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Journal of Neuroengineering and... May 2024Exoskeletons are increasingly applied during overground gait and balance rehabilitation following neurological impairment, although optimal parameters for specific... (Review)
Review
BACKGROUND
Exoskeletons are increasingly applied during overground gait and balance rehabilitation following neurological impairment, although optimal parameters for specific indications are yet to be established.
OBJECTIVE
This systematic review aimed to identify dose and dosage of exoskeleton-based therapy protocols for overground locomotor training in spinal cord injury/disease.
METHODS
A systematic review was conducted in accordance with the Preferred Reporting Items Systematic Reviews and Meta-Analyses guidelines. A literature search was performed using the CINAHL Complete, Embase, Emcare Nursing, Medline ALL, and Web of Science databases. Studies in adults with subacute and/or chronic spinal cord injury/disease were included if they reported (1) dose (e.g., single session duration and total number of sessions) and dosage (e.g., frequency of sessions/week and total duration of intervention) parameters, and (2) at least one gait and/or balance outcome measure.
RESULTS
Of 2,108 studies identified, after removing duplicates and filtering for inclusion, 19 were selected and dose, dosage and efficacy were abstracted. Data revealed a great heterogeneity in dose, dosage, and indications, with overall recommendation of 60-min sessions delivered 3 times a week, for 9 weeks in 27 sessions. Specific protocols were also identified for functional restoration (60-min, 3 times a week, for 8 weeks/24 sessions) and cardiorespiratory rehabilitation (60-min, 3 times a week, for 12 weeks/36 sessions).
CONCLUSION
This review provides evidence-based best practice recommendations for overground exoskeleton training among individuals with spinal cord injury/disease based on individual therapeutic goals - functional restoration or cardiorespiratory rehabilitation. There is a need for structured exoskeleton clinical translation studies based on standardized methods and common therapeutic outcomes.
Topics: Spinal Cord Injuries; Humans; Exoskeleton Device; Postural Balance; Exercise Therapy; Gait; Gait Disorders, Neurologic
PubMed: 38705999
DOI: 10.1186/s12984-024-01365-2 -
Global Spine Journal Mar 2024Systematic literature review and meta-analysis. (Review)
Review
Does Spinal Cord Type Predict Intraoperative Neuro-Monitoring Alerts in Scoliosis Correction Surgery? A Systematic Review and Meta-Analysis of Operative and Radiologic Predictors.
STUDY DESIGN
Systematic literature review and meta-analysis.
OBJECTIVES
Predicting patient risk of intraoperative neuromonitoring (IONM) alerts preoperatively can aid patient counselling and surgical planning. Sielatycki et al established an axial-MRI-based spinal cord classification system to predict risk of IONM alerts in scoliosis correction surgery. We aim to systematically review the literature on operative and radiologic factors associated with IONM alerts, including a novel spinal cord classification.
METHODS
A systematic review and meta-analysis was performed as per the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) Guidelines. A literature search identifying all observational studies comparing patients with and without IONM alerts was conducted. Suitable studies were included. Patient demographics, radiological measures and operative factors were collected.
RESULTS
11 studies were included including 3040 patients. Relative to type 3 cords, type 1 (OR = .03, CI = .01-.08, < .00001), type 2 (OR = .08, CI = .03, <.00001) and all non-type 3 cords (OR = .05, CI = .02-.16, < .00001) were associated with significantly lower odds of IONM alerts. Significant radiographic measures for IONM alerts included coronal Cobb angle (MD = 10.66, CI = 5.77-15.56, < .00001), sagittal Cobb angle (MD = 9.27, CI = 3.28-14.73, = .0009), sagittal deformity angle ratio (SDAR) (MD = 2.76, CI = 1.57-3.96, < .00001) and total deformity angle ratio (TDAR) (MD = 3.44, CI = 2.27-4.462, < .00001). Clinically, estimated blood loss (MD = 274.13, CI = -240.03-788.28, = .30), operation duration (MD = 50.79, CI = 20.58-81.00, = .0010), number of levels fused (MD = .92, CI = .43-1.41, = .0002) and number of vertebral levels resected (MD = .43, CI = .01-.84, = .05) were significantly greater in IONM alert patients.
CONCLUSIONS
This study highlights the relationship of operative and radiologic factors with IONM alerts.
