RESUMEN
BACKGROUND: People with incomplete spinal cord injury (iSCI) often have gait impairments that negatively affect daily life gait performance (i.e., ambulation in the home and community setting) and quality of life. They may benefit from light-weight lower extremity exosuits that assist in walking, such as the Myosuit (MyoSwiss AG, Zurich, Switzerland). A previous pilot study showed that participants with various gait disorders increased their gait speed with the Myosuit in a standardized environment. However, the effect of a soft exosuit on daily life gait performance in people with iSCI has not yet been evaluated. OBJECTIVE: The primary study objective is to test the effect of a soft exosuit (Myosuit) on daily life gait performance in people with iSCI. Second, the effect of Myosuit use on gait capacity and the usability of the Myosuit in the home and community setting will be investigated. Finally, short-term impact on both costs and effects will be evaluated. METHODS: This is a two-armed, open label, randomized controlled trial (RCT). Participants will be randomized (1:1) to the intervention group (receiving the Myosuit program) or control group (initially receiving the conventional program). Thirty-four people with chronic iSCI will be included. The Myosuit program consists of five gait training sessions with the Myosuit at the Sint Maartenskliniek. Thereafter, participants will have access to the Myosuit for home use during 6 weeks. The conventional program consists of four gait training sessions, followed by a 6-week home period. After completing the conventional program, participants in the control group will subsequently receive the Myosuit program. The primary outcome is walking time per day as assessed with an activity monitor at baseline and during the first, third, and sixth week of the home periods. Secondary outcomes are gait capacity (10MWT, 6MWT, and SCI-FAP), usability (D-SUS and D-QUEST questionnaires), and costs and effects (EQ-5D-5L). DISCUSSION: This is the first RCT to investigate the effect of the Myosuit on daily life gait performance in people with iSCI. TRIAL REGISTRATION: Clinicaltrials.gov NCT05605912. Registered on November 2, 2022.
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Marcha , Ensayos Clínicos Controlados Aleatorios como Asunto , Traumatismos de la Médula Espinal , Humanos , Traumatismos de la Médula Espinal/fisiopatología , Traumatismos de la Médula Espinal/complicaciones , Traumatismos de la Médula Espinal/rehabilitación , Resultado del Tratamiento , Factores de Tiempo , Dispositivo Exoesqueleto , Calidad de Vida , Recuperación de la Función , Trastornos Neurológicos de la Marcha/etiología , Trastornos Neurológicos de la Marcha/rehabilitación , Trastornos Neurológicos de la Marcha/fisiopatología , Fenómenos Biomecánicos , Actividades Cotidianas , Análisis Costo-Beneficio , Femenino , Adulto , Masculino , Diseño de Equipo , Costos de la Atención en Salud , Persona de Mediana EdadRESUMEN
INTRODUCTION: Spinal cord lesions (SCL) are usually followed by neurological and functional improvement. The neurological improvement is natural and improves the functional potential of the patients, while rehabilitation improves the realization of that potential. The functional change depends on the neurological change, and usually does not represent the contribution of rehabilitation alone to the functional improvement. AIMS: To evaluate the net contribution of inpatient rehabilitation in Israel to functioning after SCL, and the ability to predict this contribution, which reflects the success of rehabilitation. METHODS: Demographic and clinical data of SCL patients admitted to rehabilitation between 2011 and 2020 were collected retrospectively. The data were used to calculate Spinal Cord Injury Ability Realization Measurement Index (SCI-ARMI) scores, isolating the effect of neurologic status on functioning, its change during rehabilitation, and factors affecting it. Data were analyzed using t-tests, Pearson correlations, ANOVA, and ANCOVA. RESULTS: A total of 1,433 patients were included in the study. Their age was 54±17 years, 32% were females, and 37.2% had traumatic injuries. American Spinal Injury Association Impairment Scale (AIS) grades were A in 11% of the patients, B in 4.8%, C in 17.3% and D in 65.9%. SCI-ARMI was 52±24 at admission to rehabilitation, and 73.5±19 at discharge (41% improvement, p<0.001). Likewise, the neurological motor status and function significantly improved. SCI-ARMI improvement increased with lower admission SCI-ARMI values (r=-0.654, p<0.001) and younger age (r=-0.122, p<0.001), and correlated with longer stay in rehabilitation (r=0.261, p<0.001). CONCLUSIONS: Inpatient rehabilitation in Israel made a substantial contribution to functional improvement. Lower realization of the functional potential at admission to rehabilitation predicted greater success in the process of SCL rehabilitation.
