhang L, Lin F, Sun L et al.. Comparison of Efficacy of Lokomat and Wearable Exoskeleton- Assisted Gait Training in people with spinal cord injury: a systematic review and network meta-analysis. Frontiers in Neurology 2022;13:772660
38. Evans RW, Shackleton CL. West S et al. Robotic locomotor training leads to cardio-vascular changes in individuals with incomplete spinal cord injury over a 24-weel rehabilitation period: a randomized controlled trial. Arch Phys Med Rehabil 2021;102(8):1447-56
39. Liang ZW, Lei T, Wang S et al.. A simple electrical stimulation cell culture system on the myelination of dorsal root ganglia and Schwann cells. Biotechniques. 2019;67:11-5
40. Taccola G.. Acute neuromodulation restores spinally-induced motor responses after severe spinal cord injury. Exp. Neurol. 2020;327:113246
41. Gill ML. Neuromodulation of lumbosacral spinal networks enables independent stepping after complete paraplegia. Nat. Med. 2018;24:1677–82.
42. Inanici F. Transcutaneous electrical spinal stimulation promotes long-term recovery of upper extremity function in chronic tetraplegia. IEEE Trans. Neural Syst. Rehabil. Eng. 2018;26:1272–78
43. Li C, Wei J, Huang X et al. Effects of a Brain-Computer Interface-Operated Lower Limb Rehabilitation Robot on Motor Function Recovery in Patients with Stroke. J Healthc Eng. 2021:4710044.
44. Chung E, Lee BH, Hwang S. Therapeutic effects of brain-computer interface-controlled functional electrical stimulation training on balance and gait performance for stroke: A pilot randomized controlled trial. Medicine (Baltimore). 2020;99(51):e22612.
45. Papegaaij S, Morang F, Steenbrink F. Virtual and augmented reality based balance and gait training. White Paper, (February) (2017).
46. Geerse DJ, Coolen BH, Roerdink M. Walking-adaptability assessments with the interactive walkway: between-systems agreement and sensitivity to task and subject variations. Gait Posture 2017;54:194–201. doi: 10.1016/j.gaitpost.2017.02.021
47. Caetano MJD, Lord SR, Brodie MA et al. Executive functioning, concern about falling and quadriceps strength mediate the relationship between impaired gait adaptability and fall risk in older people. Gait Posture (2018);59:188–92.
48. van Dijsseldonk RB, de Jong LAF, Green BE et al. Gait stability in a virtual environment improves gait and dynamic balance capacity in incomplete spinal cord injury patients. Frontier In Neurology 2018;9:963
2. James SL, Theadom A, Ellenbogen RG et al. Global, regional, and national burden of traumatic brain injury and spinal cord injury, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol. 2019;18:56–87.
3. Lee BB, Cripps RA, Fitzharris M, Wing PC. The global map for traumatic spinal cord injury epidemiology: update 2011, global incidence rate. Spinal Cord. 2014;2:110–6.
4. Μ????? ?. ???????????? ?????? ?? ????? ? ?????? ???????? ??????: ??? ??? ????? ?? ??? ?????????? (????? ?). ?????: ???????????????? ???????????? 2012
5. NCSCI. Spinal Cord Injuries. Facts and Figures at a glance. 2019 [online] Available at: https://www.nscisc.uab.edu/Public/Facts%20and%20Figures%202019%20-%20Final.pdf
6. In T., Jung K., Lee MG, et al. Whole-body vibrations improves ankle spasticity, balance, and walking ability in individuals with incomplete cervical spinal cord injury. Neurorehabilitation 2018;42(4):491-97
7. Mazwi NL. Traumatic Spinal Cord Injury: Recovery, Rehabilitation, and Prognosis.Current Trauma Reports, Springer International Publishing, 2015:182- 92
8. Alizadeh A, Dyck SM and Karimi-Abdolrezaee S. Traumatic Spinal Cord Injury: An Overview of Pathophysiology, Models and Acute Injury Mechanisms.?Front. Neurol.?2019;10:282. doi: 10.3389/fneur.2019.00282
