Acute intermittent hypoxia in spinal cord injury gait rehabilitation: a systematic review of randomized trials.

BACKGROUND

Gait impairments are one of the popular consequences of spinal cord injury (SCI). Acute intermittent hypoxia (AIH) is an innovative treatment that has recently been used to enhance motor function in patients with neurological conditions. This review aims to examine the effects of AIH on gait post-SCI, verify who most likely would benefit from the treatment, and recognize the best treatment protocol, if possible.

METHODS

The search was conducted in "PubMed, MEDLINE, The Cochrane Library, Scopus, PEDro, and Web of Science" databases from inception to October 2024. This review included randomized trials involving individuals with SCI who received AIH, alone or in combination with other interventions, compared with active or passive comparators, and evaluated at least one outcome related to gait ability. The quality of the included studies was measured using the "Physiotherapy Evidence Database (PEDro)".

RESULTS

Nine studies met the eligibility criteria. In total, 158 individuals with SCI (mean age 44.45 years; 86% male) were involved in this analysis. The included studies' PEDro scores ranged from 5 to 10, with a median of 8. The main findings showed that AIH improves gait speed, walking endurance, dynamic balance, and plantar flexor strength in individuals with SCI.

CONCLUSION

AIH is a safe intervention for individuals with SCI. This review underscores the potential benefits of AIH for improving gait abilities in SCI with motor-incomplete injuries (ASIA grades C and D) at cervical, thoracic, and lumbar levels. Further studies are recommended to verify our findings.