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Motor imagery (MI) engages a broad network of brain regions to imagine a specific action. Investigating the mechanism of brain network reorganization during MI after spinal cord injury (SCI) is crucial because it reflects overall brain activity. Using electroencephalogram (EEG) data from SCI patients, we conducted EEG-based coherence analysis to examine different brain network reorganizations across different frequency bands, from resting to MI. Furthermore, we introduced a consistency calculation-based residual graph convolution (C-ResGCN) classification algorithm. The results show that the $\alpha$- and $\beta$-band connectivity weakens, and brain activity decreases during the MI task compared to the resting state. In contrast, the $\gamma$-band connectivity increases in motor regions while the default mode network activity declines during MI. Our C-ResGCN algorithm showed excellent performance, achieving a maximum classification accuracy of 96.25%, highlighting its reliability and stability. These findings suggest that brain reorganization in SCI patients reallocates relevant brain resources from the resting state to MI, and effective network reorganization correlates with improved MI performance. This study offers new insights into the mechanisms of MI and potential biomarkers for evaluating rehabilitation outcomes in patients with SCI.

Central neuropathic pain (CNP) after spinal cord injury (SCI) is related to the plasticity of cerebral cortex. The plasticity of cortex recorded by electroencephalogram (EEG) signal can be used as a biomarker of CNP. To analyze changes in the brain network mechanism under the combined effect of injury and pain or under the effect of pain, this paper mainly studies the changes of brain network functional connectivity in patients with neuropathic pain and without neuropathic pain after SCI. This paper has recorded the EEG with the CNP group after SCI, without the CNP group after SCI, and a healthy control group. Phase-locking value has been used to construct brain network topological connectivity maps. By comparing the brain networks of the two groups of SCI with the healthy group, it has been found that in the $\beta$ and $\gamma$ frequency bands, the injury increases the functional connectivity between the frontal lobe and occipital lobes, temporal, and parietal of the patients. Furthermore, the comparison of brain networks between the group with CNP and the group without CNP after SCI has found that pain has a greater effect on the increased connectivity within the patients’ frontal lobes. Motor imagery (MI) data of CNP patients have been used to extract one-dimensional local binary pattern (1D-LBP) and common spatial pattern (CSP) features, the left and right hand movements of the patients’ MI have been classified. The proposed LBP-CSP feature method has achieved the highest accuracy of 98.6% and the average accuracy of 91.5%. The results of this study have great clinical significance for the neural rehabilitation and brain–computer interface of CNP patients.

Secondary mechanisms, including inflammation and microglia activation, serve as targets for the development and application of pharmacological strategies in the management of spinal cord injury (SCI). Tetramethylpyrazine (TMP), an active ingredient of Ligusticum wallichii (chuanxiong), has shown anti-inflammatory and neuroprotective effects against SCI. However, it remains uncertain whether the inflammation-suppressive effects of TMP play a modulatory role over microglia activation in SCI. The present study investigated the effects of TMP on microglia activation and pro-inflammatory cytokines in spinal cord compression injury in mice. For a real-time PCR measurement of pro-inflammatory cytokines, SCI was induced in mice by the clip compression method (30 g force, 1 min) and TMP (15 or 30 mg/kg, i.p.) was administered once, 30 minutes before the SCI induction. For immunohistochemistry, TMP (30 mg/kg, i.p.) treatment was given three times during the first 48 hours after the SCI. 30 mg/kg of TMP treatment reduced the up-regulation of TNF-α, IL-1β and COX-2 mRNA in the spinal tissue at four hours after the SCI induction. TMP also significantly attenuated microglia activation and neutrophil infiltration at 48 hours after the SCI induction. In addition, iNOS expression in the spinal tissue was attenuated with TMP treatment. These results suggest that TMP plays a modulatory role in microglia activation and may protect the spinal cord from or potentially delay secondary spinal cord injury.

