Ji Cheol Shin

Study design Randomized controlled trial Objective To investigate whether dynamic pelvic movement via the FreeD module enhances the effect of robotic gait training in individuals with incomplete spinal cord injury (SCI), and to explore its differential impact based on baseline ambulatory function. Setting Tertiary rehabilitation hospital. Methods Thirty participants with incomplete SCI within 6 months of injury were assigned to one of three groups: (1) conventional therapy (control), (2) Lokomat-assisted gait training without FreeD module (wo-FDM), and (3) Lokomat with FreeD module (w-FDM). All received 20 sessions over 4 weeks. Primary outcomes were the Lower Extremity Motor Score (LEMS), Ambulatory Motor Index (AMI), and proprioception score. Secondary outcomes included the Berg Balance Scale (BBS), Walking Index for SCI-II (WISCI-II), and SCIM-III. Subgroup analyses were performed based on baseline AMI scores. Results Both Lokomat groups showed significant improvements in motor and functional outcomes. AMI improved in the wo-FDM (12.0 to 17.0, p = 0.034) and w-FDM groups (13.0 to 19.5, p = 0.002). Post-hoc analysis confirmed greater AMI gains in w-FDM versus control (p = 0.040). Among participants with low baseline AMI, w-FDM led to significant gains in both LEMS (25.0 to 34.0, p = 0.009) and AMI (12.0 to 16.0, p = 0.009), with significant between-group differences in ΔLEMS (p = 0.024) and ΔAMI (p = 0.028). Conclusions Lokomat-assisted gait training improved motor and functional outcomes in individuals with incomplete SCI. The effect was most pronounced in individuals with lower baseline motor scores, supporting a personalized approach to robotic rehabilitation.

Lee SJ, et al. Yonsei Med J. 2025 May;66:e45. https://doi.org/10.3349/ymj.2024.0246

Spinal cord injury (SCI) rehabilitation emphasizes locomotion. Robotic-assisted gait training (RAGT) is widely used in clinical settings because of its benefits; however, its efficacy remains controversial. We conducted a systematic review and meta-analysis to investigate the efficacy of RAGT in patients with SCI. We searched international and domestic databases for articles published until April 18, 2024. The meta-analysis employed a random effects model to determine the effect size as either mean difference (MD) or standardized MD (SMD). Evidence quality was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Twenty-three studies with a total of 690 participants were included in the final analysis. The overall pooled effect size for improvement in activities of daily living was 0.24, with SMD (95% confidence interval [95% CI], 0.04–0.43; GRADE: high) favoring RAGT over conventional rehabilitation. Muscular strength (MD, 0.23; 95% CI, 0.02–0.44; GRADE: high), walking index for SCI (MD, 0.31; 95% CI, 0.07–0.55; GRADE: moderate) and 6 min walk test distance (MD, 0.38; 95% CI, 0.14–0.63; GRADE: moderate) showed significant improvement in the robot group. Subgroup analysis revealed that subacute patients and intervention periods >2 months were more effective. This meta-analysis revealed that RAGT significantly improved activities of daily living, muscular strength, and walking abilities. Additional studies are needed to identify the optimal treatment protocol and specific patient groups for which the protocol is most effective.

Study design Retrospective cohort study. Objective To investigate the potential of technetium-99m-mercaptoacetyltriglycine (99mTc-MAG-3) renal scintigraphy for predicting maximal detrusor pressure in the early stages of spinal cord injury (SCI). Setting Tertiary rehabilitation facility. Methods Medical records of individuals with SCI admitted between January 2020 and April 2023 who underwent both 99mTc-MAG-3 renal scintigraphy and urodynamic study within 90 days of SCI onset were retrospectively reviewed. Pearson’s coefficient analysis was performed to determine the relationship between 99mTc-MAG-3 renal scintigraphy findings and urodynamic study findings. A multivariate linear regression analysis was performed to determine the best predictors of maximal detrusor pressure. A multivariate logistic regression analysis was performed to determine risk factors for high detrusor pressure. Results Ninety-four participants were enrolled in this study. Pearson’s correlation analysis showed that effective renal plasma flow (ERPF) and ERPF (% predicted) were significantly correlated with maximal detrusor pressure. The multivariate linear regression analysis demonstrated that ERPF (% predicted) was a significant predictor of maximal detrusor pressure. The multivariate logistic regression analysis showed that ERPF (% predicted) was significantly associated with high detrusor pressure. The receiver operating characteristic curve demonstrated that the predictive model had an area under the curve of 0.725, with an ERPF (% predicted) cut-off of 64.05%, sensitivity 1.000, and specificity 0.429. Conclusions These results suggest that 99mTc-MAG-3 renal scintigraphy may be useful for predicting high detrusor pressure in early SCI and may guide the timing of urodynamic studies in individuals with early SCI for appropriate management of neurogenic lower urinary tract dysfunction.

Study design Retrospective cohort study. Objective To determine the risk factors associated with dysphagia in individuals with cervical spinal cord injury (CSCI) and analyze the differences between individuals with improved penetration–aspiration (PA) and persistent PA on follow-up. Setting Tertiary inpatient rehabilitation facilities. Methods Medical records of individuals with CSCI admitted between December 2009 and February 2023 who underwent a videofluoroscopic swallowing study (VFSS) were retrospectively reviewed. Multivariate logistic regression analysis was performed to assess risk factors for dysphagia. Differences between individuals with improved PA and persistent PA were analyzed using an independent t-test. Results In total, 149 participants were enrolled. Age (odds ratio (OR) 1.08, 95% confidence interval (CI) 1.04–1.12), percentage of forced vital capacity to predicted normal (FVC (% predicted)) (OR 0.90, 95% CI 0.85–0.94), and skeletal muscle index (OR 0.89, 95% CI, 0.79–0.99) were significant factors associated with the risk of PA. Based on the receiver operating characteristic curve analysis, the cut-off values for age, FVC (% predicted), and skeletal muscle index were determined as 56.0, 45.7, and 41.0, respectively. A secondary analysis of the follow-up VFSS was conducted on 38 participants. The follow-up FVC (% predicted) and degree of weight loss differed significantly between the improved PA and persistent PA groups. Conclusions Older age, low FVC (% predicted), and low skeletal muscle index can be predictors of dysphagia in patients with CSCI. On follow-up VFSS, individuals with improved PA demonstrated greater improvement in FVC (% predicted).

