Efficacy of Virtual Reality in Upper Limb Rehabilitation in Patients with Spinal Cord Injury: A Pilot Randomized Controlled Trial

STUDY DESIGN: Pilot randomized controlled trial. PURPOSE: To compare the efficacy between virtual reality intervention (using Nintendo Wii) along with conventional occupational therapy and conventional occupational therapy alone in improving upper limb function in patients with spinal cord injury (SCI). OVERVIEW OF LITERATURE: The use of virtual reality has gained importance in the rehabilitation sector over the last few years. Nintendo Wii has the potential to encourage upper limb function while engaging in an interesting activity, which is important in long-term interventions, such as the treatment of SCI. METHODS: Overall, 22 patients with SCI participated in the study. They were randomly assigned to two groups. Group I received 30 minutes of virtual reality intervention (using Nintendo Wii) and 30 minutes of conventional therapy, whereas group II received conventional therapy only for 30 minutes. Both groups received therapy 3 days a week for 4 weeks. One hand of each patient was identified as the target hand based on the inclusion criteria. All patients were assessed at baseline, 2 weeks and 4 weeks (post-intervention), and 6 weeks (follow-up). The functional ability of the target hand was assessed using the Capabilities of Upper Extremity (CUE) questionnaire. Gross motor dexterity was assessed using the Box and Block Test (BBT). The level of independence in activities of daily living was assessed by the Spinal Cord Independence Measure-Self Report and quality of life by the World Health Organization Quality of Life-BREF. RESULTS: After 4 weeks of intervention, there was no significant difference in improved hand function between the groups. Mean scores were higher for group I than for group II, with a higher percent change (31.5% in CUE questionnaire and 51.7% in BBT) in group I. CONCLUSIONS: Virtual reality along with conventional therapy produces similar results in upper limb function as does conventional therapy alone.

Functional and Radiological Outcomes of Anterior Decompression and Posterior Stabilization via Posterior Transpedicular Approach in Thoracic and Thoracolumbar Pott's Disease: A Retrospective Study

STUDY DESIGN: This is a retrospective study. PURPOSE: To determine the efficacy and safety of a posterior transpedicular approach with regard to functional and radiological outcomes in people with thoracic and thoracolumbar spinal tuberculosis. OVERVIEW OF LITERATURE: Spinal tuberculosis can cause serious morbidity, including permanent neurological deficits and severe deformities. Medical treatment or a combination of medical and surgical strategies can control the disease in most patients, thereby decreasing morbidity incidence. A debate always existed regarding whether to achieve both decompression and stabilization via a combined anterior and posterior approach or a single posterior approach exists. METHODS: The study was conducted at the Indian Spinal injuries Centre and included all patients with thoracic and thoracolumbar Pott's disease who were operated via a Posterior transpedicular approach. Data regarding 60 patients were analyzed with respect to the average operation time, preoperative and postoperative, 6 months and final follow-up American Spinal Injury Association (ASIA) grading, bony fusion, implant loosening, implant failure, preoperative, postoperative, 6 months and final follow-up kyphotic angles, a loss of kyphotic correction, Oswestry disability index (ODI) score, and visual analog scale (VAS) score. Data were analyzed using either a paired t -test or a Wilcoxon Signed Rank test. RESULTS: The mean operation time was 260±30 minutes. Fifty-five patients presented with evidence of successful bony fusion within a mean period of 6±1.5 months. Preoperative dorsal and lumbar angles were significantly larger than postoperative angles, which were smaller than final follow-up angles. The mean kyphotic correction achieved was 12.11±14.8, with a mean decrease of 5.97 and 19.1 in VAS and ODI scores, respectively. CONCLUSIONS: Anterior decompression and posterior stabilization via a posterior transpedicular approach are safe and effective procedures, with less intraoperative surgical duration and significant improvements in clinical and functional status.