Spinal cord injury is a devastating neurological disease in desperate need of a cure. We have previously shown that overexpression of the adhesion molecule L1 contributes to locomotor recovery after injury and were therefore interested in how electro-acupuncture would influence the expression of this molecule. Here, we investigated the effects of electro-acupuncture at “Jiaji” points (EX-B2), newly established by us, in young adult mice to determine whether improved recovery via electro-acupuncture could be due to enhanced L1 expression. Locomotor function, as evaluated by the Basso Mouse Scale score and by catwalk gait parameters, was improved by electro-acupuncture at different time points after injury in parallel with enhanced levels of L1 expression. Interestingly, the levels of the astrocytic marker glial fibrillary acidic protein (GFAP) were also increased, but only in the early phase after injury, being reduced at later stages during recovery. Acupuncture alone showed less pronounced changes in expression of these molecules. We propose that electro-acupuncture improves regeneration in part by promoting the L1 expression and beneficial activation of stem cells, and by differentially modulating the expression of GFAP by promoting regeneration-conductive astrocytic responses at initial stages and reducing regeneration-adversive activation in the secondary stages. Expression of the stem cell marker nestin was upregulated by electro-acupuncture in the acute stage. The combined observations show for the first time in mice the beneficial functions of electro-acupuncture at Jiaji points in the spinal cord injury mouse model and provide novel insights into some molecular mechanisms underlying electro-acupuncture in spinal cord injury.

Spinal cord injury (SCI) is a catastrophic disease associated with damaged neurological structures and has become a significant social and economic burden for the health care system and patients’ families. The use of Chinese Herbal Medicine (CHM) to treat SCI has been increasing in recent years. This meta-analysis aimed to investigate the effectiveness of CHM for patients with SCI. Therefore, we included randomized controlled trials (RCTs) of CHM for SCI in seven databases. A total of 26 studies involving 1961 participants were included in this study. No serious heterogeneity or publication bias was observed across each study. The results showed that significant improvements of the American Spinal Injury Association (ASIA)-grading improvement rate ($\mathrm{\text{RR}}=1.44$, $p<0.0001$), clinical effective rate ($\mathrm{\text{RR}}=1.28$, $p<0.00001$), ASIA motor score ($\mathrm{\text{MD}}=7.34$, $p<0.00001$), ASIA sensory score (total) ($\mathrm{\text{MD}}=9.31$, $p<0.00001$), ASIA sensory score (light touch) ($\mathrm{\text{MD}}=7.31$, $p<0.00001$), ASIA sensory score (pinprick) ($\mathrm{\text{MD}}=7.33$, $p<0.0001$), and activities of daily living (ADL) score ($\mathrm{\text{SMD}}=0.68$, $p<0.00001$) in CHM group compared with the control group. Among the CHM groups, Buyang Huanwu decoction was the most frequently prescribed herbal formula, while Astragalus membranaceus was the most commonly used single herb. In addition, there were no serious and permanent adverse effects in the two groups. The methodological quality of the most included RCTs was poor and the quality of evidence for the main outcomes was from very low to moderate according to the GRADE system. Current evidence suggests that CHM is an effective and safe treatment for SCI and could be treated as a complementary and alternative option with few side effects. However, considering the low quality, small size, and high risk of the studies identified in this meta-analysis, higher methodological quality, rigorously designed RCTs with large sample sizes are needed to confirm the results.

The aim of modeling musculoskeletal systems is to understand the mechanisms of locomotion control in terms of neurophysiology and neuroanatomy. The complexity and unique nature of neuromuscular systems, however, make control problems in these systems very challenging due to several characteristics including speed and precision. Thus, their investigation requires the use of simple and analyzable methods. Consequently, taking into account the central pattern generator’s (CPG) function, we attempted to create a structured chaotic model of how human joints and muscles interact for the purpose of facilitating gait and rehabilitation in patients with incomplete spinal cord injury. The four muscle groups used in this model are gluteus, and hip flexor groups for flexion and extension of the hip joints as well as hamstring muscles and vasti muscles for flexion and extension of the knee joint. The results indicate that the output of the chaotic model of muscle and joint interactions in a healthy state would be chaotic, while in the incomplete spinal cord injury state, it would remain a fixed point. For model rehabilitation, afferent nerve stimulation is used in a CPG model; based on the modeling results, by applying coefficients of 1.98, 2.21, and 3.1 to the values of Ia, II, and Ib afferent nerves, the incomplete spinal cord injury model state is changed from a fix-point to periodic in a permanent fashion, suggesting locomotion with rehabilitation in our model. Based on the results obtained from the chaotic model of muscle and joint interactions as well as the comparisons made with reference papers, it can be stated that this model has acceptable output while enjoying simple computations and can predict different norms.

