Effect of Transcranial Direct Current Stimulation on Lower Extremity Muscle Strength, Quality of Life, and Functional Recovery in Individuals With Incomplete Spinal Cord Injury: A Randomized Controlled Study.

Background and objectives Muscle strength and function are essential facets of rehabilitation for incomplete spinal cord injury (iSCI) patients. Various methods are being used to improve these outcome measures, but no gold standard method exists. Transcranial direct current stimulation (tDCS) is a relatively inexpensive, portable, readily available, and easy-to-use modality. It has shown promising results in many psychiatric and neurological conditions like stroke, cerebral palsy, and depression, but its role in spinal cord injury (SCI) is relatively unexplored. The study's objectives are to investigate the effect of anodal tDCS on lower limb muscle strength, quality of Life (QoL), and function in individuals with iSCI. Methods A randomized single-blinded sham control parallel-group study was conducted at the Indian Spinal Injuries Centre in New Delhi, India. There were 32 iSCI participants (28 males and four females) with 23 traumatic and nine non-traumatic etiologies. Participants were randomly assigned to receive 40 minutes of 2 mA anodal or sham stimulation over the targeted motor cortex areas for five sessions per week over two weeks. The following outcome measures were measured at baseline after one and two weeks of the intervention: Lower Extremity Motor Score (LEMS), Spinal Cord Independence Measure (SCIM III), and WHO Quality of Life Bref (WHO QoL Bref). Results There was no significant difference at one week and two weeks of intervention for LEMS (p = 0.675, p = 0.978), SCIM III (p = 0.170, p = 0.133), WHO QoL Bref Domain 1 (p = 0.376, p = 0.282), Domain 2 (p = 0.728, p = 0.450), Domain 3 (p = 0.641, p = 0.993), Domain 4 (p = 0.294, p = 0.422), overall perception of QoL (p = 0.492, p = 1.000), and overall perception of their health (p = 0.300, p = 0.854) in the anodal and sham tDCS groups. Conclusion These primary findings suggest that anodal tDCS is ineffective in improving the QoL and motor and functional capabilities of individuals with iSCI. Further studies are necessary to determine whether it can be effective as a long-term rehabilitation strategy for the abovementioned population.

A Sonomyography-Based Muscle Computer Interface for Individuals With Spinal Cord Injury.

Impairment of hand functions in individuals with spinal cord injury (SCI) severely disrupts activities of daily living. Recent advances have enabled rehabilitation assisted by robotic devices to augment the residual function of the muscles. Traditionally, electromyography-based muscle activity sensing interfaces have been utilized to sense volitional motor intent to drive robotic assistive devices. However, the dexterity and fidelity of control that can be achieved with electromyography-based control have been limited due to inherent limitations in signal quality. We have developed and tested a muscle-computer interface (MCI) utilizing sonomyography to provide control of a virtual cursor for individuals with motor-incomplete spinal cord injury. We demonstrate that individuals with SCI successfully gained control of a virtual cursor by utilizing contractions of muscles of the wrist joint. The sonomyography-based interface enabled control of the cursor at multiple graded levels demonstrating the ability to achieve accurate and stable endpoint control. Our sonomyography-based muscle-computer interface can enable dexterous control of upper-extremity assistive devices for individuals with motor-incomplete SCI.

Interventions to Improve Standing Balance in Individuals With Incomplete Spinal Cord Injury: A Systematic Review and Meta-Analysis.

