Annals of Rehabilitation Medicine

"Spinal"

Original Articles

Predictors of Paid Employment Status Among Individuals With Spinal Cord Injury in South Korea: An Exploratory Study Using Random Forest Analysis: Kyungah Song, Jincheol Lim, Onyoo Kim; Received December 17, 2025 Accepted June 25, 2026 Published online August 12, 2026; DOI: https://doi.org/10.5535/arm.250179 [Ahead-of print articles]

Abstract
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Objective
To explore factors affecting the paid employment of individuals with spinal cord injury (SCI) in South Korea.
Methods
Data collected from previously and currently community-dwelling adults with SCI (n=538) who responded to the 125-item self-reported International Spinal Cord Injury Survey questionnaire were analyzed using random forest and decision tree modeling.
Results
In total, 75.1% responders were male, 53.9% were unmarried, 90.1% lived with family, and 84.8% received daily living assistance; the most frequent education level was high school or below (56.1%), and the percentage of participants with paraplegia and complete injuries was 57.2% and 58.7%, respectively. Average age and mean SCI duration were 46.31 and 15.25 years, respectively. Factors with a positive effect on engaging in paid employment included greater total monthly household income, younger age, higher self-efficacy, better quality of life and satisfaction, access to vocational rehabilitation services, absence of disability benefits, no need for daily living assistance, greater independence, no difficulties engaging in activities, absence of sleep disturbances, higher education level, and being unmarried.
Conclusion
Employing the random forest method and a large dataset, we identified key predictors of paid employment, corroborating previous findings and establishing a foundation for policy development for employment opportunities.

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Spinal cord injury

Reconnecting Minds to the World: Patient Perspectives on Brain–Computer Interface After High Cervical Spinal Cord Injury: Youho Myong, Eunkyung Kim, Gain Shin, Eunseo Oh, Byung-Mo Oh; Ann Rehabil Med 2026;50(3):168-178. Published online June 22, 2026; DOI: https://doi.org/10.5535/arm.260018

Objective
To explore the perspectives of individuals with high cervical spinal cord injury (C-SCI) regarding expectations, concerns, and desired applications of brain–computer interface (BCI).
Methods
A structured focus group interview was conducted with four individuals with chronic high cervical spinal cord injury, all with neurological levels of C4 or above. Pre- and post-interview questionnaires were administered to assess expectations, concerns, and acceptance of BCI before and after discussion. The interview was facilitated by experts in rehabilitation medicine and biomedical engineering, and qualitative data were analyzed inductively to identify key themes.
Results
Five major themes emerged: digital accessibility, offline physical activity, social interactions and psychological health, usability, and acceptance. Participants expressed strong interest in using BCI to improve digital independence, particularly for messaging, online banking, internet use, and smart home control. They also viewed BCI as a potential tool to enhance autonomy in daily activities and reduce reliance on caregivers. Most participants were open to training and, in some cases, invasive procedures; however, concerns regarding surgical safety, device maintenance, reliability, and practical usability were frequently raised. Views on the emotional and social impact of BCI varied across individuals. Questionnaire responses showed increased willingness to undergo invasive procedures after the focus group interview, while expected functional outcomes became more realistic, suggesting that structured group discussion may have shaped participants’ understanding of BCI.
Conclusion
BCI was perceived as a promising pathway to greater independence, participation, and autonomy among individuals with high C-SCI. These findings emphasize user-centered design and demonstrate how lived experience can guide assistive neurotechnology development in rehabilitation research.

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Pain & Musculoskeletal rehabilitation

Differential Activation of the Multifidus and Erector Spinae During Asymmetric Spinal Stabilizing Exercise in Adolescent Idiopathic Scoliosis: Sangyoung Kim, Jee Hyun Suh, Ju Seok Ryu; Ann Rehabil Med 2026;50(1):1-11. Published online February 11, 2026; DOI: https://doi.org/10.5535/arm.250148

Abstract
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Objective
To identify the asymmetric spinal stabilizing exercise (ASSE) postures that selectively activate the multifidus (Mu) relative to the erector spinae (ES) in patients with adolescent idiopathic scoliosis (AIS), thereby supporting the development of curve-specific exercise programs for three-dimensional spinal deformities.
Methods
Surface electromyography recordings were obtained bilaterally from the ES and Mu muscles during ASSE postures. Signals were normalized to the maximal voluntary isometric contraction. The asymmetry ratio, Mu/ES ratio, and additional asymmetric contraction of the Mu were analyzed.
Results
The study included 40 patients with AIS. The Mu demonstrated greater ipsilateral activation in the side-lying posture, whereas greater contralateral activation was observed during unilateral lower extremity lifting and combined upper–lower extremity lifting in the prone posture, as well as during combined upper–lower extremity lifting in the bird-dog posture. In the prone and bird-dog postures, the Mu/ES ratio exceeded 1.0, indicating relatively stronger Mu recruitment under rotational loading. Additional asymmetric contraction of the Mu was greatest in the side-lying posture (47%), with differences<15% in all other postures.
Conclusion
ASSE induces posture-specific asymmetric activation of the paraspinal muscles in patients with AIS. Although the side-lying posture produced the largest asymmetry, this reflected increased ES activity for trunk elevation rather than true selective Mu contraction. In contrast, the prone and bird-dog postures demonstrated a greater Mu contribution relative to the ES under rotational loading. These findings suggest that ASSE can be adapted to target specific paraspinal muscle components: side lying for lateral bending and bird-dog variations to enhance rotational stability.

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Review Article

Pediatric rehabilitation

Assessment and Management of Adolescent Idiopathic Scoliosis: From the Perspective of a Physiatrist: Yang-Chin Su, Chi-Kuang Feng, Tsui-Fen Yang; Ann Rehabil Med 2025;49(5):263-278. Published online October 31, 2025; DOI: https://doi.org/10.5535/arm.250097

Abstract
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Adolescent idiopathic scoliosis (AIS) is the most encountered spinal deformity in growing children, which may bring significant impacts on patients’ physical function, appearance, and overall quality of life. A physiatrist plays a crucial role in the early diagnosis of AIS and longitudinal management through continuous care. Contemporary management for AIS is according to the skeletal maturity, the magnitude of the spinal curves, and the risk of progression. For mild curves, therapeutic exercises, particularly physiotherapeutic scoliosis-specific exercises (PSSE), are employed as a conservative approach to improve postural symmetry and reduce the risk of curve progression. Bracing is required for moderate curves from 25 to 45 degrees in skeletally immature cases. Strict compliance with bracing is critical for therapeutic success. In cases that are rapidly progressive or in severe curves exceeding 40 to 45 degrees, spinal fusion surgery is considered the definitive treatment. Recent advancements in non-fusion and motion-preserving techniques provide alternative options to traditional fusion surgery. To protect maximal neurological function, intraoperative neurophysiological monitoring (IONM) is currently the trend for spinal deformity correction surgery. The care for AIS patients is an individualized, multidisciplinary, patient-centered, growth-sensitive approach, aiming to optimize outcomes and minimize long-term complications. This review outlines a comprehensive rehabilitation-oriented strategy for AIS patients from the perspective of a physiatrist, encompassing clinical assessment, conservative management with observation, therapeutic exercises, bracing, and further considerations in referral to spinal surgery.

Citations

Citations to this article as recorded by

Evaluating the Effectiveness of sEMG Biofeedback for Posture Training and Scoliosis Management
Yiu-Hong Wong, Mei-chun Cheung, Qi-Wen Emma Lei, Joanne Yip, Yoel A. Klug
BioMed Research International.2026;[Epub] CrossRef
Interrelationships among 3D spinal alignment variables during active self-correction in adolescents with idiopathic scoliosis
Arkadiusz Żurawski, Sun-Young Ha
European Spine Journal.2026;[Epub] CrossRef
Three-Dimensional Surface Topography for the Assessment of Spinal Alignment: A Cross-Sectional Study of Biomechanical Correlates
Brigitte Osser, Csongor Toth, Gyongyi Osser, Laura Ioana Bondar, Liliana-Oana Pobirci, Florin Mihai Marcu, Ramona Nicoleta Suciu, Nicoleta Anamaria Pascalau, Adina Mincic, Corina Dalia Toderescu
Diagnostics.2026; 16(10): 1445. CrossRef
Economic evaluation of school scoliosis screening in Gannan Tibetan autonomous prefecture, Gansu Province: a cost-utility analysis based on decision tree-Markov model
Shaobo Yang, Juan Wang, Peiji Miao, Chen Zhang, Jin Huang, Xiaoyun Yuan, Yanxiang Zhang, Xiaohui Dou, Zhenheng Zhang, Zhe Liu, Jianjun Duan, Xueting Xu, Jiantao Wen, Shunjun Cui, Xiaole Zhu
Frontiers in Public Health.2026;[Epub] CrossRef
Comment on “Automatic radiation-free evaluation of Cobb angle for spinal curvature based on fringe projection profilometry and deep learning technology”
Y. M. Manu, Suresha Devaraju, B. M. Praveen
Spine Deformity.2026;[Epub] CrossRef
Factors Associated With Follow-Up Attendance After School Scoliosis Screening: A Pilot Cross-Sectional Study
Takuya Nagai, Syuji Kurogi, Kiyoshi Higa, Shota Amano, Takayuki Matsumoto, Takumi Takahashi, Naosuke Kamei
Cureus.2026;[Epub] CrossRef
The Adult Idiopathic Scoliosis Phenotype Is Not Well Characterized by Individual Scoliosis ICD Codes in Health Care Databases
Kaleb Taylor, Susan Graham, Cassidy Yoshida, Harry Smith, Ethan M. Lange, Randi K. Johnson, Siera Rossi, Nancy Hadley-Miller, Patrick M. Carry
Spine Open.2026;[Epub] CrossRef
Dynamic Infrared Thermography Reveals Bilateral Thermal Recovery Asymmetry in Scoliosis
Daniel Faizy, Ramazan Beşir Yaman, Seda Nilgün Dumlu, Tuğçe Yavuz, Muhammet Alptekin Kocaoğlu, Akif Albayrak, Hande Argunsah
Journal of Clinical Medicine.2026; 15(14): 5720. CrossRef