Purpose: We investigated the kinematics of nerve growth factor (NGF)mRNA and brain-derived neurotrophic factor (BDNF)mRNA in a skeletal muscle following spinal cord and peripheral nerve injuries by utilizing the reverse-transcription polymerase chain reaction/high-performance liquid chromatography (RT-PCR/HPLC) method. Methods: We made mice models of spinal cord transection and sciatic nerve transection, plus sham and control groups. After RNA extraction from gastrocnemius muscle of mice, RT-PCR was done. We measured the levels of NGFmRNA and BDNFmRNA in a skeletal muscle following spinal cord and peripheral nerve injuries by utilizing the RT-PCR/HPLC method. All values are analyzed and graphed as means ±SED. Bonferroni test (Post-hoc test) was used when two values were compared. Differences were considered statistically significant when p < 0.05. Results: According to the wet muscle weight, at day 7, a significant difference was found between the peripheral lesion and control group, and at days 14 and 28, significant differences were found between the spinal and peripheral lesion and control group. According to the NGFmRNA, in the peripheral nerve injury group, the levels increased up to day 28 and when compared with the control group, the levels were significantly higher at days 14 and 28. According to the BDNFmRNA, levels at days 2, 7, 14, and 28 were significantly lower in the spinal cord injury group than in the control group. However, in peripheral nerve injury group, when compared with the control group, the levels significantly increased at days 7, 14, and 28. Conclusion: We clarified marked differences in chronological changes in neurotrophin kinetics in a skeletal muscle between spinal cord injury and peripheral nerve injury.

The aim of this prospective controlled study is to compare healing rate and amount of union callus formed in patients with long bone fractures and concomitant head or spinal cord injuries to patients with long bone fractures only. The healing markers of fractures were compared in three groups of patients: (A) patients with head injuries and long bone fractures, (B) patients with acute traumatic spinal cord injuries and long bone fractures, and (C) patients with long bone fractures only. The mean (range) time to union of long bone fractures in groups (A), (B), and (C) patients was 6.9 (3–20), 6.2 (3–7.7), and 22.4 (13–41) weeks. The mean (range) healing rate of long bone fractures in groups (A), (B), and (C) patients was 4.5(0.2–10.6), 4.7 (2.6–7.5), and 0.38(0.11–1) mm/week. The mean (range) thickness of callus formed at fracture sites in groups (A), (B), and (C) patients was 26(4–48), 29(10–48), and 1(2–20)mm. There were no cases of delayed or nonunion in groups (A) and (B) patients while 5 of 69 fractures (7.3%) had delayed union in group (C) and 9/69 (13%) fractures had nonunion. These results suggest acceleration of long bone fractures in patients with head or spinal cord injuries.

New Womb-Like Invention for Preterm Infants.

Reversing Paralysis: Can I Walk Again?

Background: Neuro-musculoskeletal disorders are a major source of physical disability involving more than one joint. Monitoring all joints during walking is achieved by using motion analysis system. There is limited evidence to show the suitability of motion analysis system to monitor neuro-musculoskeletal disorders. This research investigated the feasibility of this system to represent in patients with neuro-musculoskeletal disorders during walking. Method: Five groups of normal subjects with: knee osteoarthritis; avascular necrosis of hip joint; spinal cord injury and flat foot were recruited into this study. Kinetic and kinematic parameters were obtained by the use of motion analysis (Qualysis with seven cameras) and a Kistler force platform. The differences between gait parameters of normal and subjects with these disorders were examined using the independent t-tests. Paired t-test analysis was also used to determine the difference between walking with and without orthosis. Significant value was set at p ≤ 0.05. Results: There was a significant difference between the moment applied on the knee joint, the integral area between center of pressure (COP) and center of knee joint (COJ) graphs of normal and osteoarthritis (OA) subjects (p < 0.05). The area between COP and COJ of the ankle joint significantly differed between normal and flat foot subjects (p < 0.05). However, the force transmitted through the hip joint in subjects with Perthes did not differ significantly while walking with and without orthosis. In paraplegic subjects, the force applied on the limb and the mean values of gait parameters varied while walking with different orthoses which showed the feasibility of the system to monitor the performance of subjects with SCI disorder. Conclusion: The findings of the present study imply that the use of motion analysis is feasibility for assessing and monitoring neuro-musculoskeletal disorders. However, different parameters should be selected for various neuro-musculoskeletal disorders.

