Assessment of Neurorehabilitation in Spinal Cord Injury Using Neuroimage Tools.
Condition: Injuries, Spinal Cord
MeSH terms: Spinal Cord Injuries; Wounds and Injuries; Spinal Injuries
Study type: Interventional

Summary: 
      The sensorimotor cortex may play a role in the functional recovery after Spinal Cord Injury
      (SCI) through efference generated in the absence of the afference. OBJECTIVE: The purpose of
      this study was to evaluate the potential reorganization in the sensorimotor cortex in SCI
      patients after Body Weight Supported Treadmill Training (BWSTT) associated with conventional
      motor rehabilitation. METHOD: Seven SCI patients with ASIA C and D participated in this
      study. They were submitted to a motor-task functional magnetic resonance imaging study (fMRI)
      before and after the rehabilitation treatment.
    

Detailed description: 
      Motor Rehabilitation The rehabilitation program consisted of five hours per day of the
      treatment, five times a week for two months (40 sessions). The treatment protocol included
      kinesiotherapy (passive and active mobilizations, muscle lengthening), BWSTT, bicycle, manual
      therapy (with and without assistance of a mechanical device) and daily life activities
      training. The duration of each event was approximately one hour.

      The initial time of the treatment on the BWSTT was 20 minutes, and the modification of the
      time depended on the endurance and capability of each patient. Training charge began at 40%
      body weight supported and at treadmill speeds of at least 1.5 km per hour. The treadmill
      speed was increased progressively to 2.5 km per hour, and the level of weight supported was
      adjusted within sessions to achieve knee extension. Table 1 shows the initial and final
      training parameters for each patient.

      To assess functional ability, each patient was assigned a Walking Index for Spinal Cord
      Injury (WISCI II) (Ditunno and Ditunno 2001) (Table 1), Manual Muscle Testing and Functional
      Independence Measure (FIM) before and after the treatment period (Table 2).

      fMRI Protocol The patients were scanned using a 3T Siemens TIM TRIO system before and after
      the rehabilitation treatment protocol. The fMRI protocol consisted of a two motor-task fMRI
      series with the following technical parameters: TE=29 ms; TR=2000 ms, number of slices=36,
      matrix=128x128, FOV=240 mm, slice thickness= 3 mm; and FA=90º. The patients were given
      instructions for the motor task they were to perform prior to each scan. The patients were
      positioned with comfortable pads below the knee to allow the active movement of the ankle.
      During the functional imaging, each motor activation period was signalled with a short
      instruction to the subject through the headphones.

      The motor task for the fMRI exploration of the foot was the ankle plantar flexion and toe
      flexion. The block design began with a 20 second rest period, followed by 30 second periods
      of movement of the right foot, 30 seconds of the left foot movement and 10 seconds of rest.
      This cycle was repeated three times. The movement performance was controlled visually by two
      examiners to monitor any movement or apparent change during the rest periods of the
      non-moving limbs. The patients were oriented to perform the motor task through a voluntary
      movement. Approximately 15 repetitions were made in each period.

      Finally, a T1-weighted structural image of the whole brain was acquired to a perfect
      localization of activation areas. Acquisition parameters of the structural image were TE=
      2.98 ms; TR= 2300 ms; T1= 900 ms; matrix= 256x256; FA= 9º; and T voxel=1x1x1 m3.
    

Intervention name(s): rehabilitation treatment
Intervention type(s): Other
Intervention model: Single Group Assignment
Intervention model description: Seven SCI patients with ASIA C and D participated in this study. They were submitted to a motor-task functional magnetic resonance imaging study (fMRI) before and after the rehabilitation treatment.
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Spinal Cord Injury; Motor rehabilitation; Sensorimotor reorganization; Robotic; Functional magnetic resonance imaging