Journal of Spinal Cord Medicine最新文献

Objective: The Capabilities of Upper Extremity Test (CUE-T) is a tool that can assess upper limb function in more detail for cervical spinal cord injury (CSCI). This study aimed to determine the degree of difficulty of the CUE-T subtests.

Design: This was a cross-sectional study.

Setting: This study was conducted with participants from the Chiba Rehabilitation Center in Japan.

Participants: A total of 176 data sets were collected from 100 individuals with CSCI (mean age: 59.2 ± 13.8 years; men: 86, women: 14).

Interventions: We assessed the structural validity of the CUE-T for CSCI using Rasch analysis based on the Rasch Reporting Guidelines in Rehabilitation Research framework.

Outcome measures: CUE-T.

Results: The 17 items did not conform to the assumptions of Rasch analysis, such as unidimensionality and local dependence. Therefore, the Rasch analysis was reanalyzed using 10 items, excluding the seven items that were misfit by the item goodness of fit. The most difficult item was the Push Thumb, and the easiest item was Pull.

Conclusions: The CUE-T showed good structural validity for 10 items. Indicated the degree of difficulty was similar to the neurological perspective, therefore, it may reflect the clinical practice of upper limb function in CSCI. These results may be useful for setting the difficulty level for rehabilitation of upper limb function in CSCI and for developing better evaluation methods in the future.

Context: Orthostatic hypotension (OH) is a debilitating condition in spinal cord injury (SCI) patients, characterized by impaired autonomic regulation and significant drops in blood pressure (BP) upon upright positioning. Despite pharmacological and non-pharmacological interventions, OH often persists, limiting rehabilitation progression and daily functional activities. Transcutaneous spinal cord stimulation (tSCS), is a non-invasive modality that has shown promise in addressing cardiovascular dysregulation. However, clinical application of tSCS is often constrained by availability.

Findings: This case report describes a novel application of a commercially available neuromuscular electrical stimulation (NMES) device, adapted for transcutaneous spinal cord stimulation, in a 49-year-old male with C5 complete SCI and severe OH refractory to conventional treatments. The intervention demonstrated immediate stabilization of BP and symptom resolution during upright positioning, enabling significant functional gains, including improved sitting tolerance and enhanced quality of life.

Conclusion: These findings suggest that NMES can be a cost-effective and portable alternative to traditional tSCS, and may broaden therapeutic options for managing OH in SCI patients. Further research is warranted to validate these results and optimize its clinical application.

Objectives: In all patients, LFAS To explore the effect of low frequency antidromic stimulation (LFAS) of the pelvic somatic serves on intestinal peristalsis and heart rate in individuals with chronic spinal cord ird injury and spasticity.

Setting: Hospital in Zürich, Switzerland.

Methods: Ten consecutive patients underwent laparoscopic implantation of neuroprosthesis to sciatic/femoral nerves - the LION procedure: 5 patients with Thoracic (T) SCI AIS A, 1 patient T4 AIS C, 1 patient C3 AIS A, and 3 patients with cervical injury (AIS B/C). At the end of the implantation, intestinal peristalsis observed laparoscopically was recorded before and after starting with LFAS at 10 Hz. On the first postoperative day, heart rates before and after the beginning of the same LFAS were checked. Statistical analyses were performed using a paired Student's t-test.

Results: LFAS Of the pelvic somatic nerves induced strong peristalsis in the small bowel and ascending/transverse colon without affecting the urinary bladder or descending colon/rectum, and a significant slowing of the heart rate in 8 patients with an overall reduction from 96.3 bpm (bpm) (P < 0.01).

Conclusions: This case series study reports on the effect of continuous antidromic pelvic neuromodulation (CAPN) on extraspinal somatic and autonomic pathways in chronic SCI. The discussion poses a novel hypothesis about the effect of CAPN on spinal pathways and activation of corticospinal pathways and neuroplasticity via the Renshaw cells. A rationale is provided for CAPN-induced activation of the vagus nerve (VN) and the existence of anastomotic pathways between the lumbosacral somatic nerves and the VN, and the capability of an activation of the motor functions of the VN. A second hypothesis is posed for the activation of cortico-vagal plasticity that may improve recovery after complete SCI by combining CAPN with neuromodulation of the VN.Trial registration NCT03441256.