9. Hwang S, Kim HR, Han ZA, et al. Improved gait speed after robot- assisted gait training in patients with motor incomplete spinal cord injury: a preliminary study. Ann Rehabil Medπάκας Ε. Αποκατάσταση Ασθενή με Βλάβη ή Κάκωση Νωτιαίου Μυελού: Από την Βλάβη ως την Επανένταξη (τόμος Ι). Αθήνα: ΙατρικέςΕκδόσεις Κωνσταντάρας 2012
10. NCSCI. Spinal Cord Injuries. Facts and Figures at a glance. 2019 [online] Available at: https://www.nscisc.uab.edu/Public/Facts%20and%20Figures%202019%20-%20Final.pdf
11. In T., Jung K., Lee MG, et al. Whole-body vibrations improves ankle spasticity, balance, and walking ability in individuals with incomplete cervical spinal cord injury. Neurorehabilitation 2018;42(4):491-97
12. Mazwi NL. Traumatic Spinal Cord Injury: Recovery, Rehabilitation, and Prognosis.Current Trauma Reports, Springer International Publishing, 2015:182- 92
13. Alizadeh A, Dyck SM and Karimi-Abdolrezaee S. Traumatic Spinal Cord Injury: An Overview of Pathophysiology, Models and Acute Injury Mechanisms. Front. Neurol. 2019;10:282. doi: 10.3389/fneur.2019.00282
14. Hwang S, Kim HR, Han ZA, et al. Improved gait speed after robot- assisted gait training in patients with motor incomplete spinal cord injury: a preliminary study. Ann Rehabil Med 2017; 42(1):32-41
15. Tester NJ, Howland DR, Day KV et al. Device use, locomotor training and the presence of arm swing during treadmill walking after spinal cord injury. Spinal Cord 2011;49(3):451-56
16. Hasegawa T., Uchiyama Y., Uemura K, et al. Physical impairment and walking function required for community ambulation with cervical incomplete spinal cord injury. Spinal Cord 2014; 52(5):396-99
17. Gollie JM., Guccione AA., Panza GS et al. Effects of overground locomotor training on walking performance in chronic cervical motor incomplete spinal cord injury: A pilot study. Arch Phys Med Rehabil. 2016;98(6):1119-25
18. Panza GS, Herrick JE, Chin LM, et al. Effect of overground locomotor training on ventilator kinetics and rate of perceived exertion in persons with cervical motor- incomplete spinal cord injury. Spinal Cord Ser Cases 2019;26:5:80
19. Senthilvelkumar T, Magimairaj H, Fletcher J, et al. Comparison of body weight-supported treadmill training versus body weight- supported overground training in people with incomplete tetraplegia: a pilot randomized trial. Clin Rehabil 2015; 29(1):42-9
20. Walker, J. R., &Detloff, M. R. (2021). Plasticity in Cervical Motor Circuits following Spinal Cord Injury and Rehabilitation. Biology, 2021;10(10): 976.
21. Chihaya S.J., Quiros-Molina D., Tamashiro-Orrego A.D., Houle J.D., Detloff M.R. Exercise-Induced Changes to the Macrophage Response in the Dorsal Root Ganglia Prevent Neuropathic Pain after Spinal Cord Injury. J. Neurotraum. 2019;36:877–90
22. Tran A.P., Warren P.M., Silver J. New insights into glial scar formation after spinal cord injury. Cell Tissue Res. 2021
23. O’Shea, T. M., Burda, J. E., &Sofroniew, M.V. Cell biology of spinal cord injury and repair. The Journal of clinical investigation, 2017;127(9), 3259-70.
24. Jackman S.L., Regehr W.G. The Mechanisms and Functions of Synaptic Facilitation. Neuron. 2017;94:447-64.
25. Herring B.E., Nicoll R.A. Long-Term Potentiation: From CaMKII to AMPA Receptor Trafficking. Annu. Rev. Physiol. 2016;78:351-65.
26. Field-Fote E.C. Exciting recovery: Augmenting practice with stimulation to optimize outcomes after spinal cord injury. Prog. Brain Res. 2015;218:103-26.
27. Yang JF, Musselman KE, Livingstone D, Brunton K, Hendricks G, Hill D, et al. Repetitive mass practice or focused precise practice for retraining walking after incomplete spinal cord injury? A pilot randomized clinical trial. Neurorehabil Neural Repair 2014;28:314-24
28. Takeoka A, Vollenweider I, Courtine G, Arber S. Muscle spindle feedback directs locomotor recovery and circuit reorganization after spinal cord injury. Cell. 2014;159:1626-39.
