ABSTRACT
BACKGROUND: Complete spinal cord injury (SCI) is characterized by permanent loss of nerve impulse propagation through the injury level leading to complete loss of voluntary muscle contraction. However, clinically undetectable top-down modulation of lower limbs might be present and can be evidenced using surface electromyography (sEMG). CASE REPORT: A subject with complete chronic SCI and no spasticity presents voluntary modulation of sEMG signal during a task-specific activity associated with sensory input. CLINICAL REHABILITATION IMPACT: We present for the first time the spectral characterization of sEMG signal in response to orthostatic training associated with voluntary movement attempts in complete SCI. Behavior of sEMG signal varied according to kinematic properties of movement, reinforcing the voluntary influence of efferent pathways on motor output. Our findings will contribute to elaborate evaluation protocols to investigate the preservation of corticospinal activities, and to evolve more accessible strategies in a clinical setting.
Subject(s)
Spinal Cord Injuries , Electromyography/methods , Humans , Movement , Muscle Contraction , Muscle Spasticity/complications , Muscle, Skeletal/physiology , Spinal Cord Injuries/rehabilitationABSTRACT
BACKGROUND: Spinal cord injury (SCI) is characterized by a total or partial deficit of sensory and motor pathways. Impairments of this injury compromise muscle recruitment and motor planning, thus reducing functional capacity. SCI patients commonly present psychological, intestinal, urinary, osteomioarticular, tegumentary, cardiorespiratory and neural alterations that aggravate in chronic phase. One of the neurorehabilitation goals is the restoration of these abilities by favoring improvement in the quality of life and functional independence. Current literature highlights several benefits of robotic gait therapies in SCI individuals. OBJECTIVES: The purpose of this study was to compare the robotic gait devices, and systematize the scientific evidences of these devices as a tool for rehabilitation of SCI individuals. METHODS: A systematic review was carried out in which relevant articles were identified by searching the following databases: Cochrane Library, PubMed, PEDro and Capes Periodic. Two authors selected the articles which used a robotic device for rehabilitation of spinal cord injury. RESULTS: Databases search found 2941 articles, 39 articles were included due to meet the inclusion criteria. The robotic devices presented distinct features, with increasing application in the last years. Studies have shown promising results regarding the reduction of pain perception and spasticity level; alteration of the proprioceptive capacity, sensitivity to temperature, vibration, pressure, reflex behavior, electrical activity at muscular and cortical level, classification of the injury level; increase in walking speed, step length and distance traveled; improvements in sitting posture, intestinal, cardiorespiratory, metabolic, tegmental and psychological functions. CONCLUSIONS: This systematic review shows a significant progress encompassing robotic devices as an innovative and effective therapy for the rehabilitation of individuals with SCI.