Background: Incomplete spinal cord injury (iSCI) often results in impaired balance leading to functional impairments. Recovery of standing balance ability is an important aim of rehabilitative programs. However, limited information is available on effective balance training protocols for individuals with iSCI. Objectives: To assess the methodological quality and effectiveness of various rehabilitation interventions for improving standing balance in individuals with iSCI. Methods: A systematic search was performed in SCOPUS, PEDro, PubMed, and Web of Science from inception until March 2021. Two independent reviewers screened articles for inclusion, extracted data, and evaluated methodological quality of the trials. PEDro Scale was used to assess the quality of randomized controlled trials (RCT) and crossover studies while pre-post trials were assessed using the modified Downs and Black tool. A meta-analysis was performed to quantitatively describe the results. The random effects model was applied to present the pooled effect. Results: Ten RCTs with a total of 222 participants and 15 pre-post trials with 967 participants were analyzed. The mean PEDro score and modified Downs and Black score was 7/10 and 6/9, respectively. The pooled standardized mean difference (SMD) for controlled and uncontrolled trials of body weight-supported training (BWST) interventions was -0.26 (95% CI, -0.70 to 0.18; p = .25) and 0.46 (95% CI, 0.33 to 0.59; p < .001), respectively. The pooled effect size of -0.98 (95% CI, -1.93 to -0.03; p = .04) indicated significant improvements in balance after a combination of BWST and stimulation. Pre-post studies analyzing the effect of virtual reality (VR) training interventions on Berg Balance Scale (BBS) scores in individuals with iSCI reported a mean difference (MD) of 4.22 (95% CI, 1.78 to 6.66; p = .0007). Small effect sizes were seen in pre-post studies of VR+stimulation and aerobic exercise training interventions indicating no significant improvements after training on standing balance measures. Conclusion: This study demonstrated weak evidence to support the use of BWST interventions for overground training for balance rehabilitation in individuals with iSCI. A combination of BWST with stimulation however showed promising results. There is a need for further RCTs in this field to generalize findings. Virtual reality-based balance training has shown significant improvement in standing balance post iSCI. However, these results are based on single group pre-post trials and lack appropriately powered RCTs involving a larger sample size to support this intervention. Given the importance of balance control underpinning all aspects of daily activities, there is a need for further well-designed and appropriately powered RCTs to evaluate specific features of training interventions to improve standing balance function in iSCI.

Efficacy assessment of virtual reality therapy for neuromotor rehabilitation in home environment: a systematic review.

PURPOSE: Neuromotor impairments can affect any part of the body. It leads to many disorders, injuries, or disabilities, conventional rehabilitation is a long, rigorous, and tedious process. There is a need to inculcate new and innovative techniques in rehabilitation processes, to increase individuals' interest and overall performance with such therapies. Virtual Reality is considered a new technology that has the potential to be a useful aid in overcoming therapeutic problems in clinical and home-based environments. However, providing home-based rehabilitation is more practicable, cost-effective, and even safer than in-hospital rehabilitation. In addition, the need for home-based rehabilitation is growing as the number of neuromotor disorders rises and the capacity of acute inpatient rehabilitation decreases. Therefore, the main objective of this study was to assess the efficacy of a home-based Virtual Reality exercise treatment to identify the areas for future rehabilitation research. MATERIALS AND METHODS: Data Extraction of 24,257 articles from seven databases were identified and the review is narrowed down and only 45 studies were focussed on efficacy assessment of Virtual Reality in the home environment. RESULTS: The significant outcome of the effective home-based therapy system for the exercise improved functional ability, increasing range of motion, and motivation through Virtual reality-based rehabilitation is inferred. CONCLUSION: Unlike clinical settings, a home-based system provides efficacious therapy with a controlled environment. This survey facilitates bettering methods and devices for neuromotor disorders. It is a good living long-term problem-solving approach and investigates awareness, needs, and a preferred component of home-based rehabilitation services.IMPLICATIONS FOR REHABILITATIONVR-based rehabilitation in the home environment has many physical and mental benefits in persons with neuromotor disorders.The most commonly neuromotor disorders considered in the study were Stroke, Spinal Cord Injury, Parkinson's disease, and Cerebral Palsy.Assistive technologies in home environments can compensate for long-term disorders or be used in rehabilitation as an addition to conventional therapy.The study gives an overview of current interventions and how they can be of benefit for a person suffering from neuromotor disorders in the home environment.

Hindi translation and reliability testing of the international spinal cord injury quality of life basic data set version 1.0.

