Rehabilitation of spinal cord injuries

Table 2 Therapeutic strategies and results of clinical studies related to the rehabilitation of patients with spinal cord injury

Ref.	Therapeutic strategy	Results
Mehrholz et al[17]	Locomotor training for walking after spinal cord injury	There is insufficient evidence from RCTs to conclude that any one locomotor training strategy improves walking function more than another for the patients with SCI. The effects of robotic-assisted locomotor training are not clear, therefore research in the form of large RCTs, particularly for robotic training, is needed. Specific questions about which type of locomotor training might be most effective in improving walking function for the patients with SCI need to be explored
Berlowitz et al[18]	Respiratory muscle training for cervical spinal cord injury	Inspite of the relatively small number of studies included in this review, meta-analysis of the pooled data indicates that RMT is effective for increasing respiratory muscle strength and perhaps also lung volumes for people with cervical SCI. Further research is needed on functional outcomes following RMT, such as dyspnea, cough efficacy, respiratory complications, hospital admissions, and quality of life. In addition, longer-term studies are needed to ascertain optimal dosage and determine any over effects of RMT on respiratory function, quality of life, respiratory morbidity and mortality
Domingo et al[19]	A systematic review of the effects of pharmacological agents on walking function in people with spinal cord injury	There is limited evidence that pharmacological agents tested so far would facilitate the recovery of walking after SCI. More studies are needed to better understand the effects of drugs combined with gait training on walking outcomes in people with SCI
Wessels et al[20]	Body weight-supported gait training for restoration of walking in people with an incomplete spinal cord injury: a systematic review	Subjects with subacute motor incomplete spinal cord injury reached a higher level of independent walking after over ground training, compared with body weight-supported treadmill training. More randomized controlled trials are needed to clarify the effectiveness of body weight-supported gait training on walking, activities of daily living and quality of life for subgroups of persons with an incomplete spinal cord injury
Taricco et al[21]	Pharmacological interventions for spasticity following spinal cord injury	There is insufficient evidence to assist clinicians in a rational approach to antispastic treatment for SCI. Further research is urgently needed to improve the scientific basis of patient care
Hitzig et al[22]	Randomized trial of functional electrical stimulation therapy for walking in incomplete spinal cord injury: effects on quality of life and community participation	The present study provides insight into the perceived benefits acquired by participating in an RCT comparing exercises to FES therapy and serves as a model for pinpointing domains of well-being that could be targeted for assessment in future SCI trials
Astorino et al[23]	Effect of chronic activity-based therapy on bone mineral density and bone turnover in persons with spinal cord injury	Chronic activity-based therapy did not reverse bone loss typically observed soon after injury, yet reductions in BMD were less than the expected magnitude of decline in lower extremity BMD in persons with recent SCI
Sadowsky et al[24]	Lower extremity functional electrical stimulation cycling promotes physical and functional recovery in chronic spinal cord injury	FES during cycling in chronic SCI may provide substantial physical integrity benefits, including enhanced neurological and functional performance, increased muscle size and force-generation potential, reduced spasticity, and improved quality of life
Gorgey et al[25]	Neuromuscular electrical stimulation attenuates high skeletal muscles atrophy but not trunk muscles after spinal cord injury	NMES can delay the process of progressive skeletal muscle atrophy after chronic SCI However, the effects are localized to the trained high muscles and do not extend to the proximal trunk muscles
Karimi et al[26]	Robotic rehabilitation of spinal cord injury individual	Although various types of orthotic systems have been developed for paraplegic subjects for walking and rehabilitation, there is not enough research in this regard. It is not easy to determine the therapeutic influence of robotic orthosis on the health status of paraplegic subjects There is a huge gap for a randomized clinical trial research to determine the effect of robotic system on the health status of the SCI subjects
Karimi et al[27]	Functional walking ability of paraplegic patients: comparison of functional electrical stimulation vs mechanical orthoses	FES and hybrid orthoses offer considerable potential for restoring standing and walking abilities in persons with SCI. However, improvements in their designs and operation with subsequent objective evaluations are required to demonstrate that the systems enable users to improve their performance over that currently possible with passive, mechanical orthoses

SCI: Spinal cord injury; FES: Functional Electrical Stimulation; RCTs: Randomized controlled studies.