Gait Rehabilitation Techniques In Incomplete Cervical Spinal Cord Injuries
Incomplete cervical spinal cord injuries can lead to severe functional loss, with mobility deficits of the lower limbs and motor control. Contemporary gait rehabilitation techniques focus on the motor reprogramming of neuronic circuits. This systematic review aims to compare the results of different rehabilitation techniques, ranging from robotic exoskeleton systems, to new and improves weight- bearing systems, and other methods including virtual reality, on their ability to achieve measurable therapeutic goals.
Three electronic databases (MEDLINE, PEDro and Google Scholar) were systematically searched for clinical trials, up until May 2022. The following search terms were used: “Incomplete Cervical Spinal Cord Injury” AND “Gait Training” OR “Rehabilitation” OR “Exoskeletal assisted walking” OR “Lokomat” OR “Robot- assisted gait training”.
Of the initial 2.411 papers, 54 were selected to be review for eligibility to this systematic review, leading to the final 20 that were included. The most common evaluation tools were 6MWT, 10MWT, TUG, LEMS and WISCI-II. In all 20 papers significant or very significant changes were noted between the time of the first assessment and the last. 13 of them noted statistically significant differences between the control groups and the intervention groups at the end of the trial period, regardless of the method used. In this systematic review, 409 patients were recruited for trials on robotic exoskeletons, 70 participated in Weight- Bearing trials, and another 55 completed trials on interventions including WBV, OLT and GRAIL. In regards to the use of a robotic exoskeleton system, 10 out of 13 trials noted statistical significant differences between groups, a result shared by 2 out of 3 trials on weight-bearing systems. Contemporary interventions using the latest technological advances, whether they be robotic exoskeletons, advanced weight-bearing systems or enhanced virtual reality, may contribute to a faster and more efficient gait rehabilitation of patients suffering from incomplete cervical spinal cord injuries.
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