Spinal Cord Injury Subjects Research Articles

Specific Brain Reorganization Underlying Superior Upper Limb Motor Function After Spinal Cord Injury: A Multimodal MRI Study

Background We recently discovered that individuals with complete spinal cord injury (SCI) have a higher grip force control ability in their intact upper limbs than able-bodied subjects. However, the neural basis for this phenomenon is unknown. Objective This study aimed to investigate the neural basis of the higher grip force control in the brains of individuals with SCI using multimodal magnetic resonance imaging (MRI). Methods Eight SCI subjects and 10 able-bodied subjects performed hand grip force control tasks at 10%, 20%, and 30% of their maximal voluntary contraction during functional MRI (fMRI). Resting-state fMRI and T1-weighted structural images were obtained to investigate changes in brain networks and structures after SCI. Results SCI subjects showed higher grip force steadiness than able-bodied subjects (P < .05, corrected), smaller activation in the primary motor cortex (P < .05, corrected), and deactivation of the visual cortex (P < .001, uncorrected). Furthermore, SCI subjects had stronger functional connectivity between the superior parietal lobule and the left primary motor cortex (P < .001, uncorrected), as well as larger gray matter volume in the bilateral superior parietal lobule (P < .001, uncorrected). Conclusions The structural and functional reorganization observed in the superior parietal lobule of SCI subjects may represent the neural basis underlying the observed higher grip force control, and is likely responsible for the smaller activation in the primary motor cortex observed in these individuals. These findings could have applications in the fields of neurorehabilitation for improvement of intact limb functions after SCI.

Effect of 4 weeks resistive inspiratory muscle training on respiratory functions in patients with tetraplegia during in-patient rehabilitation

There is reduction in lung compliance in first week after spinal cord injury (SCI) that deteriorates further and neuroprotective therapies like strength training of respiratory muscles should begin in first month after SCI since both motor and sensory scores at baseline and their further recovery is maximum during this phase. Few studies on SCI subjects within first month of injury have supported use of resistive inspiratory muscle training (RIMT), but have advocated the need for further research in this patient population owing to pitfalls in these studies. The present study was a prospective randomized control trial being carried out to determine whether RIMT programme of four weeks duration is effective in improving respiratory functions and strength in motor complete cervical SCI patients (AIS grade A, B) during in-patient rehabilitation. Patients within first week of cervical SCI (C4-C7 level) were assigned to RIMT (48 patients) and Control (48 patients) group and completed 40 supervised training sessions over a period of four weeks. Outcome measures included: - Spirometry, inspiratory and expiratory muscle strength. No significant differences of Chi-square test (P &lt; 0.05) and unpaired “t” test (P &lt; 0.05) were found between RIMT and Control group for all demographic and pre-training measurements. Following results were recorded after 2 weeks and 4 weeks of training on all outcome measures: - Highly significant difference (P&lt;0.01) within both groups with One–way ANOVA; Highly significant difference (P&lt;0.01) with unpaired “t-test” between RIMT and control group. Cohen “d” effect sizes for RIMT vs. Control group were in large effect size zone i.e. greater than 0.8. The findings of present study show beneficial effect of RIMT on respiratory functions and strength in patients with tetraplegia in first month post injury and we propose that RIMT should be included early in acute phase rehabilitation of these patients.

In chronic complete spinal cord injury supraspinal changes detected by quantitative MRI are confined to volume reduction in the caudal brainstem

