Clinical Management and Rehabilitation of Spinal Cord Injury

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Orthopedics".

Deadline for manuscript submissions: 30 August 2024 | Viewed by 4097

Special Issue Editor


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Guest Editor
National Hospital Organization Murayama Medical Center, Musashimurayama 208-0000, Japan
Interests: spinal trauma and spinal cord injury; pediatric scoliosis; adult deformity

Special Issue Information

Dear Colleagues,

Spinal cord injury (SCI) represents a complex and challenging medical condition with profound implications for individuals and their families. This Special Issue is dedicated to advancing our understanding of SCI and improving the clinical management and rehabilitation of SCI patients. With the increasing number of SCI cases worldwide, there is a pressing need to address research gaps and to improve treatment strategies and the quality of life of those affected.

The primary aim of this Special Issue is to provide a comprehensive platform for researchers, clinicians, and rehabilitation specialists to share cutting-edge research, evidence-based practices, and innovative approaches in the field of SCI. We seek to explore current research, identify core challenges, and propose effective solutions to enhance clinical care and rehabilitation outcomes.

The scope of this Special Issue includes topics such as SCI assessment and diagnosis, novel therapeutic interventions, assistive technologies, psychosocial support, and community reintegration. By combining expertise and knowledge from across the globe, we aspire to drive advancements in SCI care and rehabilitation that will positively impact the lives of individuals with SCI.

We welcome original research, clinical studies, reviews, and case reports that contribute to the advancement of SCI management and rehabilitation. Together, we can work towards a future where individuals with SCI experience improved clinical outcomes and an enhanced quality of life.

Dr. Tsunehiko Konomi
Guest Editor

Manuscript Submission Information

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Keywords

  • spinal cord injury
  • rehabilitation
  • diagnosis and prognosis
  • comprehensive management
  • social support

Published Papers (5 papers)

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Research

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12 pages, 1477 KiB  
Article
An Innovative Method for the Conservative Treatment of Idiopathic Scoliosis Using the GraviSpine Device According to the Concept of Spinal Reflex Balance
by Marek Kluszczyński, Katarzyna Zaborowska-Sapeta, Ireneusz Kowalski and Ilona Sylwia Karpiel
J. Clin. Med. 2024, 13(14), 4044; https://doi.org/10.3390/jcm13144044 - 10 Jul 2024
Viewed by 310
Abstract
Objectives: Conservative treatment of idiopathic scoliosis is more effective as a result of early diagnosis in conjunction with the use of specific physiotherapy and bracing techniques. Our aim was to investigate the effectiveness of specific physiotherapy developed according to the concept of spinal [...] Read more.
Objectives: Conservative treatment of idiopathic scoliosis is more effective as a result of early diagnosis in conjunction with the use of specific physiotherapy and bracing techniques. Our aim was to investigate the effectiveness of specific physiotherapy developed according to the concept of spinal reflex balance using the GraviSpine device. This study is a retrospective analysis of prospectively collected data. Methods: A total of 199 patients aged 6–17 years, with a mean age of 11.26 ± 3.35 years, including 168 girls (84.4%) and 31 boys (15.6%), out of a total of 830 patients treated for IS at the Scoliosis Treatment Center in 2014–2019 were included in the assessment, which was conducted according to the inclusion and exclusion criteria. The study group was divided into three age groups. Group A subjects were 6–9 years old; group B, 10–12 years old; and group C, 13–17 years old. The mean follow-up time was 28.71 ± 10.98 months. Treatment outcomes were compared, based on changes in the Cobb angle and the angle of trunk rotation before and after treatment, both within the groups and with respect to sex and curvature location, using the Wilcoxon signed-rank test. Cobb angle changes in patients were classified as improvements, stabilizations, or deteriorations according to the SOSORT criteria. Results: A majority of patients improved or stabilized after treatment, with 67%, 71%, and 90% of subjects in groups A, B, and C, respectively, achieving these results. In group C (the oldest children), a statistically significant reduction of −1.84° ± 6.88° (6.31%) in the mean Cobb angle was achieved after treatment. With regard to sex, improvements and stabilizations accounted for 81% of cases in girls and 61% in boys, respectively. With respect to location, statistically significant reductions in the Cobb angle were noted for thoracic and thoracolumbar spines of −2.2° ± 7.54° (10.17%) p = 0.022 and −2.2° ± 6.58° (6.36%) p = 0.049, respectively. A significant reduction in the mean angle of trunk rotation was obtained in the group and in three curvature locations. Conclusions: Based on the presented research findings, the utilization of the GraviSpine device as an adjunct to specific PSSE (physiotherapeutic scoliosis-specific exercises) physiotherapy and bracing in the management of pediatric patients with mild to moderate scoliosis appears to enhance treatment efficacy. Full article
(This article belongs to the Special Issue Clinical Management and Rehabilitation of Spinal Cord Injury)
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14 pages, 2569 KiB  
Article
Active Breaks Reduce Back Overload during Prolonged Sitting: Ergonomic Analysis with Infrared Thermography
by Martina Sortino, Bruno Trovato, Marta Zanghì, Federico Roggio and Giuseppe Musumeci
J. Clin. Med. 2024, 13(11), 3178; https://doi.org/10.3390/jcm13113178 - 29 May 2024
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Abstract
Background: Prolonged sitting is a potential risk factor for musculoskeletal disorders in office workers. This study aims to evaluate the effect of active breaks on reducing muscle overload in subjects who sit for long periods using infrared thermography (IRT). Methods: A sample of [...] Read more.
Background: Prolonged sitting is a potential risk factor for musculoskeletal disorders in office workers. This study aims to evaluate the effect of active breaks on reducing muscle overload in subjects who sit for long periods using infrared thermography (IRT). Methods: A sample of 57 office workers participated in this study and were divided into two groups: active breaks (ABs) and no active breaks (NABs). The NAB group sat continuously for 90 min without standing up, while the AB group performed stretching and mobility exercises every 30 min. IRT measurements were taken every 30 min before the active breaks. Results: The results highlight that the skin temperature of the back increased significantly in both groups after 30 min of sitting; however, in the subsequent measurements, the AB group showed a decrease in temperature, while the NAB group maintained a high temperature. Exercise and time point of measurement all reported p-values < 0.001; there were no statistically significant differences between the Δt0-1 of the NAB and AB groups, while the Δt1-2 and Δt1-3 of the NAB and AB groups showed statistically significant differences for all back regions. Conclusions: The clinical relevance of this study confirms the negative effects of prolonged sitting on the health of the back, demonstrating that active breaks can reduce back strain, emphasizing the need for workplace interventions. In addition, IRT represents a non-invasive method to assess back muscle overload and monitor the effectiveness of interventions in all categories of workers who maintain a prolonged sitting position. The main limitation of this study is the absence of a questionnaire for the assessment of back pain, which does not allow a direct correlation between temperature changes and back pain outcomes. Full article
(This article belongs to the Special Issue Clinical Management and Rehabilitation of Spinal Cord Injury)
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Review

