Adverse events in cardiovascular-related training programs in people with spinal cord injury: A systematic review

Context

There are anecdotal reports of adverse events (AEs) associated with exercise in people with spinal cord injury (SCI) and consequent concern by people with SCI and their providers about potential risks of exercise. Enumeration of specific events has never been performed and the extent of risk of exercise to people with SCI is not understood.

Objective

To systematically review published evidence to identify and enumerate reports of adverse events or AEs associated with training in persons with SCI.

Methods

Review was limited to peer-reviewed studies published in English from 1970 to 2011: (1) in adults with SCI, (2) evaluating training protocols consisting of repeated sessions over at least 4 weeks to maintain or improve cardiovascular health, (3) including volitional exercise modalities and functional electrical stimulation (FES)-enhanced exercise modalities, and (4) including a specific statement about AEs. Trained reviewers initially identified a total of 145 studies. After further screening, 38 studies were included in the review. Quality of evidence was evaluated using established procedures.

Results

There were no serious AEs reported. There were no common AEs reported across most types of interventions, except for musculoskeletal AEs related to FES walking. There were few AEs in volitional exercise studies.

Conclusion

There is no evidence to suggest that cardiovascular exercise done according to guidelines and established safety precautions is harmful. To improve the strength of these conclusions, future publications should include definition of AEs, information about pre-intervention screening, and statements of the nature and extent of AEs.     

Robotically assisted treadmill exercise training for improving peak fitness in chronic motor incomplete spinal cord injury: A randomized controlled trial

Objective

To assess the effectiveness of robotically assisted body weight supported treadmill training (RABWSTT) for improving cardiovascular fitness in chronic motor incomplete spinal cord injury (CMISCI).

Design

Pilot prospective randomized, controlled clinical trial.

Setting

Outpatient rehabilitation specialty hospital.

Participants

Eighteen individuals with CMISCI with American Spinal Injury Association (ASIA) level between C4 and L2 and at least one-year post injury.

Interventions

CMISCI participants were randomized to RABWSTT or a home stretching program (HSP) three times per week for three months. Those in the home stretching group were crossed over to three months of RABWSTT following completion of the initial three month phase.

Outcome measures

Peak oxygen consumption (peak VO₂) was measured during both robotic treadmill walking and arm cycle ergometry: twice at baseline, once at six weeks (mid-training) and twice at three months (post-training). Peak VO₂ values were normalized for body mass.

Results

The RABWSTT group improved peak VO₂ by 12.3% during robotic treadmill walking (20.2 ± 7.4 to 22.7 ± 7.5 ml/kg/min, P = 0.018), compared to a non-significant 3.9% within group change observed in HSP controls (P = 0.37). Neither group displayed a significant change in peak VO₂ during arm cycle ergometry (RABWSTT, 8.5% (P = 0.25); HSP, 1.76% (P = 0.72)). A repeated measures analysis showed statistically significant differences between treatments for peak VO₂ during both robotic treadmill walking (P = 0.002) and arm cycle ergometry (P = 0.001).

Conclusion

RABWSTT is an effective intervention model for improving peak fitness levels assessed during robotic treadmill walking in persons with CMISCI.     

A systematic review of electrical stimulation for pressure ulcer prevention and treatment in people with spinal cord injuries

Context

Electrical stimulation (ES) can confer benefit to pressure ulcer (PU) prevention and treatment in spinal cord injuries (SCIs). However, clinical guidelines regarding the use of ES for PU management in SCI remain limited.

Objectives

To critically appraise and synthesize the research evidence on ES for PU prevention and treatment in SCI.

Method

Review was limited to peer-reviewed studies published in English from 1970 to July 2013. Studies included randomized controlled trials (RCTs), non-RCTs, prospective cohort studies, case series, case control, and case report studies. Target population included adults with SCI. Interventions of any type of ES were accepted. Any outcome measuring effectiveness of PU prevention and treatment was included. Methodological quality was evaluated using established instruments.