Various kinds of orthosis have been designed for paraplegic subjects to stand and walk. They have been designed based on this assumption that most of the loads applied on the orthosis (OR) and body complex is transmitted by OR. In this study, it was aimed to determine the role of OR to transmit the loads by use of strain gauge system. Three spinal cord injury subjects, with lesion between T12 and L1, were recruited in this study. A motion analysis system with a Kistler force plate was used to collect the kinetic and kinematic parameters. Moreover, the loads applied on the OR were determined by use of strain gauges attached on the lateral bar of OR. The pattern of the loads applied on the complex, OR and body, differed from that of OR. Nearly 43% of adduction moment was transmitted by OR. In contrast the role of OR to transmit the flexing/extending moments and vertical force is negligible. The results of strain gauge and motion analysis systems differed completely from each other's. As the strain gauge show the absolute values of the loads applied on OR, it is recommended using its result in order to design an OR for paraplegic subjects.

Spinal cord injury (SCI) may cause disastrous damage to human locomotion and ultimately make patients suffer from gait anomaly. In the extensive SCI research, the locomotion function serves as a vital standard not only for revealing the underlying SCI mechanism but also for evaluating the clinical therapy. Gait division is the basis of gait analysis. Calculation of gait parameters is available for locomotion function evaluation only when gait cycles are accurately divided. Based on the characteristics of stride height, which is defined as the real-time height of toes vertical to the running direction of a treadmill belt, this study presented three automatic gait division methods, divided the gait cycles for healthy and spinal cord-injured rhesus monkeys, established the evaluation standards, and made comparison of these three methods. For the healthy, injured and mixed groups, the overall accuracies of these three methods were respectively 0.871$\pm$0.223, 0.570$\pm$0.372, and 0.720$\pm$0.339 (method 1); 0.658$\pm$0.245, 0.737$\pm$0.206, and 0.698$\pm$0.228 (method 2); 0.966$\pm$0.060, 0.759$\pm$0.343, and 0.863$\pm$0.265 (method 3). The results show that the stride height characteristics combined with the filter technique may help realize the adequate gait division.

As the number of wheelchair users increases, safety accidents related to wheelchairs are increasing. Wheelchair training has been emphasized as a way to deal with this problem. Therefore, this study aimed to develop a wheelchair training structure as an adjustable type and verify its usefulness. Methods: In order to develop the wheelchair training structure as an adjustable type, idea meetings were held by related experts. The structure reflecting the ideas generated by the expert meetings was drawn through 3D modeling and it was produced by a commissioned woodwork shop. Then the final products including the adjustable curb and stairs were evaluated to verify their effectiveness and user satisfaction. Ten physical or occupational therapists rated satisfaction using the Korean-Quebec User Evaluation of Satisfaction with Assistive Technology, and four manual wheelchair users rated effectiveness using the wheelchair Skill Test-Questionnaire 5.0. And the evaluations were conducted twice before and after the 10 wheelchair training sessions each with 30 min duration. Results the result of satisfaction evaluation of the adjustable curbs and stairs by the 10 therapists showed that effectiveness was the highest, and the size and weight were the lowest. As for the effectiveness evaluation by the four manual wheelchair users, both the capacity and confidence of all subjects improved. Conclusion: This study confirmed that training using this type of wheelchair training construct will help wheelchair users improve the confidence and skills of using wheelchair which are essential for their safety and independent mobility. Therefore, if the adjustable curbs and stairs are to be used in the rehabilitation process of early manual wheelchair users, it is expected to contribute to the advancing their successful social return.