There is much controversy about the potential impact of spinal cord injury (SCI) on brain anatomy and function, which is mirrored in the substantial divergence of findings between animal models and human imaging studies. Given recent advances in quantitative magnetic resonance imaging (MRI) we sought to tackle the unresolved question about the link between the presumed injury associated volume differences and underlying brain tissue property changes in a cohort of chronic complete SCI patients. Using the established computational anatomy methods of voxel-based morphometry (VBM) and voxel-based quantification (VBQ), we performed statistical analyses on grey and white matter volumes as well as on parameter maps indicative for myelin, iron, and free tissue water content in the brain of complete SCI patients (n = 14) and healthy individuals (n = 14). Our regionally unbiased white matter analysis showed a significant volume reduction of the dorsal aspect at the junction between the most rostral part of the spinal cord and the medulla oblongata consistent with Wallerian degeneration of proprioceptive axons in the dorsal column tracts in SCI subjects. This observation strongly correlated with spinal cord atrophy assessed by quantification of the spinal cord cross-sectional area at the cervical level C2/3. These findings suggest that Wallerian degeneration of the dorsal column tracts represents a main contributor to the observed spinal cord atrophy, which is highly consistent with preclinical histological evidence of remote changes in the central nervous system secondary to SCI. Structural changes in other brain regions representing remote changes in the course of chronic SCI could neither be confirmed by conventional VBM nor by VBQ analysis. Whether and how MRI based brain morphometry and brain tissue property analysis will inform clinical decision making and clinical trial outcomes in spinal cord medicine remains to be determined.

CMAP Scan Examination of the First Dorsal Interosseous Muscle After Spinal Cord Injury.

The study assessed motor unit loss in muscles paralyzed by spinal cord injury (SCI) using a novel compound muscle action potential (CMAP) scan examination. The CMAP scan of the first dorsal interosseous (FDI) muscle was applied in tetraplegia (n = 13) and neurologically intact (n=13) subjects. MScanFit was used for estimating motor unit numbers in each subject. The D50 value of the CMAP scan was also calculated. We observed a significant decrease in both CMAP amplitude and motor unit number estimation (MUNE) in paralyzed FDI muscles, as compared with neurologically intact muscles. Across all subjects, the CMAP (negative peak) amplitude was 8.01 ± 3.97 mV for the paralyzed muscles and 16.75 ± 3.55 mV for the neurologically intact muscles (p < 0.001). The CMAP scan resulted in a MUNE of 59 ± 37 for the paralyzed muscles, much lower than 108 ± 21 for the neurologically intact muscles (p < 0.001). No significant difference in D50 was observed between the two groups (p= 0.2). For the SCI subjects, there was no significant correlation between MUNE and CMAP amplitude, or any of the clinical assessments including pinch force, grip force, the Graded Redefined Assessment of Strength, Sensibility and Prehension (GRASSP) score, and SCI duration (p > 0.05). The findings provide an evidence of motor unit loss in the FDI muscles of individuals with tetraplegia, which may contribute to weakness and other hand function deterioration. The CMAP scan offers several practical benefits compared with the traditional MUNE techniques because it is noninvasive, automated and can be performed within several minutes.

Spinal motor mapping by epidural stimulation of lumbosacral posterior roots in humans.

SummaryEpidural electrical stimulation of the spinal cord is an emergent strategy for the neurological recovery of lower-extremity motor function. Motoneuron pools are thought to be recruited by stimulation of posterior roots. Here, we linked electromyographic data of epidurally evoked lower-extremity responses of 34 individuals with upper motoneuron disorders to a population model of the spinal cord constructed using anatomical parameters of thousands of individuals. We identified a relationship between segmental stimulation sites and activated spinal cord segments, which made spinal motor mapping from epidural space possible despite the complex anatomical interface imposed by the posterior roots. Our statistical approach provided evidence for low-threshold sites of posterior roots and effects of monopolar and bipolar stimulation previously predicted by computer modeling and allowed us to test the impact of different upper motoneuron disorders on the evoked responses. Finally, we revealed a statistical association between intraoperative and postoperative mapping of the spinal cord.

Surgical intervention combined with weight-bearing walking training improves neurological recoveries in 320 patients with clinically complete spinal cord injury: a prospective self-controlled study.