Results

Twenty-seven studies were included, 9 of 27 studies were RCTs. Six RCTs were therapeutic trials. ES enhanced PU healing in all 11 therapeutic studies. Two types of ES modalities were identified in therapeutic studies (surface electrodes, anal probe), four types of modalities in preventive studies (surface electrodes, ES shorts, sacral anterior nerve root implant, neuromuscular ES implant).

Conclusion

The methodological quality of the studies was poor, in particular for prevention studies. A significant effect of ES on enhancement of PU healing is shown in limited Grade I evidence. The great variability in ES parameters, stimulating locations, and outcome measure leads to an inability to advocate any one standard approach for PU therapy or prevention. Future research is suggested to improve the design of ES devices, standardize ES parameters, and conduct more rigorous trials.     

Sensory supported FES control in gait training of incomplete spinal cord injury persons

Sensory supported electrical stimulation of the peroneal nerve during treadmill walking is proposed as a gait-training modality in incomplete spinal cord injury (SCI) patients. A multisensor device provides information on the tilt of the shank during gait. The information provided significantly improves the triggering instant of the electrical stimulation. Simultaneously, swing-phase estimation serves as a reference to determine the required motor augmentation support. Both approaches, as well as triggering using intensity control of the functional electrical stimulation were applied on a healthy person and on an incomplete C4-5 SCI patient.     

Usefulness of robotic gait training plus neuromodulation in chronic spinal cord injury: a case report

Context: Spinal cord injury (SCI) affects more than 2.5 million people worldwide, often leading to severe disability. Thus, a proper management of individuals with SCI is required either in the acute or in the post-acute rehabilitative phase.

Findings: A 31-year-old man, affected by chronic SCI, underwent two different intensive rehabilitation treatments, including either LokomatPro or a paired LokomatPro-rTMS training. We evaluated the clinical, kinetic, and electrophysiological parameters before and after each training session. In particular, the intensive robotic training was articulated in a total of 40 one-hour training sessions (i.e. 5 times a week for 8 weeks), whereas the rTMS sessions were delivered 3 days per week for 3 consecutive weeks, just before the LokomatPro session. Only at the end of the experimental treatment, we observed an important improvement in nearly all parameters we investigated.

Clinical relevance: The combined LokomatPro-rTMS rehabilitation may be a valuable approach in improving the motor function in patients affected by SCI, even in the chronic phase.     

经颅磁刺激同步踏车训练在胸腰段脊髓损伤治疗中的应用

目的:探讨经颅磁刺激同步踏车训练对胸腰段脊髓损伤患者功能恢复的影响。方法:30例不完全性T10～T12脊髓损伤患者,ASIA脊髓神经功能分级均为C级,病程3～4个月,随机分为训练组和对照组。两组均接受常规康复治疗(包括物理治疗、作业治疗、理疗和梯度气压助动等),训练组比对照组仅增加经颅磁刺激同步踏车训练1个项目。治疗时间6周,比较两组治疗前后ASIA运动评分、ASIA感觉评分、脊髓损伤步行指数Ⅱ(WISCIⅡ)和功能独立性评定(FIM)情况。结果:两组患者治疗前各临床评价指标间比较均无显著性差异(P0.05)。治疗6周后,训练组ASIA运动评分、WISCIⅡ、FIM评分较治疗前均有提高,差异有显著性(P0.05);对照组FIM评分较治疗前提高,差异有显著性(P0.05),余评价指标与治疗前比较差异无显著性(P0.05)。治疗后两组间比较,经颅磁刺激同步踏车训练组ASIA运动评分、WISCIⅡ均高于对照组,差异有显著性(P0.05),ASIA感觉评分、FIM评分两组间差异无显著性(P0.05)。结论:经颅磁刺激同步踏车训练对不完全性胸腰段脊髓损伤患者运动功能恢复有一定程度的促进作用。     

Virtual reality for the treatment of neuropathic pain in people with spinal cord injuries: A scoping review