In this study, we developed an equi-load biaxial tensile tester and applied it to a series of mechanical tests using specimens obtained from the porcine spinal dura mater. The dural sample exhibited a nonlinear and anisotropic behavior as it was more deformable in the longitudinal direction rather than in the circumferential direction at lower strains; i.e., mechanical response of the longitudinal direction was significantly compliant in the Toe region compared to that of the circumferential direction under 1:1 biaxial stretching. However, we have not observed a significant difference with respect to the resultant strain and Young’s modulus between the longitudinal and circumferential directions at higher strains or in the Linear region. Our results also indicated that the upper thoracic region (T1) was relatively compliant compared to the lumbar region (L), where the failure load was almost equal between them because the dural thickness of T1 was five-fold greater than that of L; i.e., spinal dura mater became stiffer and stronger at further distances from the brain. This shows structural effectiveness and may be preferable to mechanically protect the vulnerable spinal cord from externally applied impact loads.

Background: Transfers are very important in functional activities of subjects with spinal cord injury (SCI). The transfer assessment instrument (TAI) was the first tool to standardize the assessment of transfer technique.

Objective: The purpose of this study was to establish the reliability and validity of TAI 3.0 in people with SCI in early rehabilitation phase.

Methods: Thirty subjects with acute traumatic SCI were recruited from a tertiary care center for SCI management. Four raters assessed the quality of transfer using TAI 3.0 and a fifth rater used global assessment of transfer scale (VAS). TAI 3.0’s intraclass correlation coefficient (ICC) for intrarater and interrater reliability, standard error of measurement (SEM), minimal detectable change (MDC), limits of agreement and concurrent validity was determined.

Results: The intrarater ICC was 0.93 to 0.98 and interrater ICC was 0.99, indicating high levels of reliability. The SEMs among the raters for TAI 3.0 total was from 0.23 to 0.28. The MDC among the raters TAI 3.0 total was from 0.54 to 0.86. Correlation for different raters between the TAI 3.0 and VAS ranged between 0.88 and 0.90.

Conclusion: TAI 3.0 is a reliable and valid tool to assess the transfer skill in individuals with SCI in early rehabilitation phase.

Background: Patients with spinal cord injury (SCI) face various health-related difficulties. Physical limitations and health-related complications in individuals with SCI can lead to activity restrictions and lowering their quality of life (QoL). It is important to assess the QoL in population with SCI to gain more valuable insights into aspects of health-related QoL (HRQoL) that could play a key role in improving care for persons with SCI.

Objective: To quantitatively measure the QoL in persons with SCI in Thailand and expand the results through qualitative investigation to provide meaning, context and depth of “how” and “why” they rated, defined and addressed their QoL in that way.

Methods: The philosophical assumption of this study was set based on the post-positivist views using mixed-methods sequential explanatory design. The quantitative data were collected and analyzed in 101 Thai individuals with SCI using standardized Thai version of the Short Form Health Survey version 2 (SF-36v2), followed by the qualitative investigation of semi-structured interviews in 11 volunteers who participated in the SF-36v2 phase. Priority is given to quantitative data. The data integration occurred at the qualitative data collection through the data interpretation and discussion stage.

Results: With regard to quantitative data, a recent study found a statistically significant difference $(p<0.05)$ in four domains for male and three domains for the female when comparing the SF-36 Thai normative data with SF-36v2 SCI data. Qualitative data revealed that the most salient themes of HRQoL in individuals with SCI were “supporting factors toward QoL” and “driving force post injury”. The integration of the findings revealed that the qualitative data could individually explain and define QoL as well as support quantitative results. The connection of both findings indicated that the higher scores in psycho-social variables and lower scores in physical domains of SF-36v2 in Thai persons with SCI may be due to unique Thai family traditions and community values.

Conclusion: The scores on SF-36v2 and the replies in the qualitative investigation of QoL themes of Thai individuals with SCI were similar to those of other research, but this study is unique in that it specifically represents the Thai socio-environmental-cultural aspects.