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Original Article

Spinal cord injury

Factors Affecting Subjective Vitality and Mental Health After Spinal Cord Injury: A Cross-Sectional Study: Onyoo Kim, Jin-cheol Lim, Jinhee Jeong; Ann Rehabil Med 2025;49(5):290-301. Published online October 31, 2025; DOI: https://doi.org/10.5535/arm.250044

Abstract
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Objective
To explore subjective vitality and mental health among individuals with spinal cord injury (SCI) in South Korea; specifically the relationship between subjective vitality and mental health and their associations with SCI-related factors, including health conditions, activity, environmental, and personal factors.
Methods
This cross-sectional study utilized data from the International Spinal Cord Injury Community Survey conducted in South Korea between March and October 2017. Data from 688 community-dwelling individuals with SCI were included in this study. Correlation and multiple regression analyses were conducted to investigate the relationships between vitality, mental health, and their associated factors.
Results
A strong positive correlation was identified between subjective vitality and mental health (r=0.78, p<0.001). In multiple regression analyses, common factors significantly associated with both domains included sleep problems, healthcare-related activities, financial burden, self-efficacy, and belongingness. Bowel problems were associated only with subjective vitality, while pressure injury and perceived social attitudes were associated only with mental health.
Conclusion
These findings highlight the importance of comprehensive approaches that address secondary health complications, promote healthcare education, and alleviate financial burdens to enhance both subjective vitality and mental health in individuals with SCI. Additionally, psychological interventions that foster belongingness and strengthen self-efficacy may further contribute to psychological well-being following SCI. Further research is needed to validate these associations and evaluate the long-term effects of such multidimensional strategies on subjective vitality and overall quality of life following SCI.

Citations

Citations to this article as recorded by

Subjective Vitality and School Burnout Among Preadolescents: The Mediation Effect of Self-Efficacy
Sayema Rahman Rathi, Sabeha Sanjana, Mahbuba Sultana
Psychological Reports.2026;[Epub] CrossRef

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68 Download
1 Web of Science
1 Crossref

Review Articles

Spinal cord injury

The Effects of Inspiratory Muscle Training in Individuals With Cervical Spinal Cord Injuries: A Systematic Review and Meta-Analysis: Dat Huu Tran, Ha Thi Le, Tho Thi Quynh Chu, Hung Thi Cam Pham, Anh Ngoc Van Le; Ann Rehabil Med 2025;49(3):152-163. Published online June 17, 2025; DOI: https://doi.org/10.5535/arm.250013; Correction in: Ann Rehabil Med 2025;49(4):257

The effect of inspiratory muscle training (IMT) on cervical spinal cord injury (SCI) remains controversial. This study aimed to assess the efficacy of IMT in enhancing breathing muscle strength, pulmonary function, and quality of life (QoL) among patients with cervical SCI. A search was performed using the PubMed, Cochrane Library, Scopus, Embase, and Web of Science databases through December 2023. This review was conducted according to PRISMA guidelines and the Cochrane Library Handbook. The meta-analysis used mean differences (MDs) or standardized mean differences to pool the results. The Risk of Bias 2 and the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) were used to assess the methodological quality of the included studies. This systematic review included five randomized controlled trials (202 participants). The results of the meta-analysis showed that IMT significantly improved maximal inspiratory pressure (MIP) with MD 12.13 cmH2O (95% confidence interval [CI] 4.22 to 20.03), maximal expiratory pressure (MEP) with MD 8.98 cmH2O (95% CI 6.96 to 11.00), and vital capacity (VC) with MD 0.25 L (95% CI 0.21 to 0.28). There were no significant improvements in forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), and QoL. The quality of the evidence ranged from very low to moderate, owing to bias and heterogeneity. Our results showed that IMT may improve MIP, MEP, and VC, but not FEV1, FVC, or QoL, in patients with cervical SCI. Further large-scale studies are required to determine this effect’s optimal dosage and duration.

Citations

Citations to this article as recorded by

Rewiring the Lung–CNS Axis After Spinal Cord Injury
HaiRong Wu, Xiaolong Li, Wenjun Zhao, Yihan Li, Hang Zhang, Heng Yin, Xiaofeng Gu
Journal of Inflammation Research.2026; Volume 19: 1. CrossRef
Effects of whole-body vibration training on sarcopenia in older adults: a systematic review and meta-analysis of randomized controlled trials
Jaewon Beom, Jae-Young Lim, Sang Yoon Lee
Scientific Reports.2026;[Epub] CrossRef
RESPIRATORY MUSCLE TRAINING IN SPORTS AND REHABILITATION: A LITERATURE REVIEW
Martyna Łubianka, Wiktor Słyś
International Journal of Innovative Technologies in Social Science.2026;[Epub] CrossRef
Effects of Electrostimulation With the Laparoscopic Implantation of Neuroprosthesis Procedure Combined With Cardiorespiratory Physiotherapy on the Functional Rehabilitation of Individuals With Chronic Spinal Cord Injury: Quasirandomized Prospective Contro
Wellington Contiero, Augusta Ribeiro Morgado, Victor Croos-Bezerra, Cristiano Soares Simões, João Angelo Ferres Brogin, Jean Faber, Nucelio Lemos
Neuromodulation: Technology at the Neural Interface.2026;[Epub] CrossRef
Determinants for improving respiratory muscle training after spinal cord injury using real-world clinical data
Gabi Mueller, Marianne Tanner, Amelie Gruber, Sabrina Alessandri, Claudio Perret, Andreas Limacher
Spinal Cord.2026;[Epub] CrossRef

13,321 View
199 Download
3 Web of Science
5 Crossref

Neuromuscular disorders

Rehabilitation Strategies for Patients With Spinal Muscular Atrophy in the Era of Disease-Modifying Therapy: Hyung-Ik Shin; Ann Rehabil Med 2024;48(4):229-238. Published online August 30, 2024; DOI: https://doi.org/10.5535/arm.240046

Abstract
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The impact of disease-modifying therapy ranges from cure to no impact with a wide range of intermediates. In cases where the intermediate group reaches a plateau after the acquisition of some muscle strength, it is necessary to set a functional level appropriate for increased motor power and establish a long-term exercise plan to maintain it. As the disease status stabilizes and the life span increases, early nonsurgical interventions are required, such as using a standing frame to prevent joint contracture, applying a spinal brace at the early stage of scoliosis, and maintaining sitting postures that exaggerate lumbar lordosis. In cases where scoliosis and hip displacement occur and progress even after conservative managements are implemented, early referral to surgery should be considered. Oromotor activity and swallowing function are influenced not only by the effects of disease-modifying drugs, but also by post-birth experience and training. Therefore, although the feeding tube cannot be removed, it is necessary to make efforts to simulate the infant feeding development while maintaining partial oral feeding. Since the application period of non-invasive ventilators has increased, it has become more important to prevent long-term complications such as facial abrasion, skin allergy, orthodontic deformities, and maxillary flattening caused by the interface. Dual ventilator mode or interface can also be utilized.