Context: Virtual and augmented imagery are emerging technologies with potential to reduce the severity and impact of neuropathic pain in people with spinal cord injury (SCI).Objective: We aimed to identify and discuss studies using virtual and augmented reality applications for the management of neuropathic pain in people with spinal cord injury.Methods (data sources, data extraction): A systematic literature search was conducted using PRISMA scoping review guidelines. Articles were searched in PubMed, Embase and Web of Science databases using search terms relating to SCI, virtual and augmented reality and neuropathic pain. With no strong evidence for visual imagery in the treatment of pain in SCI patients, we selected exploratory, feasibility and more rigorous methodologies such as randomized controlled trials and case-control studies. We only selected studies evaluating the effects of visual imagery on neuropathic pain at or below the spinal cord injury level.Results: Of 60 articles located, we included nine articles involving 207 participants. All studies were exploratory using head-mounted devices or 3D and 2D screens with virtual walking or limb movement imagery. Outcomes included pain sensitivity, motor function and body ownership. Eight of the nine studies reported significant reductions in neuropathic pain intensity. However, given small sample sizes in all studies, results may be unreliable.Conclusion: Although the number of studies and individual sample sizes are small, these initial findings are promising. Given the limited options available for the effective treatment of neuropathic SCI pain and early evidence of efficacy, they provide valuable incentive for further research.     

Walking speed is not the best outcome to evaluate the effect of robotic assisted gait training in people with motor incomplete Spinal Cord Injury: A Systematic Review with meta-analysis

Context: While there are previous systematic reviews on the effectiveness of the use of robotic-assisted gait training (RAGT) in people with spinal cord injuries (SCI), as this is a dynamic field, new studies have been produced that are now incorporated on this systematic review (SR) with meta-analysis, updating the available evidence on this area.

Objective: To synthesise the available evidence on the use of RAGT, to improve gait, strength and functioning.

Methods: SR and meta-analysis following the Cochrane Handbook for Systematic Reviews of Interventions were implemented. Cochrane Injuries Group Specialized Register, PubMed, MEDLINE, EMBASE, CINAHL, ISIWeb of Science (SCIEXPANDED) databases were reviewed for the period 1990 to December 2016.

Three researchers independently identified and categorized trials; 293 studies were identified, 273 eliminated; remaining 15 randomized clinical trials (RCT) and five SR. Six studies had available data for meta-analysis (222 participants).

Results: The pooled mean demonstrated a beneficial effect of RAGT for WISCI, FIM-L and LEMS (3.01, 2.74 and 1.95 respectively), and no effect for speed.

Conclusions: The results show a positive effect in the use of RAGT. However, this should be taken carefully due to heterogeneity of the studies, small samples and identified limitations of some of the included trials.

These results highlight the relevance of implementing a well-designed multicenter RCT powered enough to evaluate different RAGT approaches.     

