Rehabilitation of patients in late period after spinal cord injury: a meta-analysis of literature data

Abstract

Material and Methods . The study design is a meta-analysis of publications with levels 1a, b, c, and 2a evidence and a level A recommendations. An electronic search was conducted in the PubMed, Web of Science, Scopus, Cochrane Library, CrossRef, AO Spine, Eurospine, ResearchGate, eLIBRARY, and MEDLINE databases, and in references of key articles. Inclusion criteria were systematic reviews, randomized controlled studies, multicenter cohort studies with a level 1a, b, c, and 2a evidence and level A recommendations for adult patients with long-term sequelae of spinal cord injury (more than 4 months after injury). Exclusion criteria were topic articles, clinical cases, observations, cohort uncontrolled studies, experimental articles, reports, articles with levels 2b, c, 3a, b, 4, and 5 evidence and level B, C, and D recommendations, pediatric patients, early period after spinal cord injury (less than 4 months), and non-traumatic lesions of the spinal cord. Results . The search returned 108 articles with publication date within 1997–2019. The inclusion criteria was met by 65 publications: 33 systematic reviews, 12 randomized controlled studies, 19 multicenter studies; and one open prospective study was included in the review due to the particular treatment method used. The greatest evidence base for the rehabilitation of patients in the long-term period after spinal cord injury is presented for physical methods of rehabilitation. The most effective are locomotor training to develop skills of movement. Auxiliary verticalization and robotic devices are needed to restore and improve proprioceptive innervation. In case of violation of the spinal tracts, the restoration of motor functions occurs due to the activation of supraspinal interneuronal connections. Epidural electrical stimulation of the lumbar thickening of the spinal cord activates a generator of voluntary movement of the limbs and, in combination with training of proprioceptive sensitivity, leads to a regression of movement disorders. The constant use of electrostimulation blocks proprioceptive sensitivity and inhibits the recovery of spinal conductivity. Parameters of clinical application are not defined for areas of regenerative medicine. Conclusion . The main problem in rehabilitation of patients in late period after spinal cord injury is the lack of a unified concept, developed strategies of rehabilitation technologies, and criteria for assessment of the initial status and treatment efficiency.