Robot-Assisted Training for People With Spinal Cord Injury: A Meta-Analysis.

OBJECTIVE: To investigate the effects of robot-assisted training on the recovery of people with spinal cord injury (SCI). DATA SOURCES: Randomized controlled trials (RCTs) or quasi-RCTs involving people with SCI that compared robot-assisted upper limbs or lower limbs training with a control of other treatment approach or no treatment. We included studies involving people with complete or incomplete SCIs. STUDY SELECTION: We searched MEDLINE, CINAHL, Cochrane Central Register of Controlled Trials (Cochrane Library), and Embase to August 2016. Bibliographies of relevant articles on the effect of body-weight-supported treadmill training on subjects with SCI were screened to avoid missing relevant articles from the search of databases. DATA EXTRACTION: All kinds of objective assessments concerning physical ability, mobility, and/or functional ability were included. Assessments could be clinical tests (ie, 6-minute walk test, FIM) or laboratory tests (ie, gait analysis). Subjective outcome measures were excluded from this review. DATA SYNTHESIS: Eleven RCT studies involving 443 subjects were included in the study. Meta-analysis was performed on the included studies. Walking independence (3.73; 95% confidence interval [CI], -4.92 to -2.53; P<.00001; I2=38%) and endurance (53.32m; 95% CI, -73.15 to -33.48; P<.00001; I2=0%) were found to have better improvement in robot-assisted training groups. Lower limb robot-assisted training was also found to be as effective as other types of body-weight-supported training. There is a lack of upper limb robot-assisted training studies; therefore, performing a meta-analysis was not possible. CONCLUSIONS: Robot-assisted training is an adjunct therapy for physical and functional recovery for patients with SCI. Future high-quality studies are warranted to investigate the effects of robot-assisted training on functional and cardiopulmonary recovery of patients with SCI.

Risk of fall for people with diabetes.

PURPOSE: To examine the risk of fall for people with diabetes compared with healthy control subjects. Correlation between tactile sensation and postural control was examined for subjects with diabetes. METHODS: Subjects with type 2 diabetes were classified into two groups: (i) diabetes without neuropathy (n = 23) and (ii) diabetic peripheral neuropathy (DPN) (n = 9). Age-matched healthy control subjects (n = 32) were recruited. Tactile sensation, equilibrium scores (ES), strategy scores and sensory analysis scores from the Sensory Organization Test (SOT) were compared among the groups. RESULTS: Subjects with diabetes without neuropathy demonstrated impaired postural control upon the disruption of somatosensory inputs. Subjects with DPN lost balance upon being deprived of visual inputs. A decrease in tactile sensation was associated with a decrease in the ESs in all subjects with diabetes (r = -0.35 to -0.77; p < 0.05), and they tend to use more hip strategy for postural control upon being deprived of visual inputs. CONCLUSIONS: Different postural control strategies are adopted by various subgroups of subjects with diabetes. Subjects with DPN demonstrated a significant shift from ankle to hip strategies for balance tests when vision was deprived. Implications for Rehabilitation The severity of diabetic peripheral neuropathy (DPN) is associated with the risk of fall. Different compensatory strategies in balance control have been adopted by different subgroups of people with diabetes. In order to minimize the risk of fall, specific balance training program should be offered to different subgroups of people with diabetes. The balance training should emphasize on optimizing the competence of their existing compensatory postural control strategies.