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14 pages, 1242 KiB  
Review
The Clinical Management of Electrical Stimulation Therapies in the Rehabilitation of Individuals with Spinal Cord Injuries
by David R. Dolbow, Ines Bersch, Ashraf S. Gorgey and Glen M. Davis
J. Clin. Med. 2024, 13(10), 2995; https://doi.org/10.3390/jcm13102995 - 20 May 2024
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Abstract
Background: People with spinal cord injuries (SCIs) often have trouble remaining active because of paralysis. In the past, exercise recommendations focused on the non-paralyzed muscles in the arms, which provides limited benefits. However, recent studies show that electrical stimulation can help engage the [...] Read more.
Background: People with spinal cord injuries (SCIs) often have trouble remaining active because of paralysis. In the past, exercise recommendations focused on the non-paralyzed muscles in the arms, which provides limited benefits. However, recent studies show that electrical stimulation can help engage the paralyzed extremities, expanding the available muscle mass for exercise. Methods: The authors provide an evidence-based approach using expertise from diverse fields, supplemented by evidence from key studies toward the management of electrical stimulation therapies in individuals with SCIs. Literature searches were performed separately using the PubMed, Medline, and Google Scholar search engines. The keywords used for the searches included functional electrical stimulation cycling, hybrid cycling, neuromuscular electrical stimulation exercise, spinal cord injury, cardiovascular health, metabolic health, muscle strength, muscle mass, bone mass, upper limb treatment, diagnostic and prognostic use of functional electrical stimulation, tetraplegic hands, and hand deformities after SCI. The authors recently presented this information in a workshop at a major rehabilitation conference. Additional information beyond what was presented at the workshop was added for the writing of this paper. Results: Functional electrical stimulation (FES) cycling can improve aerobic fitness and reduce the risk of cardiovascular and metabolic diseases. The evidence indicates that while both FES leg cycling and neuromuscular electrical stimulation (NMES) resistance training can increase muscle strength and mass, NMES resistance training has been shown to be more effective for producing muscle hypertrophy in individual muscle groups. The response to the electrical stimulation of muscles can also help in the diagnosis and prognosis of hand dysfunction after tetraplegia. Conclusions: Electrical stimulation activities are safe and effective methods for exercise and testing for motor neuron lesions in individuals with SCIs and other paralytic or paretic conditions. They should be considered part of a comprehensive rehabilitation program in diagnosing, prognosing, and treating individuals with SCIs to improve function, physical activity, and overall health. Full article
(This article belongs to the Special Issue Clinical Management and Rehabilitation of Spinal Cord Injury)
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17 pages, 504 KiB  
Review
Spinal Cord Injury Management Based on Microglia-Targeting Therapies
by Thomas Gabriel Schreiner, Oliver Daniel Schreiner and Romeo Cristian Ciobanu
J. Clin. Med. 2024, 13(10), 2773; https://doi.org/10.3390/jcm13102773 - 8 May 2024
Viewed by 765
Abstract
Spinal cord injury is a complicated medical condition both from the clinician’s point of view in terms of management and from the patient’s perspective in terms of unsatisfactory recovery. Depending on the severity, this disorder can be devastating despite the rapid and appropriate [...] Read more.
Spinal cord injury is a complicated medical condition both from the clinician’s point of view in terms of management and from the patient’s perspective in terms of unsatisfactory recovery. Depending on the severity, this disorder can be devastating despite the rapid and appropriate use of modern imaging techniques and convenient surgical spinal cord decompression and stabilization. In this context, there is a mandatory need for novel adjunctive therapeutic approaches to classical treatments to improve rehabilitation chances and clinical outcomes. This review offers a new and original perspective on therapies targeting the microglia, one of the most relevant immune cells implicated in spinal cord disorders. The first part of the manuscript reviews the anatomical and pathophysiological importance of the blood-spinal cord barrier components, including the role of microglia in post-acute neuroinflammation. Subsequently, the authors present the emerging therapies based on microglia modulation, such as cytokines modulators, stem cell, microRNA, and nanoparticle-based treatments that could positively impact spinal cord injury management. Finally, future perspectives and challenges are also highlighted based on the ongoing clinical trials related to medications targeting microglia. Full article
(This article belongs to the Special Issue Clinical Management and Rehabilitation of Spinal Cord Injury)
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Other

