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Background: Body-weight-supported treadmill training (BWSTT) is a treatment method to help patients with incomplete spinal cord injuries to restore the capability to walk again. Objective: This study aimed to assess the effects of different percentages of body-weight-support locomotor training on the enhancement of gait for persons with incomplete spinal cord injuries. Subjects and methods: Twenty male paraplegic persons, with the statistical parameters [mean ± SD] age 32.53 ± 1. 793 years, height 175.71 ± 1.658 cm, weight 71.59 ± 2.442 kg, and body mass index 23.18 ± 0.828 kg/m2) were picked by convenience sampling. Ten patients were randomly allocated to the body-weight treadmill training 30% group (Group A); and ten patients to the body-weight treadmill training 40% group (Group B). The two groups were exercised for 1h every set, at two sets weekly for 1.5 months. Body-weight-supported treadmill training was divided into a 15-min warm-up on a stationary bicycle, 45-min body-weight-supported treadmill training with 30 and 40% body weight and finally, a 10-min cool down as we started loading with 10% of body weight of each patient until reach 30% or 40% according to his group. Results: The resultant data revealed that there are significant distinctions between the body-weight treadmill training 30% and the with body-weight treadmill training 40% groups in regards to alterations in the walking speed, step length, and stride length (p < 0.001), cadence (p = 0.009). Conclusion: Body-weight-supported treadmill training 40% in comparison with body-weight-supported treadmill training 30% can enhance both the quantity and quality of gait in paraplegic patients (ASIA B, C, and D classification). [ABSTRACT FROM AUTHOR]

The timing of surgery for acute traumatic cervical spinal cord injury (SCI) has long been an issue of intense debate. The superiority of early surgical decompression for incomplete cervical SCI without concomitant bone injuries has not been established. The aim of this study was to determine whether early surgical decompression within 24 hours results in better motor recovery than delayed surgery following at least two weeks of conservative treatment. Multicenter randomized controlled trial conducted at 43 tertiary referral hospitals in Japan. Patients aged 20 to 79 years with motor-incomplete cervical SCI with pre-existing canal stenosis (American Spinal Injury Association [ASIA] Impairment Scale C; without fracture or dislocation) were included. The presence of canal stenosis was verified based on baseline imaging studies, including MRI and CT. The primary endpoints were improvement in the mean ASIA motor score, total score of the spinal cord independence measure (SCIM), and the proportion of patients able to walk independently at one year post-injury. Participants were allocated (11) by computer-based randomization to urgent surgery within 24 hours after admission or delayed surgery (later than two weeks post-injury). Among 72 randomized patients, 70 patients (mean [SD] age, 65.1 [9.4] years; 5 women and 65 men) were included in the full analysis population at one year post-injury (37 patients assigned to early surgery and 33 to delayed surgery). We found a consistent, but insignificant, trend favoring early surgery more than delayed surgery (mean change in ASIA motor score, 53.7 vs 48.5, difference, 5.2; 95% confidence interval, -4.2 to 14.5; p=0.27; mean SCIM total score, 77.9 vs 71.3, p=0.34; the proportion of ambulatory patients, 70% vs 61.5%; p=0.51). A mixed-design analysis of variance revealed a significant difference in the ASIA motor scores between the groups (p=0.03). The early surgery group showed greater motor scores than the delayed surgery group at 2, 3 and 6 months post-injury. Complications were common in both groups (death, 3 patients vs 3 patients). Among motor-incomplete cervical SCI patients, early surgery produced similar motor regain at one year post-injury as delayed surgery, but showed accelerated recovery within the first six months. This abstract does not discuss or include any applicable devices or drugs. [ABSTRACT FROM AUTHOR]

