Rehabilitation of traumatic and non-traumatic spinal cord injuries (SCI)

Kennedy P et al. working at the National Spinal Injuries Centre, Stoke Mandeville Hospital, UK discuss whether patients with traumatic spinal cord injuries and patients with non-traumatic spinal cord injuries benefitted from the same rehabilitation programme. The research published in Spinal Cord, 05/07/2013 found that the two groups has the same rehabilitation outcome. The Needs Assessment Checklist (NAC) was used as the outcome measure. The group concluded that it is effective to admit and rehabilitate patients with injuries resulting from both traumatic and non-traumatic aetiologies in the same specialised in patient and out patient rehabilitation setting.

 

Spinal cord injury and intensive locomotor training

Evidence of improvements following a less-intensive locomotor training programme in an outpatient setting in Spinal Cord, 04/30/2013. The outcome measures looked at were Lower Extremity Motor Score (LEMS), Walking Index for Spinal Cord Injury (WISCI II), 6-min walk test (6MWT), 10-m walk test (10MWT), Timed Up and Go (TUG), and the PedsQL - Quality of Life Inventory – health-related quality of life (HRQOL). The pediatric patient was an incomplete spinal injury at T6, classified as American Spinal Injury Association (ASIA) level C. The less-intensive locomotor training programme in an outpatient setting two weekly sessions of locomotor training for a period of 6 weeks. The report was written by O’Donnell CM et al from Victorian Paediatric Rehabilitation Service, Royal Children’s Hospital, Melbourne, Victoria, Australia.

Factors associated with employment in Spinal Cord Injury (SCI)

Participation in organized sports is positively associated with employment in adults with Spinal Cord Injury (SCI). This conclusion was reached by Blauwet C et al. and published in the American Journal of Physical Medicine & Rehabilitation, 04/22/2013. The researchers are from the Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston and Spaulding-Harvard Model System, Spaulding Rehabilitation Hospital, Boston, Massachusetts USA. Alternatively, sex, duration of injury, wheelchair use, and participation in individually planned exercise were not significantly associated with employment.

 

Assisted active exercise practice and the HandTutor and ArmTutor

Occupational an physical therapists are using the MediTouch system in combination with active assistance. People with arm weakness can exercise their arms without assistance, but if their arms and hand movement ability is severely impaired, such exercise is difficult and compliance with exercise programs is low. Using the HandTutor and the ArmTutor the occupational therapist and the physical therapist can give the patient “assistance-as needed” to perform the required customized arm or finger a wrist exercise task. This clinical technique is known as active assisted exercise. During active assistance practice the patient actively contributes to the movement, this active exercise contribution is an essential feature of motor sensory and cognitive recovery and allows motor learning and plasticity. This means that the the HandTutor and ArmTutor can be used by patients with very little Active Range of Motion (AROM) as well as by patients with little ROM deficit.

Active assistance therefore allows OT and PT to use the MediTouch and provide their patients with severe deficits in AROM a customized exercise that gives immediate movement feedback and the enjoyment and motivation of video game based rehabilitation.

The MediTouch benefits patients with movement dysfunction or impaired functional activity caused by neurological disorders, including traumatic brain injury (tbi), stroke, cerebral palsy, spinal cord injury, and multiple sclerosis.

OT and PT therapeutic goals

The MediTouch system is a state of the art targeted rehabilitation system that hones in on specific therapeutic goals. Through the enjoyment and motivation of video game based rehabilitation which gives immediate feedback to the patient, the HandTutor, ArmTutor, LegTutor and 3DTutor address the challenge of impaired movement ability. The system is used in the clinic and at home and offers motivating customized exercise practice with OT and PT support.

The system benefits patients with movement dysfunction or impaired functional activity caused by neurological disorders, including traumatic brain injury (tbi), stroke, cerebral palsy, spinal cord injury, and multiple sclerosis. In addition the system is used for physical therapy after shoulder, elbow, hip and knee surgery.

Improving the walking function of community-based of incomplete spinal cord injury (SCI) patients

Community-based ambulation training for ambulatory patients with incomplete spinal cord injury (SCI) seen to remarkably improve both indoor and outdoor walking function of incomplete spinal cord injury patients. These results were reported in NeuroRehabilitation, 04/15/2013 by Oh DW et al from Department of Physical Therapy, College of Health Science, Cheongju University, Chungbuk, Republic of Korea. The walking training consisted on 1-hour sessions six times a week for a 4-week period.

Comparing the HandTutor to the Wii

The Wii is an example of a activity promoting video game (APVG). Practice with the Wii will increase recorded pulmonary ventilation (VE), oxygen consumption (VO2) and HR in normal uninjured subjects. Published in European Journal of Physical and Rehabilitation Medicine, 04/12/2013, Gaffurini P et al show that while practicing with the Wii Spinal cord injury (SCI) patients also saw an increase in energy expenditure (EE). The Physical and occupational therapists from the Laboratory of Neuromuscular Rehabilitation (LaRiN), University of Brescia, Italy conclude that APVG practice in subjects with SCI can be used to counteract deconditioning due to inactivity.

In contrast to exercise activity promoting video games, the HandTutor works with dedicated rehabilitation software that motivates the patient to do controlled finger exercise practice and improve their motor sensory and cognitive movement ability. This allows SCI patients to better do functional tasks. The MediTouch system  is a targeted rehabilitation systems that hones in on specific therapeutic goals. Through the enjoyment and motivation of game-based rehabilitation supported by the OT and PT the system addresses the challenge of impaired movement ability.

 

Torso stabilization and upper extremity function following Spinal Cord Injury

Following cervical spinal cord injury patients with partial spinal cord injury will benefit from exercises that result in the strengthening of the torso. Stability of the torso will positively impact spinal alignment, seated posture, pulmonary function, trunk stability, and functional reach. Outcome measures that can be assessed include spinal alignment and pelvic orientation, pulmonary function and ventilatory volumes, seated stability and resistance to externally applied disturbances, forward bimanual reaching distance.  Additionally maximal force and speed of rowing-like movements, roll in bed without assistance, the ability to independently return to an erect seated position following full forward or lateral flexion and  can be assessed.

 

Improving walking endurance, functionality and home/ community ambulation in SCI

Published in Archives of Physical Medicine and Rehabilitation, 03/20/2013 Dr. Kressler J et al discuss body weight supported training approaches in Incomplete Spinal Cord Injury (SCI). The group look at treadmill-based LT with manual assistance (TM), electrical stimulation (TS), and a driven gait orthosis (DGO) and overground LT with electrical stimulation (OG). The group draw conclusions as to which approach better enhances endurance, functionality and home/community ambulation.

Motivation and participation in exercise practice improves rehabilitation outcome

Writing in Archives of Physical Medicine and Rehabilitation, 03/19/2013 Dr. Bolliger from Balgrist University Hospital Forchstrasse 340, 8008 Zurich discusses the importance of active participation of patients during robotic-assisted rehabilitation. The group looked at spinal cord injury patients (SCI).

The HandTutor, ArmTutor and LegTutor use augmented motion feedback so that the patients are encouraged to do repetitive customized active and assisted active exercises with instant feedback on their performance.