Although a large number of trials in the SCI field have been conducted, few proven gains have been realized for patients. In the present study, we determined the efficacy of a novel combination treatment involving surgical intervention and long-term weight-bearing walking training in spinal cord injury (SCI) subjects clinically diagnosed as complete or American Spinal Injury Association Impairment Scale (AIS) Class A (AIS-A). A total of 320 clinically complete SCI subjects (271 male and 49 female), aged 16–60 years, received early (≤ 7 days, n = 201) or delayed (8–30 days, n = 119) surgical interventions to reduce intraspinal or intramedullary pressure. Fifteen days post-surgery, all subjects received a weight-bearing walking training with the “Kunming Locomotion Training Program (KLTP)” for a duration of 6 months. The neurological deficit and recovery were assessed using the AIS scale and a 10-point Kunming Locomotor Scale (KLS). We found that surgical intervention significantly improved AIS scores measured at 15 days post-surgery as compared to the pre-surgery baseline scores. Significant improvement of AIS scores was detected at 3 and 6 months and the KLS further showed significant improvements between all pair-wise comparisons of time points of 15 days, 3 or 6 months indicating continued improvement in walking scores during the 6-month period. In conclusion, combining surgical intervention within 1 month post-injury and weight-bearing locomotor training promoted continued and statistically significant neurological recoveries in subjects with clinically complete SCI, which generally shows little clinical recovery within the first year after injury and most are permanently disabled. This study was approved by the Science and Research Committee of Kunming General Hospital of PLA and Kunming Tongren Hospital, China and registered at ClinicalTrials.gov (Identifier: NCT04034108) on July 26, 2019.

Platelet-Rich Plasma Content of Active Spinal Cord Injured Patients: A Controlled Laboratory Study.

Platelet-rich plasma has potential uses for patients with spinal cord injuries. However, no study has quantified the cellular and growth factor content of platelet-rich plasma in this population. This study aimed to analyze (1) platelet-rich plasma content of spinal cord injury subjects and (2) the effect of high-intensity interval exercise on their platelet-rich plasma. Ten spinal cord injury patients and 10 controls were enrolled. At rest, platelet-rich plasma was created from both groups. The spinal cord injury group then performed high-intensity interval exercise and underwent a second blood draw to create post-high-intensity interval exercise platelet-rich plasma. Complete blood counts and growth factor analysis (via enzyme-linked immunosorbent assay) was performed on all platelet-rich plasma. The spinal cord injury group had lower platelets (305,700 ± 85,697/μl vs 380,800 ± 57,301/μl, P = 0.015) and transforming growth factor β (12.84 ± 1.58 vs 14.33 ± 0.63 ng/ml, P = 0.023). Four minutes of high-intensity interval exercise increased the platelets (305,700 ± 85,697/μl to 399,200 ± 96,251/μl, P = 0.004), leukocytes (906 ± 930 vs 2504 ± 3765/μl, P = 0.002) and transforming growth factor β (12.84 ± 1.58 to 14.28 ± 1.21 ng/ml, P = 0.020). Spinal cord injury patients have fewer platelets and transforming growth factor β in their platelet-rich plasma at baseline compared with controls. Exercise increased platelet, leukocyte, and transforming growth factor β yield, compensating for the baseline deficits.

Gait training with Achilles ankle exoskeleton in chronic incomplete spinal cord injury subjects

Gait training with Achilles ankle exoskeleton in chronic incomplete spinal cord injury subjects

Dynamic Bayesian Adjustment of Dwell Time for Faster Eye Typing.

Eye typing is a hands-free method of human computer interaction, which is especially useful for people with upper limb disabilities. Users select a desired key by gazing at it in an image of a keyboard for a fixed dwell time. There is a tradeoff in selecting the dwell time; shorter dwell times lead to errors due to unintentional selections, while longer dwell times lead to a slow input speed. We propose to speed up eye typing while maintaining low error by dynamically adjusting the dwell time for each letter based on the past input history. More likely letters are assigned shorter dwell times. Our method is based on a probabilistic generative model of gaze, which enables us to assign dwell times using a principled model that requires only a few free parameters. We evaluate our model on both able-bodied subjects and subjects with a spinal cord injury (SCI). Compared to the standard dwell time method, we find consistent increases in typing speed in both cases. e.g., 41.8% faster typing for able-bodied subjects on a transcription task and 49.5% faster typing for SCI subjects in a chatbot task. We observed more inter-subject variability for SCI subjects.

