The Rehabilitation of Spinal Cord Injury Patients in Europe

Scivoletto, Giorgio; Miscusi, Massimo; Forcato, Stefano; Ricciardi, Luca; Serrao, Mariano; Bellitti, Roberto; Raco, Antonino

doi:10.1007/978-3-319-39546-3_31

Cited by 19 publications

(17 citation statements)

References 34 publications

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“…The incidence of spinal cord injury (SCI) worldwide is between 250,000 and 500,000 individuals each year ( Quadri et al, 2020 ). In Western European countries traumatic SCI incidence is of 16 to 19.4 new cases per million inhabitants per year ( Scivoletto et al, 2017 ). Walking is usually affected in patients with SCI according to the lesion level and the resulting different levels of muscle paralysis, sensory impairment, spasticity, and the lack of trunk control ( Bani et al, 2013 ).…”

Section: Introductionmentioning

confidence: 99%

Application of the Gait Deviation Index to Study Gait Impairment in Adult Population With Spinal Cord Injury: Comparison With the Walking Index for Spinal Cord Injury Levels

Sinovas-Alonso

Herrera-Valenzuela

Cano‐de‐la‐Cuerda

et al. 2022

Front. Hum. Neurosci.

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The Gait Deviation Index (GDI) is a multivariate measure of overall gait pathology based on 15 gait features derived from three-dimensional (3D) kinematic data. GDI aims at providing a comprehensive, easy to interpret, and clinically meaningful metric of overall gait function. It has been used as an outcome measure to study gait in several conditions: cerebral palsy (CP), post-stroke hemiparetic gait, Duchenne muscular dystrophy, and Parkinson’s disease, among others. Nevertheless, its use in population with Spinal Cord Injury (SCI) has not been studied yet. The aim of the present study was to investigate the applicability of the GDI to SCI through the assessment of the relationship of the GDI with the Walking Index for Spinal Cord Injury (WISCI) II. 3D gait kinematics of 34 patients with incomplete SCI (iSCI) was obtained. Besides, 3D gait kinematics of a sample of 50 healthy volunteers (HV) was also gathered with Codamotion motion capture system. A total of 302 (iSCI) and 446 (HV) strides were collected. GDI was calculated for each stride and grouped for each WISCI II level. HV data were analyzed as an additional set. Normal distribution for each group was assessed with Kolmogorov-Smirnov tests. Afterward, ANOVA tests were performed between each pair of WISCI II levels to identify differences among groups (p < 0.05). The results showed that the GDI was normally distributed across all WISCI II levels in both iSCI and HV groups. Furthermore, our results showed an increasing relationship between the GDI values and WISCI II levels in subjects with iSCI, but only discriminative in WISCI II levels 13, 19, and 20. The index successfully distinguished HV group from all the individuals with iSCI. Findings of this study indicated that the GDI is not an appropriate multivariate walking metric to represent the deviation of gait pattern in adult population with iSCI from a normal gait profile when it is compared with the levels of walking impairment described by the WISCI II. Future work should aim at defining and validating an overall gait index derived from 3D kinematic gait variables appropriate for SCI, additionally taking into account other walking ability outcome measures.

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Section: Introductionmentioning

confidence: 99%

Application of the Gait Deviation Index to Study Gait Impairment in Adult Population With Spinal Cord Injury: Comparison With the Walking Index for Spinal Cord Injury Levels

Sinovas-Alonso

Herrera-Valenzuela

Cano‐de‐la‐Cuerda

et al. 2022

Front. Hum. Neurosci.

