Monitoring Upper Limb Recovery after Cervical Spinal Cord Injury: Insights beyond Assessment Scores

Abstract

BackgroundPreclinical investigations in animal models demonstrate that enhanced upper limb (UL) activity during rehabilitation promotes motor recovery following spinal cord injury (SCI). Despite this, following SCI in humans, no commonly applied training protocols exist, and therefore, activity-based rehabilitative therapies (ABRT) vary in frequency, duration, and intensity. Quantification of UL recovery is limited to subjective questionnaires or scattered measures of muscle function and movement tasks.ObjectiveTo objectively measure changes in UL activity during acute SCI rehabilitation and to assess the value of wearable sensors as novel measurement tools that are complimentary to standard clinical assessments tools.MethodsThe overall amount of UL activity and kinematics of wheeling were measured longitudinally with wearable sensors in 12 thoracic and 19 cervical acute SCI patients (complete and incomplete). The measurements were performed for up to seven consecutive days, and simultaneously, SCI-specific assessments were made during rehabilitation sessions 1, 3, and 6 months after injury. Changes in UL activity and function over time were analyzed using linear mixed models.ResultsDuring acute rehabilitation, the overall amount of UL activity and the active distance wheeled significantly increased in tetraplegic patients, but remained constant in paraplegic patients. The same tendency was shown in clinical scores with the exception of those for independence, which showed improvements at the beginning of the rehabilitation period, even in paraplegic subjects. In the later stages of acute rehabilitation, the quantity of UL activity in tetraplegic individuals matched that of their paraplegic counterparts, despite their greater motor impairments. Both subject groups showed higher UL activity during therapy time compared to the time outside of therapy time.ConclusionTracking day-to-day UL activity is necessary to gain insights into the real impact of a patient’s impairments on their UL movements during therapy and during their leisure time. In the future, this novel methodology may be used to reliably control and adjust ABRT and to evaluate the progress of UL rehabilitation in clinical trials.

Estimation of Energy Expenditure in Wheelchair-Bound Spinal Cord Injured Individuals Using Inertial Measurement Units

“…There are, however, wheelchair users who cannot achieve a wheeling speed of 5 km/h and therefore cannot fulfill the proposed combination of extra calories and intensity. Nevertheless, these wheelchair users could try to reach the goal of 3 km/day, first, because even at lower speeds they reach the recommended daily goal of additional 75 kcal, and second, because 3 km per day is more than what an average wheelchair user travels per day (around 2 km) ( 57 , 58 , 67 , 68 ).…”

Upper Limb Robotic Rehabilitation for Patients With Cervical Spinal Cord Injury: A Comprehensive Review

“…[6,7] High-level spinal cord lesions could lead subjects to a high disability, considering the loss of arms and hands function related to detrimental consequences of functional impairment, reduced independence in activities of daily living (ADL), and a poor Health-Related Quality of Life (HRQoL). [1,2,7,8] Rehabilitation might play a crucial role in the arm and hand functional recovery of patients affected by SCI, with a large variety of therapeutic options currently adopted. [7,9] It has been recently proposed that repetitive, task-specific, functional training could be considered effective in improving upper limb functions, even potentially interacting with the self-repair capacity of the spinal cord.…”

A wearable vision-based system for detecting hand-object interactions in individuals with cervical spinal cord injury: First results in the home environment

“…Wearable sensors such as accelerometers, magnetometers, and inertial measurement units (IMUs) have been used to fill this gap. For example, clinical assessment scales (e.g., the functional ability scale) were estimated in stroke survivors by using accelerometer data from upper limb movements [5], [6], whereas IMUs were used in patients with acute SCI for monitoring their upper limb and wheeling activities [7], [8]. Although well-established and easy-to-implement for long and continuous recordings, these systems allow extracting only global kinematic information of the upper limbs, with no details regarding hand manipulations or finger movements.…”