Life Care Planning Projections for Individuals With Motor Incomplete Spinal Cord Injury Before and After Locomotor Training Intervention

Morrison, Sarah; Pomeranz, Jamie L.; Yu, Nami S.; Read, Mary Schmidt; Sisto, Sue Ann; Behrman, Andrea L.

doi:10.1097/npt.0b013e318262e5ab

Cited by 6 publications

(3 citation statements)

References 32 publications

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“…Limiting our analysis to health system rehabilitation costs may be acceptable because rehabilitation is the largest cost post-SCI [ 53 ], but focusing on health system costs misses potential out of pocket costs borne by individuals and family members. Limiting the analysis to one-year costs may be acceptable because there is no evidence suggesting that incremental differences exist between locomotor training strategies over the long term, though savings have been estimated for locomotor training strategies versus no training [ 54 ].…”

Section: Strengths and Limitationsmentioning

confidence: 99%

Cost-effectiveness analysis of overground robotic training versus conventional locomotor training in people with spinal cord injury

Pinto

Heinemann

Chang

et al. 2023

J NeuroEngineering Rehabil

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Background Few, if any estimates of cost-effectiveness for locomotor training strategies following spinal cord injury (SCI) are available. The purpose of this study was to estimate the cost-effectiveness of locomotor training strategies following spinal cord injury (overground robotic locomotor training versus conventional locomotor training) by injury status (complete versus incomplete) using a practice-based cohort. Methods A probabilistic cost-effectiveness analysis was conducted using a prospective, practice-based cohort from four participating Spinal Cord Injury Model System sites. Conventional locomotor training strategies (conventional training) were compared to overground robotic locomotor training (overground robotic training). Conventional locomotor training included treadmill-based training with body weight support, overground training, and stationary robotic systems. The outcome measures included the calculation of quality adjusted life years (QALYs) using the EQ-5D and therapy costs. We estimate cost-effectiveness using the incremental cost utility ratio and present results on the cost-effectiveness plane and on cost-effectiveness acceptability curves. Results Participants in the prospective, practice-based cohort with complete EQ-5D data (n = 99) qualified for the analysis. Both conventional training and overground robotic training experienced an improvement in QALYs. Only people with incomplete SCI improved with conventional locomotor training, 0.045 (SD 0.28), and only people with complete SCI improved with overground robotic training, 0.097 (SD 0.20). Costs were lower for conventional training, $1758 (SD $1697) versus overground robotic training $3952 (SD $3989), and lower for those with incomplete versus complete injury. Conventional overground training was more effective and cost less than robotic therapy for people with incomplete SCI. Overground robotic training was more effective and cost more than conventional training for people with complete SCI. The incremental cost utility ratio for overground robotic training for people with complete spinal cord injury was $12,353/QALY. Conclusions The most cost-effective locomotor training strategy for people with SCI differed based on injury completeness. Conventional training was more cost-effective than overground robotic training for people with incomplete SCI. Overground robotic training was more cost-effective than conventional training for people with complete SCI. The effect estimates may be subject to limitations associated with small sample sizes and practice-based evidence methodology. These estimates provide a baseline for future research.

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Section: Strengths and Limitationsmentioning

confidence: 99%

Cost-effectiveness analysis of overground robotic training versus conventional locomotor training in people with spinal cord injury

Pinto

Heinemann

Chang

et al. 2023

J NeuroEngineering Rehabil

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“… 87 , 88 Recent small scale studies on locomotor training with FES and robotic assistance demonstrated improvements in mental health related quality-of-life in SCI, 89 , 90 and likewise high intensity body weight support locomotor training has also been shown to improve quality of life in people with Parkinsonism. 91 By virtue of improving walking ability, locomotor training may reduce home renovation costs by >US$50,000/person and also substantially reduce lifetime healthcare costs in more impaired individuals., 81 , 92 thus easing these patients’ overall disease burden. PwCM remain at increased risk of falls and fragility fractures, and due to their sedentary lifestyles they are also prone to developing coronary artery disease, arrhythmias, and strokes.…”

Section: Mental Health Quality Of Life and Economicsmentioning

confidence: 99%

Developing Peri-Operative Rehabilitation in Degenerative Cervical Myelopathy [AO Spine RECODE-DCM Research Priority Number 6]: An Unexplored Opportunity?