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Actividades Cotidianas , Pacientes Internos , Recuperación de la Función , Traumatismos de la Médula Espinal , Humanos , Israel , Femenino , Traumatismos de la Médula Espinal/rehabilitación , Traumatismos de la Médula Espinal/fisiopatología , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Adulto , Pacientes Internos/estadística & datos numéricos , Anciano , Resultado del TratamientoRESUMEN
BACKGROUND: Individuals with spinal cord injury (SCI) often suffer from neuropathic pain which is often disabling and negatively affects function, participation, and quality of life (QoL). Pharmacological treatments lack efficacy in neuropathic pain reduction hence studying alternatives to drug treatment is necessary. Preclinical evidence of various aerobic exercises has shown positive effects on neuropathic pain but scientific studies investigating its effect in the SCI human population are limited. METHODOLOGY: This study is a double-blind, parallel, two-group, randomized controlled trial with an interventional study design that aims to evaluate the effectiveness of aerobic exercise program on neuropathic pain and quality of life (QoL) in individuals with chronic paraplegia. Thirty individuals with chronic paraplegia with the neurological level of injury from T2 to L2 will be recruited from the rehabilitation department at a super specialty hospital based on the inclusion criteria. Using a 1:1 allocation ratio, the participants will be randomly assigned to one of the two groups. The intervention group will perform high-intensity interval training (HIIT) aerobic exercise using an arm ergometer based on their peak heart rate, and the control group will perform free-hand arm aerobic exercise. In both groups, the intervention will be delivered as 30-min sessions, four times a week for 6 weeks. OUTCOME MEASURES: International Spinal Cord Injury Pain Basic Data Set Version 3.0 will be used for diagnosing and assessing neuropathic pain and its interference with day-to-day activities, mood, and sleep. The International Spinal Cord Society (ISCoS) QoL basic data set will be used to assess QoL, and 6-min push test distance will be used to assess peak heart rate and aerobic capacity. DISCUSSION: The effectiveness of the aerobic exercise program will be assessed based on the changes in neuropathic pain score and its interference with day-to-day activities, mood, sleep, QoL, and aerobic capacity after 3 weeks mid-intervention and after 6 weeks post-intervention. The trial will provide new knowledge about the effectiveness of the aerobic exercise program in improving neuropathic pain and QoL in individuals with chronic paraplegia. TRIAL REGISTRATION: Clinical Trials Registry-India CTRI/2023/08/056257. Registered on 8 August 2023.
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Terapia por Ejercicio , Neuralgia , Paraplejía , Calidad de Vida , Ensayos Clínicos Controlados Aleatorios como Asunto , Traumatismos de la Médula Espinal , Humanos , Neuralgia/terapia , Neuralgia/fisiopatología , Neuralgia/psicología , Paraplejía/rehabilitación , Paraplejía/fisiopatología , Paraplejía/psicología , Método Doble Ciego , Terapia por Ejercicio/métodos , Traumatismos de la Médula Espinal/complicaciones , Traumatismos de la Médula Espinal/rehabilitación , Traumatismos de la Médula Espinal/fisiopatología , Traumatismos de la Médula Espinal/psicología , Adulto , Persona de Mediana Edad , Resultado del Tratamiento , Masculino , Femenino , Ejercicio Físico , Dimensión del Dolor , Factores de Tiempo , Adulto JovenRESUMEN
BACKGROUND: Reaching and grasping (R&G) in rats is commonly used as an outcome measure to investigate the effectiveness of rehabilitation or treatment strategies to recover forelimb function post spinal cord injury. Kinematic analysis has been limited to the wrist and digit movements. Kinematic profiles of the more proximal body segments that play an equally crucial role in successfully executing the task remain unexplored. Additionally, understanding of different forelimb muscle activity, their interactions, and their correlation with the kinematics of R&G movement is scarce. NEW METHOD: In this work, novel methodologies to comprehensively assess and quantify the 3D kinematics of the proximal and distal forelimb joints along with associated muscle activity during R&G movements in adult rats are developed and discussed. RESULTS: Our data show that different phases of R&G identified using the novel kinematic and EMG-based approach correlate with the well-established descriptors of R&G stages derived from the Whishaw scoring system. Additionally, the developed methodology allows describing the temporal activity of individual muscles and associated mechanical and physiological properties during different phases of the motor task. COMPARISON WITH EXISTING METHOD(S): R&G phases and their sub-components are identified and quantified using the developed kinematic and EMG-based approach. Importantly, the identified R&G phases closely match the well-established qualitative descriptors of the R&G task proposed by Whishaw and colleagues. CONCLUSIONS: The present work provides an in-depth objective analysis of kinematics and EMG activity of R&G behavior, paving the way to a standardized approach to assessing this critical rodent motor function in future studies.
