Transcranial direct current stimulation combined with robotic therapy for upper and lower limb function after stroke: a systematic review and meta-analysis of randomized control trials.

BACKGROUND: Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation method able to modulate neuronal activity after stroke. The aim of this systematic review was to determine if tDCS combined with robotic therapy (RT) improves limb function after stroke when compared to RT alone. METHODS: A search for randomized controlled trials (RCTs) published prior to July 15, 2021 was performed. The main outcome was function assessed with the Fugl-Meyer motor assessment for upper extremities (FM/ue) and 10-m walking test (10MWT) for the lower limbs. As secondary outcomes, strength was assessed with the Motricity Index (MI) or Medical Research Council scale (MRC), spasticity with the modified Ashworth scale (MAS), functional independence with the Barthel Index (BI), and kinematic parameters. RESULTS: Ten studies were included for analysis (n = 368 enrolled participants). The results showed a non-significant effect for tDCS combined with RT to improve upper limb function [standardized mean difference (SMD) = - 0.12; 95% confidence interval (CI): - 0.35-0.11)]. However, a positive effect of the combined therapy was observed in the lower limb function (SMD = 0.48; 95% CI: - 0.15-1.12). Significant results favouring tDCS combined with RT were not found in strength (SMD = - 0.15; 95% CI: - 0.4-0.1), spasticity [mean difference (MD) = - 0.15; 95% CI: - 0.8-0.5)], functional independence (MD = 2.5; 95% CI: - 1.9-6.9) or velocity of movement (SMD = 0.06; 95% CI: - 0.3-0.5) with a "moderate" or "low" recommendation level according to the GRADE guidelines. CONCLUSIONS: Current findings suggest that tDCS combined with RT does not improve upper limb function, strength, spasticity, functional independence or velocity of movement after stroke. However, tDCS may enhance the effects of RT alone for lower limb function. tDCS parameters and the stage or type of stroke injury could be crucial factors that determine the effectiveness of this therapy.

Cardiorespiratory fitness and arm bone mineral health in young males with spinal cord injury: the mediator role of lean mass.

Spinal cord injury (SCI) derives in loss of bone mineral content (BMC) and bone mineral density (BMD). However, physical activity is an important determinant in bone mass acquisition, which is partially mediated through the lean mass (LM). The aim was to examine the effect of cardiorespiratory fitness (CRF) on BMD and BMC arms of adult males with SCI and able-bodied controls using the arm LM as a mediator variable. Thirty able-bodied men and thirty men with SCI participated. BMC and BMD were analysed by DXA, and indirect calorimetry was used to calculate VO2peak during a progressive arm-cranking test. When groups were divided by the amount of LM, the subgroup with highest LM had significantly higher arm BMC compared to the lowest LM subgroup (p ≤ 0.05) in both SCI and able-bodied groups. Moreover, same differences were found when confidence intervals were analysed. Only in the SCI group, arm LM mediated the relationship between bone mass and CRF at 30.9%, as indicated by the Sobel test (z = 2.17 and z = 2.04 for BMC and BMD, respectively). In conclusion, LM mediates the indirect association between CRF and bone health, specifically in the arms. This finding highlights the importance of having an adequate CRF for the maintenance of good bone health in SCI men.

Spinal cord injury in pediatric age in Spain. Reality of a national reference center.

UNLABELLED: The aim of this study was to analyze the incidence and the main characteristics of ambulant children with spinal cord injury (SCI) treated at the Unit of Biomechanics and Technical Assistance, at the National Spinal Cord Injury Hospital in Toledo, Spain. To date, there are no detailed studies on the effects of this disease in children regarding their walking ability. MATERIAL AND METHODS: A retrospective study was performed including all patients attending the unit between January 2006 and December 2013, who were aged 18 years or younger and who were outpatients able to walk independently for at least 10 m, with or without technical aids. RESULTS: Forty-eight patients were included in this study (25 males and 23 females) aged between 2 and 18 years (mean age, 12 ± 2.31 years). The etiology of SCI ranged between congenital (33.33%), traumatic (29.16%), and neoplastic (8.33%), and the level of injury varied between cervical (31.25%), lumbar (29.16%), a non-spinal origin (20.83%), dorsal (16.66%), and sacral (2.08%). The mean score on the Barthel Index was 82.61, the mean value of the Functional Independence Measure (FIM) locomotion score was 6.4, and 29 patients did not require the use of walking aids (WISCI 20). CONCLUSION: The findings of this study contribute to the knowledge regarding the situation of children with SCI in Spain. The incidence of pediatric SCI is very low; however, the provision of care remains a personal and social challenge.