跳舞“下腰”致脊髓损伤后继发麻痹性脊柱侧凸的临床及影像学特征

【摘要】 目的：探讨因跳舞“下腰”致脊髓损伤后继发麻痹性脊柱侧凸（paralytic scoliosis secondary to spinal cord injury）的临床及影像学特征。方法：回顾性分析2016年6月~2023年8月跳舞“下腰”致脊髓损伤后继发脊柱侧凸于南京鼓楼医院脊柱外科行手术治疗患者的临床和影像学资料。所有患者均行坐位全脊柱正侧位X线片检查。记录患者脊髓损伤时年龄、确诊脊柱侧凸年龄、手术时年龄、截瘫平面、侧凸弯型、累及节段数、顶椎旋转情况,是否合并髋关节脱位,并于全脊柱正、侧位和Bending位X线片上测量冠状面侧凸主弯Cobb角、骨盆倾斜角和矢状面成角,计算侧凸柔韧度。对骨盆倾斜角和主弯Cobb角进行相关性分析。结果：共19例患者纳入本研究,均为女性,脊髓损伤时年龄5～9岁（6.8±1.1岁）,确诊脊柱侧凸时年龄6～11岁（8.6±1.3岁）,手术时年龄10～26岁（13.2±3.9岁）。损伤平面以下均为完全性瘫痪,其中13例截瘫平面位于T10水平,2例位于T9水平,4例位于T8水平。主弯均为长C型腰弯或胸腰弯,主弯累及节段数为7～13个（9±2个）,Cobb角为50°～110°（74.2°±14.6°）,主弯柔韧度为30%~54%（41%±10%）。顶椎旋转按Nash-Moe法分级,Ⅳ度 12例,Ⅲ度 6例,Ⅱ度 1例。矢状面上,腰椎后凸15例（78.9%）,局部后凸角为27°～47°（34.3°±5.8°）,腰椎前凸角为-47°～55°（-16.9°±34.1°）;胸椎呈代偿性后凸减小甚至前凸,胸椎后凸角为-10°～25°（10.4°±9.1°）。所有患者均合并髋关节半脱位,其中单侧17例（89.5%）,大部分位于主弯凹侧;双侧2例（10.5%）,主弯凹侧半脱位更严重。所有患者均合并骨盆倾斜,骨盆倾斜角为9°～39°（22.8°±8.4°）。Pearson相关分析显示骨盆倾斜角与主弯Cobb角存在显著相关性（r=0.635,P＜0.05）。结论：跳舞“下腰”致脊髓损伤后继发麻痹性脊柱侧凸的主弯为长C型腰弯或者单胸腰弯,弯曲跨度大,节段长,椎体旋转严重,畸形相对柔软,在主弯近端可出现短的代偿弯,且均合并骨盆倾斜和位于主弯凹侧的髋关节半脱位,骨盆倾斜与侧凸严重程度呈正相关;矢状面表现为胸椎代偿性的后凸减小,腰椎或胸腰段后凸畸形。     

嗅鞘细胞移植联合跑步训练对改善脊髓损伤大鼠后肢运动功能的研究

目的 :研究嗅鞘细胞移植联合跑步训练对改善脊髓损伤大鼠后肢运动功能的效果,同时探索嗅鞘细胞移植联合跑步训练改善大鼠运动功能的可能机制。方法:选用雄性SD大鼠80只,随机分为4组,每组20只,均进行脊髓损伤造模后进行如下分组处理:生理盐水注射组(A组)、嗅鞘细胞移植组(B组)、生理盐水注射联合跑步训练组(C组)和嗅鞘细胞移植联合跑步训练组(D组)。建模3 d后C、D两组进行跑步训练,1周后B、D两组进行嗅鞘细胞移植(每只大鼠注射总量为4μl,细胞浓度为1.0×106/μl),A、C两组给予相应剂量盐水。观察时间为4周,每组每周测量BBB评分,利用免疫组化染色观察Bax、Bcl-2及NF-200的表达,采用Mallory磷钨酸苏木素染色观察神经纤维数量,使用TUNEL染色观察神经元凋亡。结果:(1)BBB评分:嗅鞘细胞联合跑步训练组与其他3组在第4周差异有统计学意义(P0.05)。(2)在Bcl-2蛋白表达上,嗅鞘细胞移植联合跑步训练有交互作用,两者相互促进(P0.05);在Bax蛋白的表达上,嗅鞘细胞移植可以明显降低其表达,与跑步训练交互作用不明显(P0.05);TUNEL染色显示,嗅鞘细胞移植、跑步训练与时间因素三者具有交互作用,显著抑制细胞凋亡(P0.05)。(3)在Mallory磷钨酸苏木素染色及NF-200免疫组化染色上,嗅鞘细胞移植、跑步训练与时间因素三者具有交互作用(P0.05),促进神经再生。结论 :嗅鞘细胞移植联合跑步训练能够显著改善大鼠后肢运动功能,这可能通过以下途径实现:嗅鞘细胞移植与跑步训练能够相互协同,明显上调Bcl-2基因的表达,从而显著抑制神经元凋亡;同时能明显促进神经元轴索再生,提高神经纤维数量,并且这种效果可以随时间的延长更加显著。     

Management of obesity after spinal cord injury: a systematic review

Context: Individuals with chronic spinal cord injury (SCI) are susceptible to central and visceral obesity and it’s metabolic consequences; consensus based guidelines for obesity management after SCI have not yet been stablished.