Context/objective: Spinal cord injury (SCI) is a severe condition characterized by neuronal apoptosis and inflammation, with limited therapeutic options. This study aimed to assess the effects of platelet-rich plasma (PRP)-derived exosomes (Exo), Cerebrolysin (CBL), and Cerebrolysin-loaded exosomes (CLE) on inflammation, apoptosis, tissue organization, and motor function recovery in a mouse model of compression SCI.

Design: An experimental study using a mouse model of SCI, investigating the effects of Exo, CBL, and CLE treatments.

Setting: Laboratory-based research in a controlled environment.

Participants: Sixty healthy adult female BALB/c mice, aged 8-10 weeks, weighing 24 ± 2 g were used. SCI was induced via compression to model SCI.

Interventions: Mice with induced SCI were treated with Exo, CBL, or CLE. Apoptosis was assessed by Bax and Bcl2 expression. Inflammatory markers TNF-α and IL-10 were measured. Histological analysis examined tissue organization, and motor function recovery was evaluated using the Basso-Beattie-Bresnahan (BBB) locomotor scale.

Outcome measures: The study measured Bax and Bcl2 expression, TNF-α and IL-10 levels, tissue organization, and motor function recovery.

Results: CLE treatment significantly modulated Bax and Bcl2 expression, reducing apoptosis and enhancing neuronal survival. TNF-α levels decreased, indicating reduced inflammation, while IL-10 levels increased, showing anti-inflammatory effects. Histological assessment revealed improved tissue organization, and motor function recovery was significantly enhanced as measured by BBB scores.

Conclusion: CLE showed neuroprotective and anti-inflammatory effects, reducing apoptosis and inflammation while promoting tissue repair and motor function recovery in SCI, making it a promising therapeutic candidate.

Study design: Case report.

Objectives: Pressure ulcers (PUs) affect many spinal cord-injured individuals and can result in serious life-threatening complications including infections and gangrene. Treatment is lengthy and extremely expensive due to recurrent and prolonged hospitalization and multiple surgeries. Consequently, for both medical and economic reasons, intensive efforts in prophylaxis and new effective therapeutic options are mandatory. This report presents the positive effects of pelvic nerve stimulation on the healing of gluteal and heel PUs.

Setting: Hospital in Zürich/CH.

Methods: Five patients with spinal cord injuries with PUs underwent continuous low-frequency electrostimulation (10 Hz) of the sciatic and femoral nerves by means of laparoscopic implantation of a neuroprosthesis via the LION procedure. This procedure is primarily performed in persons with chronic spinal cord injuries to facilitate voluntary electrically assisted walking function. Evaluations included quadriceps muscle thickness, regional skin temperature, and subjective healing reports. Evaluations were conducted at baseline and after three months of stimulation.

Results: The LION procedure significantly increased the healing process of gluteal (n = 3) and heel (n = 2) PUs in 5 patients. Besides cutaneous vasodilation, there was a significant increase in gluteal/legs muscle mass on both sides. All ulcers completely healed within three months.

Conclusions: Pelvic somatic nerve stimulation showed promise as a treatment for pressure ulcers in patients with spinal cord injuries by enabling gluteal pressure relief, peripheral vasodilation, and muscle building.

The peripheral arousal response of each sex includes erection. Understanding of the mechanism and physiology of erection has increased over millennia, at times facilitated by observations of the effects of spinal cord injury (SCI). These observations have furthered our understanding of normal and impaired function.

Context: Spinal cord injury (SCI) disrupts gut microbiota composition, resulting in dysbiosis that can worsen neuroinflammation and impede post-injury recovery. Short-chain fatty acids (SCFA), metabolites produced by the gut microbiome with anti-inflammatory properties, offer a promising avenue for improving recovery and rehabilitation outcomes.

Objective: We aimed to compile a summary of the human and animal evidence on the potential benefits of SCFA or SCFA  - producing bacteria in individuals with SCI.

Methods: Three databases (EMBASE, Medline (Ovid) and Web of Science) were searched from inception until 19 October 2023. No language restrictions were applied. Title and abstract screening, data extraction and risk of bias assessments were done independently by two reviewers.