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Immediate and Sustained Effects of Intensive Equine-Assisted Physiotherapy Based on Neuroproprioceptive “Facilitation and Inhibition” on Psychomotor Development, Clinical Functions, Quality of Life, and Molecular Biological Indicators in Children With Spi
Katerina Marikova, Jindra Reissigova, Miloslav Vilimek, Marie Cerna, Marketa Pokorna, Kamila Rasova
JMIR Research Protocols.2026; 15: e83266. CrossRef
Skeletal muscle in spinal muscular atrophy: Critical insights from pathogenesis to therapeutic strategies
Linda Ottoboni, Chiara Panicucci, Giulia Magni, Delia Gagliardi, Michela Ripolone, Laura Napoli, Maurizio Moggio, Giacomo Pietro Comi, Claudio Bruno, Stefania Paola Corti
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Yuliya O. Papina, Aleksandr R. Stevanovich, Evgeniya A. Melnik, Svetlana B. Artemyeva, Dmitry V. Vlodavets
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The role of rehabilitation in the development of motor skills in patients with spinal muscular atrophy 5q receiving pathogenetic therapy
Yuliya O. Papina, Aleksandr R. Stevanovich, Evgeniya A. Melnik, Svetlana B. Artemyeva, Dmitry V. Vlodavets
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Inga Partlova, Laura H. Comley, Alice E. Haigh, Paloma Serena Tarodo, Lyndsay M. Murray
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Short-term and long-term outcomes of transcutaneous spinal cord stimulation in SMA: findings from consecutive courses
Natalia Shamantseva, Anton Novikov, Maria Maldova, Ivan Shalmiev, Margarita Bystrova, Natalia Krutikova, Tatiana Moshonkina
Journal of Neural Engineering.2026; 23(4): 046013. CrossRef
Physical and Respiratory Rehabilitation in Spinal Muscular Atrophy: A Critical Narrative Review
Serena Cammarano, Vincenzo Alessio Chirico, Benedetto Giardulli, Giovanna Mazzuoccolo, Carlo Ruosi, Bruno Corrado
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Treatment Guidelines and Rehabilitation in Spinal Muscular Atrophy and Duchenne’s Muscular Dystrophy
Eleni Drakou, Sarah Wright, Leslie D. Delfiner, David Cancel
Physical Medicine and Rehabilitation Clinics of North America.2025; 36(3): 531. CrossRef
Management of Hip and Spine in Neuromuscular Disorders
Unwana Abasi, Abigail Allen, Coral Candelario-Velazquez, Sheena Ranade, David Cancel
Physical Medicine and Rehabilitation Clinics of North America.2025; 36(3): 429. CrossRef
Multimodal Analysis of Biomarkers for SMA - Data from the First Six-Month Nusinersen Follow-Up
Corina Sporea, Mihaela Axente, Gabriel Cristian Bejan, Andrada Mirea, Mihaela Badina
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The effect of thoracolumbosacral orthosis on scoliosis progression and chest deformity in children with type 1 spinal muscular atrophy: A randomized controlled trial
Emre Dansuk, Ayşe Nur Tunalı Van Den Berg, Görkem Ata, Seval Kutluturk Yıkılmaz, Sedat Oktem, Taher Babaee
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Spinal Muscular Atrophy (SMA)
Kaitlyn Rodriguez, Mara Karamitopoulos
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11,902 View
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12 Web of Science
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Spinal cord injury

Effects of Botulinum Toxin-A for Spasticity and Nociceptive Pain in Individuals with Spinal Cord Injury: A Systematic Review and Meta-Analysis: Dewan Md. Sumsuzzman, Zeeshan Ahmad Khan, Irin Sultana Nila, Vanina Myuriel Villagra Moran, Madhuvilakku Rajesh, Won Jong Yang, Yonggeun Hong; Ann Rehabil Med 2024;48(3):192-202. Published online June 28, 2024; DOI: https://doi.org/10.5535/arm.240034

We conducted a systematic review and meta-analysis to examine the protective effects of botulinum toxin-A (Botox-A) on spasticity and nociceptive pain in individuals with spinal cord injuries (SCIs). PubMed, Embase, and Cochrane Library databases were searched from inception to July 2023. The primary outcome of interest was spasticity and nociceptive pain. We pooled the available data using the generic inverse variance method, and we used a fixed-effect/random-effects model. We then calculated standardized mean difference (SMD) and 95% confidence intervals (95% CIs) to estimate the effect size. A total of fourteen studies meeting the inclusion criteria comprised two randomized controlled trials, five pre-post studies, and seven case reports. Across the various study designs, the majority of trials were assessed to have fair to high quality. The meta-analysis shows that Botox-A significantly decreased spasticity (SMD, -1.73; 95% CI, -2.51 to -0.95; p<0.0001, I2=48%) and nociceptive pain (SMD, -1.79; 95% CI, -2.67 to -0.91; p<0.0001, I2=0%) in SCI patients. Furthermore, Botox-A intervention improved motor function, activities of daily living (ADL), and quality of life. Our study suggests that Botox-A may alleviate spasticity and nociceptive pain in SCI patients. Moreover, the observed improvements in motor function, ADL, and overall quality of life following Botox-A intervention underscore its pivotal role in enhancing patient outcomes.

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Botulinum Toxin for Spasticity: Real-World Effects on Patient Health-Related Quality of Life and Caregiver Burden -A Long-Term Retrospective Study
Giorgio Mandalà, Maria Luisa Capuana, Giacomo Fisco, Giuliana Grimaldi, Provvidenza Sansone, Maria Silvia Mangano
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Botulinum Toxin for Spasticity: Real-World Effects on Patient Health-Related Quality of Life and Caregiver Burden -A Long-Term Retrospective Study
Giorgio Mandalà, Maria Luisa Capuana, Giacomo Fisco, Giuliana Grimaldi, Provvidenza Sansone, Maria Silvia Mangano
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British Journal of Pharmacology.2025;[Epub] CrossRef
Combined Extracorporeal Shock Wave Therapy and Botulinum Toxin Injection for Spasticity in the Acute Phase of Spinal Cord Injury: A Case Report
Maiko Nishimura, Risa Harada, Takumi Hirabayashi, Yuka Muranaka, Toshiki Usui, Mariko Nagase, Ryoga Kashima, Wataru Saho, Ryo Yoshikawa, Yoshitada Sakai
Progress in Rehabilitation Medicine.2025; 10: n/a. CrossRef

11,406 View
161 Download
4 Web of Science
5 Crossref

Spinal cord injury

Robot-Assisted Gait Training in Individuals With Spinal Cord Injury: A Systematic Review and Meta-Analysis of Randomized Controlled Trials: Jong Mi Park, Yong Wook Kim, Su Ji Lee, Ji Cheol Shin; Ann Rehabil Med 2024;48(3):171-191. Published online June 28, 2024; DOI: https://doi.org/10.5535/arm.230039

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.

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Prakash V., Shrushti Shah
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Exercise training promotes nerve cell repair and regeneration after spinal cord injury
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Impact and feasibility of a group-based therapeutic exercise program on strength and endurance in hospitalized patients with spinal cord injury: a quasi-experimental study
Aitor Garay-Sánchez, Mercedes Ferrando-Margelí, María Navarro-Segura, Aloña Fernández-Celaya, Elena Orejuela-Aparicio, Juan Nicolas Cuenca-Zaldivar, Eleuterio A. Sánchez-Romero, Yolanda Marcén-Román
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Exploring the Feasibility and Patient Acceptance of RAGT for Overground Ambulation in Adults With Guillain–Barré Syndrome: A Scoping Review
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Investigating the role of therapist-patient interaction during robot-assisted gait training after incomplete spinal cord injury: the INTER-RO-GAIT randomized controlled trial
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The Role of Combined Vojta and Lokomat Therapy in Restoring Lower Limb Mobility and Muscle Strength in Patients With Spinal Cord Lesion
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Case Report: Efficacy of transcutaneous spinal cord stimulation combined with overground robotic-assisted gait training in chronic incomplete spinal cord injury
Gobinathan Chandran, Nur Shafawati Kamsani, Ning Tang, Hwa Sen Lai, Tracy Ong, Su-Ann Cheng, Jeong Hoon Lim, Ravi Shankar, Effie Chew
Frontiers in Human Neuroscience.2026;[Epub] CrossRef
Використання роботизованих технологій у реабілітації пацієнтів із травмами спинного мозку: розгляд доказів та практичні висновки
Діана Котєрєва, Дарія Попович
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Yi-Ting Sun, Xiao-Na Xiang, Jia-Lei Peng, Yan Liu, Jiang-Yin Zhang, Hong-Chen He
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Feasibility and Safety of Combined Robot-Assisted Gait Training and Transcutaneous Spinal Cord Stimulation in Pediatric Incomplete Spinal Cord Injury: A Case Series
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Giuliana De Maio, Daniele Conte, Matteo Olivieri, Dolores Catelan, Giulia Stampacchia, Emiliana Bizzarini
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Kap-Soo Han, Myoung-Hwan Ko
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Antonio Montoto-Marqués, Jesús Benito-Penalva, María Elena Ferreiro-Velasco, Mark Andrew Wright, Sebastian Salvador-De la Barrera, Hatice Kumru, Nelson Gaitán-Pérez, Agustin Hernández-Navarro, Antonio Rodríguez-Sotillo, Fernando Martins Braga, Angela Pale
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Hong-Bo Zhao, Xiang-Jiang Rong, Qi Zhang, Ting-Ting Ma, He Yan, Tian-Tian Zhou, Yan-Qing Zhang
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Electromechanical-assisted training for walking after stroke
Jan Mehrholz, Joachim Kugler, Marcus Pohl, Bernhard Elsner
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Oluwasola Okhuoya, Lara A. Thompson
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Yuan-Yuan Wu, Yi-Meng Gao, Ting Feng, Jia-Sheng Rao, Can Zhao
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Alexandru Ilies, Cornel Cheregi, Hassan Thowayeb, Jan Wendt, Maur Horgos, Liviu Lazar
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Jiae Kim, Jungwha Do, Cho Rong Bae, Young Hoon Mo, Ji Hye Kim, Dae Yul Kim
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Hui Zhu, Kwok-Fai So, Xiaoqing Feng, Fang Niu, James David Guest
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Hasan Aytepe
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Anamaria Gherle, Carmen Delia Nistor-Cseppento, Liviu Lazar, Ștefania Deac, Mirela Elena Bodea, Florin Mihai Marcu, Sebastian Tirla, Mariana Lidia Cevei
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Martina Regazzetti, Mirko Zitti, Giovanni Lazzaro, Samuel Vianello, Sara Federico, Błażej Cieślik, Agnieszka Guzik, Carlos Luque-Moreno, Pawel Kiper
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Original Articles