Distal nerve transfers can restore precise motor control in tetraplegic patients. When nerve transfers are not successful, tendon transfers may be used for subsequent reconstruction. In this case, an extensor carpi radialis brevis (ECRB) tendon transfer was used to restore thumb and finger flexion following an unsuccessful ECRB to anterior interosseous nerve transfer in a young tetraplegic patient. Twelve months following tendon transfer, the patient demonstrated functional grip and pinch strength and was using both hands for daily activities.

Level of Evidence: Level V (Therapeutic)

This study presents a novel mouth-controlled text input (McTin) device that enables users with severe disabilities to access the keyboard and mouse facilities of a standard personal computer via the input of suitable Morse codes processed by sliding window averaging and a fuzzy recognition algorithm. The device offers users the choice of four different modes of operation, namely keyboard-, mouse-, practice-, and remote-control mode. In the keyboard-mode, the user employs a simple mouth-controlled switch to input Morse codes, which the McTin device then translates into the corresponding keyboard character, symbol, or function. In the mouse-mode, the user is able to control the direction of the mouse movement and access the various mouse functions by inputting a maximum of four Morse code elements. The remote-control-mode gives the user the ability to control some of the functions of household appliances such as TV, air conditioner, fan, and lamp. Finally, the practice-mode employs a training environment within which the user may be trained to input Morse codes accurately and quickly via the mouth-controlled switch. Although this study presents the use of a mouth-controlled switch for the input of Morse codes, the form of the input device can be modified to suit the particular requirements of users with different degrees of physical disability. The proposed device has been tested successfully by two users with severe spinal cord injuries to generate text-based articles, send e-mails, draw pictures, and browse the Internet.

There is a lack of studies concerning standing stability in subjects with incomplete spinal cord injury (SCI). The aims of this study were to analyze the changes of center of pressure (COP), joint moment, joint angle, and muscle activities in patients with incomplete SCI during quiet stance with and without arm support. Ten cervical–thoracic cord incompletely injured patients (mean age: 47.8 ± 13.4 years old) participated in this study. They performed quiet standing with each leg on separate force plate (AMTI, USA) for 5 s with and without holding the walker to obtain the kinetic data. The kinematic data of joint angles were recorded by Motion Analysis System (Vicon 250, Oxford, UK). The electromyographic activities of trunk muscles and quadriceps were recorded by surface electrodes. The results indicated that the COP sway area and the normalized COP sway area significantly (P < 0.01) increased from 94.9 ± 61.3 mm² to 254.6 ± 91.8 mm² and from 0.0013 ± 0.0007 to 0.0037 ± 0.0012, respectively, in patients with incomplete SCI, while standing with arms released from walker. The ankle and knee moments also increased significantly (P < 0.05) during stance without support. However, the joint angles and recorded muscle activities were not significantly different between those with and without support. The conclusion was that the proprioceptive feedback of postural sway, and the motor control strategies of knee–ankle muscles would be important for patients with incomplete SCI during stance without arm support.

Induced pluripotent stem (iPS) cells are pluripotent stem cells directly reprogrammed from cultured mouse fibroblast by introducing Oct3/4, Sox2, c-Myc, and Klf4. Cells obtained using this technology, which allows the ethical issues and immunological rejection associated with embryonic stem (ES) cells to be avoided, might be a clinically useful source for cell replacement therapics. Here we demonstrate that murine iPS cells formed neurospheres that produced electrophysiologically functional neurons, astrocytes, and oligodendrocytes. Secondary neurospheres (SNSs) generated from various mouse iPS cell showed their neural differentiation capacity and teratoma formation after transplantation into the brain of immunodeficient NOD/SCID mice. We found that origin (source of somatic cells) of the iPS cells are the crucial determinant for the potential tumorigenicity of iPS-derived neural stem/progenitor cclls and that their tumorigenicity results from the persistent presence of undifferentiated cells within the SNSs. Furthermore, transplantation of non-tumorigenic Nanog-iPS-derived SNSs into mouse spinal cord injury (SCI) model promoted locomotor function recovery. Surprisingly, SNSs derived from c-Myc minus iPS cells generated without drug selection showed robust tumorigenesis, in spite of their potential to contribute adult chimeric mice without tumor formation.