Recent Trends and its Effect in Incomplete Spinal Cord Injury Loco-Motor Rehabilitation – A Review

Niharika Aswal^* and Sanghamitra Jena
^*Correspondence: Niharika Aswal, Galgotias University, Greater Noida, India, Email:

Keywords

SCI • Incomplete SCI • Rehabilitation • Gait training • Locomotor • Recent technologies • Walking • Robotics • Impairment

Introduction

A spinal cord injury is the damage to the spinal cord lesion which results in loss of sensory or motor function. SCI is a devastating condition results in poor quality of life [1]. Approx. 17,730 individual’s experiences SCI each year [2] in a gender ratio of 3:4 in male is to female. As per the WHO, the frequency of SCI is expanding in developing countries including India [3]. In India, the average annual incidence of SCI is 15,000 with a prevalence of 0.15 million [4]. Generally, more than 50% of patients having motor incomplete injury [5], it depends on the level and extent of the lesion. In this article, we are discussing about the locomotor rehabilitation in incomplete spinal cord injury patient. Motor dysfunction leads to disturbances in gait pattern and weakened muscular strength [6]. Incomplete SCI with locomotor dysfunction experiences limited or no movement and completely rely on assistive device as well as physically dependent on others. The inability to stand and walk not only limit community involvement, but the patient may expose to other secondary health complications [7]. Many rehabilitation techniques have been come across to conquer these physical demands. Through this study, we discuss the emerging trend in the rehabilitation of individuals with incomplete spinal cord lesion, focusing mainly on locomotor function. Many rehabilitation techniques have been explored to enhance the quality of life of patient and help in reducing primary as well as secondary complications. We are focusing only on the lower extremity devices. Orthosis and wheelchair are primary sources but they require a significant amount of energy expenditure. Thus, the patient may feel some sort of difficulty in accessing and mobility [8]. Other than this, there are various locomotor training devices which are used to recover walking function and improve gait pattern.

Researches in SCI rehabilitation has expanded that initiate or augmenting movements, like external motorized or robotics devices. These devices are utilized with two objectives: to improve recovery through repetitive functional movement and to act as a mobility device beyond orthosis and wheelchairs [8]. Various gait training methods has been proposed in recent years- Conventional Over-ground Walking Therapy (OGT), Body Weight Supported Treadmill Training (BSWTT), Virtual Reality (VR), Functional Electrical Stimulus (FES), Robot-Assisted Gait Training (RAGT) or Lokomat, Powered Exoskeletons [9- 12] or Robotic Exoskeleton (RT-exo), and many more. Locomotor training using partial BWS, TM, manual assistance by therapist are important therapeutic intervention to retrain walking in people with incomplete SCI patients. Manual assisted technique requires 2-3 patients to provide body weight support and prevent the subject from falling during gait training program. BWS and TM system are designed to combine with Robotic device, so that it can reduce additional cost required in manual assistance of physical therapist. A metaanalysis study investigates that robotic training in iSCI patients found greater improvement in walking independently [13]. BWS without TM can be used in over-ground surfaces. Advancement and utilization of powered exoskeleton is moderately new, the current evidence supporting their use and purported benefits. Powered exoskeleton devices have raised as potential upright mobility devices [14]. The benefit of this device is to enhance walking speed and improve strength and tending to other conditions like spasticity, pain, and quality of life [15]. The use of Virtual reality (VR) therapy is also a new rehabilitation approach among individuals with spinal cord injury [16]. Robot- Assisted Gait Training (RAGT) helps improve muscle tone and lower motor function like walking in people with spinal cord injury and decrease secondary complications like pain and spasticity [17]. However, recent advances in clinical research using various interventions designed to improve locomotor ability in a variety of patient population.

Literature Search

Inclusion criteria

• Incomplete SCI [18]

• Recent articles

• ASIA scale C, D [18]

• Age: more than 16 year, both male and female [19]

• Acute, sub-acute and chronic conditions [19]

• Traumatic and non-Traumatic injury [19]

Exclusion criteria

• Complete SCI [18]

Data sources

Articles were searched through PubMed, Google scholar. Only studies publish in the English language were preferred, based on current evidence from 2016- 2020. Using appropriate inclusion and exclusion criteria, 20 articles were reviewed in which, only 10 articles fulfill the criteria. All studies mainly focus on advancement in locomotor rehabilitation technologies of incomplete spinal cord injury.

Conclusion

We investigated the advancement in various locomotor rehabilitation techniques and its effect in incomplete SCI patients. The effect of various therapeutic techniques which we discuss has significant improvement in locomotor function and enhances the quality of life of the patient. These technologies are continually being advanced, and long-term follow up data are needed to understand the efficacy of these devices. The fate of these latest technologies is brilliant for iSCI patients and will keep on being researched. However, progressively clinical preliminaries and research will continue to establish their viability.

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