Spinal cord injury rehabilitation: which way forward?

BACKGROUND: Spinal cord injury (SCI), damage to spinal cord, influences the ability of the subjects to stand and walk. Moreover, they have some problems such as osteoporosis, muscle spasm, joint contracture and bowel and bladder function. These subjects use various orthoses and undergo different rehabilitation programmes to restore their ability. It is controversial whether use of aforementioned methods improves the physiological health of SCI individuals and improves their ability to ambulate or not. Therefore, the aim of this review was to investigate the effectiveness of assistive devices to restore their physiological health and their functional ability in patients with SCI. METHOD: A search was done in some databases such as Medline, Embasco, and ISI Web of sciences between 1960 and 2013. The quality of studies was assessed using the Down and Black tool. RESULTS: Two hundred articles were found based on the selected key words. Sixty papers were selected for final analysis, of which 35 and 45 focused on benefits of standing and walking, performance of SCI during standing and walking with various systems, respectively. CONCLUSION: Although there was lots of variation between the studies based on the number of subjects, level of lesion, type of lesion and time post injury, it can be concluded that use of various orthoses neither improve the abilities of subjects to stand and walk nor improve their physiological health. It may be concluded that the use of other methods of exercise may have more physiological benefits for SCI subjects.

A new approach to measure stability during quiet standing.

BACKGROUND: Stability during standing is achieved by a complex process which involves the performance of various systems. Using a force plate for analysing the stability for a period of one minute has been reported exclusively by many investigators. Most of people stand for a long period of time when chatting with somebody, doing a job and when waiting in a queue. However nobody has analysed the stability during quiet standing for a prolonged standing (5 minutes). OBJECTIVE: The main aim of this research study was to analyse the performance of the subjects regarding stability for a period of 5 minutes. METHOD: A group of 40 normal subjects from the staff and students of Rehabilitation Faculty of Isfahan University of Medical Sciences were recruited in this research project. They were asked to stand on the force plate (Kistler) for a period of 5 minutes. They were instructed to look straight ahead and with their head erect and their arms at their sides in a comfortable position. The excursions of the COP sway in both planes were measured for all 20 seconds periods of data collection. RESULTS: The results of this research study showed that stability analysing based on the sway of the COP, while the test was collected for one minute, is not recommended. There is a significant difference between the excursions of the COP during the first to fifth minutes. The stability of the subject was optimum in the third and fourth minutes of standing. CONCLUSION: Using the COP sway, based on the first minute of standing, is neither a good representative of the more stable position nor the unstable position. It is recommended to discuss the stability of subjects based on their ability to return from an unstable position to a more stable position.