Spinal cord injury

Epidemiology of Traumatic Spinal Cord Injury in the Himalayan Range and Sub-Himalayan region: A Retrospective Hospital Data-Based Study: Osama Neyaz, Vinay Kanaujia, Raj Kumar Yadav, Bhaskar Sarkar, Md. Quamar Azam, Pankaj Kandwal; Ann Rehabil Med 2024;48(1):86-93. Published online December 26, 2023; DOI: https://doi.org/10.5535/arm.23107

Objective
To compile epidemiological characteristics of traumatic spinal cord injury (TSCI) in the Northern Indian Himalayan regions and Sub-Himalayan planes.
Methods
The present study is a retrospective, cross-sectional descriptive analysis based on hospital data conducted at the Department of Physical Medicine and Rehabilitation and Spine Unit of Trauma Centre in a tertiary care hospital in Uttarakhand, India. People hospitalized at the tertiary care center between August 2018 and November 2021 are included in the study sample. A prestructured proforma was employed for the evaluation, including demographic and epidemiological characteristics.
Results
TSCI was found in 167 out of 3,120 trauma patients. The mean age of people with TSCI was 33.5±13.3, with a male-to-female ratio of 2.4:1. Eighty-three participants (49.7%) were from the plains, while the hilly region accounts for 50.3%. People from the plains had a 2.9:1 rural-to-urban ratio, whereas the hilly region had a 6:1 ratio. The overall most prevalent cause was Falls (59.3%), followed by road traffic accidents (RTAs) (35.9%). RTAs (57.2%) were the most common cause of TSCI in the plains’ urban regions, while Falls (58.1%) were more common in rural plains. In both urban (66.6%) and rural (65.3%) parts of the hilly region, falls were the most common cause.
Conclusion
TSCI is more common in young males, especially in rural hilly areas. Falls rather than RTAs are the major cause.

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Comparative study of photobiomodulation therapy and low-intensity pulsed ultrasound for nerve regeneration and pain alleviation in an acute spinal cord injury model
Negin Khosravipour, Ali Motamed Nezhad, Fatemeh Ramezani, Molood Gooniband Shooshtari, Mehrad Mahdavi, Soroush Taherkhani, Negin Mojarad, Ali Moshiri, Atousa Janzadeh
Journal of Neuropathology & Experimental Neurology.2026; 85(2): 167. CrossRef
Development and validation of a multilevel scale for quantitative assessment of mechanical exposure in traumatic spinal injuries
Oleksii S. Nekhlopochyn, Vadym V. Verbov, Ievgen V. Cheshuk, Milan V. Vorodi
Ukrainian Neurosurgical Journal.2026; 32(1): 69. CrossRef
Traumatic Spine Injury in Southern Ethiopia: Falls, Delayed Presentation, and High Early Mortality at a Tertiary Referral Center
Mengistu G. Mengesha, Sultan Baz, Hermella Damenu, Hana-Joy Hanks, Ryan Beyer, Alexander Nazareth, Sohaib Hashmi, Hao-Hua Wu
Journal of Clinical Medicine.2026; 15(9): 3276. CrossRef
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César Daniel Amador Aburto, Aída Barrera Ortiz, Marlene Rodríguez Barragán, Jimena Quinzaños Fresnedo
Revista Mexicana de Medicina Física y Rehabilitación.2026; 38(1): 12. CrossRef
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Xiaochun Xiong, Chao Zhou, Yijun Yu, Qiong Xie, Linying Xia, Qingping Li, Hongming Lin, Songou Zhang, Wenqing Liang
Journal of Orthopaedic Translation.2025; 52: 441. CrossRef

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Spinal cord injury

Epidemiology and Assessment of Traumatic Spinal Cord Injury With Concomitant Brain Injury: An Observational Study in a Regional Trauma Center: Tae Woong Yang, Dong Ho Yoo, Sungchul Huh, Myung Hun Jang, Yong Beom Shin, Sang Hun Kim; Ann Rehabil Med 2023;47(5):385-392. Published online October 12, 2023; DOI: https://doi.org/10.5535/arm.23054

Objective
To analyze the epidemiological information of patients with traumatic spinal cord injury (SCI) and concomitant traumatic brain injury (TBI) and to suggest points to be aware of during the initial physical examination of patients with SCI.
Methods
This study was a retrospective, observational study conducted in a regional trauma center. All the records of patients diagnosed with traumatic SCI between 2016 and 2020 were reviewed. A total of 627 patients with confirmed traumatic SCI were hospitalized. A retrospective study was conducted on 363 individuals.
Results
The epidemiological data of 363 individuals were investigated. Changes in American Spinal Injury Association Impairment Scale (AIS) scores in patients with SCI were evaluated. The initial evaluation was performed on average 11 days after the injury, and a follow-up examination was performed 43 days after. Fourteen of the 24 patients identified as having AIS A and SCI with concomitant TBI in the initial evaluation showed neurologic level of injury (NLI) recovery with AIS B or more. The conversion rate in patients with SCI and concomitant TBI exceeded that reported in previous studies in individuals with SCI.
Conclusions
Physical, cognitive, and emotional impairments caused by TBI present significant challenges in rehabilitating patients with SCI. In this study, the influence of concomitant TBI lesions could have caused the initial AIS assessment to be incorrect.

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Neurologic Decline After Spinal Cord Injury
Zakari R. Dymock, Sara Shahid Salles
Physical Medicine and Rehabilitation Clinics of North America.2025; 36(1): 47. CrossRef
Screening and outcomes of co-occurring traumatic brain injury among people with spinal cord injury: a scoping review
Deborah L. Snell, Phoebe Wynands, Jennifer Dunn, Joanne Nunnerley, Alice Theadom
Journal of Rehabilitation Medicine.2025; 57: jrm41897. CrossRef
Animal Models of Spinal Cord Injury
Vladislav E. Sobolev, Yuriy I. Sysoev, Tatiana V. Vyunova, Pavel E. Musienko
Biomedicines.2025; 13(6): 1427. CrossRef
Concomitant Traumatic Brain Injury Exacerbates Endotheliopathy in Patients with Spinal Cord Injury
Shahab Hafezi, Miguel A. Ruiz-Cardozo, Sarbani Ghosh, Sravanthi Bandla, Matthew N. Montoya Rush, Anand Dharmarajan, Mark H. Hoofnagle, Isaiah R. Turnbull, Camilo A. Molina, Grace M. Niziolek
Neurotrauma Reports.2025;[Epub] CrossRef
The Critical Management of Spinal Cord Injury: A Narrative Review
Emilio Moreno-González, Antonio Ibarra
Clinics and Practice.2024; 15(1): 2. CrossRef

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Spinal cord injury

Risk Factors for Suicidality in Individuals With Spinal Cord Injury: A Focus on Physical and Functional Characteristics: Sora Han, Wooyeung Kim, Onyoo Kim; Ann Rehabil Med 2023;47(5):377-384. Published online October 4, 2023; DOI: https://doi.org/10.5535/arm.23110

Objective
To demonstrate the association between the physical and functional characteristics of individuals with spinal cord injury (SCI) and suicidality, an area of research that is less understood than the association with demographic, social, and psychological characteristics.
Methods
A retrospective cross-sectional study was conducted with 259 patients with SCI admitted for rehabilitation at the National Rehabilitation Center, Seoul, between January 2019 and December 2021. Demographic, SCI-related, physical, and functional data were collected from their medical records. Suicide risk was assessed using the Mini International Neuropsychiatric Interview.
Results
The 259 participants had an average age of 49.1 years, and 75.7% were male. The analysis revealed a statistically significant negative correlation between age and suicidality. No significant differences were found for sex, education, occupation, or SCI-related factors. Lower upper extremity motor score (UEMS) was significantly associated with higher suicide risk. Regarding functional factors, the inability to perform independent rolling, come to sit, wheelchair propelling, and self-driving were associated with increased suicidality. In the multiple linear regression analysis, lower UEMS, limited shoulder joint motion, upper extremity spasticity, and dependent wheelchair propulsion were predictors of higher suicide risk.
Conclusion
This study highlights the associations among physical status, functional dependency, and suicide risk in individuals with SCI. These findings emphasize the need to address psychological aspects and physical and functional factors in the management of individuals with SCI who are at a high risk of suicide.

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Leslie R. Morse, Ricardo A. Battaglino, Nguyen Nguyen, Brian DeVries, Abigail Welch, Ana Lucia Battaglino, Clas Linnman, Michael Stillman, Robert Wudlick, Joda Glossner, Grant Anderton, Richard Goldstein, Scott P. Falci
PAIN Reports.2025; 10(4): e1301. CrossRef
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R Dinesh Iyer, Pranavakumar Palaninathan, Prashasth Belludi Suresh, Vignesh Gunasekaran, Sathiyamoorthi Periyaswamy, Ajoy Prasad Shetty, K S Sri Vijayanand, Rishi Mugesh Kanna, Rajasekaran Shanmuganathan
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Review Article

Spinal Cord Injury

Spinal Cord Injury Fact Sheet in Korea: Han-Kyoul KIM, Ja-Ho Leigh, Yoonjeong Choi, Jong Hwa Lee, Moon Suk Bang; Ann Rehabil Med 2023;47(1):4-10. Published online February 28, 2023; DOI: https://doi.org/10.5535/arm.23020

Abstract
PDF

Spinal cord injury (SCI) has been recognized as a medically complex and life-disrupting condition. As the aging of the population accelerates, the trend of SCI has changed. This review aimed to provide comprehensive statistics and recent epidemiological changes in SCI and rehabilitation in Korea. All three insurance databases (National Health Insurance Service [NHIS], automobile insurance [AUI], and industrial accident compensation insurance [IACI]) were considered. These nationwide databases provide data on the current trends in term of incidence, etiology, and rehabilitation of SCI. Traumatic spinal cord injury (TSCI) was more frequent among the elderly in the NHIS compared to working age individuals in the AUI and IACI. In all three trauma-related insurance databases, male with TSCI outnumbered female. TSCI incidence per year was approximately 17 times higher among males than females, on average, in IACI. In all three insurances, the cervical level of TSCI was the most frequent. Although the ratio of SCI patients receiving rehabilitation treatment at primary and secondary hospitals increased for nine years, the increase in training on activities of daily living (ADL training) was found to be relatively small. This review provides a broader and comprehensive understanding of the incidence, etiology, and rehabilitation treatment of SCI in Korea.