Objectives: To identify and compare effective means of obesity management among SCI individuals.

Methods: This systematic review included English and non-English articles, published prior to April 2017 found in the PubMed/Medline, Embase, CINAHL Psychinfo and Cochrane databases. Studies evaluating any obesity management strategy, alone or in combination, including: diet therapy, voluntary and involuntary exercise such as neuro-muscular electric stimulation (NMES), pharmacotherapy, and surgery, among individuals with chronic SCI were included. Outcomes of interest were reductions in waist circumference, body weight (BW), body mass index (BMI) and total fat mass (TFM) and increases in total lean body mass (TLBM) from baseline. From 3,553 retrieved titles and abstracts, 34 articles underwent full text review and 23 articles were selected for data abstraction. Articles describing weight loss due to inflammation, cancer or B12 deficiency were excluded. The Downs and Black reported poor to moderate quality of the studies.

Results: Bariatric surgery produced the greatest permanent weight reduction and BMI correction followed by combinations of physical exercise and diet therapy. Generally, NMES and pharmacotherapy improved TLBM and reduced TFM but not weight.

Conclusions: The greatest weight reduction and BMI correction was produced by bariatric surgery, followed by a combination of physical exercise and diet therapy. NMES and pharmacologic treatment did not reduce weight or TFM but increased in TLBM.     

骨髓间充质干细胞移植对大鼠脊髓损伤后功能恢复的影响

目的 观察骨髓间充质干细胞(MSCs)移植对脊髓损伤修复的促进作用.方法 用改良Allen法制作大鼠脊髓损伤动物模型.随机分成对照组(A组),脊髓损伤9 d后脊髓内微量注射生理盐水溶液5μl;骨髓间充质干细胞移植组(B组),脊髓损伤9 d后脊髓内注射骨髓间充质干细胞悬液5μl.移植后7、14、28 d采用斜板实验、脊髓运动功能BBB评分法观察大鼠运动功能恢复情况,脊髓诱发电位的检测观察神经功能恢复,苏木素-伊红(HE)染色观察脊髓损伤处空洞面积的改变情况,免疫组织化学法观察移植的骨髓间充质干细胞的存活及分化情况,损伤部位神经纤维的再生情况.结果 移植后28 d,两组斜板倾斜角度差异有统计学意义[A组(44.96±5.70)度,B组(53.19±6.51)度,P＜0.05];两组BBB评分差异有统计学意义[A组(6.8±1.2),B组(10.1±3.5),P＜0.05].同时,两组MEP潜伏期差异有统计学意义[A组(4.69±0.47)ms,B组(3.97±0.83)ms,P＜0.05],两组SEP潜伏期差异有统计学意义[A组(4.19±1.97)ms,B组(2.60±0.92)ms,P＜0.05].两组神经轴突计数差异有统计学意义[A组(32.8±6.1)条/mm2,B组(39.0±4.6)条/mm2,P＜0.05].实验组可见明显星形胶质细胞和神经纤维再生,脊髓损伤处的空洞面积明显减小.结论 骨髓间充质干细胞可在脊髓损伤处分化为神经元和神经胶质细胞,能够减小脊髓损伤处的空洞面积,促进受损轴突的再生和运动功能的恢复.     