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“…Guttman pioneered the division of SCI patients into "complete" and "incomplete" injury categories, which helped with treatment, decision-making, and providing more accurate prognoses. 19,33 He also made significant strides in treating patients with bed sores and urological complications, such as replacing indwelling catheters with sterile, intermittent catheterization. 33 By the end of the war, the philosophical approach to SCI treatment had undergone a foundational paradigm shift.…”

Section: World War IImentioning

confidence: 99%

Advancements in the treatment of traumatic spinal cord injury during military conflicts

Hersh

Davidar

Weber-Levine

et al. 2022

Neurosurgical Focus

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Significant advancements in the treatment of spinal cord injury (SCI) were developed in the setting of military conflicts, partly due to the large numbers of injuries sustained by service members. No effective SCI treatment options existed into the early 20th century, and soldiers who sustained these injuries were usually considered untreatable. Extensive progress was made in SCI treatment during and after World War II, as physical therapy was increasingly encouraged for patients with SCI, multidisciplinary teams oversaw care, pathophysiology was better understood, and strategies were devised to prevent wound infection and pressure sores. Recent conflicts in Iraq and Afghanistan have caused a substantial rise in the proportion of SCIs among causes of casualties and wounds, largely due to new forms of war and weapons, such as improvised explosive devices. Modern military SCIs resulting from blast mechanisms are substantively different from traumatic SCIs sustained by civilians. The treatment paradigms developed over the past 100 years have increased survival rates and outcomes of soldiers with SCI. In this paper, the authors review the role of military conflicts in the development of therapeutic interventions for SCI and discuss how these interventions have improved outcomes for soldiers and civilians alike.

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“…Rehabilitation of SCI victims remains a significant challenge, aimed at restoring independence in activities of daily living (ADL) and walking in those patients [ 51 ]. Still, poor neurological outcomes are common with almost one-third of injuries resulting in permanent complete paraplegia or tetraplegia [ 46 ].…”

Section: Clinical Challenges and Robotic Rehabilitation Applicatiomentioning

confidence: 99%

Converging Robotic Technologies in Targeted Neural Rehabilitation: A Review of Emerging Solutions and Challenges

Nizamis

Athanasiou

Almpani

et al. 2021

Sensors

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Recent advances in the field of neural rehabilitation, facilitated through technological innovation and improved neurophysiological knowledge of impaired motor control, have opened up new research directions. Such advances increase the relevance of existing interventions, as well as allow novel methodologies and technological synergies. New approaches attempt to partially overcome long-term disability caused by spinal cord injury, using either invasive bridging technologies or noninvasive human–machine interfaces. Muscular dystrophies benefit from electromyography and novel sensors that shed light on underlying neuromotor mechanisms in people with Duchenne. Novel wearable robotics devices are being tailored to specific patient populations, such as traumatic brain injury, stroke, and amputated individuals. In addition, developments in robot-assisted rehabilitation may enhance motor learning and generate movement repetitions by decoding the brain activity of patients during therapy. This is further facilitated by artificial intelligence algorithms coupled with faster electronics. The practical impact of integrating such technologies with neural rehabilitation treatment can be substantial. They can potentially empower nontechnically trained individuals—namely, family members and professional carers—to alter the programming of neural rehabilitation robotic setups, to actively get involved and intervene promptly at the point of care. This narrative review considers existing and emerging neural rehabilitation technologies through the perspective of replacing or restoring functions, enhancing, or improving natural neural output, as well as promoting or recruiting dormant neuroplasticity. Upon conclusion, we discuss the future directions for neural rehabilitation research, diagnosis, and treatment based on the discussed technologies and their major roadblocks. This future may eventually become possible through technological evolution and convergence of mutually beneficial technologies to create hybrid solutions.

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The Rehabilitation of Spinal Cord Injury Patients in Europe

Cited by 19 publications

References 34 publications

Application of the Gait Deviation Index to Study Gait Impairment in Adult Population With Spinal Cord Injury: Comparison With the Walking Index for Spinal Cord Injury Levels

Application of the Gait Deviation Index to Study Gait Impairment in Adult Population With Spinal Cord Injury: Comparison With the Walking Index for Spinal Cord Injury Levels

Advancements in the treatment of traumatic spinal cord injury during military conflicts

Converging Robotic Technologies in Targeted Neural Rehabilitation: A Review of Emerging Solutions and Challenges

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