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Electromiografía , Miembro Anterior , Fuerza de la Mano , Músculo Esquelético , Animales , Fenómenos Biomecánicos/fisiología , Miembro Anterior/fisiología , Electromiografía/métodos , Músculo Esquelético/fisiología , Fuerza de la Mano/fisiología , Ratas , Traumatismos de la Médula Espinal/fisiopatología , Femenino , Destreza Motora/fisiología , Masculino , Ratas Sprague-Dawley , Conducta Animal/fisiología , Movimiento/fisiologíaRESUMEN
This retrospective study analyzed prognostic factors for neurological improvement and ambulation in 194 adult patients (≥ 15 years) with traumatic cervical spinal cord injuries treated at the neurological SCI unit (SCIU) at the Karolinska University Hospital Stockholm, Sweden, between 2010 and 2020. The primary outcome was American spinal injury association impairment scale (AIS) improvement, with secondary focus on ambulation restoration. Results showed 41% experienced AIS improvement, with 51% regaining ambulation over a median follow-up of 3.7 years. Significant AIS improvement (p < 0.001) and reduced bladder/bowel dysfunction (p < 0.001) were noted. Multivariable analysis identified initial AIS C-D (< 0.001), central cord syndrome (p = 0.016), and C0-C3 injury (p = 0.017) as positive AIS improvement predictors, while lower extremity motor score (LEMS) (p < 0.001) and longer ICU stays (p < 0.001) were negative predictors. Patients with initial AIS C-D (p < 0.001) and higher LEMS (p < 0.001) were more likely to regain ambulation. Finally, older age was a negative prognostic factor (p = 0.003). In conclusion, initial injury severity significantly predicted neurological improvement and ambulation. Recovery was observed even in severe cases, emphasizing the importance of tailored rehabilitation for improved outcomes.
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Médula Cervical , Recuperación de la Función , Traumatismos de la Médula Espinal , Humanos , Traumatismos de la Médula Espinal/rehabilitación , Traumatismos de la Médula Espinal/fisiopatología , Femenino , Masculino , Persona de Mediana Edad , Adulto , Estudios Retrospectivos , Anciano , Médula Cervical/lesiones , Pronóstico , Caminata , Adulto Joven , Adolescente , Resultado del Tratamiento , Suecia/epidemiología , Vértebras Cervicales/lesiones , Vértebras Cervicales/fisiopatología , Anciano de 80 o más AñosRESUMEN
The mechanisms of secondary injury following spinal cord injury are complicated. The role of ferroptosis, which is a newly discovered form of regulated cell death in the neurovascular unit(NVU), is increasingly important. Ferroptosis inhibitors have been shown to improve neurovascular homeostasis and attenuate secondary spinal cord injury(SCI). This review focuses on the mechanisms of ferroptosis in NVU cells and NVU-targeted therapeutic strategies according to the stages of SCI, and analyzes possible future research directions.
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Ferroptosis , Traumatismos de la Médula Espinal , Traumatismos de la Médula Espinal/patología , Traumatismos de la Médula Espinal/fisiopatología , Ferroptosis/fisiología , Ferroptosis/efectos de los fármacos , Humanos , AnimalesRESUMEN
Traumatic spinal cord injury (SCI) is a devastating condition that impacts over 300,000 individuals in the US alone. Depending on the severity of the injury, SCI can lead to varying degrees of sensorimotor deficits and paralysis. Despite advances in our understanding of the underlying pathological mechanisms of SCI and the identification of promising molecular targets for repair and functional restoration, few therapies have made it into clinical use. To improve the success rate of clinical translation, more robust, sensitive, and reproducible means of functional assessment are required. The gold standards for the evaluation of locomotion in rodents with SCI are the Basso Beattie Bresnahan (BBB) scale and Basso Mouse Scale (BMS). To overcome the shortcomings of current methods, we developed two separate markerless kinematic analysis paradigms in mice, MotorBox and MotoRater, based on deep-learning algorithms generated with the DeepLabCut open-source toolbox. The MotorBox system uses an originally designed, custom-made chamber, and the MotoRater system was implemented on a commercially available MotoRater device. We validated the MotorBox and MotoRater systems by comparing them with the traditional BMS test and extracted metrics of movement and gait that can provide an accurate and sensitive representation of mouse locomotor function post-injury, while eliminating investigator bias and variability. The integration of MotorBox and/or MotoRater assessments with BMS scoring will provide a much wider range of information on specific aspects of locomotion, ensuring the accuracy, rigor, and reproducibility of behavioral outcomes after SCI.