脊柱脊髓损伤合并重型颅脑损伤的早期诊治体会

目的：探讨早期诊治脊柱、脊髓损伤合并重型颅脑损伤病例，降低伤残率、死亡率的有效措施。方法：回顾性分析本院45例患者，及采取的相应诊断治疗措施。结果：临床治愈26例，好转14例，死亡5例。结论：骨科、神经外科和急诊科医生必须给予足够的重视，早期正确检查、及早诊断和有效治疗至关重要，常规行头部和脊柱脊髓影像学检查十分必要，进一步可采取CT三维重建、MRI等检查，提高早期诊断率，对降低伤残与死亡率有着十分重要的临床意义。     

Community exercise for individuals with spinal cord injury with inspiratory muscle training: A pilot study

Context/Objective: Respiratory disorders are a common cause of rehospitalization, and premature death in individuals with spinal cord injuries (SCI). Respiratory training combined with community exercise programs may be a method to reduce secondary complications in this population.Objective: The present study explores the inclusion of inspiratory muscle training (IMT) in an existing community exercise program.Design: Case series.Setting: Community.Participants: Participants (N = 6) completed the exercise program. Five were male and one was female; four reported incomplete injuries, and two reported complete injuries; four had cervical injuries, and two had thoracic injuries. The average age was 33 years (SD = 18.6) and time since injury was 7 years (SD = 4.0).Interventions: Participants completed an 8-week program, once-per-week for 4 h that included a circuit of resistance training, aerobic exercise, trunk stability, and education. IMT was completed as a home exercise program.Outcome Measures: Transfer test, T-shirt test, four-directional reach, four-directional trunk strength, weekly training diaries, and a subjective interview.Results: Twenty-eight training logs were collected. All measures improved: transfer test (mean = −14.62, SD = 7.00 s), T-shirt test (mean = −7.83, SD = 13.88 s), four-directional reach (mean = 3.75, SD = 8.06 in) and hand-held dynamometer (mean = 6.73, SD = 8.02 kg). Individuals reported a positive impact of the program.Conclusions: This pilot study demonstrated community exercise with IMT use may have positive impact on functional measures for people with SCI who are vulnerable to respiratory compromise. Continued education may increase successful health outcomes.Trial Registration: {"type":"clinical-trial","attrs":{"text":"NCT03743077","term_id":"NCT03743077"}}NCT03743077.     

Spinal injuries in the pediatric age group: a review of 82 cases of spinal cord and vertebral column injuries

A review of 82 children with spinal cord and/or vertebral column injury treated in our department between 1968 and 1993 showed that 67% of the patients were boys and the average age was 11.4 years. The cause, vertebral level, and type of injury, and the severity of neurological injury varied with the age of the patient. The cause of pediatric injuries differed from that of adult injuries in that falls were the most common causative factor (56%) followed by vehicular accidents (23%). The most frequent level of spinal injury was in the cervical region (57%, 47 patients) followed by the lumbar region (16.5%, 13 patients). In our series, 18% of the patients had complete injury and the overall mortality rate was 3.6%. Eleven children (13%) had spinal cord injury without radiographic abnormality (SCIWORA), whereas 39 (47%) had evidence of neurological injury. Although the spinal injury patterns differed between children and adolescents, the outcome was found to be predominantly affected by the type of neurological injury (P<0.05). Children with complete myelopathy uniformly remained with severe neurological dysfunction; children with incomplete myelopathy recovered nearly normal neurological function. Finally, the authors conclude that most spinal injuries can be successfuly managed with nonoperative therapy. The literature is reviewed as to the treatment and outcome of pediatric spinal injuries.     

A brief fall prevention intervention for manual wheelchair users with spinal cord injuries: A pilot study

Objective: To conduct a pilot study of an intervention to decrease fall incidence and concerns about falling among individuals living with Spinal Cord Injury who use manual wheelchairs full-time.

Design: Pre/post. After a baseline assessment, a structured intervention was implemented. The assessment protocol was repeated 12 weeks after the baseline assessment.

Setting: Research laboratory and community.

Participants: 18 individuals living with SCI who use a manual wheelchair full-time with an average age of 35.78?±?13.89 years, lived with SCI for 17.06?±?14.6 years; 61.1% were female.

Intervention: A 1:1, 45 minute, in-person intervention focused on factors associated with falls and concerns about falling: transfers skills and seated postural control.

Outcome measures: Participants reported fall incidence and completed the Spinal Cord Injury Fall Concerns Scale, Community Participation Indicators and the World Health Organization Quality of Life – short version (WHOQOL-BREF). Transfer quality was assessed with the Transfer Assessment Instrument (TAI) and seated postural control with the Function In Seating Test (FIST).

