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Rehabilitation technologies and interventions for individuals with spinal cord injury: translational potential of current trends

In the past, neurorehabilitation for individuals with neurological damage, such as spinal cord injury (SCI), was focused on learning compensatory movements to regain function. Presently, the focus of neurorehabilitation has shifted to functional neurorecovery, or the restoration of function through...

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Autores principales: Musselman, Kristin E., Shah, Meeral, Zariffa, José
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5956557/
https://www.ncbi.nlm.nih.gov/pubmed/29769082
http://dx.doi.org/10.1186/s12984-018-0386-7
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author Musselman, Kristin E.
Shah, Meeral
Zariffa, José
author_facet Musselman, Kristin E.
Shah, Meeral
Zariffa, José
author_sort Musselman, Kristin E.
collection PubMed
description In the past, neurorehabilitation for individuals with neurological damage, such as spinal cord injury (SCI), was focused on learning compensatory movements to regain function. Presently, the focus of neurorehabilitation has shifted to functional neurorecovery, or the restoration of function through repetitive movement training of the affected limbs. Technologies, such as robotic devices and electrical stimulation, are being developed to facilitate repetitive motor training; however, their implementation into mainstream clinical practice has not been realized. In this commentary, we examined how current SCI rehabilitation research aligns with the potential for clinical implementation. We completed an environmental scan of studies in progress that investigate a physical intervention promoting functional neurorecovery. We identified emerging interventions among the SCI population, and evaluated the strengths and gaps of the current direction of SCI rehabilitation research. Seventy-three study postings were retrieved through website and database searching. Study objectives, outcome measures, participant characteristics and the mode(s) of intervention being studied were extracted from the postings. The FAME (Feasibility, Appropriateness, Meaningfulness, Effectiveness, Economic Evidence) Framework was used to evaluate the strengths and gaps of the research with respect to likelihood of clinical implementation. Strengths included aspects of Feasibility, as the research was practical, aspects of Appropriateness as the research aligned with current scientific literature on motor learning, and Effectiveness, as all trials aimed to evaluate the effect of an intervention on a clinical outcome. Aspects of Feasibility were also identified as a gap; with two thirds of the studies examining emerging technologies, the likelihood of successful clinical implementation was questionable. As the interventions being studied may not align with the preferences of clinicians and priorities of patients, the Appropriateness of these interventions for the current health care environment was questioned. Meaningfulness and Economic Evidence were also identified as gaps since few studies included measures reflecting the perceptions of the participants or economic factors, respectively. The identified gaps will likely impede the clinical uptake of many of the interventions currently being studied. Future research may lessen these gaps through a staged approach to the consideration of the FAME elements as novel interventions and technologies are developed, evaluated and implemented. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12984-018-0386-7) contains supplementary material, which is available to authorized users.
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spelling pubmed-59565572018-05-24 Rehabilitation technologies and interventions for individuals with spinal cord injury: translational potential of current trends Musselman, Kristin E. Shah, Meeral Zariffa, José J Neuroeng Rehabil Commentary In the past, neurorehabilitation for individuals with neurological damage, such as spinal cord injury (SCI), was focused on learning compensatory movements to regain function. Presently, the focus of neurorehabilitation has shifted to functional neurorecovery, or the restoration of function through repetitive movement training of the affected limbs. Technologies, such as robotic devices and electrical stimulation, are being developed to facilitate repetitive motor training; however, their implementation into mainstream clinical practice has not been realized. In this commentary, we examined how current SCI rehabilitation research aligns with the potential for clinical implementation. We completed an environmental scan of studies in progress that investigate a physical intervention promoting functional neurorecovery. We identified emerging interventions among the SCI population, and evaluated the strengths and gaps of the current direction of SCI rehabilitation research. Seventy-three study postings were retrieved through website and database searching. Study objectives, outcome measures, participant characteristics and the mode(s) of intervention being studied were extracted from the postings. The FAME (Feasibility, Appropriateness, Meaningfulness, Effectiveness, Economic Evidence) Framework was used to evaluate the strengths and gaps of the research with respect to likelihood of clinical implementation. Strengths included aspects of Feasibility, as the research was practical, aspects of Appropriateness as the research aligned with current scientific literature on motor learning, and Effectiveness, as all trials aimed to evaluate the effect of an intervention on a clinical outcome. Aspects of Feasibility were also identified as a gap; with two thirds of the studies examining emerging technologies, the likelihood of successful clinical implementation was questionable. As the interventions being studied may not align with the preferences of clinicians and priorities of patients, the Appropriateness of these interventions for the current health care environment was questioned. Meaningfulness and Economic Evidence were also identified as gaps since few studies included measures reflecting the perceptions of the participants or economic factors, respectively. The identified gaps will likely impede the clinical uptake of many of the interventions currently being studied. Future research may lessen these gaps through a staged approach to the consideration of the FAME elements as novel interventions and technologies are developed, evaluated and implemented. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12984-018-0386-7) contains supplementary material, which is available to authorized users. BioMed Central 2018-05-16 /pmc/articles/PMC5956557/ /pubmed/29769082 http://dx.doi.org/10.1186/s12984-018-0386-7 Text en © The Author(s). 2018 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Commentary
Musselman, Kristin E.
Shah, Meeral
Zariffa, José
Rehabilitation technologies and interventions for individuals with spinal cord injury: translational potential of current trends
title Rehabilitation technologies and interventions for individuals with spinal cord injury: translational potential of current trends
title_full Rehabilitation technologies and interventions for individuals with spinal cord injury: translational potential of current trends
title_fullStr Rehabilitation technologies and interventions for individuals with spinal cord injury: translational potential of current trends
title_full_unstemmed Rehabilitation technologies and interventions for individuals with spinal cord injury: translational potential of current trends
title_short Rehabilitation technologies and interventions for individuals with spinal cord injury: translational potential of current trends
title_sort rehabilitation technologies and interventions for individuals with spinal cord injury: translational potential of current trends
topic Commentary
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5956557/
https://www.ncbi.nlm.nih.gov/pubmed/29769082
http://dx.doi.org/10.1186/s12984-018-0386-7
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