Type and Timing of Rehabilitation Following Acute and Subacute Spinal Cord Injury: A Systematic Review

Global Spine Journal, 2017 · DOI: 10.1177/2192568217703084 · Published: March 31, 2017

Spinal Cord Injury Rehabilitation Research Methodology & Design

Simple Explanation

Spinal cord injury often leads to motor, sensory, and autonomic impairments, which are associated with functional limitations and reduced quality of life. Rehabilitation during the acute and subacute phases focuses on preventing secondary complications, promoting neurorecovery, and maximizing function. A systematic appraisal of the evidence base will inform clinical decision making and highlight current knowledge gaps that require additional investigation.

Study Duration

Not specified

Participants

Adults with acute or subacute traumatic SCI

Evidence Level

Systematic Review

Key Findings

1
There was no difference between body weight–supported treadmill training and conventional rehabilitation with respect to improvements in Functional Independence Measure (FIM) Locomotor score.
2
Functional electrical therapy resulted in slightly better FIM Motor, FIM Self-Care, and Spinal Cord Independence Measure Self-Care subscores compared with conventional occupational therapy.
3
Comparisons using the Toronto Rehabilitation Institute Hand Function Test demonstrated no differences between groups in 7 of 9 domains.

Research Summary

The objective of this study was to conduct a systematic review of the literature to address the clinical questions regarding rehabilitation strategies in adults with acute or subacute traumatic SCI. The search strategy yielded 384 articles, 19 of which met our inclusion criteria. The current evidence base for rehabilitation following acute and subacute spinal cord injury is limited.

Practical Implications

Rehabilitation Timing

A delay in the initiation of specialized rehabilitation could be detrimental. Rehabilitation should be initiated as early as possible.

BWSTT vs. Overground Training

BWSTT is as effective as overground mobility training for improving ambulation outcomes in individuals with incomplete SCI. BWSTT might have advantages for improving very specific gait parameters.

FES for Upper Extremity Function

FES is better than conventional rehabilitation in individuals with incomplete cervical SCI. This strategy warrants further investigation to confirm its generalizability and feasibility in diverse clinical settings.

Study Limitations

1
Lack of standardization of interventions and therapeutic doses
2
Heterogeneous patient populations
3
Methodological challenges associated with assessing efficacy of concurrent treatments

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