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Aprendizaje Profundo , Ratones Endogámicos C57BL , Traumatismos de la Médula Espinal , Animales , Ratones , Fenómenos Biomecánicos/fisiología , Traumatismos de la Médula Espinal/fisiopatología , Femenino , Locomoción/fisiologíaRESUMEN
BACKGROUND: Spinal cord injury without radiographic abnormality (SCIWORA) is defined as having clinical symptoms of traumatic myelopathy with no radiographic or computed tomographic features of spinal fracture or instability. An abnormal finding, such as a fracture, subluxation, or abnormal intersegmental motion at the level of the spinal cord injury, excludes SCIWORA as the diagnosis. Prevalence of SCIWORA is highest among children younger than 8 years, and is a diagnosis seen primarily in children, owing to anatomic differences that put children at more risk of this condition. In more recent years, with the increasing use of magnetic resonance imaging in patients with suspected spinal cord injury, a new term, spinal cord injury without neuroimaging abnormality (SCIWONA) has been suggested as a more specific way to describe cases of SCIWORA that have negative neuroimaging. CASE REPORT: Here we describe a case of a woman who presented with symptoms consistent with a spinal cord injury after a traumatic fall. Her presentation and imaging were consistent with SCIWONA. The patient subsequently had rapid and complete recovery of her neurologic function. Why Should an Emergency Physician Be Aware of This? Early recognition of SCIWONA and subsequent medical management is imperative for improved outcomes for these patients. Operative treatment is rare and typically only necessary in patients with consistent spinal cord instability.
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Accidentes por Caídas , Imagen por Resonancia Magnética , Neuroimagen , Traumatismos de la Médula Espinal , Humanos , Traumatismos de la Médula Espinal/complicaciones , Traumatismos de la Médula Espinal/fisiopatología , Femenino , Imagen por Resonancia Magnética/métodos , Neuroimagen/métodos , Tomografía Computarizada por Rayos X/métodos , AdultoRESUMEN
Traumatic spinal cord injury is a major cause of disability for which there are currently no fully effective treatments. Recent studies using epidural electrical stimulation have shown significant advances in motor rehabilitation, even when applied during chronic phases of the disease. The present study aimed to investigate the effectiveness of epidural electric stimulation in the motor recovery of rats with spinal cord injury. Furthermore, we aimed to elucidate the neurophysiological mechanisms underlying motor recovery. First, we improved upon the impact spinal cord injury model to cause severe and permanent motor deficits lasting up to 2 months. Next, we developed and tested an implantable epidural spinal cord stimulator device for rats containing an electrode and an implantable generator. Finally, we evaluated the efficacy of epidural electrical stimulation on motor recovery after spinal cord injury in Wistar rats. A total of 60 animals were divided into the following groups: (i) severe injury with epidural electrical stimulation (injury + stim, n = 15), (ii) severe injury without stimulation (group injury, n = 15), (iii) sham implantation without battery (sham, n = 15), and (iv) a control group, without surgical intervention (control, n = 15). All animals underwent weekly evaluations using the Basso, Beattie, Bresnahan (BBB) locomotor rating scale index, inclined plane, and OpenField test starting one week before the lesion and continuing for eight weeks. After this period, the animals were sacrificed and their spinal cords were explanted and prepared for histological analysis (hematoxylin-eosin) and immunohistochemistry for NeuN, ß-III-tubulin, synaptophysin, and Caspase 3. Finally, NeuN-positive neuronal nuclei were quantified through stereology; fluorescence signal intensities for ß-tubulin, synaptophyin, and Caspase 3 were quantified using an epifluorescence microscope. The injury + stim group showed significant improvement on the BBB scale compared with the injured group after the 5th week (p < 0.05). Stereological analysis showed a significantly higher average count of neural cells in the injury + stim group in relation to the injury group (1783 ± 2 vs. 897 ± 3, p < 0.001). Additionally, fluorescence signal intensity for synaptophysin was significantly higher in the injury + stim group in relation to the injury group (1294 ± 46 vs. 1198 ± 23, p < 0.01); no statistically significant difference was found in ß-III-tubulin signal intensity. Finally, Caspase 3 signal intensity was significantly lower in the stim group (727 ± 123) compared with the injury group (1225 ± 87 p < 0.05), approaching levels observed in the sham and control groups. Our data suggest a regenerative and protective effect of epidural electrical stimulation in rats subjected to impact-induced traumatic spinal cord injury.
