Motor rehabilitation as a therapeutic tool for spinal cord injury: New perspectives in immunomodulation

Walsh, Ciara M.; Gull, Khadija; Dooley, Dearbhaile

doi:10.1016/j.cytogfr.2022.08.005

Cited by 14 publications

(3 citation statements)

References 79 publications

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“…5 Estudos em animais mostram que além desses benefícios, os exercícios em esteira podem ter impacto na modulação inflamatória com aumento da liberação de TNF alta, IL-2, IL-4, IL-6, IL-12, IL18, IFN GAMA, IL1BETA, que estariam relacionados a neuroplasticidade e redução do dano secundário na lesão medular. 6 As ondas de choque tem conhecidos efeitos em aumento de MAPK, aumento da angiogênese, ativação de fatores de crescimento endotelial via aumento de eNOS e VEGF 7 e podem também exercer efeito imunomodulatório por diversas vias como as relacionadas a TLR 3, 8 IL-6 e IL-8, 9 redução de TNF-alfa e aumento de IL-1beta, 10 além do efeito no aumento de microRNA375 possivelmente envolvido no efeito neuroprotetor e de neuroplasticidade relacionado a BDNF. 11 Diversos estudos em ratos mostraram que aplicação de ondas de choque em região medular promove aumento de fatores de crescimento endotelial e melhora funcional 2,12,13,14 e em 2022 foi publicado o primeiro estudo realizado em humanos.…”

Section: Discussionunclassified

Associação de estimulação por ondas de choque a toxina botulínica e baclofeno durante a reabilitação de paciente com lesão medular e trauma cranioencefálico: relato de caso

Ferreira,

Shinzato,

Ribeiro

et al. 2023

Acta Fisiátr.

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Recentemente, a terapia por ondas de choque extracorpóreas (TOCE) mostraram-se ser uma promissora tecnologia não invasiva para neuromodulação e recuperação funcional devido a melhora em brotamento neuronal, neuroproteção, controle de neuroplasticidade e reorganização neuronal, além de atuar em fatores de neurogênese. Objetivo: Descrever um caso que usa TOCE como um adjuvante na reabilitação de trauma medular. Relato de caso: LPS, 25 anos, estudante de medicina, sofreu uma queda de altura indeterminada com fratura de C5 e lesão medular associada a trauma cranioencefálico. Na fase aguda, ele se recuperou adequadamente, tendo sido submetido a descompressão e fixação de coluna e hospitalizado por 5 meses devido a disautonomias e infecções urinárias. Após esse período, ele iniciou um programa de reabilitação intensiva para tetraplegia espástica com classificação inicial segundo o ASIA (American Spinal Injury Association) nível C5 motor e C6 sensório. O tratamento incluiu 10 sessões de TOCE, realizadas com Duolith SD1 (Storz Medical, Suíça) com uma densidade de energia de 0,25mJ/mm², 5 cm e 3 cm de profundidade de foco, 2000 pulsos aplicados na linha média de coluna níveis C5 a T1 e 2000 pulsos a 5 cm de profundidade aplicados em região plantar bilateral. Bloqueio com toxina botulínica e fenol foram realizados com resposta parcial apesar da dose otimizada de baclofeno.

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Section: Discussionunclassified

Associação de estimulação por ondas de choque a toxina botulínica e baclofeno durante a reabilitação de paciente com lesão medular e trauma cranioencefálico: relato de caso

Ferreira,

Shinzato,

Ribeiro

et al. 2023

Acta Fisiátr.

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“…This has the advantage of an available body of data reporting both pathophysiological and functional outcomes following interventions of mobilisation (e.g. treadmill training) initiated within this early period [ 18 , 19 ]. Measures of pathophysiology are commonly used in pre-clinical research including levels of brain-derived neurotrophic factor (BDNF) as an indicator of neuroplasticity and neural recovery (with higher levels a marker of better recovery), and indicators of inflammation, e.g.…”

Section: Introductionmentioning

confidence: 99%

The effect of early mobilisation (< 14 days) on pathophysiological and functional outcomes in animals with induced spinal cord injury: a systematic review with meta-analysis

