Narrative Review of Clinical Practice Guidelines for Rehabilitation of People With Spinal Cord Injury

Abstract

Bed Positioning21. Use bed positioning devices and techniques that are compatible with the bed type and the individual's health status.Avoid positioning individuals directly on pressure ulcers regardless of the pressure ulcer anatomical location (trochanter, ischium, sacrum, and heel) unless such position is necessanry for performance of ADLs, such as eating or hygiene.Use pillows, cushions, and positioning aids to reduce pressure on existing pressure ulcers or vulnerable skin areas by elevating them away from the support surface.Avoid closed cutouts or donut-type cushions.Prevent contact between bony prominences.Elevate the head of the bed no higher than 30 degrees unless medically necessary.Reposition individuals in bed at least every 2 hours. Sources: Sackett, D.L. Rules of evidence and clinical recommendations on the use of antithrombotic agents. Chest 95 (2 Suppl) (1989): 25-45; and the U.S. Preventive Health Services Task Force. Guide to clinical preventive services: An assessment of the effectiveness of 169 interventions. Baltimore, MD: Williams and Wilkins, 1996.

Factors for Predicting Instant Neurological Recovery of Patients with Motor Complete Traumatic Spinal Cord Injury

“…Inpatient rehabilitation plays an important role in neurological recovery in patients with TSCI. Research has shown that activity-based interventions, such as transcranial magnetic stimulation, functional electrical stimulation, and robotic-assisted treadmill training, are effective in improving function in individuals with spinal cord injury [ 24 , 25 ]. Nam et al [ 26 ] demonstrated that robot-assisted gait training can restore functional walking and improve locomotor ability, which might enable patients with SCI to increase their level of physical activity and maintain a healthy lifestyle.…”

Global Research on Neuropathic Pain Rehabilitation over the Last 20 Years

“…Studies have shown that spinal cord stimulation, dorsal root ganglion stimulation (DRGS), is effective in treating the disease [ 39 , 40 ] Spinal cord injury: chronic neuropathic pain after SCI is a complex disease, and transcranial direct current stimulation is effective in clinical treatment [ 41 ]. The latest clinical practice guidelines also point to the use of sensors and mechanical devices can help patients achieve functional movement, enhance recovery, and increase neural plasticity, as well as potential adjuncts [ 42 – 44 ] Central sensitization: central sensitization is a kind of hypersensitivity to pain caused by central neural plasticity, which is interwoven with psychoneuroimmunological interactions [ 34 , 35 ], and is of great significance for the diagnosis and treatment of pain. Recent studies have shown that cGMP-dependent protein kinase I, a nociceptor locator, is a key producer of central sensitization and neuropathic pain [ 45 ].…”

“…Spinal cord injury: chronic neuropathic pain after SCI is a complex disease, and transcranial direct current stimulation is effective in clinical treatment [ 41 ]. The latest clinical practice guidelines also point to the use of sensors and mechanical devices can help patients achieve functional movement, enhance recovery, and increase neural plasticity, as well as potential adjuncts [ 42 – 44 ]…”

“…The latest clinical practice guidelines also point to the use of sensors and mechanical devices can help patients achieve functional movement, enhance recovery, and increase neural plasticity, as well as potential adjuncts [42][43][44] (3) Central sensitization: central sensitization is a kind of hypersensitivity to pain caused by central neural plasticity, which is interwoven with psychoneuroimmunological interactions [34,35], and is of great significance for the diagnosis and treatment of pain.…”

Robot-assisted gait training: more randomized controlled trials are needed! Or maybe not?

“…There have been many conflicting results regarding these devices’ effectiveness compared to non-robotic treadmill training, and already early on, large trials concluded that robot-assisted gait training is not superior to conventional physiotherapeutic interventions when it comes to reducing motor impairment [ 4 , 5 ]. This did not significantly change moving forward, which has led to the publication of conflicting clinical practice guidelines for stroke, traumatic brain injury, and spinal cord injury that cover the recommendation spectrum from do to don’t do [ 6 – 12 ].…”