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Clinical Predictors of Dysphagia in Acute and Subacute Traumatic Cervical Spinal Cord Injury: A Retrospective Observational Study
Yong Beom Shin, Jin A Yoon, Byeong Ju Lee, Myung Hun Jang, Hyuk Jin Choi, Sang Hun Kim
Dysphagia.2026; 41(1): 149. CrossRef
Patient-reported outcomes, rehabilitation utilization, and unmet needs after traumatic spinal cord injury: A regional pilot survey in Korea
Sang-Hun Kim, Sungchul Huh, Eun Heui Lim, Hee Jung Kim, Cho Hui Hong, Seunghan Yu, Mahnjeong Ha, Yong Beom Shin
The Journal of Spinal Cord Medicine.2026; : 1. CrossRef
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Manuel F. Mas, Félix Pérez, Anna Blanco, Javier Deya, Natasha L. Frontera, Marcos R. Latimer, José Quintana, José G. Conde, Walter R. Frontera
The Journal of Spinal Cord Medicine.2025; 48(5): 773. CrossRef
Effectiveness of a Community-Based Exercise Program for Ambulatory Individuals With Spinal Cord Injury: A Randomized Controlled Trial
Sungchul Huh, Yuna Kim, Hyun-Yoon Ko, Mi Sook Yun, Yong Il Shin, Jung Lim Lee, Sung-Hwa Ko
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Boram Lee, Hyeong Jun Kim
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Hyun-Joon Yoo, Kwang-Sig Lee, Bummo Koo, Chan-Woo Yong, Chae-Won Kim
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Seonghye Kim, Bongseong Kim, Kyung-Do Han, Junhee Park, Jung Eun Yoo, Hea Lim Choi, Won Hyuk Chang, In Young Cho, Dong Wook Shin
Bone.2024; 183: 117093. CrossRef
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Kimin Yun, Jin-cheol Lim, Onyoo Kim
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Dongheon Kang, Jiyoung Park
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Trends in the Incidence and Etiology of Non-Traumatic Spinal Cord Injury in Korea: A Nationwide Population-Based Study From 2007 to 2020
Yoonjeong Choi, Ja-Ho Leigh, Jooeun Jeon, Goo Joo Lee, Hyung-Ik Shin, Moon Suk Bang
Journal of Korean Medical Science.2023;[Epub] CrossRef
Risk Factors for Suicidality in Individuals With Spinal Cord Injury: A Focus on Physical and Functional Characteristics
Sora Han, Wooyeung Kim, Onyoo Kim
Annals of Rehabilitation Medicine.2023; 47(5): 377. CrossRef

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Original Articles

Spinal cord injury

Characteristics of Pediatric Spinal Cord Injury in South Korea: A Single-Centered Study: Wooyeung Kim, Bum-Suk Lee, Onyoo Kim, Hyeyeung Yun, So-Ra Han; Ann Rehabil Med 2022;46(5):248-255. Published online October 31, 2022; DOI: https://doi.org/10.5535/arm.22062

Abstract
PDF

Objective
To determine the characteristics of pediatric spinal cord injury (SCI) in South Korea from 1990 to 2019.
Methods
This single-centered retrospective study included pediatric SCIs. Individuals were divided into the following five groups according to onset age: ≤5, 6–12, 13–14, 15–17, and 18–19 years. The severity of complete injury was graded according to the American Spinal Injury Association impairment scale A (AIS A). Incomplete injury was graded according to AIS B, C, and D. Pearson chi-square test was used for statistical analysis.
Results
Of the 267 individuals included, 216 (80.9%) had traumatic SCIs (male-to-female ratio of 3.2:1), and 51 (19.1%) had non-traumatic SCIs (male-to-female ratio of 0.7:1). In the traumatic SCI group, 192 (88.9%) individuals were ≥15 years at the time of injury (males, 78.6%). The most common etiologies of traumatic SCIs, ranging from most to least common, were accidents related to motorcycles, falls, cars, and diving. In the non-traumatic SCI group, inflammatory (33.3%) and neoplastic (25.5%) etiologies were found to be the most common ones.
Conclusion
We found that traumatic SCIs incidence in the pediatric population was high, particularly in male individuals aged 15–19 years. The non-traumatic SCIs mostly cause paraplegia and incomplete injury. Therefore, it can be used as a basic data for the evaluation, treatment and prevention strategy of pediatric patients with SCI.

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Öner ÖZBEY, Fatma Zeynep ARSLAN, Muslu Kazım KÖREZ, Müge PAYASLI
Journal of Health Sciences and Medicine.2023; 6(2): 456. CrossRef
A systematic review and meta-analysis of the global epidemiology of pediatric traumatic spinal cord injuries
Seyed Behnam Jazayeri, Samuel Berchi Kankam, Ali Golestani, Parnian Shobeiri, Morteza Gholami, Mohammad Amin Dabbagh Ohadi, Seyed Farzad Maroufi, Mohammad Reza Fattahi, Hamid Malekzadeh, Seyed Behzad Jazayeri, Zahra Ghodsi, Seyed Mohammad Ghodsi, Vafa Rah
European Journal of Pediatrics.2023; 182(12): 5245. CrossRef

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Spinal cord injury

Quantitative Analysis in Cervical Spinal Cord Injury Patients Using Diffusion Tensor Imaging and Tractography: Geun Seok Park, Tae Uk Kim, Seong Jae Lee, Jung Keun Hyun, Seo Young Kim; Ann Rehabil Med 2022;46(4):172-184. Published online August 31, 2022; DOI: https://doi.org/10.5535/arm.22053

Abstract
PDF

Objective
To investigate the clinical usefulness of diffusion tensor imaging (DTI) and tractography in the prediction of outcomes after traumatic cervical spinal cord injury (SCI) and to assess whether the predictability is different between DTI and tractography administered before and after surgery.
Methods
Sixty-one subjects with traumatic cervical SCI were randomly assigned to preop or postop groups and received DTI accordingly. Among the patients who had DTI before surgery, we assigned 10 patients who had received repeated DTI examinations at 8 weeks after injury to the follow-up group. Fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values were obtained from DTI, and imaginary fiber and crossing fiber numbers were calculated from the tractography. Neurological status and functional status were assessed at 4 and 8 weeks after SCI.
Results
The neurologic and functional statuses of both groups improved after 4 weeks. Out of the initial 61 patients who were enrolled in the study, the failure rate of DTI image analysis was significantly higher in the postop group (n=17, 41.5%) than in the preop group (n=6, 20%). The FA values and fiber numbers in the preop group tended to be higher than those in the postop group, whereas ADC values were lower in the preop group. When comparing the tractographic findings in the follow-up group, imaginary fiber numbers at the C6 and C7 levels and crossing fiber numbers from the C3 to C6 levels were significantly decreased after surgery. Several DTI and tractographic parameters (especially the ADC value at the C4 level and imaginary fiber numbers at the C6 level) showed significant correlations with neurologic and functional statuses in both the preop and postop groups. These findings were most prominent when DTI and physical examination were simultaneously performed.
Conclusion
Preoperative DTI and tractography demonstrated better FA and ADC values with lower interpretation failure rates than those obtained after surgery, whereas postoperative data significantly reflected the patient’s clinical state at the time of evaluation. Therefore, DTI and tractography could be useful in predicting clinical outcomes after traumatic cervical SCI and should be interpreted separately before and after spine surgery.

