Evidence-Based Physical Therapy (EBP) uses the best research evidence with clinical expertise and user’s preferences to produce the most appropriate and effective care. At week 43 in 2023, we had Blended Intensive program (BIP) in Finland, Kuopio Savonia University of Applied Science about EBP. This BIP program opened with welcome words of the president of The European Network of Physiotherapy in Higher Education (ENPHE) and followed with the basis of EBP and teachers who highlighted the main challenges at different Physical Therapy fields week 43 in 2023 we had Blended Intensive program (BIP) in Finland, Kuopio Savonia University of applied science. More than 40 physiotherapy students and 7 teachers from three universities (Savonia University of Applied Sciences, Finland, Universidade da Coruña, Spain, and Charles University Prague, actively participated this week and shared experiential group dynamics and social activities. Students worked together and wrote articles devoted to the following themes: Evidence Based in McKenzie, back pain, spinal cord injuries, aquatic therapy, ergonomics at work, Nordic walking, sport injuries, sport and young adults: Prevention of sport injuries and children with disabilities. In the following you can consult the works presented by the students on each topic.

Introduction

“Spinal Cord Injury (SCI) is an injury to the spinal cord that results in temporary or permanent changes in the spinal cord’s normal, sensory-motor or autonomic function.” (ISCoS, 2023).

The appearance of transportation and industrialisation increased the incidence of spinal cord injuries (SCI). This incidence varies worldwide depending on region characteristics such as economy, culture or even traumatic vs non-traumatic causes.

Once it is damaged, below that injury level appears a loss of either sensation or muscle function, or even both (incomplete or complete SCI). Thus, static or dynamic balance use to be affected in patients, due to the motor function weakness and perception detriment, which are major causes of decreased quality of patients’ lives. In this line, the main concern of both family and patient is about their gait recovery, in which balance is essential. Therefore, physiotherapists essentially focused on improving their motor function by intensive and repetitive training in order to induce activity-learning plasticity.

However, SCI patients tend to be unmotivated or even depressed, that added to their susceptibility of being fatigued and their intrinsic pathology complications, makes intervention, thus recovery, harder. These complications include neuropathic pain (especially at the beginning) and pulmonary dysfunction, which don’t help the recovery process. That’s why new tendencies try to overcome all these limitations.

On the other hand, technology has taken a primordial role in society’s lives and it has shown usefulness for people’s well-being. Nowadays, it has been included in the health care system. But, could it be helpful for this pathology?

Considering different kind of intrinsic and extrinsic devices, various results can be highlighted.

Firstly, Xiao Na Xiang et al (2021) investigate the use of an extrinsic device (exoskeleton) as an aid to improve balance and it not only brings good outcome for that but also, as it requires trunk muscles to walk, increases the accessory respiratory muscles’ strength. Comparing to the control group, their study (n=18) showed that the experimental group improved their pulmonary function (PFT) by 14%, maximum voluntary ventilation (MVV) by 10% and forced expiratory flow (FEF) by a 10%.

Following with SCI complications, neuropathic pain was the other one. Kapadia et al. (2014), studied the effect of immersive device, Virtual Reality-Augmented, to improve motor function and neuropathic pain in incomplete spinal cord injuries (iSCI) measuring. More studies around this might be needed. Electrostimulation has shown optimistic outcomes for neuropathic pain managing. Moreover, same study tried to demonstrate how advantageous it was for gait recovery in iSCI. While both groups where ambulating, EG used a weight support treadmill and harness system, but CG not. The differences on the intervention of exercises may have altered the outcomes, which can be overcome in future research, even though results saw light at the end of the tunnel.

Furthermore, VR appears to have many utilities. Related to balance, and study measured how a football game VR could improve kick speed as the muscles involved are mainly important in balance and gait function. They took a sample of 40 people and blinded-divided them in two groups: an experimental group who did a kick once while they saw a ball, stopping when there was a plumb ball, while the control group did the same but without VR. Results were positive as it showed improvement in the experimental group. However, more research might be needed for example with a greater sample or using electromyography to see bilateral changes. Similarly, another randomised clinical trial tried to simulate with different kind of sports while CG did uniplanar movements, which could have affect the result, even though they tend to be positive anyways.

Summing up, analysed studies show good pathways to follow in future investigations. However, samples were small, so for more reliable results, bigger experiments might be done and by comparing muscle strength. As in An Y Park et al. (2022), more homogenous standardised outcome measures might be necessary to weight the impact on motor skills improvements (e.g. Electromyography measurement in both legs).