29. Arpin DJ, Ugiliweneza B, Forrest G, Harkema SJ, Rejc E. Optimizing neuromuscular electrical stimulation pulse width and amplitude to promote central activation in individuals with severe spinal cord injury. Front. Physiol. 2019;10:1310.
30. Wagner FB, et al. Targeted neurotechnology restores walking in humans with spinal cord injury. Nature. 2018;563:65-71.
31. Côté MP, Murray M, Lemay MA. Rehabilitation Strategies after Spinal Cord Injury: Inquiry into the Mechanisms of Success and Failure. J Neurotrauma. 2017;34(10):1841-57. doi: 10.1089/neu.2016.4577. Epub 2016 Nov 21. PMID: 27762657; PMCID: PMC5444418
32. Guo LY, Lozinski B, Yong VW. Exercise in multiple sclerosis and its models: focus on the central nervous system outcomes. J. Neurosci. Res. 2020;98:509-23.
33. Asboth L, et al. Cortico-reticulo-spinal circuit reorganization enables functional recovery after severe spinal cord contusion. Nat. Neurosci. 2018;21:576-88.
34. Fu J, Wang H, Deng L et al.. Exercise training promotes functional recovery after spinal cord injury. Neural Plast. 2016;2016:4039580 [online]
35. Nas K, Yazmalar L, Sah V et al. Rehabilitation of spinal cord injuries. World J Orthop 2015;6(1):8-16
36. Marinho- Buzelli AR, Barela AMF, Craven BC et al. Effects of water immersion on gait initiation: part II of a case series after incomplete spinal cord injury. Spinal Cord Ser Cases. 2019;16:6:84
37. Zhang L, Lin F, Sun L et al.. Comparison of Efficacy of Lokomat and Wearable Exoskeleton- Assisted Gait Training in people with spinal cord injury: a systematic review and network meta-analysis. Frontiers in Neurology 2022;13:772660
38. Evans RW, Shackleton CL. West S et al. Robotic locomotor training leads to cardio-vascular changes in individuals with incomplete spinal cord injury over a 24-weel rehabilitation period: a randomized controlled trial. Arch Phys Med Rehabil 2021;102(8):1447-56
39. Liang ZW, Lei T, Wang S et al.. A simple electrical stimulation cell culture system on the myelination of dorsal root ganglia and Schwann cells. Biotechniques. 2019;67:11-5
40. Taccola G.. Acute neuromodulation restores spinally-induced motor responses after severe spinal cord injury. Exp. Neurol. 2020;327:113246
41. Gill ML. Neuromodulation of lumbosacral spinal networks enables independent stepping after complete paraplegia. Nat. Med. 2018;24:1677–82.
42. Inanici F. Transcutaneous electrical spinal stimulation promotes long-term recovery of upper extremity function in chronic tetraplegia. IEEE Trans. Neural Syst. Rehabil. Eng. 2018;26:1272–78
43. Li C, Wei J, Huang X et al. Effects of a Brain-Computer Interface-Operated Lower Limb Rehabilitation Robot on Motor Function Recovery in Patients with Stroke. J Healthc Eng. 2021:4710044.
44. Chung E, Lee BH, Hwang S. Therapeutic effects of brain-computer interface-controlled functional electrical stimulation training on balance and gait performance for stroke: A pilot randomized controlled trial. Medicine (Baltimore). 2020;99(51):e22612.
45. Papegaaij S, Morang F, Steenbrink F. Virtual and augmented reality based balance and gait training. White Paper, (February) (2017).
46. Geerse DJ, Coolen BH, Roerdink M. Walking-adaptability assessments with the interactive walkway: between-systems agreement and sensitivity to task and subject variations. Gait Posture 2017;54:194–201. doi: 10.1016/j.gaitpost.2017.02.021
47. Caetano MJD, Lord SR, Brodie MA et al. Executive functioning, concern about falling and quadriceps strength mediate the relationship between impaired gait adaptability and fall risk in older people. Gait Posture (2018);59:188–92.
48. van Dijsseldonk RB, de Jong LAF, Green BE et al. Gait stability in a virtual environment improves gait and dynamic balance capacity in incomplete spinal cord injury patients. Frontier In Neurology 2018;9:963
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