STUDY DESIGN: Methodological study design: translation and test-retest reliability testing. OBJECTIVES: To translate International Spinal Cord Injury Quality of Life Basic Data Set (ISCIQoLBDS) Version 1.0 into Hindi language and conduct reliability testing of Hindi ISCIQoLBDS (hISCIQoLBDS). SETTING: The study was conducted at Indian Spinal Injuries Centre, New Delhi, India. METHODS: The study was done in two phases-translation of ISCIQoLBDS Version 1.0 into Hindi language and reliability testing of hISCIQoLBDS. In the translation phase, the data set was forward translated by two independent professional translators. Then backward translation was done by another pair of professional translators to ensure the essence of the data set. For their feedback, field testing of hISCIQoLBDS was done on ten individuals with Spinal Cord Injury (SCI). After this, an expert panel reviewed their recommendations, and the final hISCIQoLBDS was administered on 50 participants with SCI for test-retest reliability of the data set. RESULTS: hISCIQoLBDS was found to be equivalent to ISCIQoLBDS Version 1.0 on back-translation. It showed high test-retest reliability for each item in the data set. Intraclass Correlation Coefficient (95% CI) for items of hISCIQoLBDS was within the range of (0.91-0.98). CONCLUSION: The hISCIQoLBDS is a stepwise systematic Hindi translation of the ISCIQoLBDS Version 1.0 for the Hindi literate population with high test-retest reliability. It can facilitate international data exchange on the quality of life (QoL) of Hindi literate individuals with SCI.

Errors in Measuring Glenohumeral Arthrokinematics With 2-Dimensional Fluoroscopy.

Two-dimensional fluoroscopic imaging allows measurement of small magnitude humeral head translations that are prone to errors due to optical distortion, out-of-plane imaging, repeated manual identification of landmarks, and magnification. This article presents results from in vivo and in vitro fluoroscopy-based experiments that measure the errors and variability in estimating the humeral head translated position in true scapular plane and axillary views. The errors were expressed as bias and accuracy. The variability with repeated digitization was calculated using the intraclass correlation coefficient (ICC) and the standard error of measurement. Optical distortion caused underestimation of linear distances. The accuracy was 0.11 and 0.43 mm for in vitro and in vivo experiments, respectively, for optical distortion. The intrarater reliability was excellent for both views (ICC = .94 and .93), and interrater reliability was excellent (ICC = .95) for true scapular view but moderate (ICC = .74) for axillary views. The standard error of measurement ranged from 0.27 to 0.58 mm. The accuracy for the humeral head position in 10° out of true scapular plane images ranged from 0.80 to 0.87 mm. The current study quantifies the magnitude of error. The results suggest that suitable measures could be incorporated to minimize errors and variability for the measurement of glenohumeral parameters.

Efficacy of Electrical Stimulation-Augmented Virtual Reality Training in Improving Balance in Individuals with Incomplete Spinal Cord Injury: Study Protocol of a Randomized Controlled Trial.

STUDY DESIGN: This study is a single-blind, parallel, three-group, and randomized controlled trial. PURPOSE: This study aimed to investigate the effectiveness of electrical stimulation-augmented virtual reality training in improving balance in individuals with incomplete spinal cord injury (iSCI). OVERVIEW OF LITERATURE: Individuals with iSCI often face significant balance and mobility impairments affecting their quality of life. Scientific studies focusing on standing balance training in the iSCI population are limited. Virtual reality-based balance training has shown positive results in several neurological populations. Electrical stimulation has also proved to be effective in improving voluntary muscle strength in partially paralyzed muscles after iSCI as well as promoting neuroplasticity. METHODS: Forty-eight iSCI participants will be recruited based on the inclusion criteria. The participants will be randomly assigned to any of the three groups: virtual reality-based balance training along with the electrical stimulation group, virtual reality-based balance training along with sham stimulation group, or virtual reality-based balance training group. The intervention will be delivered as 60-minute sessions, thrice a week for 4 weeks. RESULTS: The performance of the participants will be assessed using the lower extremity motor score, static and dynamic balance assessment using TechnoBody ProKin tilting platform and Berg Balance Scale, Walking Index for Spinal Cord Injury, and World Health Organization Quality of Life-BREF at pre-intervention, after 4 weeks post-intervention, and at 1-month follow-up. CONCLUSIONS: The trial will provide new knowledge about the effectiveness of electrical stimulation-augmented virtual reality training in improving balance in individuals with iSCI. The study results will contribute to the design of better rehabilitation programs for individuals with iSCI.

Development and validation of the Standing Balance Assessment for Individuals with Spinal Cord Injury (SBASCI) - A new outcome measure.

