A Systematic Review of the Scientific Literature for Rehabilitation/Habilitation Among Individuals With Pediatric-Onset Spinal Cord Injury

Abstract

Objectives To conduct a systematic review to examine the scientific literature for rehabilitation/habilitation among individuals with pediatric-onset spinal cord injury (SCI). Methods A literature search of multiple databases (i.e., PubMed/MEDLINE, CINAHL, EMBASE, PsychINFO) was conducted and was filtered to include studies involving humans, published as full-length articles up to December 2020, and in English. Included studies met the following inclusion criteria: (1) ≥50% of the study sample had experienced a traumatic, acquired, nonprogressive spinal cord injury (SCI) or a nontraumatic, acquired, noncongenital SCI; (2) SCI onset occurred at ≤21 years of age; and (3) sample was assessed for a rehabilitation/habilitation-related topic. Studies were assigned a level of evidence using an adapted Sackett scale modified down to five levels. Data extracted from each study included author(s), year of publication, country of origin, study design, subject characteristics, rehabilitation/habilitation topic area, intervention (if applicable), and outcome measures. Results One hundred seventy-six studies were included for review (1974–2020) with the majority originating from the United States (81.3%). Most studies were noninterventional observational studies (n = 100; 56.8%) or noninterventional case report studies (n = 5; 2.8%). Sample sizes ranged from 1 to 3172 with a median of 26 (interquartile range [IQR], 116.5). Rehabilitation/habilitation topics were categorized by the International Classification of Functioning, Disability and Health (ICF); most studies evaluated ICF Body Function. There were 69 unique clinical health outcome measures reported. Conclusion The evidence for rehabilitation/habilitation of pediatric-onset SCI is extremely limited; nearly all studies (98%) are level 4–5 evidence. Future studies across several domains should be conducted with novel approaches to research design to alleviate issues related to sample sizes and heterogeneity.

Pediatric Spinal Cord Injury: A Review

“…Although a pediatric SCI is a devastating condition that can cause lifelong neurological sequela impacting the individual and their family, the research on rehabilitation in this population is still scarce, focusing mainly on the adult group [ 127 ]. Recently, a project named The Spinal Cord Injury Rehabilitation Evidence (SCIRE) commenced a combined effort to produce chapters on relevant topics related to SCIs in the pediatric population [ 127 ], but there is still a lack of research on this area to fill in the gaps. It is important to acknowledge that the rehabilitation of these patients is complex and involves their mental, physical, and social health.…”

“…Mental illness, especially depression, is common in individuals with an SCI. It is estimated that 22% of the adult population presents with depression [ 50 ] but in the pediatric population, the prevalence seems to be lower [ 127 , 128 ], with a certain predominance in older adolescents (12–18 years). Anxiety is more common in older female adolescents, and clinical factors such as a short duration of injury are more associated with mental-illness development [ 129 ].…”

“…Nevertheless, it is also important to focus on cardiovascular care and skin health. Although evidence regarding cardiovascular care is very limited in pediatric medicine [ 127 ], relevant studies targeted general outcomes, including body composition (i.e., total lean mass, fat mass, % body fat, and bone mineral content/density), anthropometric measures (i.e., weight, height, and body mass index), metabolic efficiency (e.g., fasting lipids/glucose and resting metabolism rate), cardio-respiratory function (e.g., heart rate), and functional performance (e.g., muscle strength and power input) [ 127 ]. Overall, the pediatric population with SCIs exhibits body composition changes such as higher fat mass, lower total lean mass, and increased body mass index, amongst other changes that can predispose an individual to poor cardiovascular health [ 130 , 131 , 132 , 133 , 134 , 135 ].…”

“…Returning to school is a primary rehabilitation goal, and physical accessibility and social participation must be reassured. It is important to involve the physical and occupational therapist in this process, as well as use assistive technology and include the child’s perspective on this process [ 127 , 150 , 151 ]. Community integration is also important, and it may mitigate some of the long-term consequences of SCI.…”

Brain Activation Evoked by Motor Imagery in Pediatric Patients with Complete Spinal Cord Injury

“…1 It can occur at any age, including childhood, not only causing a heavy burden on the families but also having serious consequences for children's physical and mental well-being. 2 The most common rehabilitation strategy used in patients with incomplete spinal cord injury is physical training, which is intended to promote cortical plasticity by driving motor neural networks and facilitating functionally relevant muscle activity below the injury level. 3 However, due to the complete disruption of afferent and efferent pathways, 4 pediatric patients with complete spinal cord injury (CSCI) are not able to execute physical movement.…”