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Diffusion tractography outside the brain: the road less travelled
Kurt G. Schilling, Irvin Teh, Julien Cohen-Adad, Richard Dortch, Ibrahim Ibrahim, Nian Wang, Bruce Damon, Rory L. Cochran, Alexander Leemans
Brain Structure and Function.2026;[Epub] CrossRef
Negative Correlation Between Fractional Anisotropy on Diffusion Tensor Imaging and Neck Disability Index in Cervical Spondylotic Radiculopathy After Percutaneous Cervical Nucleoplasty: A Cross-Sectional Study
Ning Fan, Tusheng Li, Xuanyu Lu, Xinyu Ma, Lihui Yang, Peng Du, Lei Zang, Shuo Yuan
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Archives of Medical Research.2024; 55(5): 103012. CrossRef

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Spinal cord injury

Effects of Resistance Circuit Training on Health-Related Physical Fitness in People With Paraplegia: A Pilot Randomized Controlled Trial: Minkyoung Son, Hyejin Lee, Bum-Suk Lee, EunYoung Kim, Hyeyeong Yun, Seck Jin Kim, JaeHak Kim, Seung-Mo Jin, Seon-Deok Eun; Ann Rehabil Med 2022;46(2):87-96. Published online April 30, 2022; DOI: https://doi.org/10.5535/arm.22012; Correction in: Ann Rehabil Med 2022;46(4):219

Objective
To evaluate the efficacy and safety of 8 weeks of resistance circuit training in people with paraplegia due to spinal cord injury.
Methods
Participants were randomized into experimental and control groups. Although the intensity and sequence of movements of the exercise programs were identical in both groups, the resting time between sets was limited to 1 minute in the experimental group. In the control group, the participants were allowed to rest until they were comfortable. Both groups received 8 weeks of training twice per week. Before and after the program, muscle mass, body fat percentage, fat mass, blood pressure, heart rate, muscle strength and muscular endurance were evaluated, and 6-minute propulsion test was conducted. Additionally, the safety of the program was assessed.
Results
Twenty-two individuals with paraplegia were enrolled (11 in each group). After the training program, the experimental group showed a significant decrease in the resting blood pressure and improvement in the upper extremity muscle mass, strength, and endurance (p<0.05). Each variable showed significant inter-group differences (p<0.05). Furthermore, none of the participants showed autonomic adverse events, musculoskeletal side effects, or discomfort.
Conclusion
The results show that resistance circuit training programs with short resting intervals are superior to the usual resistance exercise programs in improving the blood pressure and physical strength and are safe for people with upper thoracic level injuries at T6 or higher.

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Spinal cord injury

Factors Affecting Metabolic Syndrome in Individuals With Chronic Spinal Cord Injury: Ji Won Shin, Tayeon Kim, Bum-Suk Lee, Onyoo Kim; Ann Rehabil Med 2022;46(1):24-32. Published online February 28, 2022; DOI: https://doi.org/10.5535/arm.21144; Correction in: Ann Rehabil Med 2022;46(2):109

Objective
To assess the validity of different anthropometric measures (waist circumference [WC], body mass index [BMI], and percentage body fat) in diagnosing metabolic syndrome (MetS) among individuals with SCI and provides preliminary data for future studies in setting obesity cutoff values for this population.
Methods
This was a single-center retrospective cohort study. Sample information, anthropometric measures, and MetS variables of 157 individuals with chronic SCI were collected from an electronic medical records database.
Results
Increasing age (odds ratio [OR]=1.040, p=0.016) and lower neurological level of injury (OR=1.059, p=0.046) were risk factors for MetS. Male BMI (r=0.380, p<0.001) and male WC (r=0.346, p<0.001) were positively correlated with the number of MetS subfactors. Individuals with non-obese WC, excluding central obesity, were associated with having no MetS subfactors (p=0.005), and individuals with obese WC were associated with one or more subfactors (p=0.005). BMI was associated with MetS diagnosis (area under the curve=0.765, p<0.001), with the calculated cutoff value for BMI being 22.8 kg/m².
Conclusion
This study calls for a stricter BMI cutoff for individuals with SCI in diagnosing MetS and warrants a large population-based study to define central obesity according to sex and ethnicity.

Citations

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Physical and emotional consequences of excess weight as experienced by individuals with spinal cord injuries
Sherri L. LaVela, Justina Wu, Alex H.S. Harris, Susan M. Frayne, Andrea L. Nevedal, Katherine D. Arnow, Nicolas B. Barreto, Kristen Davis, Dan Eisenberg
The Journal of Spinal Cord Medicine.2024; 47(3): 412. CrossRef
Correlates of metabolic syndrome in people with chronic spinal cord injury
F. Di Giulio, C. Castellini, S. Palazzi, D. Tienforti, F. Antolini, G. Felzani, M. Giorgio Baroni, A. Barbonetti
Journal of Endocrinological Investigation.2024; 47(8): 2097. CrossRef
Increased Risk of Myocardial Infarction, Heart Failure, and Atrial Fibrillation After Spinal Cord Injury
Jung Eun Yoo, Miso Kim, Bongseong Kim, Heesun Lee, Won Hyuk Chang, Jeehyun Yoo, Kyungdo Han, Dong Wook Shin
Journal of the American College of Cardiology.2024; 83(7): 741. CrossRef
The Clinical Management of Electrical Stimulation Therapies in the Rehabilitation of Individuals with Spinal Cord Injuries
David R. Dolbow, Ines Bersch, Ashraf S. Gorgey, Glen M. Davis
Journal of Clinical Medicine.2024; 13(10): 2995. CrossRef
Racial differences in serological markers across the first year of injury in spinal cord injury: a retrospective analysis of a multi-center interventional study
Jia Li, Matthew Farrow, Kerollos Ibrahim, Dana M. McTigue, John Kramer, Bobo Tong, Catherine Jutzeler, Linda Jones, Ceren Yarar-Fisher
Spinal Cord.2024; 62(8): 486. CrossRef
Effect of Detraining on Muscle Strength, Functional Capacity, Mental Health, and Body Composition in Individuals with Spinal Cord Injury
Lucas Almada, Lucas Santos, Karla Freitas, Joel Rodrigues, Elizângela Diniz, Mauro Mazini-Filho, Luís Leitão, Eveline Pereira, Cláudia Oliveira, Osvaldo Moreira
International Journal of Environmental Research and Public Health.2024; 21(7): 900. CrossRef
Impaired Glucose Tolerance and Visceral Adipose Tissue Thickness among Lean and Non-Lean People with and without Spinal Cord Injury
Amy L. Kimball, Michael A. Petrie, Patrick M. McCue, Kristin A. Johnson, Richard K. Shields
Journal of Functional Morphology and Kinesiology.2023; 8(3): 123. CrossRef
The Diagnosis and Management of Cardiometabolic Risk and Cardiometabolic Syndrome after Spinal Cord Injury
Gary J. Farkas, Adam M. Burton, David W. McMillan, Alicia Sneij, David R. Gater
Journal of Personalized Medicine.2022; 12(7): 1088. CrossRef

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Physical Therapy

Effects of Paraplegia Fitness Integrated Training on Physical Function and Exercise Self-Efficacy and Adherence Among Individuals With Spinal Cord Injury: Hafifi Hisham, Maria Justine, Nazirah Hasnan, Haidzir Manaf; Ann Rehabil Med 2022;46(1):33-44. Published online February 28, 2022; DOI: https://doi.org/10.5535/arm.21127

Abstract
PDF

Objective
To determine the effects of the Paraplegia Fitness Integrated Training (PARAFiT) program, which is an integrated graded physical exercise and health education program for individuals with spinal cord injury (SCI).
Methods
This nonrandomized single-blind study included 44 participants, who were assigned to either an intervention (PARAFiT) group or an active control (conventional physiotherapy) group. The intervention group underwent the PARAFiT program (8 weeks), which consisted of circuit-based interval training, progressive upper limb resistance training, and health education sessions. During the unsupervised period, the intervention group continuously underwent health education program once a month for 2 months (8 weeks). Repeated-measures analysis of variance was used for the analysis.
Results
The intervention group presented with a higher level of physical activity than did the control group; however, the difference was not significant (p=0.36). Additionally, the intervention group presented with better exercise self-efficacy and cardiorespiratory fitness and stronger bilateral shoulder muscle and handgrip than did the control group (all p<0.05). Exercise adherence was higher in the intervention group than in the control group during both the supervised (80% vs. 75%) and unsupervised (40% vs. 20%) periods.
Conclusion
The PARAFiT program enhanced the level of physical activity, exercise self-efficacy, physical fitness, and exercise adherence among the patients with SCI. Future studies should incorporate guidelines for home-based exercises and regular monitoring to promote long-term adherence to exercise and physical activity among individuals with SCI.

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Effectiveness of aerobic physical training for spinal cord injury rehabilitation: A mini-review
Md Kutub Uddin, Faruq Ahmed, Muhammad Rezaul Karim, Myeen Uddin Ahmad, Md Morshedul Islam, Abu Sufian, Md Nuruzzaman, Md Bellal Hossain, Morshada Rahman Mitu
Hong Kong Physiotherapy Journal.2026; 46(02): 107. CrossRef
The Effect of Overground Locomotor Training on Self-Efficacy Following Spinal Cord Injury: An Exploratory Study
Gino S. Panza, Amanda K. Rounds, Rosanne DiZazzo-Miller, Andrew D. Delgado, Andrew A. Guccione
Occupational Therapy In Health Care.2026; 40(2): 521. CrossRef
Reliability and Validity of the Japanese Version of the Exercise Self‐Efficacy Scale in Older People Undergoing Lower Extremity Arthroplasty
Mina Matsumura, Kimie Fujita, Yuriko Matsunaga‐Myoji, Goro Motomura, Satoshi Hamai, Yasuharu Nakashima
Nursing & Health Sciences.2025;[Epub] CrossRef
A Home-Based Balance Exercise Training Program with Intermittent Visual Deprivation for Persons with Chronic Incomplete Spinal Cord Injury: A Pilot Study on Feasibility, Acceptability, and Preliminary Outcomes
Riccardo Bravi, Sara Guarducci, Giulia Panconi, Magdalena Sicher, Lorenzo Mucchi, Giacomo Lucchesi, Gabriele Righi, Giulio Del Popolo, Diego Minciacchi
Sensors.2025; 25(20): 6320. CrossRef
The Relationship Between Physical Activity and Mental Health Among Individuals With Spinal Cord Injury: Protocol for a Scoping Review
Winslet Ong, Noor Arfa Omar, Asfarina Zanudin, Muhamad Faiz Alias, Lim Hui Wen, Angel Thang Xue Ee, Nor Azlin Mohd Nordin, Haidzir Manaf, Basri Husin, Mahadir Ahmad, Hafifi Hisham
JMIR Research Protocols.2024; 13: e56081. CrossRef
Effects of behaviour change interventions on physical activity in people with spinal cord injury: A systematic review and meta-analysis
Paul K. Watson, Aitthanatt C. Eitivipart, Glen M. Davis, Mohit Arora, James W. Middleton, Camila Quel De Oliveira
Psychology of Sport and Exercise.2023; 67: 102408. CrossRef
Feasibility, Usability, and Safety of ParaGym, an Intelligent Mobile Exercise App for Individuals With Paraplegia: Protocol for a Pilot Block-Randomized Controlled Trial
Janika Bolz, Adrian Löscher, Rainer Muhl, Andreas Badke, Hans-Georg Predel, Claudio Perret
JMIR Research Protocols.2023; 12: e45652. CrossRef
Risk Factors for Suicidality in Individuals With Spinal Cord Injury: A Focus on Physical and Functional Characteristics
Sora Han, Wooyeung Kim, Onyoo Kim
Annals of Rehabilitation Medicine.2023; 47(5): 377. CrossRef