Boerger

Hyngstrom

Furlan

et al. 2022

Global Spine Journal

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Study Design Narrative review. Objective Degenerative cervical myelopathy is one of the most frequent impairments of the spinal cord encountered internationally in adults. Currently, surgical decompression is the recommended treatment for people with DCM (PwCM) presenting with moderate to severe symptoms or neurological deficits. However, despite surgical intervention, not all patients make a complete recovery due to the irreversible tissue damage within the spinal cord. The objective of this review is to describe the state and gaps in the current literature on rehabilitation for PwCM and possible innovative rehabilitation strategies. Methods Literature search. Results In other neurological disorders such as stroke and acute traumatic spinal cord injury (SCI), timely and strategic rehabilitation has been shown to be indispensable for maximizing functional outcomes, and it is imperative that appropriate perioperative rehabilitative interventions accompany surgical approaches in order to enable the best outcomes. In this review, the current state of knowledge regarding rehabilitation for PwCM is described. Additionally, various therapies that have shown to improve outcomes in comparable neurological conditions such as stroke and SCI which may be translated to DCM will be reviewed. Conclusions We conclude that locomotor training and arm/hand therapy may benefit PwCM. Further, we conclude that body weight support, robotic assistance, and virtual/augmented reality therapies may be beneficial therapeutic analogs to locomotor and hand therapies.

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“…Less intensive locomotor training (twice a week) also appears to be beneficial (187). Morrison et al (178,179) estimated that locomotor training reduced lifetime care costs. Two reviews (169,176) suggested that while some of these approaches show potential for ambulatory improvement, randomized clinical trials are needed to show that these instrument-intensive programs are better than progressive overground training (55).…”

Section: Importance Of Locomotor Trainingmentioning

confidence: 99%

Electrical Stimulation and Motor Recovery

Young

2015

Cell Transplant

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In recent years, several investigators have successfully regenerated axons in animal spinal cords without locomotor recovery. One explanation is that the animals were not trained to use the regenerated connections. Intensive locomotor training improves walking recovery after spinal cord injury (SCI) in people, and >90% of people with incomplete SCI recover walking with training. Although the optimal timing, duration, intensity, and type of locomotor training are still controversial, many investigators have reported beneficial effects of training on locomotor function. The mechanisms by which training improves recovery are not clear, but an attractive theory is available. In 1949, Donald Hebb proposed a famous rule that has been paraphrased as "neurons that fire together, wire together." This rule provided a theoretical basis for a widely accepted theory that homosynaptic and heterosynaptic activity facilitate synaptic formation and consolidation. In addition, the lumbar spinal cord has a locomotor center, called the central pattern generator (CPG), which can be activated nonspecifically with electrical stimulation or neurotransmitters to produce walking. The CPG is an obvious target to reconnect after SCI. Stimulating motor cortex, spinal cord, or peripheral nerves can modulate lumbar spinal cord excitability. Motor cortex stimulation causes long-term changes in spinal reflexes and synapses, increases sprouting of the corticospinal tract, and restores skilled forelimb function in rats. Long used to treat chronic pain, motor cortex stimuli modify lumbar spinal network excitability and improve lower extremity motor scores in humans. Similarly, epidural spinal cord stimulation has long been used to treat pain and spasticity. Subthreshold epidural stimulation reduces the threshold for locomotor activity. In 2011, Harkema et al. reported lumbosacral epidural stimulation restores motor control in chronic motor complete patients. Peripheral nerve or functional electrical stimulation (FES) has long been used to activate sacral nerves to treat bladder and pelvic dysfunction and to augment motor function. In theory, FES should facilitate synaptic formation and motor recovery after regenerative therapies. Upcoming clinical trials provide unique opportunities to test the theory. INTRODUCTIONIn the past decade, several prominent laboratories have shown axonal regeneration in animal spinal cord injury (SCI) models, but locomotor recovery did not follow regeneration (277). For example Lu et al. (159,160) and He's group (156,282) regenerated many axons that synapsed with neurons in the lower spinal cord, but the animals did not recover walking. To explain the lack of locomotor recovery, the investigators assume that insufficient numbers of regenerated axons have formed synapses with appropriate neurons in the lower spinal cord to support locomotion. Another explanation for the lack of locomotor recovery after complete SCI and regeneration is that the animals did not learn to use their newly regrown connections.Regenerated fibe...

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Life Care Planning Projections for Individuals With Motor Incomplete Spinal Cord Injury Before and After Locomotor Training Intervention

Cited by 6 publications

References 32 publications

Cost-effectiveness analysis of overground robotic training versus conventional locomotor training in people with spinal cord injury

Cost-effectiveness analysis of overground robotic training versus conventional locomotor training in people with spinal cord injury

Developing Peri-Operative Rehabilitation in Degenerative Cervical Myelopathy [AO Spine RECODE-DCM Research Priority Number 6]: An Unexplored Opportunity?

Electrical Stimulation and Motor Recovery

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