Introduction: When it is difficult to determine whether a muscle is grade 0 or 1, manual muscle test (MMT) accuracy can be further improved by using needle electromyography (EMG) as a supplementary and confirmatory examination tool. Objective: To evaluate concordance between needle EMG and MMT findings for key muscles with motor grades 0 and 1 on the International Standards of Neurological Classification of Spinal Cord Injury (ISNCSCI) examination, and to potentially improve the prognosis for grade 0 muscles with proven muscle activity based on needle EMG findings. Design: A retrospective analysis. Setting: Inpatient tertiary rehabilitation facility. Interventions: Not applicable. Patients: One hundred seven patients with spinal cord injury (SCI) admitted for rehabilitation (n = 1218 key muscles, grades 0 or 1). Main Outcome Measures: Inter-rater reliability between MMTs and needle EMG was analyzed using Cohen's kappa coefficient (.). A Mantel Haenszel linear-by-linear association chi-square test was used to determine whether the presence of motor unit action potentials (MUAPs) in muscles graded 0 on the initial MMT at admission was associated with MMT grades at discharge and readmission. Results: Moderate-to-substantial agreement between needle EMG and MMT findings was observed (. = 0.671, p <.01). Concerning key upper and lower extremity muscles, moderate and substantial agreement was identified, respectively. The lowest agreement was noted for C6 muscles. During follow up, 68.8% of muscles with proven MUAPs showed improved motor grades. Conclusions: At initial assessment, distinguishing between motor grades 0 and 1 is imperative because motor grade 1 muscles are more likely to have a better prognosis for improvement. Moderate-to-substantial agreement was observed between MMT and needle EMG findings. The MMT is a reliable method of muscle grading, yet needle EMG may be of value in certain clinical situations to evaluate for the presence of MUAPs when evaluating motor function.

Study design: Retrospective cohort study Objective: To investigate the potential of technetium-99m-mercaptoacetyltriglycine (99mTc-MAG-3) renal scintigraphy in predicting maximal detrusor pressure in the early stages of spinal cord injury (SCI). Setting: Tertiary rehabilitation facility Methods: Medical records of individuals with SCI admitted between January 202 and April 2023 who underwent both 99mTc-MAG-3 renal scintigraphy and urodynamic study within 90 days of SCI onset were retrospectively reviewed. Pearson's coefficient analysis was performed to determine the relationship between 99mTc-MAG-3 renal scintigraphy findings and urodynamic study findings. Multivariate linear regression analysis was performed to determine the best predictors of maximal detrusor pressure. Multivariate logistic regression analysis was performed to determine risk factors for high detrusor pressure. Results: Ninety-four participants were enrolled in this study. The Pearson's correlation analysis showed that ERPF and ERPF (% predicted) were significantly correlated with maximal detrusor pressure. The multivariate linear regression analysis demonstrated that ERPF (% predicted) was a significant predictor of maximal detrusor pressure. The multivariate logistic regression analysis showed that ERPF (% predicted) was significantly associated with high detrusor pressure. Receiver operating characteristic curves demonstrated that the predictive model had an area under the curve of 0.725, and the cut-off value for ERPF (% predicted) was 64.05%, with a sensitivity of 1.000 and specificity of 0.429. Conclusion: These results suggest that 99mTc-MAG-3 renal scintigraphy may be useful for predicting high detrusor pressure in early SCI, and may guide the timing of urodynamic studies in individuals with early SCI for appropriate management of neurogenic bladder.

Study design: Retrospective cohort study. Objective: To determine the risk factors associated with dysphagia in individuals with cervical spinal cord injury (CSCI) and analyze the differences between individuals with improved penetration-aspiration (PA) and persistent PA on follow-up. Setting: Tertiary inpatient rehabilitation facilities. Methods: Medical records of individuals with CSCI admitted between December 2009 and February 2023 who underwent a videofluoroscopic swallowing study (VFSS) were retrospectively reviewed. Multivariate logistic regression analysis was performed to assess risk factors for dysphagia. Differences between individuals with improved PA and persistent PA were analyzed using an independent t-test. Results: In total, 149 participants were enrolled. Age (odds ratio (OR) 1.077, 95% confidence interval (CI), 1.043 to 1.118), percentage of forced vital capacity to predicted normal (FVC (% predicted)) (OR 0.897, 95% CI, 0.850 to 0.941), and skeletal muscle mass ratio (SMMR) (OR 0.888, 95% CI, 0.791 to 0.991) were significant factors associated with the risk of PA. According to the receiver operating characteristic curve analysis, the cut-off values for age, FVC (% predicted), and SMMR were 55.50, 46.11, and 41.01, respectively. A secondary analysis of the follow-up VFSS was performed in 38 participants. The follow-up FVC(%predicted) and degree of weight loss differed significantly between the improved PA and persistent PA groups. Conclusions: Older age, low FVC (% predicted), and low SMMR can be predictors of dysphagia in patients with CSCI. On follow-up VFSS, individuals with improved PA demonstrated greater improvement in FVC (% predicted).