12,815 View
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Spinal cord injury

Utilizing Pulmonary Function Parameters to Predict Dysphagia in Individuals With Cervical Spinal Cord Injuries: So Jung Lee, Sungchul Huh, Sung-Hwa Ko, Ji Hong Min, Hyun-Yoon Ko; Ann Rehabil Med 2021;45(6):450-458. Published online December 31, 2021; DOI: https://doi.org/10.5535/arm.21161

Abstract
PDF

Objective
To utilize pulmonary function parameters as predictive factors for dysphagia in individuals with cervical spinal cord injuries (CSCIs).
Methods
Medical records of 78 individuals with CSCIs were retrospectively reviewed. The pulmonary function was evaluated using spirometry and peak flow meter, whereas the swallowing function was assessed using a videofluoroscopic swallowing study. Participants were divided into the non-penetration-aspiration group (score 1 on the Penetration-Aspiration Scale [PAS]) and penetration-aspiration group (scores 2–8 on the PAS). Individuals with pharyngeal residue grade scores >1 were included in the pharyngeal residue group.
Results
The mean age was significantly higher in the penetration-aspiration and pharyngeal residue groups. In this study, individuals with clinical features, such as advanced age, history of tracheostomy, anterior surgical approach, and higher neurological level of injury, had significantly more penetration-aspiration or pharyngeal residue. Individuals in the penetration-aspiration group had significantly lower peak cough flow (PCF) levels. Individuals in the pharyngeal residue group had a significantly lower forced expiratory volume in 1 second (FEV1). According to the receiver operating characteristic curve analysis of PCF and FEV1 on the PAS, the cutoff value was 140 L/min and 37.5% of the predicted value, respectively.
Conclusion
Low PCF and FEV1 values may predict the risk of dysphagia in individuals with CSCIs. In these individuals, active evaluation of swallowing is recommended to confirm dysphagia.

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Clinical Predictors of Dysphagia in Acute and Subacute Traumatic Cervical Spinal Cord Injury: A Retrospective Observational Study
Yong Beom Shin, Jin A Yoon, Byeong Ju Lee, Myung Hun Jang, Hyuk Jin Choi, Sang Hun Kim
Dysphagia.2026; 41(1): 149. CrossRef
Association Between Oral and Pharyngeal Functions in Patients in Medical‐Dental Cooperation at an Acute Hospital
Ryo Tagaino, Kana Saijo, Naru Shiraishi, Takamasa Komiyama, Kuniyuki Izumita, Takuma Hisaoka, Ai Hirano, Jun Ota, Yukio Katori, Toru Ogawa, Keiichi Sasaki, Nobuhiro Yoda, Hiroshi Egusa, Shigeto Koyama
Journal of Oral Rehabilitation.2026; 53(7): 1296. CrossRef
Methods of diagnosis and rehabilitation of dysphagia in patients with spinal cord injury: a systematic review
Roberta ZUPO, Beatrice POGGI, Nicole CAGGIANO, Giulio VARRONE, Fabio CASTELLANA, Silvia NATOLI, Rodolfo SARDONE, Antonio NARDONE, Chiara PAVESE
European Journal of Physical and Rehabilitation Medicine.2025;[Epub] CrossRef
Pulmonary function and sarcopenia as predictors of dysphagia in cervical spinal cord injury
Su Ji Lee, Ji Cheol Shin
Spinal Cord.2024; 62(1): 42. CrossRef
Evaluation of clinical factors predicting dysphagia in patients with traumatic and non-traumatic cervical spinal cord injury: a retrospective study
Jin-Woo Choi, Dae Yeong Kim, Sun Young Joo, Donghwi Park, Min Cheol Chang
Frontiers in Neurology.2024;[Epub] CrossRef
Coordination Between Respiration and Swallowing in Patients With Dysphagia After Cervical Spinal Cord Injury: An Observational Case–Control Study
Xuluan Xu, Qingsu Zhang, Yongqi Xie, Degang Yang, Feng Gao, Yongxue Yuan, Yu Zhang, Jianjun Li
American Journal of Speech-Language Pathology.2024; 33(5): 2572. CrossRef
Flujo máximo de tos y evaluación de la deglución: Una revisión de literatura
Amalia Nanjarí R , María del Carmen Campos
Revista Científica Signos Fónicos.2024; 10(1): 7. CrossRef
Voluntary Cough Testing as a Clinical Indicator of Airway Protection in Cervical Spinal Cord Injury
Laura Pitts, Valerie K. Hamilton, Erin A. Walaszek, Stephanie Watts, Leora R. Cherney
The Laryngoscope.2023; 133(6): 1434. CrossRef
Association between Anterior Surgical Approach and Dysphagia Severity in Patients with Cervical Spinal Cord Injury
Min Cheol Chang, Dae Yeong Kim, Jin-Woo Choi, Ho Yong Choi, Jin-Sung Park, Donghwi Park
Journal of Clinical Medicine.2023; 12(9): 3227. CrossRef
Successful Continuation of Oral Intake in a Dysphagic and Tetraplegic Patient With Alternate Right and Left Complete Lateral Decubitus Positions in Rehabilitation
Yoshinori Maki, Mayumi Takagawa, Akio Goda, Junichi Katsura, Ken Yanagibashi
Cureus.2023;[Epub] CrossRef
Laryngeal and swallow dysregulation following acute cervical spinal cord injury
Teresa Pitts, Kimberly E. Iceman, Alyssa Huff, M. Nicholas Musselwhite, Michael L. Frazure, Kellyanna C. Young, Clinton L. Greene, Dena R. Howland
Journal of Neurophysiology.2022; 128(2): 405. CrossRef

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Spinal cord injury

Development and Evaluation of the Korean Version of Hospital-Based Transitional Rehabilitation Program Using Daily Living Home for Spinal Cord Injury: Chang-Won Moon, Il-Young Jung, Ju Young Kim, Ha Neul Jang, Kang Hee Cho; Ann Rehabil Med 2021;45(5):379-392. Published online October 31, 2021; DOI: https://doi.org/10.5535/arm.21119

Abstract
PDF

Objective
To develop and evaluate the Korean version of a hospital-based transitional rehabilitation program (TRP), using daily living home for spinal cord injury (SCI) patients.
Methods
In this study, we developed the Korean version of a hospital-based TRP through domestic and overseas surveys and focus group meetings. By applying this to chronic SCI patients, we observed the functional and quality of life (QOL) changes and evaluated the degree of achievement of the core goals set for each patient during hospital-based TRP.
Results
Hospital-based TRP, for 21.8±3.9 days on average, was applied to four chronic SCI patients (two patients with long-term hospital stays and two homebound disabled individuals) with an average injury period of 736.8±185.4 days. The Korean version of the Spinal Cord Independence Measure (49.3±6.9 vs. 62.5±6.0; p<0.05) showed functional improvement at the end of TRP, when compared to that before the TRP. The Korean version of the World Health Organization’s QOL scale, abbreviated version (159.8±36.6 vs. 239.8±36.1; p<0.05), showed improvement in QOL. Goal attainment scaling showed a significant degree of achievement for the core goals through TRP (33.6±4.4 vs. 70.0±2.8; p<0.05). These results confirmed that the effect was maintained 1 month after the end of TRP. Additionally, two patients were successfully discharged after TRP completion, and the other two could start social activities.
Conclusion
The Korean version of the hospital-based TRP, applied to chronic SCI patients, showed the potential to improve the patients’ functioning and QOL and appeared to be effective in successful discharge and social participation.