BACKGROUND: Injury to the spinal cord results in standing balance impairment following variable sensorimotor loss. Standing balance training is a realistic goal for the majority of individuals with spinal cord injury (SCI) for which therapists need valid measures to assess standing ability in people with SCI that are relevant to functionality. OBJECTIVE: The objective of the study was to develop an all inclusive Standing Balance Assessment for Individuals with Spinal Cord Injury (SBASCI) measure and to establish its initial psychometric properties. METHODS: The study was carried out in three phases: Item development, scale development and scale evaluation. Literature review, focus group discussions and evaluation by experts resulted in the development of a 22-item SBASCI scale. The scale was administered on 120 participants with SCI. Exploratory factor analysis and item analysis were used to determine construct validity and internal consistency of the scale. RESULTS: Content validity was established qualitatively and quantitatively. The scale shows high internal consistency reliability (Cronbach's alpha 0.96). The results of the exploratory factor analysis suggested a four factor structure retaining all the 22 items. CONCLUSION: SBASCI is a valid and reliable scale to measure the standing balance of individuals with SCI. Further studies are required to establish other psychometric properties.

The effects of 10,000 voluntary contractions over 8 weeks on the strength of very weak muscles in people with spinal cord injury: a randomised controlled trial.

STUDY DESIGN: A multi-centred, single-blinded randomised controlled trial. OBJECTIVES: To determine the effect of 10,000 voluntary contractions over 8 weeks on the strength of very weak muscles in people with spinal cord injury (SCI). SETTINGS: Seven hospitals in Australia and Asia. METHODS: One hundred and twenty people with recent SCI undergoing inpatient rehabilitation were randomised to either a Treatment or Control Group. One major muscle group from an upper or lower limb was selected if the muscle had grade 1 or grade 2 strength on a standard six-point manual muscle test. Participants allocated to the Treatment Group performed 10,000 isolated contractions of the selected muscle group, as well as usual care in 48 sessions over 8 weeks. Participants allocated to the Control Group received usual care alone. Participants were assessed at baseline and 8 weeks by a blinded assessor. The primary outcome was voluntary muscle strength on a 13-point manual muscle test. There were three secondary outcomes capturing therapists' and participants' perceptions of strength and function. RESULTS: The mean between-group difference of voluntary strength at 8 weeks was 0.4/13 points (95% confidence interval -0.5 to 1.4) in favour of the Treatment Group. There were no notable between-group differences on any secondary outcome. CONCLUSION: Ten thousand isolated contractions of very weak muscles in people with SCI over 8 weeks has either no or a very small effect on voluntary strength.

Effectiveness of robo-assisted lower limb rehabilitation for spastic patients: A systematic review.

BACKGROUND: Though many rehabilitative treatments are available for treatment of spasticity, thus the effectiveness of different robo-rehabilitative devices needs to be evaluated through a systematic review. OBJECTIVE: The objective of this study is to focuses on the efficacy of Robot assistive rehabilitation device for the removal of spasticity from the lower limb of Spastic patients. DATA SOURCESSOURCES: PubMed, Web of Sciences, EMBASE (Excerpta Medical database), CDSR (Cochrane database of systematic reviews), Scopus, IEEE Xplore, Wiley online library, MEDLINE (OvidSP), Science Direct, Springer Link were from January 1980 to September 2017 DATA EXTRACTIONEXTRACTION: Seventy-one publications from eleven databases published were selected using keywords Ankle foot, spasticity, robotic rehabilitation, efficacy of robotics and Ankle foot rehabilitation. The review is narrowed down to twenty-six articles which were selected for they focused on effects of Robot assistive rehabilitation device quantitatively. RESULT: A quantitative study from analyzing 26 studies comprising of 786 subjects is carried out. The major outcome of the effectiveness of the robot assistive therapy for the movement of ankle and functioning of gait is deduced. As the used protocols and treatment procedures vary, made comparative study complex or impracticable. CONCLUSION: Robo-rehabilitation possesses an ability to provide unified therapy protocols with greater ease in comparison to conventional therapies. They continuously prove to be irreplaceable assistant devices when it comes to providing excellent treatment in terms of improvement from this study. Though many mechatronic devices are available but the devices for treatment of early stage rehabilitation of stroke patients is very limited.