Ground Walking in Chronic Complete Spinal Cord Injury

Tesio, Luigi; Scarano, Stefano

doi:10.1097/phm.0000000000001520

Cited by 5 publications

(1 citation statement)

References 26 publications

(21 reference statements)

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“…Several aspects of the human gait cycle incorporate complex sensory-motor behaviors, which may be the result of the spinal CPG recruiting both supraspinal and propriospinal circuits. Many studies investigating the efficacy of eSCS in locomotion have employed rehabilitation techniques that provide sensory input to presumably activate the CPG [76].…”

Section: Central Pattern Generators (Cpgs)mentioning

confidence: 99%

Epidural Spinal Cord Stimulation for Spinal Cord Injury in Humans: A Systematic Review

Chalif,

Chavarro,

Mensah

et al. 2024

JCM

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(1) Background: Spinal cord injury (SCI) represents a major health challenge, often leading to significant and permanent sensorimotor and autonomic dysfunctions. This study reviews the evolving role of epidural spinal cord stimulation (eSCS) in treating chronic SCI, focusing on its efficacy and safety. The objective was to analyze how eSCS contributes to the recovery of neurological functions in SCI patients. (2) Methods: We utilized the PRISMA guidelines and performed a comprehensive search across MEDLINE/PubMed, Embase, Web of Science, and IEEE Xplore databases up until September 2023. We identified studies relevant to eSCS in SCI and extracted assessments of locomotor, cardiovascular, pulmonary, and genitourinary functions. (3) Results: A total of 64 studies encompassing 306 patients were identified. Studies investigated various stimulation devices, parameters, and rehabilitation methods. Results indicated significant improvements in motor function: 44% of patients achieved assisted or independent stepping or standing; 87% showed enhanced muscle activity; 65% experienced faster walking speeds; and 80% improved in overground walking. Additionally, eSCS led to better autonomic function, evidenced by improvements in bladder and sexual functions, airway pressures, and bowel movements. Notable adverse effects included device migration, infections, and post-implant autonomic dysreflexia, although these were infrequent. (4) Conclusion: Epidural spinal cord stimulation is emerging as an effective and generally safe treatment for chronic SCI, particularly when combined with intensive physical rehabilitation. Future research on standardized stimulation parameters and well-defined therapy regimens will optimize benefits for specific patient populations.

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Section: Central Pattern Generators (Cpgs)mentioning

confidence: 99%

Epidural Spinal Cord Stimulation for Spinal Cord Injury in Humans: A Systematic Review

Chalif,

Chavarro,

Mensah

et al. 2024

JCM

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Holism and Reductionism in the Illness/Disease Debate

Tesio

Stuart

2022

The Frontiers Collection

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In the last decades it has become clear that medicine must find some way to combine its scientific and humanistic sides. In other words, an adequate notion of medicine requires an integrative position that mediates between the analyticreductionist and the normative-holistic tendencies we find therein. This is especially important as these different styles of reasoning separate "illness" (something perceived and managed by the whole individual in concert with their environment) and "disease" (a "mechanical failure" of a biological element within the body). While the demand for an integrative view has typically been motivated by ethical concerns, we claim that it is also motivated, perhaps even more fundamentally, by epistemological and methodological reasons. Evidence-based bio-medicine employs experimental and statistical techniques which eliminate important differences in the ways that conscious humans evaluate, live with, and react to disease and illness. However, it is precisely these experiences that underpin the concepts and norms of bio-medicine. Humanistic disciplines, on the other hand, have the resources to investigate these experiences in an intersubjectively testable way. Medicine, therefore, cannot afford to ignore its nature as a human science; it must be concerned not only with disease and illness, but also with the ways in which patients as persons respond to malady. Insofar as attitudes and expectations influence the criteria of illness and disease, they must be studied as part of the genuine subject matter of medicine as a human science. In general, we urge that this is a necessary step to overcome today's trend to split evidence-based and clinical medicine.2 In this last case, in accordance with the work of Parsons about the "sick role" (Parsons 1951(Parsons , 1975, "sickness" is the more often used term, but it will be included here under the umbrella of "illness", which emphasizes the interpersonal and social aspect (consistent with this, in common parlance, is calling work absences due to health care problems "sick" leave). On this point see also Twaddle (1968Twaddle ( , 1994aTwaddle ( , 1994b, who was one of the first authors to distinguish between disease, illness, and sickness.

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The illness-disease dichotomy and the biological-clinical splitting of medicine

Tesio

2020

Med Humanities

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In a recent paper, Sharpe and Greco (2019) argue that some clinical conditions, such as chronic fatigue syndrome (sometimes called myalgic encephalomyelitis), should be treated by altering the patient's experience and response to symptoms without necessarily searching for an underlying cause. As a result, we should allow for the existence of ‘illnesses without (underlying) diseases’. Wilshire and Ward (2019) reply that this possibility requires unwarranted causal assumptions about the psychosocial origins of conditions not predicted by a disease model. In so doing, it is argued that Sharpe and Greco introduce epistemological and methodological problems with serious medical consequences, for example, patients feel guilt for seeking treatment for illnesses that only exist ‘all in the mind’, and medical researchers are discouraged from looking for more effective treatments of such conditions. We propose a view that integrates the insights of both papers. We abandon both the strict distinction between disease and illness and the naïve unidirectional account of causality that accompanies it. This, we claim, is a step towards overcoming the current harmful tendencies to conceptually separate (1) Symptom management and disease-modifying treatments. (2) Rehabilitative-palliative care and ‘causal’ curing. (3) Most importantly, biomedicine and clinical medicine, where the latter is currently at risk of losing its status as scientific.

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Ground Walking in Chronic Complete Spinal Cord Injury

Cited by 5 publications

References 26 publications

Epidural Spinal Cord Stimulation for Spinal Cord Injury in Humans: A Systematic Review

Epidural Spinal Cord Stimulation for Spinal Cord Injury in Humans: A Systematic Review

Holism and Reductionism in the Illness/Disease Debate

The illness-disease dichotomy and the biological-clinical splitting of medicine

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