PubMed: 38428951
DOI: 10.1177/21925682241237475 -
Journal of Clinical Medicine Apr 2024: Cranio-maxillofacial (CMF) injuries represent a significant challenge in low- and middle-income countries (LMICs), exacerbated by inadequate infrastructure, resources,... (Review)
Review
: Cranio-maxillofacial (CMF) injuries represent a significant challenge in low- and middle-income countries (LMICs), exacerbated by inadequate infrastructure, resources, and training. This systematic review aims to evaluate the current strategies and solutions proposed in the literature to improve CMF fracture care in LMICs, focusing on education, patient transfer, and off-label solutions. : A comprehensive literature search was conducted using PubMed/Medline from January 2000 to June 2023. Studies were selected based on the Preferred Reporting Items for Systematic Review and Meta-analysis Statement (PRISMA). Solutions were categorized into three main areas: education (digital and on-site teaching, fellowships abroad), patient transfer to specialized clinics, and off-label/non-operative solutions. : Twenty-three articles were included in the review, revealing a consensus on the necessity for enhanced education and training for local surgeons as the cornerstone for sustainable improvements in CMF care in LMICs. Digital platforms and on-site teaching were identified as key methods for delivering educational content. Furthermore, patient transfer to specialized national clinics and innovative off-label techniques were discussed as immediate solutions to provide quality care despite resource constraints. : Effective CMF fracture care in LMICs requires a multifaceted approach, prioritizing the education and training of local healthcare professionals, facilitated patient transfer to specialized centers, and the adoption of off-label solutions to leverage available resources. Collaborative efforts between international organizations, local healthcare providers, and educational institutions are essential to implement these solutions effectively and improve patient outcomes in LMICs.
PubMed: 38673709
DOI: 10.3390/jcm13082437 -
European Journal of Physical and... Jun 2024Spinal cord injuries have a considerable impact on healthcare in terms of mortality and morbidity. To address the difficulties faced by people affected by this condition...
INTRODUCTION
Spinal cord injuries have a considerable impact on healthcare in terms of mortality and morbidity. To address the difficulties faced by people affected by this condition and to raise awareness among stakeholders and policymakers, it is crucial to understand factors impacting survival. The purpose of this study is to systematically review the literature on life expectancy in people with traumatic spinal cord injury (tSCI), identifying key factors influencing mortality and survival.
EVIDENCE ACQUISITION
We conducted a systematic review, searching the literature for articles published up to July 2023 in PubMed, Web of Science, Cochrane Library, Google Scholar, and PEDro. Study outcomes had to be one of survival rate, life expectancy, standardized mortality ratio, or mortality rate. Only original research articles published in English were included. The quality of evidence was evaluated with the MINORS scale. The level of evidence was categorized according to the OCEBM model.
EVIDENCE SYNTHESIS
A comprehensive literature search yielded 102 articles, after the selection process 20 studies were included in our review. The main factors negatively influencing survival and life expectancy included higher neurological level of injury (NLI), completeness of the lesion, need for mechanical ventilation, increasing age, and male gender. The development of SCI-related comorbidities also negatively impacted survival as well as the lack of specialized care, especially in low-income countries. Additionally, pre-injury health status and personal income may affect survival.
CONCLUSIONS
Current literature shows that people affected by tSCI have a shorter life expectancy compared to the general population, highlighting some factors as possible predictors. It is difficult to compare available evidence due to the methodological heterogeneity across studies, which makes it challenging to draw generalizable conclusions on life expectancy in people with tSCI. Further studies are required to address these issues and accurately estimate life expectancy accounting for gaps in the management of people affected by tSCI to improve their care.
PubMed: 38842067
DOI: 10.23736/S1973-9087.24.08462-4 -
Biomedizinische Technik. Biomedical... Aug 2023Leg exercises through standing, cycling and walking with/without FES may be used to preserve lower limb muscle and bone health in persons with physical disability due to... (Review)
Review
Leg exercises through standing, cycling and walking with/without FES may be used to preserve lower limb muscle and bone health in persons with physical disability due to SCI. This study sought to examine the effectiveness of leg exercises on bone mineral density and muscle cross-sectional area based on their clinical efficacy in persons with SCI. Several literature databases were searched for potential eligible studies from the earliest return date to January 2022. The primary outcome targeted was the change in muscle mass/volume and bone mineral density as measured by CT, MRI and similar devices. Relevant studies indicated that persons with SCI that undertook FES- and frame-supported leg exercise exhibited better improvement in muscle and bone health preservation in comparison to those who were confined to frame-assisted leg exercise only. However, this observation is only valid for exercise initiated early (i.e., within 3 months after injury) and for ≥30 min/day for ≥ thrice a week and for up to 24 months or as long as desired and/or tolerable. Consequently, apart from the positive psychological effects on the users, leg exercise may reduce fracture rate and its effectiveness may be improved if augmented with FES.
Topics: Humans; Spinal Cord Injuries; Bone Density; Leg; Muscle, Skeletal; Electric Stimulation Therapy; Lower Extremity
PubMed: 36852605
DOI: 10.1515/bmt-2021-0195 -
Neural Regeneration Research Dec 2024Regenerative approaches towards neuronal loss following traumatic brain or spinal cord injury have long been considered a dogma in neuroscience and remain a cutting-edge...