Stability Limits for Vertical Vibrations of Paraplegic Subjects while Using Passive Orthosis

Spinal cord injury (SCI) subjects use passive orthosis to assist them with the postural balance in daily life. Vertical vibrations are used to improve the postural balance of theses patients, mainly in terms of whole-body-vibrations, as in therapies. It is noteworthy to understand in what situation these patients are able to tolerate vertical vibrations while wearing orthosis. The main focus of this paper is to model vertical vibrations in the postural balance of arm free standing of the paraplegic subjects who use passive orthosis, and, mathematically understand the stability limits for these vibrations. To find the stable amplitudes and frequencies, equations of motions of the system are translated into non-homogeneous Mathieu equations, which are then analytically solved and the results are numerically plotted. In addition, the effect of shoe stiffness on the amplitude and frequency of the vibrations which violate stability are studied. The results show to be sure of the stability of the paraplegics in vertical vibrations, the shoe sole of the orthosis should have high values of stiffness, and this will guarauntee bigger ranges of stable vibrations and safer stance for the patients. Using the results, one can interpret how a paraplegic subject with passive orthosis may react to vertical perturbations, meaning, what ranges of frequencies and amplitudes of perturbations is tolerable without losing stability. This study is one of the necessities in designing new passive orthosis with more stability when exposed to perturbations.

Beta-band oscillations as a biomarker of gait recovery in spinal cord injury patients: A quantitative electroencephalography analysis

ObjectiveThe gait recovery in spinal cord injury (SCI) seems to be partially related to the reorganization of cerebral function; however, the neural mechanisms and the respective biomarkers are not well known. This study tested the hypothesis that enhanced beta-band oscillations may be a marker of compensatory neural plasticity during the recovery period in SCI. We tested this hypothesis at baseline in SCI subjects and also in response to cortical stimulation with transcranial direct current stimulation (tDCS) combined with robotic-assisted gait training (RAGT). MethodsIn this neurophysiological analysis of a randomized controlled trial, thirty-nine patients with incomplete SCI were included. They received 30 sessions of either active or sham anodal tDCS over the primary motor area for 20 min combined with RAGT. We analyzed the Electroencephalography (EEG) power spectrum and task-related power modulation of EEG oscillations, and their association with gait function indexed by Walk Index for Spinal Cord Injury (WISCI-II). Univariate and multivariate linear/logistic regression analyses were performed to identify the predictors of gait function and recovery. ResultsConsistent with our hypothesis, we found that in the sensorimotor area: (1) Anodal tDCS combined with RAGT can modulate high-beta EEG oscillations power and enhance gait recovery; (2) higher high-beta EEG oscillations power at baseline can predict baseline gait function; (3) high-beta EEG oscillations power at baseline can predict gait recovery – the higher power at baseline, the better gait recovery; (4) decreases in relative high-beta power and increases in beta power decrease during walking are associated with gait recovery. ConclusionsEnhanced EEG beta oscillations in the sensorimotor area in SCI subjects may be part of a compensatory mechanism to enhance local plasticity. Our results point to the direction that interventions enhancing local plasticity such as tDCS combined with robotic training also lead to an immediate increase in sensorimotor cortex activation, improvement in gait recovery, and subsequent decrease in high-beta power. These findings suggest that beta-band oscillations may be potential biomarkers of gait function and recovery in SCI. SignificanceThese findings are significant for rehabilitation in SCI patients, and as EEG is a portable, inexpensive, and easy-to-apply system, the clinical translation is feasible to follow better the recovery process and to help to individualize rehabilitation therapies of SCI patients.

