Traumatic and non-traumatic spinal cord lesions: an Italian comparison of neurological and functional outcomes

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Overground robotic training effects on walking and secondary health conditions in individuals with spinal cord injury: systematic review

Overground powered lower limb exoskeletons (EXOs) have proven to be valid devices in gait rehabilitation in individuals with spinal cord injury (SCI). Although several articles have reported the effects of EXOs in these individuals, the few reviews available focused on specific domains, mainly walking. The aim of this systematic review is to provide a general overview of the effects of commercial EXOs (i.e. not EXOs used in military and industry applications) for medical purposes in individuals with SCI. This systematic review was conducted following the PRISMA guidelines and it referred to MED-LINE, EMBASE, SCOPUS, Web of Science and Cochrane library databases. The studies included were Randomized Clinical Trials (RCTs) and non-RCT based on EXOs intervention on individuals with SCI. Out of 1296 studies screened, 41 met inclusion criteria. Among all the EXO studies, the Ekso device was the most discussed, followed by ReWalk, Indego, HAL and Rex devices. Since 14 different domains were considered, the outcome measures were heterogeneous. The most investigated domain was walking, followed by cardiorespiratory/metabolic responses, spasticity, balance, quality of life, human–robot interaction, robot data, bowel functionality, strength, daily living activity, neurophysiology, sensory function, bladder functionality and body composition/bone density domains. There were no reports of negative effects due to EXOs trainings and most of the significant positive effects were noted in the walking domain for Ekso, ReWalk, HAL and Indego devices. Ekso studies reported significant effects due to training in almost all domains, while this was not the case with the Rex device. Not a single study carried out on sensory functions or bladder functionality reached significance for any EXO. It is not possible to draw general conclusions about the effects of EXOs usage due to the lack of high-quality studies as addressed by the Downs and Black tool, the heterogeneity of the outcome measures, of the protocols and of the SCI epidemiological/neurological features. However, the strengths and weaknesses of EXOs are starting to be defined, even considering the different types of adverse events that EXO training brought about. EXO training showed to bring significant improvements over time, but whether its effectiveness is greater or less than conventional therapy or other treatments is still mostly unknown. High-quality RCTs are necessary to better define the pros and cons of the EXOs available today. Studies of this kind could help clinicians to better choose the appropriate training for individuals with SCI

An international survey of the structure and process of care for traumatic spinal cord injury in acute and rehabilitation facilities: lessons learned from a pilot study

Background: To describe the key findings and lessons learned from an international pilot study that surveyed spinal cord injury programs in acute and rehabilitation facilities to understand the status of spinal cord injury care. Methods: An online survey with two questionnaires, a 74-item for acute care and a 51-item for rehabilitation, was used. A subset of survey items relevant to the themes of specialized care, timeliness, patient-centeredness, and evidence-based care were operationalized as structure or process indicators. Percentages of facilities reporting the structure or process to be present, and percentages of indicators met by each facility were calculated and reported separately for facilities from high-income countries (HIC) and from low and middle-income countries (LMIC) to identify “hard to meet” indicators defined as those met by less than two-thirds of facilities and to describe performance level. Results: A total of 26 acute and 26 rehabilitation facilities from 25 countries participated in the study. The comparison of the facilities based on the country income level revealed three general observations: 1) some indicators were met equally well by both HIC and LMIC, such as 24-hour access to CT scanners in acute care and out-patient services at rehabilitation facilities; 2) some indicators were hard to meet for LMIC but not for HIC, such as having a multidisciplinary team for both acute and rehabilitation settings; and 3) some indicators were hard to meet by both HIC and LMIC, including having peer counselling programs. Variability was also observed for the same indicator between acute and rehabilitation facilities, and a wide range in the total number of indicators met among HIC facilities (acute 59–100%; rehabilitation 36–100%) and among LMIC facilities (acute: 41–82%; rehabilitation: 36–93%) was reported. Conclusions: Results from this international pilot study found that the participating acute and rehabilitation facilities on average adhered to 74% of the selected indicators, suggesting that the structure and processes to provide ideal traumatic spinal cord injury care were broadly available. Recruiting a representative sample of SCI facilities and incorporating regional attributes in future surveys will be helpful to examine factors affecting adherence to indicators

Service engagement in interventions for street-connected children and young people: a summary of evidence supplementing a recent Cochrane–Campbell review