Regenerative approaches towards neuronal loss following traumatic brain or spinal cord injury have long been considered a dogma in neuroscience and remain a cutting-edge area of research. This is reflected in a large disparity between the number of studies investigating primary and secondary injury as therapeutic targets in spinal cord and traumatic brain injuries. Significant advances in biotechnology may have the potential to reshape the current state-of-the-art and bring focus to primary injury neurotrauma research. Recent studies using neural-glial factor/antigen 2 (NG2) cells indicate that they may differentiate into neurons even in the developed brain. As these cells show great potential to play a regenerative role, studies have been conducted to test various manipulations in neurotrauma models aimed at eliciting a neurogenic response from them. In the present study, we systematically reviewed the experimental protocols and findings described in the scientific literature, which were peer-reviewed original research articles (1) describing preclinical experimental studies, (2) investigating NG2 cells, (3) associated with neurogenesis and neurotrauma, and (4) in vitro and/or in vivo, available in PubMed/MEDLINE, Web of Science or SCOPUS, from 1998 to 2022. Here, we have reviewed a total of 1504 papers, and summarized findings that ultimately suggest that NG2 cells possess an inducible neurogenic potential in animal models and in vitro. We also discriminate findings of NG2 neurogenesis promoted by different pharmacological and genetic approaches over functional and biochemical outcomes of traumatic brain injury and spinal cord injury models, and provide mounting evidence for the potential benefits of manipulated NG2 cell ex vivo transplantation in primary injury treatment. These findings indicate the feasibility of NG2 cell neurogenesis strategies and add new players in the development of therapeutic alternatives for neurotrauma.
PubMed: 38595286
DOI: 10.4103/NRR.NRR-D-23-01031 -
European Journal of Orthopaedic Surgery... Jan 2024Acetabular fracture fixation can be challenging, especially in the elderly. Open reduction and internal fixation (ORIF) alone may not allow for early weight bearing and... (Review)
Review
PURPOSE
Acetabular fracture fixation can be challenging, especially in the elderly. Open reduction and internal fixation (ORIF) alone may not allow for early weight bearing and is associated with a high rate of secondary osteoarthritis; therefore, a combined hip procedure (CHP) or ORIF with acute total hip arthroplasty, may be beneficial in this population. The objective of this study was to perform a systematic review of all reported cases of CHP.
METHODS
PubMed, Embase, Scopus, and Cochrane databases were searched for studies analyzing acetabular fractures in the elderly managed with a combined hip procedure (CHP). The research was performed following the PRISMA guidelines. The included studies' methodological quality was evaluated using the MINORS score. The present study was registered on PROSPERO.
RESULTS
Eleven clinical studies were included in the final analysis. The mean age was 74.4 (63.2-78) years. Low-energy trauma was the most common mechanism of injury (64%). The most prevalent fracture pattern was the anterior column and posterior hemitransverse (ACPHT) (30.6%). The Kocher-Langenbeck approach was preferred for ORIF of posterior fractures and hip arthroplasty. The ilioinguinal approach and modified Stoppa were generally used for anterior fractures. The overall complication rate was 12.2%, and hip dislocation was the most frequent cause of reoperation (4.4%). The average Harris Hip Score reported postoperatively was 81.6 points, which was considered "good."
CONCLUSIONS
CHP is a safe treatment for elderly acetabular fractures with an acceptable complication and reoperation rate that results in good clinical outcomes.
LEVEL OF EVIDENCE
Level of evidence IV.
Topics: Humans; Aged; Arthroplasty, Replacement, Hip; Acetabulum; Fracture Fixation, Internal; Hip Fractures; Fractures, Bone; Open Fracture Reduction; Spinal Fractures; Treatment Outcome; Retrospective Studies
PubMed: 37640795
DOI: 10.1007/s00590-023-03701-z -
Frontiers in Neuroscience 2023With the aging of the global population, Spinal injuries are often prone to occur and affect human health. The development of technology has put robots on the stage to...
BACKGROUND
With the aging of the global population, Spinal injuries are often prone to occur and affect human health. The development of technology has put robots on the stage to assist in the treatment of spinal injuries.
METHODS
A comprehensive literature search were carried out in multiple databases, including PubMed, Medline (Ovid), Web of Science, Cochrane, Embase, Scopus, CKNI, Wang fang, VIP database, Sino Med, Clinical Trails until 20th, June, 2023 to collect effect of robot-assisted gait training for patients with spinal cord injury patients. Primary outcome includes any changes of gait distance and gait speed. Secondary outcomes include any changes in functions (Such as TUG, Leg strength, 10 MWT) and any advent events. Data were extracted from two independent individuals and Cochrane Risk of Bias tool version 2.0 was assessed for the included studies. Systematic review and meta-analysis were performed by RevMan 5.3 software.