Handrim forces during wheelies performance in able-bodied and SCI subjects

Context: Manual wheelchair users must be able to carry out wheelies in order to tackle obstacles in the outdoor environment. To date, no studies have compared balance variables and forces exerted on the handrim during a stationary wheelie between able bodied and spinal cord injury subjects. Objectives: To compare the distribution of forces applied to the handrim and the center of pressure displacement during a stationary wheelie between able-bodied (AB) subjects and manual wheelchair users with spinal cord injury (SCI). Design: Prospective experimental study. Setting: A university hospital laboratory. Participants: 27 participants (14 AB and 13 SCI). Outcome Measure: Each participant performed 3 stationary wheelies of 60 s duration using a wheelchair equipped with an instrumented wheel. Two force platforms were used to calculate the displacement of the center of pressure (DCOP). Results: Median group DCOP amplitude in the anteroposterior axis was smaller and less variable in the AB (19.6 mm [8.1,49.6]) than the SCI (14.9 mm [7.6,141.1]) group. Forces applied to the handrim only differed significantly between the AB (6 N [−13.8,16.6]) and SCI groups (2.7 N [−12.1 21.9]) in the posteroanterior axis. Conclusions: The results showed that the participants with SCI exerted greater PA forces on the handrim, moreover, the direction of force was opposite to that of the AB group, suggesting that the SCI group used a proactive balance strategy while the AB group used a retroactive strategy. The results suggest that the direction of force applied should be considered when teaching individuals to perform wheelies.

Supporting front crawl swimming in paraplegics using electrical stimulation: a feasibility study

BackgroundParticipation in physical and therapeutic activities is usually severely restricted after a spinal cord injury (SCI). Reasons for this are the associated loss of voluntary motor function, inefficient temperature regulation of the affected extremities, and early muscle fatigue. Hydrotherapy or swim training offer an inherent weight relief, reduce spasticity and improve coordination, muscle strength and fitness.MethodsWe present a new hybrid exercise modality that combines functional electrical stimulation (FES) of the knee extensors and transcutaneous spinal cord stimulation (tSCS) with paraplegic front crawl swimming. tSCS is used to stimulate the afferent fibers of the L2–S2 posterior roots for spasticity reduction. By activating the tSCS, the trunk musculature is recruited at a motor level. This shall improve trunk stability and straighten the upper body. Within this feasibility study, two complete SCI subjects (both ASIA scale A, lesion level Th5/6), who have been proficient front crawl swimmers, conducted a 10-week swim training with stimulation support. In an additional assessment swim session nine months after the training, the knee extension, hip extension, and trunk roll angles where measured using waterproof inertial measurement units (IMUs) and compared for different swimming conditions (no stimulation, tSCS, FES, FES plus tSCS).ResultsFor both subjects, a training effect over the 10-week swim training was observed in terms of measured lap times (16 m pool) for all swimming conditions. Swimming supported by FES reduced lap times by 15.4% and 8.7% on average for Subject A and Subject B, respectively. Adding tSCS support yielded even greater mean decreases of 19.3% and 20.9% for Subjects A and B, respectively. Additionally, both subjects individually reported that swimming with tSCS for 30–45 minutes eliminated spasticity in the lower extremities for up to 4 hours beyond the duration of the session. Comparing the median as well as the interquartile range of all different settings, the IMU-based motion analysis revealed that FES as well as FES+tSCS improve knee extension in both subjects, while hip extension was only increased in one subject. Trunk roll angles were similar for all swimming conditions. tSCS had no influence on the knee and hip joint angles. Both subjects reported that stimulation-assisted swimming is comfortable, enjoyable, and they would like to use such a device for recreational training and rehabilitation in the future.ConclusionsStimulation-assisted swimming seems to be a promising new form of hybrid exercise for SCI people. It is safe to use with reusable silicone electrodes and can be performed independently by experienced paraplegic swimmers except for transfer to water. The study results indicate that swimming speed can be increased by the proposed methods and spasticity can be reduced by prolonged swim sessions with tSCS and FES. The combination of stimulation with hydrotherapy might be a promising therapy for neurologic rehabilitation in incomplete SCI, stroke or multiples sclerosis patients. Therefore, further studies shall incorporate other neurologic disorders and investigate the potential benefits of FES and tSCS therapy in the water for gait and balance.

