Wearable powered exoskeletons for gait training in tetraplegia: a systematic review on feasibility, safety and potential health benefits

Background: Recent developments in wearable powered exoskeletons (WPE) allow gait training (GT) for patients after spinal cord injury (SCI). Two recent meta-analyses on GT using WPE showed promising results for paraplegic patients (PP). To this date, there is no review focusing on tetraplegic patients (TP). Objectives: The main objective of this review was to assess feasibility and safety of GT using WPE in patients after tetraplegia. Method: This systematic review was performed according to PRISMA-S guidelines. Two independent reviewers searched several databases for studies on GT using WPE for TP. Primary outcomes concerned the number, type and severity of reported adverse events (AE). Secondary outcomes examined potential additional health benefits (AHB). Results: Forty-one studies (6 randomized trials, 24 cohorts and 11 cases series) were selected, including 166 TP, 26 with complete lesions (AIS A) and 71 with level of injury above C6. Minor AE were reported in 17 TP, concerning cutaneous, cardiovascular or musculoskeletal systems. Occurrence of AE is significantly higher in a PP population compared to TP (p-value = 0.001). Only one major AE concerned a TP. Studies of low level of evidence suggest that GT using WPE could lead to improvements in walking parameters, cardiovascular efficiency and to a reduction of spasticity. Discussion & conclusion: GT using WPE is a feasible and safe intervention for TP. To minimize occurrence of AE, a good patient selection and preparation is proposed. Future clinical trials should be performed to confirm current trends in terms of efficacy and potential AHB

Sympathetic skin response in spinal cord injured patients: preliminary report.

Sympathetic skin responses (SSRs) were recorded in six spinal cord injured patients. These SSRs were obtained at hands and feet, after electrical stimulation of the median or the posterior tibial nerves. Below the level of the lesion, SSRs had similar latencies than normal subjects, but were more inconstant, with a lesser amplitude and elicited after stronger stimulus intensity. The origin of these somatosympathetic reflexes are discussed. SSRs recordings seem to be a simple and suitable technique for investigation of the autonomic nervous system of the spinal cord injured patients

Rapport sur l'organisation de l'enseignement industriel,

Mode of access: Internet

Validation d'un questionnaire spécifique des troubles anorectaux dans la sclérose en plaques: STAR-Q

International audienceBackground: Bowel symptoms are commonly experienced by patients with Multiple sclerosis (PwMS), but no specific questionnaire validated in this population allows a rigorous assessment. Objective: Validation of a multidimensional questionnaire assessing bowel disorders in PwMS. Methods: A prospective, multicenter study was conducted between April 2020 and April 2021. The STAR-Q (Symptoms’ assessmenT of AnoRectal dysfunction Questionnaire), was built in 3 steps. First, literature review and qualitative interviews were performed to create the first version, discussed with a panel of experts. Then, a pilot study assessed comprehension, acceptation and pertinence of items. Finally, the validation study was designed to measure content validity, internal consistency reliability (alpha coefficient of Cronbach) and test–retest reliability [intraclass correlation coefficient (ICC)]. The primary outcome was good psychometric properties with Cronbach's α > 0.7 and ICC > 0.7. Results: We included 231 PwMS. Comprehension, acceptation and pertinence were good. STAR-Q showed a very good internal consistency reliability (Cronbach's α = 0.84) and test-retest reliability (ICC = 0.89). Final version of STAR-Q was composed of 3 domains corresponding in symptoms (Q1–Q14), treatment and constraints (Q15–Q18) and impact on quality of life (Q19). Three categories of severity were determined (STAR-Q ≤ 16: minor, between 17 and 20: moderate, and ≥ 21: severe). Conclusions: STAR-Q presents very good psychometric properties and allows a multidimensional assessment of bowel disorders in PwMS. Level of evidence: