A Comparison of FES and SCS for Neuroplastic Recovery After SCI: Historical Perspectives and Future Directions

There is increasing evidence that neuroplastic changes can occur even years after spinal cord injury, leading to reduced disability and better health which should reduce the cost of healthcare. In motor-incomplete spinal cord injury, recovery of leg function may occur if repetitive training causes afferent input to the lumbar spinal cord. The afferent input may be due to activity-based therapy without electrical stimulation but we present evidence that it is faster with electrical stimulation. This may be spinal cord stimulation or peripheral nerve stimulation. Recovery is faster if the stimulation is phasic and that the patient is trying to use their legs during the training. All the published studies are small, so all conclusions are provisional, but it appears that patients with more disability (AIS A and B) may need to continue using stimulation and for them, an implanted stimulator is likely to be convenient. Patients with less disability (AIS C and D) may make useful recovery and improve their quality of life from a course of therapy. This might be locomotion therapy but we argue that cycling with electrical stimulation, which uses biofeedback to encourage descending drive, causes rapid recovery and might be used with little supervision at home, making it much less expensive. Such an electrical therapy followed by conventional physiotherapy might be affordable for the many people living with chronic SCI. To put this in perspective, we present some information about what...
Source: Frontiers in Neurology - Category: Neurology Source Type: research

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CONCLUSION: Our results highlight that employment plays an important role in QoL for individuals who sustained a TSCI. They also suggest that increased time since the injury is most likely to provide individuals an opportunity to develop efficient coping strategies, allowing for greater overall adjustment and life satisfaction, leading to a better quality of life. IMPLICATIONS FOR REHABILITATION Since the time of the injury was found to be improved QoL, there is a need to improve the health care system of Individuals with SCI. As the employment is a significant factor positively influencing QoL, vocational rehabilitation p...
Source: Disability and Rehabilitation - Category: Rehabilitation Authors: Tags: Disabil Rehabil Source Type: research
Eye typing is a hands-free method of human computer interaction, which is especially useful for people with upper limb disabilities. Users select a desired key by gazing at it in an image of a keyboard for a fixed dwell time. There is a tradeoff in selecting the dwell time; shorter dwell times lead to errors due to unintentional selections, while longer dwell times lead to a slow input speed. We propose to speed up eye typing while maintaining low error by dynamically adjusting the dwell time for each letter based on the past input history. More likely letters are assigned shorter dwell times. Our method is based on a prob...
Source: IEE Transactions on Neural Systems and Rehabilitation Engineering - Category: Neuroscience Source Type: research
Abstract Secondary axonal loss contributes to the persistent functional disability following trauma. Consequently, preserving axons following spinal cord injury (SCI) is a major therapeutic goal to improve neurological outcome; however, the complex molecular mechanisms that mediate secondary axonal degeneration remain unclear. We previously showed that IP3R-mediated Ca2+ release contributes to axonal dieback and axonal loss following an ex vivo laser-induced SCI. Nevertheless, targeting IP3R in a clinically relevant in vivo model of SCI and determining its contribution to secondary axonal degeneration has yet to b...
Source: Neurobiology of Disease - Category: Neurology Authors: Tags: Neurobiol Dis Source Type: research
We describe pain intensity and interference at baseline and 1 year postinjury in burn, traumatic brain injury (TBI), and spinal cord injury (SCI) survivors and compare them with the general population (GP). We tested a custom Patient Reported Outcomes Measurement Information System (PROMIS) pain interference short form developed for use in trauma populations. METHODS We administered a pain intensity numerical rating scale and custom PROMIS pain interference short forms at baseline and/or 1 year postinjury from participants (≥18 years) at three Model System projects (burn, TBI, and SCI). Scores were compared across in...
Source: Journal of Trauma and Acute Care Surgery - Category: Surgery Tags: BRIEF REPORTS Source Type: research
Conclusion: We have identified multiple areas of interest in the design and production of educational resources for individuals with SCI. PMID: 32970969 [PubMed - as supplied by publisher]
Source: Journal of Spinal Cord Medicine - Category: Orthopaedics Tags: J Spinal Cord Med Source Type: research
CONCLUSIONS: A brief spiritual care training program can impact positively upon perceptions and practice of rehabilitation professionals. Ongoing training is needed to ensure that staff retain what was learnt. IMPLICATIONS FOR REHABILITATION Brief spiritual care training can impact positively upon rehabilitation professionals' perceptions of spirituality and lead to practice change in the delivery of spiritual care across many clinical disciplines. The stories of patients and family members are powerful staff education tools in spiritual care training. Client spirituality is an under recognised resource that staff can draw...
Source: Disability and Rehabilitation - Category: Rehabilitation Authors: Tags: Disabil Rehabil Source Type: research
CONCLUSIONS: The current implementation of wheelchair and seating assistive technology provision as described in this paper impacts the ability of individuals living with an SCI to participate as equal members of society. A review of wheelchair provision is essential to optimize access to services for appropriate wheelchairs. IMPLICATIONS FOR REHABILITATION As a basic human right, appropriate wheelchair and seating assistive technology provision facilitates people's optimal independence, health and well-being, social engagement, and participation in everyday life. The development of adequate wheelchair services should be a...
Source: Disability and Rehabilitation - Category: Rehabilitation Authors: Tags: Disabil Rehabil Source Type: research
This study investigates whether individual and country-level characteristics predict the partnership status and the living situation of persons with spinal cord injury (SCI) from 22 countries. We used data from 12,591 participants of the International SCI Community Survey (InSCI) and regressed partnership status and living situation on individual (sociodemographic and injury characteristics) and country-level characteristics (Human Development Index, HDI) using multilevel models. Females, younger persons, those with lower income, without paid work, more severe injuries, and longer time since injury were more often single. ...
Source: International Journal of Environmental Research and Public Health - Category: Environmental Health Authors: Tags: Article Source Type: research
ner As the world’s population gradually grows older, more and more adults are experiencing sensory–motor disabilities due to stroke, traumatic brain injury, spinal cord injury and other diseases [...]
Source: Sensors - Category: Biotechnology Authors: Tags: Editorial Source Type: research
CONCLUSIONS: The findings from this study highlight the importance of looking beyond individual factors to consider the social and environmental factors that support continued independence and participation in society as people living with long term SCI experience their aging process. Qualitative research that delves further into the dynamics behind this process is needed to fully anticipate the needs of this growing population. IMPLICATIONS FOR REHABILITATION People aging with spinal cord injury (SCI) who are engaged in their social and physical environments have become increasingly adaptive when faced with accelerating a...
Source: Disability and Rehabilitation - Category: Rehabilitation Authors: Tags: Disabil Rehabil Source Type: research
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