Results: A total of 2492 studies were retrieved, 69 full-text studies were reviewed, and 13 studies were included (11 animal and 2 human). Human studies, which involved participants with chronic SCI, linked gut dysbiosis (a proxy for low SCFA production) and human metabolic profiles, suggesting a potential role for microbiome-targeted interventions even in later stages of injury. Evidence from animal studies, predominantly in acute and sub-acute models of SCI, consistently associated SCFA interventions with improved motor function, reduced tissue damage and favorable changes in inflammatory and oxidative stress markers. Fecal microbiota transplantation and probiotics improved motor function and reduced lesion size in animal models. Gut microbiome modulations through treatments such as melatonin, moxibustion, and intermittent fasting was correlated with improved motor outcomes and increased abundance of SCFA-producing bacteria.

Conclusions: This review highlights the potential of targeting the gut microbiota and SCFAs as therapeutic strategies for SCI recovery. However, despite promising results in animal models, human evidence remains limited.

Objective: Osteoporosis and fractures are significant secondary complications in individuals with traumatic spinal cord injury (TSCI). However, national-level data that can inform targeted screening and management strategies are limited.

Design: Retrospective cohort study.

Methods: We measured the mean times for osteoporosis and fracture onset, analyzed the incidence of osteoporosis and fracture, and identified risk factors, using the National Health Insurance Service claims data (2012-2019).

Results: The mean times for osteoporosis and fracture onset were 1.7 and 2.5 years, respectively, among patients with TSCI. The risk of osteoporosis was 2.1- and 3.6-fold higher in those aged 65-79 and 80 years, respectively, than in those aged <50 years. Fracture risk was 0.8-fold lower in those aged 50-64 and 65-79 years, respectively, than in those <50 years.

Conclusion: These results provide nationwide evidence supporting age - and sex-specific screening and prevention strategies for osteoporosis and fractures in patients with TSCI, which may help improve long-term outcomes and reduce secondary complications.

Background and purpose: Locomotor Clinical Practice Guidelines recommend intensities of 70-85% predicted maximum heart rate (HR) during gait training to improve walking speed and endurance for persons with chronic motor incomplete spinal cord injury (iSCI). However, attainment of these intensities may be limited during inpatient rehabilitation due to the significant physical assistance required for gait training. Therefore, the objective of this study was to examine the association between attainment of 70% HR max intensities and meaningful changes in walking outcomes for persons with SCI during inpatient rehabilitation who required physical assistance to ambulate.

Methods: This cross-sectional study examined records of 127 persons with SCI admitted to inpatient rehabilitation from June 2020 to June 2023. We utilized data from locomotor training sessions and co-treatments to compare those who achieved 70% HR max intensity and those who did not. Change in Walking Index for Spinal Cord Injury II (WISCI II) and 10 Meter Walk Test (10MWT) scores were examined in fully adjusted regression models.

Results: Approximately 65% of persons with SCI achieved 70% HR max during at least 1 locomotor session. Attainment of 70% HR max intensity was associated with positive changes of WISCI II scores (OR = 2.52, 95% CI = 1.01-6.42) and positive changes in 10 MWT (OR = 3.72, 95% CI = 1.38-10.99).

Discussion and conclusion: Higher locomotor training intensities were associated with meaningful improvements in walking function. Persons with SCI, who require physical assistance for ambulation, can achieve meaningful improvements in walking outcomes with attainment of 70% HR max intensity during inpatient rehabilitation.

Background: Kinesio Taping (KT) is commonly used in musculoskeletal disorders and rehabilitation practice, but its role in spinal cord injury (SCI) has received little scientific attention.

Objective: This scoping review aimed to map the existing literature on KT use in persons with SCI, describing how it has been applied, which outcomes were assessed, and the study designs employed.

Methods: Eight databases were examined: MEDLINE/PubMed, Cochrane CENTRAL, Web of Science Core Collection, Scopus, PEDro, LILACS, CINAHL, and SPORTDiscus, covering January 2000 to October 2025. We included human studies involving participants with SCI of any level or chronicity. Eligible studies used KT as an intervention and reported at least one clinical or functional outcome.

Results: Four studies met the inclusion criteria, including three randomized controlled designs and one observational add-on study. Across these studies, Kinesio Taping was applied alongside conventional rehabilitation and was associated with short-term changes in spasticity, postural control, hand function, or pressure injury outcomes; however, findings were heterogeneous and based on small samples.

Conclusions: Evidence on KT use in SCI remains limited. These preliminary findings require confirmation through larger well-controlled studies.