The AO Spine Subaxial and Thoracolumbar Injury Classifications denote "Type C" fractures as dislocation-translation type injuries. These injuries are often grossly unstable due severe ligamentous compromise, which place patients at high risk for spinal cord injury (SCI). While prior research has investigated the role of early surgical decompression on neurologic outcomes, the relationship between the amount of vertebral column displacement and preoperative neurologic injury and postoperative neurologic recovery has been poorly documented. The purpose of this study is to 1) identify if preoperative vertebral column displacement (in millimeters) is predictive of a complete SCI (defined as ASIA A) prior to fracture fixation and 2) identify if the preoperative or postoperative vertebral column displacement is predictive of no postoperative neurologic improvement (ie, no improvement in ASIA score) following fixation. Retrospective cohort study. All patients with cervical or thoracolumbar Type C injuries between 2006-2021 were identified from a prospectively collected database. Only patients who underwent operative intervention were included. Neurologic injury and/or recovery based on the ASIA Impairment Scale. Patient demographics, surgical characteristics and clinical outcomes were collected. Preoperative and postoperative CT scans or MRI were utilized to measure the fracture-dislocation translation (in millimeters [mm]) prior to and following surgical fixation. Receiver operating characteristic (ROC) curves were generated to predict the probability of a SCI prior to reduction and fixation based on the preoperative fracture-dislocation displacement with optimal cutoffs identified using Youden's index. A second ROC curve was generated to predict the probability of having no postoperative neurologic recovery following reduction and fixation. Alpha was set at P<0.05. A total of 67 patients were included. The cohort was predominantly male (80.6%) with a mean age of 42.9 + 18.8 years. The majority of the injuries involved cervical vertebrae (n=45; 67.2%). The mean preoperative vertebral column displacement was 10 + 10 mm, and the mean postoperative vertebral column displacement was 1.87 + 2.08 mm. A majority of patients (n=61, 91.0%) underwent neurologic decompression within 24 hours following admission. Of the 67 patients, 42 (62.7%) were determined to have a complete SCI (ASIA A) upon admission; two patients experienced neurologic deterioration following surgery and 7 patients experienced some degree of neurologic recovery. ROC analysis identified 6.10 mm (AUC: 0.771, CI: 0.650-0.892) of preoperative vertebral column displacement as an optimal cutoff, predictive of a complete SCI. ROC analysis also identified 6.70 mm (AUC: 0.654, CI: 0.421-0.887) of preoperative vertebral column displacement and 5.40 mm (AUC: 0.427, CI: 0.214-0.639) of postoperative vertebral column displacement as optimal cutoff values predictive of no postoperative neurologic recovery following fixation. The distance of vertebral column translation in subaxial cervical and thoracolumbar AO Spine Type C injuries is highly predictive of a complete SCI. However, the amount of preoperative fracture-dislocation translation is only mildly predictive of neurologic recovery. The remaining postoperative fracture-dislocation displacement had no predictive effect on neurologic recovery. This abstract does not discuss or include any applicable devices or drugs. [ABSTRACT FROM AUTHOR]

Spinal cord injury (SCI) is a lesion of neural elements of spinal cord. Frequently, there is motor incomplete injury and locomotor disability. Robot assisted locomotor training, functional electrical stimulation (FES) devices, and repetitive transcranial magnetic stimulation (rTMS) devices are commonly used to improve motor control and gait of patients with SCI. The efficacies of different interventions for SCI have not been reported comprehensively, and a full comparison of these strategies may benefit clinicians who apply these techniques in the rehabilitation of patients with SCI. This study aimed to comprehensively evaluate the efficacies of different interventions for SCI. We did a systematic review and meta-analysis by searching for publications using PubMed, Embase, the Cochrane Database, the database of the US National Institutes of Health, and the WHO International Clinical Trials Registry Platform on Dec 30, 2018. Randomised controlled trials and controlled trials that compared interventions with usual care or a no exercise control, and that were published in English, were selected for our meta-analysis. The primary outcomes included functional independence (assessed using the functional independence measure, SCI independence measure, American Spinal Injury Association [ASIA] upper extremity motor score [UEMS] or lower extremity motor score [LEMS], and other hand function tests), walking speed (10 m walking test [10MWT]) and walking distance (6 min walking test [6MWT]), walking capacity (walking index for spinal cord injuries version II [WISCI II]), spasticity (modified Ashworth scale [MAS]), and quality of life of patients with SCI. The secondary outcomes included patient dropout and adverse events during intervention. Weighted mean differences and 95% CIs were used to measure intervention efficacy, and the OR was used for analysis of adverse events. Physiotherapy Evidence Database (PEDro) scale scores were used for quality assessment of the included studies. Meta-analysis was performed using Revman 5.0 software. Our initial search yielded 1410, 1643, and 452 English articles reporting the effectiveness of rTMS or FES, exercise or training, and robot assisted locomotor treadmill training on functional recovery after SCI. Of these articles, 27 randomised controlled trials and three controlled trials, including 1020 patients with SCI, were included for meta-analysis. Four articles were available for evaluating rTMS versus control (81 participants), six for FES (174 participants), nine for massed practice or treadmill training (218 participants), and 11 for robot assisted treadmill training (547 participants). rTMS improved walking speed (mean absolute difference [MD] 0·09, 95% CI 0·01–0·16, p=0·03, 10MWT) and lower extremity motor function (4·41, 1·55–7·27, p=0·003, ASIA LEMS) compared with control (sham rTMS plus gait training), but not spasticity and walking index. FES significantly increased upper extremity independence (2·92, 0·37–5·48, p=0·03) compared with control (conventional occupational therapy [COT] or resistance and aerobic training), but not upper extremity or lower extremity function and quality of life. Activity-based therapy (massed practice and treadmill training) showed no benefit to nerve injury and functional rehabilitation compared with control (no intervention, overground mobility therapy, self-regulated exercises, or conventional rehabilitation program), whereas robot assisted treadmill training significantly improved ASIA LEMS scores (5·00, 3·44–6·56, p<0·00001) and lower extremity independence (3·73, 2·53–4·92, p<0·00001) compared with control interventions (no intervention, cycling and walking), but not walking capacity (10MWT and 6MWT). No difference was seen in the incidence of adverse events in pairwise comparison of robot assisted treadmill training with control and activity-based therapy with control. rTMS, FES, and robot assisted treadmill training are effective in rehabilitating patients with SCI. The efficacies of rTMS and robot assisted treadmill training were relatively consistent among articles. The combination of rTMS and robot assisted treadmill training was effective in the rehabilitation of patients with SCI. None. [ABSTRACT FROM AUTHOR]