RESULTS
11 studies were included in meta-analysis. The result showed that gait distance [WMD = 16.05, 95% CI (-15.73, 47.83), I = 69%], gait speed (RAGT vs. regular treatment) [WMD = 0.01, 95% CI (-0.04, 0.05), I = 43%], gait speed (RAGT vs. no intervention) [WMD = 0.07, 95% CI (0.01, 0.12), I = 0%], leg strength [WMD = 0.59, 95% CI (-1.22, 2.40), I = 29%], TUG [WMD = 9.25, 95% CI (2.76, 15.73), I = 74%], 10 MWT [WMD = 0.01, 95% CI (-0.15, 0.16), I = 0%], and 6 MWT [WMD = 1.79, 95% CI (-21.32, 24.90), I = 0%].
CONCLUSION
Robot-assisted gait training seems to be helpful for patients with spinal cord to improve TUG. It may not affect gait distance, gait speed, leg strength, 10 MWT, and 6 MWT.
PubMed: 37680972
DOI: 10.3389/fnins.2023.1252651 -
Emergency Medicine Journal : EMJ Jun 2024Trauma accounts for a huge burden of disease worldwide. Trauma systems have been implemented in multiple countries across the globe, aiming to link and optimise multiple...
BACKGROUND
Trauma accounts for a huge burden of disease worldwide. Trauma systems have been implemented in multiple countries across the globe, aiming to link and optimise multiple aspects of the trauma care pathway, and while they have been shown to reduce overall mortality, much less is known about their cost-effectiveness and impact on morbidity.
METHODS
We performed a systematic review to explore the impact the implementation of a trauma system has on morbidity, quality of life and economic outcomes, in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. All comparator study types published since 2000 were included, both retrospective and prospective in nature, and no limits were placed on language. Data were reported as a narrative review.
RESULTS
Seven articles were identified that met the inclusion criteria, all of which reported a pre-trauma and post-trauma system implementation comparison in high-income settings. The overall study quality was poor, with all studies demonstrating a severe risk of bias. Five studies reported across multiple types of trauma patients, the majority describing a positive impact across a variety of morbidity and health economic outcomes following trauma system implementation. Two studies focused specifically on traumatic brain injury and did not demonstrate any impact on morbidity outcomes.
DISCUSSION
There is currently limited and poor quality evidence that assesses the impact that trauma systems have on morbidity, quality of life and economic outcomes. While trauma systems have a fundamental role to play in high-quality trauma care, morbidity and disability data can have large economic and cultural consequences, even if mortality rates have improved. The sociocultural and political context of the surrounding healthcare infrastructure must be better understood before implementing any trauma system, particularly in resource-poor and fragile settings.
PROSPERO REGISTRATION NUMBER
CRD42022348529 LEVEL OF EVIDENCE: Level III.
Topics: Humans; Wounds and Injuries; Morbidity; Quality of Life; Cost-Benefit Analysis; Trauma Centers
PubMed: 38388191
DOI: 10.1136/emermed-2023-213782 -
Systematic Reviews Nov 2023Stem cell sheet implantation offers a promising avenue for spinal cord injury (SCI) and is currently under investigation in pre-clinical in vivo studies. Nevertheless, a...
BACKGROUND
Stem cell sheet implantation offers a promising avenue for spinal cord injury (SCI) and is currently under investigation in pre-clinical in vivo studies. Nevertheless, a systematic review of the relevant literature is yet to be performed. Thus, this systematic review aims to explore the efficacy of stem cell sheet technology in treating SCI, as indicated by experimental animal model studies.
METHODS
We searched PubMed, EMBASE, and Web of Science. Manuscripts that did not pertain to in vivo pre-clinical studies and those published in non-English languages were excluded. A risk assessment for bias was performed using the SYRCLE tool. Extracted data were synthesized only qualitatively because the data were not suitable for conducting the meta-analysis.
RESULTS
Among the 847 studies retrieved from electronic database searches, seven met the inclusion criteria. Six of these studies employed a complete transection model, while one utilized a compression model. Stem cell sources included bone marrow mesenchymal stem cells, stem cells from human exfoliated deciduous teeth, and adipose-derived mesenchymal stem cells. In all included studies, stem cell sheet application significantly improved motor and sensory functional scores compared to intreated SCI rats. This functional recovery correlated with histological improvements at the injury site. All studies are at low risk of bias but certain domains were not reported by some or all of the studies.
CONCLUSION
The results of our systematic review suggest that stem cell sheets may be a feasible therapeutic approach for the treatment of SCI. Future research should be conducted on stem cell sheets in various animal models and types of SCI, and careful validation is necessary before translating stem cell sheets into clinical studies.
Topics: Animals; Humans; Rats; Mesenchymal Stem Cell Transplantation; Mesenchymal Stem Cells; Spinal Cord Injuries
PubMed: 38037129
DOI: 10.1186/s13643-023-02390-3