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Modelos Animales de Enfermedad , Plasticidad Neuronal , Ratas Wistar , Traumatismos de la Médula Espinal , Animales , Traumatismos de la Médula Espinal/terapia , Traumatismos de la Médula Espinal/fisiopatología , Traumatismos de la Médula Espinal/patología , Ratas , Recuperación de la Función , Terapia por Estimulación Eléctrica/métodos , Sinaptofisina/metabolismo , Tubulina (Proteína)/metabolismo , Espacio Epidural/patología , Médula Espinal/metabolismo , Médula Espinal/patología , Médula Espinal/fisiopatología , Masculino , Caspasa 3/metabolismo , Regeneración Nerviosa , Femenino , Proteínas del Tejido Nervioso , Antígenos NuclearesRESUMEN
The increased risk of cardiovascular disease in people with spinal cord injuries motivates work to identify exercise options that improve health outcomes without causing risk of musculoskeletal injury. Handcycling is an exercise mode that may be beneficial for wheelchair users, but further work is needed to establish appropriate guidelines and requires assessment of the external loads. The goal of this research was to predict the six-degree-of-freedom external loads during handcycling from data similar to those which can be measured from inertial measurement units (segment accelerations and velocities) using machine learning. Five neural network models and two ensemble models were compared against a statistical model. A temporal convolutional network (TCN) yielded the best predictions. Predictions of forces and moments in-plane with the crank were the most accurate (r = 0.95-0.97). The TCN model could predict external loads during activities of different intensities, making it viable for different exercise protocols. The ability to predict the loads associated with forward propulsion using wearable-type data enables the development of informed exercise guidelines.
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Aprendizaje Automático , Humanos , Fenómenos Biomecánicos/fisiología , Redes Neurales de la Computación , Masculino , Traumatismos de la Médula Espinal/fisiopatología , Adulto , Silla de Ruedas , Dispositivos Electrónicos Vestibles , Ciclismo/fisiología , FemeninoRESUMEN
Spinal cord injuries cause irreversible loss of sensory and motor functions. In mammals, intrinsic and extrinsic inhibitions of neuronal regeneration obstruct neural repair after spinal cord injury. Although astrocytes have been involved in a growing list of vital homeostatic functions in the nervous system, their roles after injury have fascinated and puzzled scientists for decades. Astrocytes undergo long-lasting morphological and functional changes after injury, referred to as reactive astrogliosis. Although reactive astrogliosis is required to contain spinal cord lesions and restore the blood-spinal cord barrier, reactive astrocytes have detrimental effects that inhibit neuronal repair and remyelination. Intriguingly, elevated regenerative capacity is preserved in some non-mammalian vertebrates, where astrocyte-like glial cells display exclusively pro-regenerative effects after injury. A detailed molecular and phenotypic catalog of the continuum of astrocyte reactivity states is an essential first step toward the development of glial cell manipulations for spinal cord repair.
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Astrocitos , Neuronas , Traumatismos de la Médula Espinal , Traumatismos de la Médula Espinal/metabolismo , Traumatismos de la Médula Espinal/fisiopatología , Traumatismos de la Médula Espinal/patología , Astrocitos/metabolismo , Animales , Humanos , Neuronas/metabolismo , Gliosis/metabolismo , Gliosis/patología , Regeneración Nerviosa/fisiología , Médula Espinal/metabolismo , Comunicación Celular/fisiologíaRESUMEN
Following spinal cord injury (SCI), the regenerative capacity of the central nervous system (CNS) is severely limited by the failure of axonal regeneration. The regeneration of CNS axons has been shown to occur by grafting predegenerated peripheral nerves (PPNs) and to be promoted by the transplantation of neural precursor cells (NPCs). The introduction of a combinatorial treatment of PPNs and NPCs after SCI has to address the additional problem of glial scar formation, which prevents regenerating axons from leaving the implant and making functional connections. Previously, we discovered that the synthetic sulfoglycolipid Tol-51 inhibits astrogliosis. The objective was to evaluate axonal regeneration and locomotor function improvement after SCI in rats treated with a combination of PPN, NPC, and Tol-51. One month after SCI, the scar tissue was removed and replaced with segments of PPN or PPN+Tol-51; PPN+NPC+Tol-51. The transplantation of a PPN segment favors regenerative axonal growth; in combination with Tol-51 and NPC, 30% of the labeled descending corticospinal axons were able to grow through the PPN and penetrate the caudal spinal cord. The animals treated with PPN showed significantly better motor function. Our data demonstrate that PPN implants plus NPC and Tol-51 allow successful axonal regeneration in the CNS.