Results: Recruitment, assessment and delivery of the intervention were successfully completed. After exposure to the intervention, fall incidence significantly decreased, (P?=?0.047, d_{z ?}=?0.507) and FIST scores improved (P?=?0.035, d_z? =?0.54). Significant improvements were also found in the WHOQOL-BREF Physical (P?=?0.05, d_{z ?}=?1.566) and Psychological (P?=?0.040, d_{z ?}=?0.760) domains.

Conclusion: The feasibility of the structured intervention was established and the intervention has the potential to reduce fall incidence and improve quality of life among individuals living with SCI who use a wheelchair. Appropriately powered randomized controlled trials of the program are warranted.     

A scoping review on the effect of cannabis on pain intensity in people with spinal cord injury

ContextThis scoping review examines the current research on the effect of cannabis upon pain intensity in spinal cord injury (SCI) pain. Chronic pain is a significant secondary condition following SCI, and traditional treatments (e.g. opioids, NSAIDs) are often criticized for providing inadequate relief. As a result, there is increasing interest in and use of cannabis and cannabinoid-based medications as an alternative means of pain control.ObjectiveThe purpose of this review was to examine the scientific evidence on the effect of cannabis/cannabinoids upon pain intensity in SCI by mapping the current literature.MethodsTwo hundred and fifty-two studies were identified by searching electronic databases for articles published through February 2020. In addition, reviewers scanned the reference lists of identified articles and examined clinicaltrials.gov for unpublished data in this area. Title, abstract, and full-text reviews were completed by two independent reviewers. Data extraction was performed by a single reviewer and verified by a second reviewer.ResultsSix articles covering five treatment studies were included. Studies yielded mixed findings likely due to large variability in methodology, including lack of standardized dosing paradigms, modes of use, and duration of trial.ConclusionsThe current quality and level of evidence is insufficient to draw reliable conclusions of the efficacy of cannabis upon SCI-related pain itensity. We identify specific limitations of past studies and present guidelines for future research.Trial registration: ClinicalTrials.gov identifier: Nct01606202..     

Comparison of the effects of body-weight-supported treadmill training and tilt-table standing on spasticity in individuals with chronic spinal cord injury

Objective

Determine the effects of body-weight-supported treadmill training (BWSTT) and tilt-table standing (TTS) on clinically assessed and self-reported spasticity, motor neuron excitability, and related constructs in individuals with chronic spinal cord injury (SCI).

Design

Random cross-over.

Methods

Seven individuals with chronic SCI and spasticity performed thrice-weekly BWSTT for 4 weeks and thrice-weekly TTS for 4 weeks, separated by a 4-week wash-out. Clinical (Modified Ashworth Scale, Spinal Cord Assessment Tool for Spinal reflexes) and self-report (Spinal Cord Injury Spasticity Evaluation Tool, Penn Spasm Frequency Scale) assessments of spasticity, quality of life (Quality of Life Index Spinal Cord Injury Version – III), functional mobility (FIM Motor Subscale), plus soleus H-reflex were measured at baseline, after the first training session and within 2 days of completing each training condition.

Results

In comparison with TTS, a single session of BWSTT had greater beneficial effects for muscle tone (effect size (ES) = 0.69), flexor spasms (ES = 0.57), and the H/M ratio (ES = 0.50). Similarly, flexor spasms (ES = 0.79), clonus (ES = 0.66), and self-reported mobility (ES = 1.27) tended to benefit more from 4 weeks of BWSTT than of TTS. Participation in BWSTT also appeared to be favorable for quality of life (ES = 0.50). In contrast, extensor spasms were reduced to a greater degree with TTS (ES = 0.68 for single session; ES = 1.32 after 4 weeks).

Conclusion

While both BWSTT and TTS may provide specific benefits with respect to spasticity characteristics, data from this pilot study suggest that BWSTT may result in a broader range of positive outcomes.