Rehabilitation of patients in late period after spinal cord injury: a meta-analysis of literature data

Material  and Methods. The  study design is a meta-analysis of publications with levels  1a, b, c, and  2a evidence and  a level A recommendations. An electronic search was conducted in the  PubMed, Web of Science, Scopus, Cochrane Library, CrossRef, AO Spine, Eurospine, ResearchGate, eLIBRARY, and MEDLINE databases, and in references of key articles. Inclusion criteria were systematic reviews, randomized controlled studies, multicenter cohort studies with a level 1a, b, c, and 2a evidence and level A recommendations for adult patients with long-term sequelae of spinal cord  injury (more than 4 months after injury). Exclusion criteria were  topic articles, clinical  cases, observations, cohort uncontrolled studies, experimental articles, reports, articles with levels 2b, c, 3a, b, 4, and 5 evidence and level B, C, and D recommendations, pediatric patients, early period after spinal cord injury (less than 4 months), and non-traumatic lesions of the spinal cord.

Results. The  search returned 108 articles with publication date within 1997–2019. The  inclusion criteria was  met  by 65 publications: 33 systematic reviews, 12 randomized controlled studies, 19 multicenter studies; and one open  prospective study was included in the  review due  to the  particular treatment method used. The  greatest evidence base  for the  rehabilitation of patients in the  long-term period after spinal cord  injury is presented for physical methods of rehabilitation. The  most effective are locomotor training to develop skills  of movement. Auxiliary verticalization and robotic devices are needed to restore and improve proprioceptive innervation. In case of violation of the  spinal tracts, the  restoration of motor functions occurs due  to the  activation of supraspinal interneuronal connections. Epidural electrical stimulation of the  lumbar thickening of the  spinal cord  activates a generator of voluntary movement of the  limbs  and,  in combination with training of proprioceptive sensitivity, leads to a regression of movement disorders. The  constant use  of electrostimulation blocks proprioceptive sensitivity and inhibits the  recovery of spinal conductivity. Parameters of clinical  application are not  defined for areas of regenerative medicine.

Conclusion. The  main problem in rehabilitation of patients in late  period after spinal cord injury is the lack of a unified concept, developed strategies of rehabilitation technologies, and criteria for assessment of the  initial status and treatment efficiency.

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