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Regeneración Nerviosa , Células-Madre Neurales , Nervios Periféricos , Traumatismos de la Médula Espinal , Animales , Traumatismos de la Médula Espinal/fisiopatología , Traumatismos de la Médula Espinal/terapia , Traumatismos de la Médula Espinal/patología , Ratas , Regeneración Nerviosa/efectos de los fármacos , Células-Madre Neurales/efectos de los fármacos , Células-Madre Neurales/trasplante , Células-Madre Neurales/citología , Nervios Periféricos/efectos de los fármacos , Nervios Periféricos/patología , Femenino , Axones/efectos de los fármacos , Glucolípidos/farmacología , Recuperación de la Función/efectos de los fármacosRESUMEN
AIMS: To compare the changes in brain network topological properties and structure-function coupling in patients with complete spinal cord injury (CSCI) and incomplete spinal cord injury (ICSCI), to unveil the potential neurobiological mechanisms underlying the different effects of CSCI and ICSCI on brain networks and identify objective neurobiological markers to differentiate between CSCI and ICSCI patients. METHODS: Thirty-five SCI patients (20 CSCI and 15 ICSCI) and 32 healthy controls (HCs) were included in the study. Here, networks were constructed using resting-state functional magnetic resonance imaging to analyze functional connectivity (FC) and diffusion tensor imaging for structural connectivity (SC). Then, graph theory analysis was used to examine SC and FC networks, as well as to estimate SC-FC coupling values. RESULTS: Compared with HCs, CSCI patients showed increased path length (Lp), decreased global efficiency (Eg), and local efficiency (Eloc) in SC. For FC, ICSCI patients exhibited increased small-worldness, clustering coefficient (Cp), normalized clustering coefficient, and Eloc. Also, ICSCI patients showed increased Cp and Eloc than CSCI patients. Additionally, ICSCI patients had reduced SC-FC coupling values compared to HCs. Moreover, in CSCI patients, the SC network's Lp and Eg values were significantly correlated with motor scores, while in ICSCI patients, the FC network's Cp, Eloc, and SC-FC coupling values were related to sensory/motor scores. CONCLUSIONS: These results suggest that CSCI patients are characterized by decreased efficiency in the SC network, while ICSCI patients are distinguished by increased local connections and SC-FC decoupling. Moreover, the differences in network metrics between CSCI and ICSCI patients could serve as objective biological markers, providing a basis for diagnosis and treatment strategies.
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Encéfalo , Imagen de Difusión Tensora , Imagen por Resonancia Magnética , Red Nerviosa , Traumatismos de la Médula Espinal , Humanos , Traumatismos de la Médula Espinal/diagnóstico por imagen , Traumatismos de la Médula Espinal/fisiopatología , Masculino , Femenino , Adulto , Imagen por Resonancia Magnética/métodos , Persona de Mediana Edad , Red Nerviosa/diagnóstico por imagen , Red Nerviosa/fisiopatología , Encéfalo/diagnóstico por imagen , Encéfalo/fisiopatología , Adulto JovenRESUMEN
BACKGROUND: Among ambulatory people with incomplete spinal cord injury (iSCI), balance deficits are a primary factor limiting participation in walking activities. There is broad recognition that effective interventions are needed to enhance walking balance following iSCI. Interventions that amplify self-generated movements (e.g., error augmentation) can accelerate motor learning by intensifying sensorimotor feedback and facilitating exploration of motor control strategies. These features may be beneficial for retraining walking balance after iSCI. We have developed a cable-driven robot that creates a movement amplification environment during treadmill walking. The robot applies a continuous, laterally-directed, force to the pelvis that is proportional in magnitude to real-time lateral velocity. Our purpose is to investigate the effects of locomotor training in this movement amplification environment on walking balance. We hypothesize that for ambulatory people with iSCI, locomotor training in a movement amplification environment will be more effective for improving walking balance and participation in walking activities than locomotor training in a natural environment (no applied external forces). METHODS: We are conducting a two-arm parallel-assignment intervention. We will enroll 36 ambulatory participants with chronic iSCI. Participants will be randomized into either a control or experimental group. Each group will receive 20 locomotor training sessions. Training will be performed in either a traditional treadmill environment (control) or in a movement amplification environment (experimental). We will assess changes using measures that span the International Classification of Functioning, Disability and Health (ICF) framework including 1) clinical outcome measures of gait, balance, and quality of life, 2) biomechanical assessments of walking balance, and 3) participation in walking activities quantified by number of steps taken per day. DISCUSSION: Training walking balance in people with iSCI by amplifying the individual's own movement during walking is a radical departure from current practice and may result in new strategies for addressing balance impairments. Knowledge gained from this study will expand our understanding of how people with iSCI improve walking balance and how an intervention targeting walking balance affects participation in walking activities. Successful outcomes could motivate development of clinically feasible tools to replicate the movement amplification environment within clinical settings. TRIAL REGISTRATION: NCT04340063.