Neuromuscular Controller Embedded in a Powered Ankle Exoskeleton: Effects on Gait, Clinical Features and Subjective Perspective of Incomplete Spinal Cord Injured Subjects.

Powered exoskeletons are among the emerging technologies claiming to assist functional ambulation. The potential to adapt robotic assistance based on specific motor abilities of incomplete spinal cord injury (iSCI) subjects, is crucial to optimize Human-Robot Interaction (HRI). Achilles, an autonomous wearable robot able to assist ankle during walking, was developed for iSCI subjects and utilizes a NeuroMuscular Controller (NMC). NMC can be used to adapt robotic assistance based on specific residual functional abilities of subjects. The main aim of this pilot study was to analyze the effects of the NMC-controlled Achilles, used as an assistive device, on chronic iSCI participants' performance, by assessing gait speed during 10-session training of robot-aided walking. Secondary aims were to assess training impact on participants' motion, clinical and functional features and to evaluate subjective perspective in terms of attitude towards technology, workload, usability and satisfaction. Results showed that 5 training sessions were necessary to significantly improve robot-aided gait speed on short paths and consequently to optimize HRI. Moreover, the training allowed participants who initially were not able to walk for 6 minutes, to improve gait endurance during Achilles-aided walking and to reduce perceived fatigue. Improvements were obtained also in gait speed during free walking, thus suggesting a potential rehabilitative impact, even if Achilles-aided walking was not faster than free walking. Participants' subjective evaluations indicated a positive experience.

Comparison of the quality of life in individuals with spinal cord injury wearing either reciprocating gait orthosis or hip knee ankle foot orthosis: a cross-sectional study

Background The quality of life (QoL) for patients with spinal cord injuries (SCI) is lower than that for healthy individuals. The main purpose of prescribing orthoses for these individuals is to improve their mobility and QoL. The hip knee ankle foot orthosis (HKAFO) has been the conventional choice for such patients, whilst the reciprocating gait orthosis (RGO) is a more contemporary option. Although the impact of these two types of orthoses on the biomechanics of walking has been previously evaluated in patients with SCI, there has been no specific comparison of their relative effects on QoL. Objectives This study aimed to evaluate the Sickness Impact Profile (SIP-68) QoL questionnaire’s total score and its sub-scores in patients with SCIs wearing either RGOs or HKAFOs. Methods This study was performed on 22 participants (11 participants wearing RGOs and 11 wearing HKAFOs). QoL scores were evaluated in each group of patients using the total and sub-scores from the SIP-68 questionnaire. Results There were no significant differences in the total SIP-68 scores between the RGO and HKAFO groups (p = .57). However, emotional stability and emotional independence sub-scores were significantly lower for the RGO users than for the HKAFO users (p = .03 and p = .01), respectively. Conclusions Based upon this preliminary study, participants wearing RGOs or HKAFOs had similar QoL scores. However, those wearing RGOs may experience better emotional stability, communication, and emotional independence. This preliminary study does not provide definite conclusions since a large randomized control trial is required to compare the effects of these orthoses on the QoL scores in patients with SCIs. Implications for rehabilitation Our main aim in the current investigation was to shed light on the question that does the biomechanical superiority of the RGO to the HKAFO leads to better quality of life in SCI subjects who are using RGO. Regarding the fact that the primary goal of rehabilitation of people with SCI is to improve their quality of life, it seems that the more complicated newer orthosis (RGO) has no difference with the older type (HKAFO) in achieving the rehabilitation goals. More studies will in fact be necessary to find a definitive answer for this important question. According to the findings of our study, it seems to be more appropriate to prescribe RGO for male participants with higher body weight.