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14 pages, 1629 KiB  
Systematic Review
Comprehensive Insights into Metastasis-Associated Spinal Cord Compression: Pathophysiology, Diagnosis, Treatment, and Prognosis: A State-of-the-Art Systematic Review
by Michail Vavourakis, Evangelos Sakellariou, Athanasios Galanis, Panagiotis Karampinas, Dimitrios Zachariou, Georgios Tsalimas, Vasileios Marougklianis, Evangelia Argyropoulou, Meletis Rozis, Angelos Kaspiris and Spiros G. Pneumatikos
J. Clin. Med. 2024, 13(12), 3590; https://doi.org/10.3390/jcm13123590 - 19 Jun 2024
Viewed by 474
Abstract
Background: Spinal cord compression is a formidable complication of advanced cancer, and clinicians of copious specialities often have to encounter significant complex challenges in terms of diagnosis, management, and prognosis. Metastatic lesions from cancer are a common cause of spinal cord compression, affecting [...] Read more.
Background: Spinal cord compression is a formidable complication of advanced cancer, and clinicians of copious specialities often have to encounter significant complex challenges in terms of diagnosis, management, and prognosis. Metastatic lesions from cancer are a common cause of spinal cord compression, affecting a substantial portion of oncology patients, and only in the US has the percentage risen to 10%. Acute metastasis-correlated spinal cord compression poses a considerable clinical challenge, necessitating timely diagnosis and intervention to prevent neurological deficits. Clinical presentation is often non-specific, emphasizing the importance of thorough evaluation and appropriate differential diagnosis. Diagnostic workup involves various imaging modalities and laboratory studies to confirm the diagnosis and assess the extent of compression. Treatment strategies focus on pain management and preserving spinal cord function without significantly increasing patient life expectancy, while multidisciplinary approaches are often required for optimal outcomes. Prognosis depends on several factors, highlighting the importance of early intervention. We provide an up-to-date overview of acute spinal cord compression in metastases, accentuating the importance of comprehensive management strategies. Objectives: This paper extensively explores the pathophysiology, clinical presentation, diagnostic strategies, treatment modalities, and prognosis associated with spinal cord metastases. Materials and Methods: A systematic literature review was conducted in accordance with the PRISMA guidelines. Conclusions: We aim to help healthcare professionals make informed clinical decisions when treating patients with spinal cord metastases by synthesizing current evidence and clinical insights. Full article
(This article belongs to the Special Issue Clinical Management and Rehabilitation of Spinal Cord Injury)
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