Changes in gut microbiota in the acute phase after spinal cord injury correlate with severity of the lesion.

After spinal cord injury (SCI), patients face many physical and psychological issues including intestinal dysfunction and comorbidities, strongly affecting quality of life. The gut microbiota has recently been suggested to influence the course of the disease in these patients. However, to date only two studies have profiled the gut microbiota in SCI patients, months after a traumatic injury. Here we characterized the gut microbiota in a large Italian SCI population, within a short time from a not only traumatic injury. Feces were collected within the first week at the rehabilitation center (no later than 60 days after SCI), and profiled by 16S rRNA gene-based next-generation sequencing. Microbial profiles were compared to those publicly available of healthy age- and gender-matched Italians, and correlated to patient metadata, including type of SCI, spinal unit location, nutrition and concomitant antibiotic therapies. The gut microbiota of SCI patients shows distinct dysbiotic signatures, i.e. increase in potentially pathogenic, pro-inflammatory and mucus-degrading bacteria, and depletion of short-chain fatty acid producers. While robust to most host variables, such dysbiosis varies by lesion level and completeness, with the most neurologically impaired patients showing an even more unbalanced microbial profile. The SCI-related gut microbiome dysbiosis is very likely secondary to injury and closely related to the degree of completeness and severity of the lesion, regardless of etiology and time interval. This microbial layout could variously contribute to increased gut permeability and inflammation, potentially predisposing patients to the onset of severe comorbidities.

Assistive powered exoskeleton for complete spinal cord injury: correlations between walking ability and exoskeleton control.

BACKGROUND: Wearable powered robotic exoskeletons allow patients with complete spinal cord injury (SCI) to practice over-ground real-world gait scenarios. The global functional interaction subject-exoskeleton is a key factor to produce interlimb coordinated movements. Efficacy and efficiency of over-ground walking abilities using powered exoskeletons are related not only to the symbiotic sensory-motor interaction subject-exoskeleton but also to exoskeleton control. AIM: Assess if walking ability of motor complete SCI patients at thoracic or lower level, using a wearable powered exoskeleton (ReWalk), can be influenced by different exoskeleton software control. DESIGN: Observational study; an open, non-comparative, non-randomized study. SETTING: A single neurological rehabilitation center for inpatients and outpatients. POPULATION: Fifteen SCI chronic patients (4 females and 11 males) were recruited and divided in two groups: group 1, trained with the first software generation of ReWalk, and group 2, trained with the second software generation, a software upgrade of the previous version. METHODS: Subjects were trained during three 60-minute sessions a week, during at least eight weeks using ReWalk, a wearable lower limb powered exoskeleton that allows thoracic or lower level motor-complete individuals with SCI to walk, stand, sit and climb/descend stairs. Outcome measures, collected at the end of the training period wearing the exoskeleton, were: 6-min Walking Test, 10-m Walking Test, and the time necessary to pass from sitting to standing and start to walk (STS-time). For each group Pearson Coefficient was calculated to explore correlations between the subjects' characteristics and gait performance reached at the end of the training period. RESULTS: Group 1 showed correlation between performances and weight, height, neurological lesion level, while group 2 showed no correlation between performances weight and height, but correlation only with neurological lesion level. Group 2 covered more distance in 6 min (+124.52%) and required less time (-70.34%) to perform 10 mtWT and to STS-time (-38.25%) if compared to group 1. CONCLUSIONS: ReWalk allows chronic complete spinal cord injury patients to perform over-ground walking. Different exoskeleton software control of the smoothness of the gait pattern improves functional outcome, eliminating the relationship between anthropometric factors and gait performances. The smoothness of the kinematic control of the lower limbs of the exoskeleton is a key factor to facilitate human-robot interaction and to increase walking abilities of the subject. CLINICAL REHABILITATION IMPACT: To underline how the kinematic control of the exoskeleton influences the walking abilities of the complex system subject-exoskeleton.

Instrumental evaluation of gait modifications before and during intrathecal baclofen therapy: a 2-year follow-up case study.

Intrathecal baclofen therapy has been used for several years, despite the fact that long-term gait modifications in ambulatory patients have not been thoroughly investigated. A 31-yr-old male patient affected by hereditary spastic paraparesis was evaluated clinically and by gait analysis. Evaluations were made before and at 6, 12, 16, and 24 mos after implantation. The patient showed a clear improvement in self-selected speed, step and stride length, knee and ankle kinematics, and ankle kinetics. Moreover, the response observed on self-selected speed is consistent with the intrathecal baclofen dose administered. To our knowledge, this is the first report of a long-term instrumental gait analysis assessment of a patient receiving intrathecal baclofen. Gait analysis could be a reliable and feasible assessment tool to evaluate ambulatory patients receiving intrathecal baclofen therapy over time and to help clinicians in determining exact dose requirements.