Despite of the limitations already outlined, this narrative review presents a good overview for future research, as the main question was answered, technology is helpful as a complementary aid in SCI physical therapy -intervention.

Authors
Lotta Rantanen. Physiotherapy student. Savonia-UAS
Venla Hirvonen. Physiotherapy student. Savonia-UAS
Mari Eskola. Physiotherapy student. Savonia-UAS
Carmen Pilar Barra Moreno. Physiotherapy student. Universidade da Coruña
Alejandro Alonso Vicente. Physiotherapy student. Universidade da Coruña
Marja Äijö, PhD, PhD, Principal lecturer of gerontology and rehabilitation, Savonia University of Applied Sciences, Finland
Mari Tuppurainen, physiotherapy lecture, Savonia University of Applied Sciences, Kuopio, Finland
Dagmar Pavlu, Physiotherapist, Assoc. Prof. Charles University, Czech Republic
Ivana Vláčilová, Professor, Charles University, Czech Republic
Jamile Vivas Costa, PhD, MSc, PT. Lecturer at Department of Physical Therapy, Medicine and Biomedical Sciences, Faculty of Physiotherapy and Researcher at Psychosocial intervention and functional rehabilitation group, Universidade da Coruña, Spain
Montserrat Fernández Pereira, MSc, PT. Lecturer at Department of Physical Therapy, Medicine and Biomedical Sciences, Faculty of Physiotherapy and Physiotherapist at Spinal Cord Injury Unit, A Coruña Hospital (CHUAC), Spain
Verónica Robles García, PhD, MSc, PT, OT. Lecturer at Department of Physical Therapy, Medicine and Biomedical Sciences, Faculty of Physiotherapy and Researcher at the Neuroscience and motor control group, Universidade da Coruña and Biomedical Institute of A Coruña, Spain

References:
ISCoS (2023). Spinal Cord Injury. In E-Learning ISCoS (Ed.) Obtained on 23th October 2023 from: https://www.elearnsci.org/pages.aspx?id=5&page=Glossary

Villiger M, Bohli D, Kiper D, et al. Virtual Reality Augmented Neurorehabilitation Improves Motor Function and Reduces Neuropathic Pain in Patients With Incomplete Spinal Cord Injury. Neurorehabilitation and Neural Repair. 2013;27(8):675-683. doi:10.1177/1545968313490999

Khurana M, Walia S, Noohu MM. Study on the Effectiveness of Virtual Reality Game-Based Training on Balance and Functional Performance in Individuals with Paraplegia. Top Spinal Cord Inj Rehabil. 2017 Summer;23(3):263-270. doi: 10.1310/sci16-00003. Epub 2017 May 4. PMID: 29339902; PMCID: PMC5562034.

Xiang XN, Zong HY, Ou Y, Yu X, Cheng H, Du CP, He HC. Exoskeleton-assisted walking improves pulmonary function and walking parameters among individuals with spinal cord injury: a randomized controlled pilot study. J Neuroeng Rehabil. 2021 May 24;18(1):86. doi: 10.1186/s12984-021-00880-w. PMID: 34030720; PMCID: PMC8146689.

An Y, Park C. The effects of virtual soccer game on balance, gait function, and kick speed in chronic incomplete spinal cord injury: a randomized controlled trial. Spinal Cord. 2022 Jun;60(6):504-509. doi: 10.1038/s41393-021-00745-y. Epub 2022 Jan 8. PMID: 34999726.

Nair MS, Kulkarni VN, Shyam AK. Combined Effect of Virtual Reality Training (VRT) and Conventional Therapy on Sitting Balance in Patients with Spinal Cord Injury (SCI): Randomized Control Trial. Neurol India. 2022 Sep-Oct;70(Supplement):S245-S250. doi: 10.4103/0028-3886.360934. PMID: 36412376.

Kapadia N, Masani K, Catharine Craven B, Giangregorio LM, Hitzig SL, Richards K, Popovic MR. A randomized trial of functional electrical stimulation for walking in incomplete spinal cord injury: Effects on walking competency. J Spinal Cord Med. 2014 Sep;37(5):511-24. doi: 10.1179/2045772314Y.0000000263. PMID: 25229735; PMCID: PMC4166186.