Abstract Background This paper builds on a Cochrane–Campbell systematic review of interventions that reduce harms and promote reintegration in street-connected children and young people focusing on intervention outcomes. The aim of the present analysis is to explore questions raised in the systematic review over the potential role of service engagement in mediating outcomes of relevant interventions. Objective The paper summarises engagement-related findings from quantitative intervention evaluations with street-connected populations of children and young people, as reported by study authors. It seeks to contribute to theoretical and methodological understandings of service engagement with street-connected youth populations and to highlight gaps in current knowledge. Methods Drawing on the original search for the Cochrane–Campbell review, we rescreened search results in our database and included quantitative findings if relevant to our current research questions, regardless of study design. Additionally, we sought new study publications from authors whose work was included in the original systematic review. The discussion explores relevant data from five studies included in the original systematic review, ten studies excluded from the review, and two studies published after the completion of the review. Results The measures of service engagement in the included studies focused on treatment attendance, ‘level of engagement’, and service satisfaction. Evidence on the impact of service engagement on other outcomes in interventions for street-connected children and young people was limited. Available data on the predictors and impact of service engagement were mixed and appear not to provide robust support for common hypotheses in the relevant context

Rehabilitation of hand function after spinal cord injury using a novel handgrip device: a pilot study

BackgroundActivity-based therapy (ABT) for patients with spinal cord injury (SCI), which consists of repetitive use of muscles above and below the spinal lesion, improves locomotion and arm strength. Less data has been published regarding its effects on hand function. We sought to evaluate the effects of a weekly hand-focused therapy program using a novel handgrip device on grip strength and hand function in a SCI cohort.MethodsPatients with SCI were enrolled in a weekly program that involved activities with the MediSens (Los Angeles, CA) handgrip. These included maximum voluntary contraction (MVC) and a tracking task that required each subject to adjust his/her grip strength according to a pattern displayed on a computer screen. For the latter, performance was measured as mean absolute accuracy (MAA). The Spinal Cord Independence Measure (SCIM) was used to measure each subject's independence prior to and after therapy.ResultsSeventeen patients completed the program with average participation duration of 21.3 weeks. The cohort included patients with American Spinal Injury Association (ASIA) Impairment Scale (AIS) A (n = 12), AIS B (n = 1), AIS C (n = 2), and AIS D (n = 2) injuries. The average MVC for the cohort increased from 4.1 N to 21.2 N over 20 weeks, but did not reach statistical significance. The average MAA for the cohort increased from 9.01 to 21.7% at the end of the study (p = .02). The cohort's average SCIM at the end of the study was unchanged compared to baseline.ConclusionsA weekly handgrip-based ABT program is feasible and efficacious at increasing hand task performance in subjects with SCI

Visión de jóvenes Costarricenses, de zonas rurales, en un programa de rehabilitación, sobre el consumo de drogas

Este estudio cualitativo tuvo como objetivo investigar la visión de jóvenes Costarricenses, institucionalizados en dos organizaciones no gubernamentales de Costa Rica, sobre el consumo de drogas ilícitas. Se aplicó la técnica de grupo focal para que los adolescentes expresasen sus sentimientos y sus vivencias acerca del consumo de drogas ilícitas. Entre los resultados se obtuvo que la percepción de los adolescentes sobre sí mismo tiene como enfoque un proceso de cambio y de desarrollo de la identidad y experimentación que los hace tomar decisiones negativas, como es el consumo de drogas. También, se encontró que las relaciones que tienen con sus padres son conflictivas debido a que provienen de hogares disfuncionales y de comunidades marginales. Los amigos representan el apoyo a sus vicisitudes y la inducción del consumo. Se concluye que es necesario que Costa Rica modifique y cree nuevas políticas públicas para mejorar la calidad de vida de este grupo poblacional.Trata-se de estudo qualitativo que teve como objetivo investigar a visão de jovens costarriquenhos, institucionalizados em duas organizações não-governamentais de Costa Rica, sobre o consumo de drogas ilícitas. A técnica de grupo focal foi aplicada para que os adolescentes expressassem seus sentimentos e suas vivências sobre o processo de consumo de drogas ilícitas. Entre os resultados, obteve-se que a percepção que os adolescentes têm de si mesmos está focada em processo de mudança e de desenvolvimento da identidade e experimentação que os faz tomar decisões negativas, como o consumo de drogas. As relações que têm com seus pais são conflitantes por virem de lares disfuncionais e de comunidades marginalizadas. Os amigos representam o apoio às suas vicissitudes e à indução do consumo. Há necessidade de o Estado de Costa Rica delimitar políticas públicas para melhorar a qualidade de vida dessa população.This qualitative study aimed to investigate the view of adolescents following rehabilitation programs about the consumption of illicit drugs. It was carried out in two Non-Governmental Organizations in Costa Rica. The focus group technique was applied, aiming to allow adolescents to express their feelings and experiences regarding illicit drug consumption. Results showed that the perception adolescents have of themselves is focused on a process of change and development of their identity and experimentation, which influence them in taking negative decisions like drug consumption. The relationships they have with their parents are conflicting, as they come from dysfunctional homes and marginal communities. Friends represent support for their difficulties and lead to drug consumption. The state of Costa Rica needs to define public policies to improve the lives of this population