Gray,

Shaikh,

Cowley

et al. 2024

BMC Neurosci

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Introduction The optimum time to mobilise (standing, walking) following spinal cord injury (SCI) is unknown but may have implications for patient outcomes. There are no high-quality experimental studies that examine this issue, with a paucity of guidance for clinicians. Pre-clinical studies lead research in this field and can contribute to knowledge and support future clinical practice. Objective: to evaluate the effect of early compared to no mobilisation on pathophysiological and functional outcomes in animals with induced SCI. Methods A systematic review with meta-analysis was conducted by searching pre-clinical literature in MEDLINE (PubMed), Embase (Ovid), Web of Science, OpenGrey, and EThOS (June 2023). Studies were included of any research method giving numerical results comparing pathophysiological and functional outcomes in rats and mice mobilised within 14-days of induced SCI to those that did not mobilise. Data were synthesised using random-effects meta-analyses. The quality of the evidence was assessed using the CAMARADES checklist. The certainty of findings was reported using the GRADE approach. This study is registered on PROSPERO (CRD42023437494). Results Seventeen studies met the inclusion criteria. Outcomes found that Brain Derived Neurotrophic Factor levels were greater in those that initiated mobilisation within 14-days of SCI compared to the groups that did not. Mobilisation initiated within 14-days of SCI was also associated with statistically significant functional gains: (Basso, Beattie and Bresnahan locomotor rating score (BBB) = 2.13(0–21), CI 1.43, 2.84, Ladder Rung Walking Task = − 12.38(0–100), CI 20.01, − 4.76). Meta-analysis identified the greatest functional gains when mobilisation was initiated within 3 days of SCI (BBB = 3.00, CI 2.31–3.69, p < 0.001), or when delivered at low intensity (BBB = 2.88, CI 2.03–3.70, p < 0.001). Confidence in the findings from this review was low to moderate due to the risk of bias and mixed methodological quality. Conclusion Mobilisation instigated within 14-days of injury, may be an effective way of improving functional outcomes in animal models following SCI, with delays potentially detrimental to recovery. Outcomes from this study support further research in this field to guide future clinical practice.

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“…In the study by Ying et al, 2022 [25], it was shown that water treadmill training facilitates axon growth, associated with the Nogo receptor/Rho-associated protein kinase (NGR/RhoA/ROCK) signaling pathway, by inhibiting the activation of astrocytes. A significant reduction in pro-inflammatory factors induced by SCI, such as interleukin-1β, -6 (IL-1β, IL-6) and TNFα, was reported following the training [26].…”

Section: Introductionmentioning

confidence: 99%

The Impact of Treadmill Training on Tissue Integrity, Axon Growth, and Astrocyte Modulation

Ageeva,

Sabirov,

Sufianov

et al. 2024

IJMS

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Spinal cord injury (SCI) presents a complex challenge in neurorehabilitation, demanding innovative therapeutic strategies to facilitate functional recovery. This study investigates the effects of treadmill training on SCI recovery, emphasizing motor function enhancement, neural tissue preservation, and axonal growth. Our research, conducted on a rat model, demonstrates that controlled treadmill exercises significantly improve motor functions post-SCI, as evidenced by improved scores on the Basso, Beattie, and Bresnahan (BBB) locomotor rating scale and enhanced electromyography readings. Notably, the training facilitates the preservation of spinal cord tissue, effectively reducing secondary damage and promoting the maintenance of neural fibers in the injured area. A key finding is the significant stimulation of axonal growth around the injury epicenter in trained rats, marked by increased growth-associated protein 43 (GAP43) expression. Despite these advancements, the study notes a limited impact of treadmill training on motoneuron adaptation and highlights minimal changes in the astrocyte and neuron–glial antigen 2 (NG2) response. This suggests that, while treadmill training is instrumental in functional improvements post-SCI, its influence on certain neural cell types and glial populations is constrained.

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Motor rehabilitation as a therapeutic tool for spinal cord injury: New perspectives in immunomodulation

Cited by 14 publications

References 79 publications

Associação de estimulação por ondas de choque a toxina botulínica e baclofeno durante a reabilitação de paciente com lesão medular e trauma cranioencefálico: relato de caso

Associação de estimulação por ondas de choque a toxina botulínica e baclofeno durante a reabilitação de paciente com lesão medular e trauma cranioencefálico: relato de caso

The effect of early mobilisation (< 14 days) on pathophysiological and functional outcomes in animals with induced spinal cord injury: a systematic review with meta-analysis

The Impact of Treadmill Training on Tissue Integrity, Axon Growth, and Astrocyte Modulation

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