Wee Seng Kwee, Valerie Zhi Yan Ng, Phua Min Wee, Lui Wen Li, Misbaah Fatimah, Ker Rui Xin Justin, Ng Wai Hoe, Rui Wan Kai
Department of Rehabilitation Medicine, Tan Tock Seng Hospital, Singapore.
Institute of Rehabilitation Excellence (IREx), Tan Tock Seng Hospital Rehabilitation Centre, Singapore.
Adv Rehabil Sci Pract. 2025 Jun 24;14:27536351251343738. doi: 10.1177/27536351251343738. eCollection 2025 Jan-Dec.
OBJECTIVE: To present the rehabilitation considerations in prehabilitation and the rehabilitation phase post spinal cord stimulator implantation; and to evaluate the efficacy of synergistic combination of epidural spinal cord stimulation (SCS) with motor imagery, trunk rehabilitation, robotic and overground gait training in improving mobility in persons with sensorimotor complete spinal cord injury (SCI). DESIGN: A non-controlled before-after clinical trial. METHODS: Epidural spinal cord stimulators were implanted into 3 participants with complete thoracic SCI (Thoracic 4, Thoracic 2 and Thoracic 10 respectively). They underwent 1 month of prehabilitation, followed by 7 months of daily rehabilitation post-implantation, consisting of SCS, motor imagery, trunk rehabilitation, robotic therapy and overground gait training. Pre-post assessments include the American Spinal Injury Association Impairment Scale (AIS) examination, Spinal Cord Independence Measure version III (Mobility subscale) (SCIM-III), Walking Index for Spinal Cord Injury II (WISCI-II), Trunk Assessment Scale for Spinal Cord Injury (TASS), Five Times Sit-to-Stand (5×STS) and 2-minute Walk Test (2mWT). RESULTS: Post rehabilitation, there were improvements in WISCI-II, TASS, 5×STS and 2mWT in all 3 participants; and no change in AIS sensory scores. Only participants 2 and 3 exhibited slight improvement in SCIM-III. The WISCI-II of all participants improved, ranging from 3 levels to 9 levels, which was considered a clinically meaningful change. Furthermore, the change in TASS exceeded the minimal clinically important difference (MCID) of 4 points for two participants. The change in 5×STS exceeded the MCID of 2.27 seconds for all participants. These significant improvements translated into the participants' ability to perform sit-to-stand independently and ambulate with a rollator frame under supervision of a carer. CONCLUSION: This clinical trial demonstrated proof-of-concept and promising findings that support our rehabilitation protocol in improving functional mobility of people with sensorimotor complete SCI, which may be replicated in future studies.*The study protocol was registered with Clinical-trials.gov (NCT05644171; Registered 13 November 2022. https://clinicaltrials.gov/ct2/show/NCT05644171).
目的：介绍脊髓刺激器植入术前康复和术后康复阶段的康复考量；并评估硬膜外脊髓刺激（SCS）与运动想象、躯干康复、机器人辅助和地面步态训练协同组合在改善感觉运动完全性脊髓损伤（SCI）患者活动能力方面的疗效。 设计：一项非对照前后临床试验。 方法：将硬膜外脊髓刺激器分别植入3例完全性胸段SCI患者（分别为胸4、胸2和胸10）。他们接受了1个月的术前康复，然后在植入后进行7个月的每日康复，包括SCS、运动想象、躯干康复、机器人辅助治疗和地面步态训练。术前和术后评估包括美国脊髓损伤协会损伤量表（AIS）检查、脊髓独立性测量第三版（活动能力亚量表）（SCIM-III）、脊髓损伤步行指数II（WISCI-II）、脊髓损伤躯干评估量表（TASS）、五次坐立试验（5×STS）和2分钟步行试验（2mWT）。 结果：康复后，所有3例患者的WISCI-II、TASS、5×STS和2mWT均有改善；AIS感觉评分无变化。只有患者2和患者3在SCIM-III上有轻微改善。所有患者的WISCI-II均有改善，改善幅度为3级至9级，这被认为是具有临床意义的变化。此外，两名患者的TASS变化超过了4分的最小临床重要差异（MCID）。所有患者的5×STS变化超过了2.27秒的MCID。这些显著改善转化为患者在护理人员监督下独立进行坐立和使用助行器行走的能力。 结论：这项临床试验证明了概念验证并得出了有前景的结果，支持我们的康复方案在改善感觉运动完全性SCI患者功能活动能力方面的作用，这可能在未来的研究中得到重复验证。*该研究方案已在Clinical-trials.gov注册（NCT05644171；于2022年11月13日注册。https://clinicaltrials.gov/ct2/show/NCT056
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