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Marcha , Traumatismos de la Médula Espinal , Traumatismos de la Médula Espinal/rehabilitación , Traumatismos de la Médula Espinal/fisiopatología , Humanos , Marcha/fisiología , Adulto , Terapia por Ejercicio/métodos , Equilibrio Postural/fisiología , Caminata/fisiología , Masculino , Femenino , Robótica/métodos , Método Simple Ciego , Persona de Mediana Edad , Locomoción/fisiologíaRESUMEN
Background: Guidelines fail to recommend objective measures to assist with treatment of neurogenic bowel dysfunction (NBD) in spinal cord injury (SCI). Objectives: The main objective was to review the literature to identify the objective measures used in all NBD populations and to present their results and any correlations performed to validated subjective measures. Methods: A systematic review of the literature was performed in accordance with PRISMA (2020) guidelines, including all records from January 2012 to May 2023 with MeSH terms like "neurogenic bowel" indexed in the following databases: PubMed, EMBASE, CINAHL, Cochrane Central Trials Register, and ClinicalTrials.gov. Abstracts were excluded if they did not include objective measures or if they only mentioned the esophagus, stomach, and/or small bowel. Records were screened independently by at least two collaborators, and differences were resolved by unanimous agreement. Results: There were 1290 records identified pertaining to NBD. After duplicates were removed, the remaining records were screened for a total of 49 records. Forty-one records (82%) included subjective measures. Two-thirds of the articles involved the population with SCI/disease (n = 552) and one-third were non-SCI NBD (n = 476). Objective measures were categorized as (1) transit time, (2) anorectal physiology testing, and (3) miscellaneous. Of the 38 articles presenting results, only 16 (42%) performed correlations of objective measures to subjective measures. Conclusion: There is an abundance of literature supporting the use of objective outcome measures for NBD in SCI. Strong correlations of subjective measures to objective outcome measures were generally lacking, supporting the need to use both measures to help with NBD management.
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Intestino Neurogénico , Traumatismos de la Médula Espinal , Humanos , Intestino Neurogénico/terapia , Intestino Neurogénico/fisiopatología , Intestino Neurogénico/etiología , Traumatismos de la Médula Espinal/complicaciones , Traumatismos de la Médula Espinal/fisiopatologíaRESUMEN
Spinal cord injury (SCI) is damage or trauma to the spinal cord, which often results in loss of function, sensation, or mobility below the injury site. Transcranial direct current stimulation (tDCS) is a non-invasive and affordable brain stimulation technique used to modulate neuronal circuits, which changes the morphology and activity of microglia in the cerebral cortex. However, whether similar morphological changes can be observed in the spinal cord remains unclear. Therefore, we evaluated neuronal population activity in layer 5 (L5) of M1 following SCI and investigated whether changes in the activities of L5 neurons affect microglia-axon interactions using C57BL/6J mice. We discovered that L5 of the primary motor cortex (corticospinal neurons) exhibited reduced synchronized activity after SCI that correlates with microglial morphology, which was recovered using tDCS. This indicates that tDCS promotes changes in the morphological properties and recovery of microglia after SCI. Combining immunotherapy with tDCS may be effective in treating SCI.
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Ratones Endogámicos C57BL , Microglía , Corteza Motora , Recuperación de la Función , Traumatismos de la Médula Espinal , Estimulación Transcraneal de Corriente Directa , Traumatismos de la Médula Espinal/terapia , Traumatismos de la Médula Espinal/fisiopatología , Animales , Microglía/metabolismo , Estimulación Transcraneal de Corriente Directa/métodos , Ratones , Corteza Motora/fisiopatología , Modelos Animales de Enfermedad , Masculino , Médula Espinal/fisiopatología , Médula Espinal/patología , FemeninoRESUMEN
INTRODUCTION: Spinal cord injury (SCI) causes damage to neurons and results in motor and sensory dysfunction. Intermittent theta burst stimulation (iTBS) has been used to induce neuronal and synaptic plasticity by applying a magnetic field in the brain. The plasticity induced in the cortex has an imperative role in the recovery of motor and sensory functioning. However, the effect of iTBS in complete SCI patients is still elusive. CASE PRESENTATION: We report here the case of a 27-year-old female who sustained an L1 complete spinal cord injury (SCI) with an ASIA score of A. The patient lost all the sensory and motor functions below the level of injury. Intermittent theta burst stimulation (iTBS) was administered at 80% of the resting motor threshold over the M1 motor cortex, along with intensive rehabilitation training to promote sensorimotor function. DISCUSSION: There was a partial recovery in functional, electrophysiological, and neurological parameters. The case report also demonstrates the safety and efficacy of iTBS in complete SCI patients. No adverse event has been observed in the patient during intervention sessions.