Evaluation of Static and Dynamic Stability of Spinal Cord Injuries: What Are the Gaps

Background. Depending on the level of lesion, spinal cord injury (SCI) individuals have limited ability to stand and walk. They have to use various assistive devices to restore their abilities. The aim of this study was to evaluate the stability of SCI individuals during walking and quiet standing. Material and methods. Three groups: normal subjects and SCI individuals with complete and incomplete lesions, were enrolled. Stability of the subjects was evaluated based on center of pressure (COP) sways in quiet standing and spatiotemporal gait parameters in walking. The difference between the stability of normal and SCI subjects was determined by use of the two-sample t test. The correlation between the mean values of stability parameters in standing and walking and lesion level was determined by use of Pearson’s correlation. Results. The stability of SCI subjects during quiet standing was better than that of normal subjects. How­ever, their dynamic stability was significantly less than normal subjects. The dynamic stability of complete and incomplete SCI subjects did not differ significantly (P-value&lt;0.05). There was no correlation between lesion level and stability parameters. Conclusion. 1. SCI individuals suffer mostly from lack of dynamic stability, which does not depend on their lesion levels. 2. It seems that this problem may be due to rehabilitation methods used to improve stability in these patients. 3. It is recommended that new methods of rehabilitation or assistive devices should be used to improve stability of these individuals.

Improvement of hand functions of spinal cord injury patients with electromyography-driven hand exoskeleton: A feasibility study.

We have developed a one-of-a-kind hand exoskeleton, called Maestro, which can power finger movements of those surviving severe disabilities to complete daily tasks using compliant joints. In this paper, we present results from an electromyography (EMG) control strategy conducted with spinal cord injury (SCI) patients (C5, C6, and C7) in which the subjects completed daily tasks controlling Maestro with EMG signals from their forearm muscles. With its compliant actuation and its degrees of freedom that match the natural finger movements, Maestro is capable of helping the subjects grasp and manipulate a variety of daily objects (more than 15 from a standardized set). To generate control commands for Maestro, an artificial neural network algorithm was implemented along with a probabilistic control approach to classify and deliver four hand poses robustly with three EMG signals measured from the forearm and palm. Increase in the scores of a standardized test, called the Sollerman hand function test, and enhancement in different aspects of grasping such as strength shows feasibility that Maestro can be capable of improving the hand function of SCI subjects.

Effects of Paired Associative Nerve Stimulation on Spinal Cord Injury Subjects

Effects of Paired Associative Nerve Stimulation on Spinal Cord Injury Subjects

A Cross Sectional Study of Spinal Cord Injury-Induced Musculoskeletal Pain

Background:Musculoskeletal pain is a common consequence in a person with spinal cord injury. It brings a major impact on the quality of life, making prone to complications in both the short and the long term.Purpose: The purpose of the study to determine the spinal cord injury-induced musculoskeletal pain.Materials and Methods: A cross-sectional study was conducted at two different reputed institutes in Dhaka city. Ninety spinal cord injury subjects were selected with their inform consent. Data were collected by face to face interview with the interviewer-administered structured questionnaire. Numerical Pain Rating Scale was used to assess the grade of musculoskeletal pain and American Spinal Injury Association scale was used to find out the types of injury. Chi-square test was used where p-value (p<0.05) indicated as the level of significance.Results: Results indicated that more than two-third of the person with spinal cord injury complained to musculoskeletal pain. Neck, shoulder, and back were the more prevalent site of musculoskeletal pain found in this study. Road traffic accident and fall from height were the common causes of injury. Cervical and thoracic levels were the vulnerable site in person with spinal cord injury. However, there was a highly significant relationship found between the level of injury and musculoskeletal pain (p=0.001<0.05).Conclusion: The prevalence of musculoskeletal pain is extremely high in person with spinal cord injury which is concluded in this study. Some factors like spinal levels and causes of injury are significantly accountable for musculoskeletal pain. Adequate physiotherapy might help to reduce the incidence and intensity of spinal cord injury-induced musculoskeletal pain.

Efficiency and effectiveness of combined cell therapy in previously chronic and complete spinal cord injury subjects

Efficiency and effectiveness of combined cell therapy in previously chronic and complete spinal cord injury subjects