Asunto(s)
Traumatismos de la Médula Espinal , Estimulación Magnética Transcraneal , Humanos , Traumatismos de la Médula Espinal/rehabilitación , Traumatismos de la Médula Espinal/complicaciones , Traumatismos de la Médula Espinal/terapia , Traumatismos de la Médula Espinal/fisiopatología , Femenino , Adulto , Estimulación Magnética Transcraneal/métodos , Recuperación de la Función/fisiología , Corteza Motora , Ritmo Teta/fisiologíaRESUMEN
Spinal cord injury (SCI) is one of the most serious health problems, with no effective therapy. Recent studies indicate that Fisetin, a natural polyphenolic flavonoid, exhibits multiple functions, such as life-prolonging, antioxidant, antitumor, and neuroprotection. However, the restorative effects of Fisetin on SCI and the underlying mechanism are still unclear. In the present study, we found that Fisetin reduced LPS-induced apoptosis and oxidative damage in PC12 cells and reversed LPS-induced M1 polarization in BV2 cells. Additionally, Fisetin safely and effectively promoted the motor function recovery of SCI mice by attenuating neurological damage and promoting neurogenesis at the lesion. Moreover, Fisetin administration inhibited glial scar formation, modulated microglia/macrophage polarization, and reduced neuroinflammation. Network pharmacology, RNA-seq, and molecular biology revealed that Fisetin inhibited the activation of the JAK2/STAT3 signaling pathway. Notably, Colivelin TFA, an activator of JAK2/STAT3 signaling, attenuated Fis-mediated neuroinflammation inhibition and therapeutic effects on SCI mice. Collectively, Fisetin promotes functional recovery after SCI by inhibiting microglia/macrophage M1 polarization and the JAK2/STAT3 signaling pathway. Thus, Fisetin may be a promising therapeutic drug for the treatment of SCI.
Asunto(s)
Flavonoles , Janus Quinasa 2 , Macrófagos , Microglía , Factor de Transcripción STAT3 , Transducción de Señal , Traumatismos de la Médula Espinal , Animales , Humanos , Masculino , Ratones , Ratas , Polaridad Celular/efectos de los fármacos , Flavonoides/farmacología , Flavonoides/administración & dosificación , Flavonoles/farmacología , Janus Quinasa 2/metabolismo , Janus Quinasa 2/genética , Macrófagos/efectos de los fármacos , Macrófagos/inmunología , Macrófagos/metabolismo , Ratones Endogámicos C57BL , Microglía/efectos de los fármacos , Microglía/metabolismo , Microglía/inmunología , Células PC12 , Recuperación de la Función/efectos de los fármacos , Transducción de Señal/efectos de los fármacos , Traumatismos de la Médula Espinal/tratamiento farmacológico , Traumatismos de la Médula Espinal/metabolismo , Traumatismos de la Médula Espinal/genética , Traumatismos de la Médula Espinal/fisiopatología , Traumatismos de la Médula Espinal/inmunología , Factor de Transcripción STAT3/metabolismo , Factor de Transcripción STAT3/genéticaRESUMEN
Hand function assessments in a clinical setting are critical for upper limb rehabilitation after spinal cord injury (SCI) but may not accurately reflect performance in an individual's home environment. When paired with computer vision models, egocentric videos from wearable cameras provide an opportunity for remote hand function assessment during real activities of daily living (ADLs). This study demonstrates the use of computer vision models to predict clinical hand function assessment scores from egocentric video. SlowFast, MViT, and MaskFeat models were trained and validated on a custom SCI dataset, which contained a variety of ADLs carried out in a simulated home environment. The dataset was annotated with clinical hand function assessment scores using an adapted scale applicable to a wide range of object interactions. An accuracy of 0.551±0.139, mean absolute error (MAE) of 0.517±0.184, and F1 score of 0.547±0.151 was achieved on the 5-class classification task. An accuracy of 0.724±0.135, MAE of 0.290±0.140, and F1 score of 0.733±0.144 was achieved on a consolidated 3-class classification task. This novel approach, for the first time, demonstrates the prediction of hand function assessment scores from egocentric video after SCI.
Asunto(s)
Actividades Cotidianas , Mano , Traumatismos de la Médula Espinal , Grabación en Video , Traumatismos de la Médula Espinal/rehabilitación , Traumatismos de la Médula Espinal/fisiopatología , Humanos , Mano/fisiopatología , Masculino , Femenino , Adulto , Reproducibilidad de los Resultados , Persona de Mediana Edad , Algoritmos , Adulto Joven , Fuerza de la Mano/fisiología , Dispositivos Electrónicos VestiblesRESUMEN
Spinal cord injury (SCI) presents a critical medical challenge, marked by substantial neural damage and persistent functional deficits. This study investigates the therapeutic potential of cold atmospheric plasma (CAP) for SCI, utilizing a tailored dielectric barrier discharge (DBD) device to conduct comprehensive in vivo and in vitro analyses. The findings show that CAP treatment significantly improves functional recovery after SCI, reduces neuronal apoptosis, lowers inflammation, and increases axonal regeneration. These findings illustrate the efficacy of CAP in fostering a conducive environment for recovery by modulating inflammatory responses, enhancing neuronal survival, and encouraging regenerative processes. The underlying mechanism involves CAP's reactive oxygen species (ROS) reduction, followed by activating antioxidant enzymes. These findings position CAP as a pioneering approach for spinal cord injury (SCI) treatment, presenting opportunities for improved neural recovery and establishing a new paradigm in SCI therapy.