Citations

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Psychosocial Factors Influencing Quality of Life After Spinal Cord Injury: A Scoping Review Between the United States and South Korea
Hyun-Ju Ju, Debra A. Harley, Si-Yi Chao
Healthcare.2026; 14(12): 1736. CrossRef
Interventional Programs for Community Reintegration after Spinal Cord Injury: A Scoping Review
Surajo Kamilu Sulaiman, Bashir Kaka, Bashir Bello, Ashiru Hamza Mohammed, Dauda Salihu, Umar Muhammad Bello, Muhammad Chutiyami, Francis Fatoye
Critical Reviews in Physical and Rehabilitation Medicine.2023; 35(3): 19. CrossRef

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Spinal cord injury

Should We Delay Urodynamic Study When Patients With Spinal Cord Injury Have Asymptomatic Pyuria?: EunYoung Kim, Hye Jin Lee, Onyoo Kim, In Suk Park, Bum-Suk Lee; Ann Rehabil Med 2021;45(3):178-185. Published online June 14, 2021; DOI: https://doi.org/10.5535/arm.20241

Objective
To assess the incidence of urinary tract infection (UTI) with post-urodynamic study (post-UDS) in patients with spinal cord injury (SCI) and study its relationship with pre-UDS pyuria.
Methods
Patients with SCI who were hospitalized and underwent UDS during a 4-year period were reviewed. Patients with pre-test lower urinary tract symptoms were excluded. Urinalysis and urine culture were performed before and 24 hours after UDS. Prophylactic antibiotics were administered for 5 days starting from the morning of the UDS. UTI was defined as bacteriuria with accompanying symptoms.
Results
Of 399 patients reviewed, 209 (52.4%) had pyuria in pre-UDS urinalysis, and 257 (64.4%) had bacteriuria in pre-UDS culture. Post-UDS UTI occurred in 6 (1.5%) individuals who all complained of fever: 5 (2.4%) of the post-UDS UTI cases occurred in patients with pre-UDS pyuria, and 1 (0.5%) in a person without. The differences between groups were not statistically significant (p=0.218). Of 221 patients with bacteriuria (gram-negative isolates) on pre-UDS culture, resistance to ciprofloxacin, cephalosporin, and trimethoprim/sulfamethoxazole (TMP/SMT) was noted in 52.9% (117 cases), 57.0% (126 cases), and 38.9% (86 cases), respectively.
Conclusion
No difference was found in the prevalence of post-UDS UTI based on the presence of pyuria in pre-UDS urinalysis. UDS may be performed even in SCI cases of pre-UDS pyuria without increasing the prevalence of post-UDS UTI if prophylactic antibiotics are administered. TMP/SMT could be used as a first-line antibiotic for the prevention of post-UDS UTI in Korea.

7,890 View
171 Download

Pain & Musculoskeletal rehabilitation

Is Abnormal Electrodiagnostic Finding Related to the Cross-Sectional Area of the Nerve Root in Cervical Radiculopathy?: JuHyong Jeoung, Hyuk Sung Choi, Sang Rok Woo, Seok Kang, Joon Shik Yoon; Ann Rehabil Med 2021;45(2):116-122. Published online April 30, 2021; DOI: https://doi.org/10.5535/arm.20172

Abstract
PDF

Objective
To assess the relevance of electrodiagnosis (EDX) in the cross-sectional area (CSA) of the nerve root of patients with cervical radiculopathy (CR) by using high-resolution ultrasonography (HRUS).
Methods
The CSAs of the cervical nerve roots at C5, C6, and C7 were measured bilaterally using HRUS in 29 patients with unilateral CR whose clinical symptoms, magnetic resonance imaging (MRI) findings, and EDX
results
corresponded with each other (CR-A group), and in 26 patients with unilateral CR whose clinical symptoms and MRI findings matched with each other but did not correspond with the EDX findings (CR-B group). Results The CSA of the affected side in each nerve root was significantly larger than that of the unaffected side in both the CR-A and CR-B groups. The side-to-side difference in the bilateral CSAs of the nerve root and the ratio of the CSAs between the unaffected and affected sides were statistically larger in the CR-A group than in the CR-B group.
Conclusion
The increased CSAs in the CR-A group reflect the physiological changes of the cervical nerve root, which is supported by the EDX findings.

Citations

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Ultrasound-Guided Selective Cervical Root Block in Spondylotic Radiculopathy: Advantages and Safety
Dong Gyu Lee
Clinical Pain.2023; 22(2): 61. CrossRef

7,243 View
163 Download
1 Crossref

Spinal cord injury

Correlation Between Duration From Injury and Bone Mineral Density in Individuals With Spinal Cord Injury: Hyehoon Choi, So-youn Chang, Jaewan Yoo, Seong Hoon Lim, Bo Young Hong, Joon Sung Kim; Ann Rehabil Med 2021;45(1):1-6. Published online February 9, 2021; DOI: https://doi.org/10.5535/arm.20169

Abstract
PDF

Objective
To investigate the correlation between bone mineral density (BMD) and duration of injury in individuals with spinal cord injury (SCI).
Methods
Patients with SCI who visited the outpatient department between January 2009 and January 2019 were enrolled. Patients’ most recent dual energy X-ray absorptiometry images were reviewed. According to the 2007 International Society for Clinical Densitometry guidelines, vertebrae with a local structural change were excluded when deriving spine BMD. If one or no vertebra is suitable for evaluation, spine BMD was judged as “improper for assessment”. Correlation analysis was performed between duration from injury and BMD Z-scores of the hip and spine.
Results
Among 83 individuals with SCI, the spines of 44 were judged as improper for assessment. The correlation analysis showed a significant negative relationship between the duration from injury and femur neck BMD (r=-0.40, p<0.01) and total proximal femur BMD (r=-0.39, p<0.01). However, no significant correlation was found between the duration from injury and spine BMD Z-score.
Conclusion
The duration of SCI correlated with hip BMD, but not with spine BMD. Further, more than half of the individuals with SCI could not undergo spinal assessment due to local structural changes. Therefore, spine BMD measurement is not an appropriate method for predicting future fracture risk in those with SCI.

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Beyond the initial impact: a systematic review of post-traumatic bone loss and its mechanisms
Adibeh Rahmani, Ulrike Weichelt, Denise Jahn, Ellen Otto, Arne Kienzle, Svilen Angelov, Vanessa Hubertus, Jennifer Shue, Alexander P. Hughes, Georg N. Duda, Serafeim Tsitsilonis, Matthias Pumberger, Paul Köhli
Osteoporosis International.2026; 37(1): 15. CrossRef
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Linn C. Risvang, Jan-Willem van Dijk, Julia K. Baumgart, Hannah M. Rice, Anja M. F. Liljegren, Vegard Strøm, Truls Raastad, Kristin L. Jonvik
European Journal of Applied Physiology.2026; 126(5): 2879. CrossRef
Muscle Atrophy Secondary to Spinal Cord Injury: A Global Understanding
Diego Bustamante-Laguna, Ivan Ignacio-Mejia , Humberto Carrasco-Vargas, Marco Antonio Vargas-Hernández, Antonio Ibarra
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Claire Hickey, Éimear Smith, Sara Hayes
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Georgia Antoniou, Ioannis S Benetos, John Vlamis, Spyros G Pneumaticos
Cureus.2022;[Epub] CrossRef

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212 Download
4 Web of Science
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Spinal cord injury

Epidemiology of Spinal Cord Injury: Changes to Its Cause Amid Aging Population, a Single Center Study: Ha Seong Kim, Kil-Byung Lim, Jiyong Kim, Joongmo Kang, Hojin Lee, Sang Wan Lee, Jeehyun Yoo; Ann Rehabil Med 2021;45(1):7-15. Published online February 9, 2021; DOI: https://doi.org/10.5535/arm.20148

Abstract
PDF

Objective
To investigate the epidemiologic and demographic characteristics of patients with spinal cord injury (SCI) who were admitted to a department of rehabilitation of a university hospital.
Methods
This was a descriptive cross-sectional study. Medical records including sex, age at injury, type of disability, traumatic or non-traumatic etiology and presence of ossification of posterior longitudinal ligament (OPLL) of patients with SCI who were admitted to the department of rehabilitation between 2012 and 2018 were reviewed.
Results
Of the 221 cases of SCI, 161 were traumatic and 60 were non-traumatic. The mean age at injury was 52.8 years. People aged 40–49 years showed highest proportion among overall SCI patients (19.0%). The proportion of male patients was higher in traumatic SCI at 4.96:1 than in non-traumatic SCI at 1.30:1. The most common cause of traumatic SCI was falling off (37.3%), followed by motor vehicle crash (35.4%) and tripping over (19.3%). Meanwhile, the most common cause of non-traumatic SCI was neoplasm (35.0%). Tripping over was the leading cause of traumatic SCI in patients aged ≥60 years (42.6%). A high proportion of traumatic SCI patients were found to have underlying OPLL (26.1%), particularly those who were injured by tripping over (64.5%).
Conclusion
The mean age of SCI patients was higher than that of previous studies. Falls was the single most common cause of traumatic SCI, and tripping over was the most common cause of injury in the elderly patients. OPLL was prevalent in patients who were injured from tripping over.

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Morgan Godwin, Sharon J. Brown, Gabriel Mateus Bernardo Harrington, Srinivasa C. Budithi, John S. Riddell, Charlotte H. Hulme, Karina T. Wright
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Xiuzhi Li, Zengzhen Cui, Yuwei Li, Yuan Cao, Haijiao Wang, Yuliang Fu, Jiwei Zhang, Liangyu Bai, Zhuoqi Wei, Gao Si, Yang Lv
European Spine Journal.2026;[Epub] CrossRef
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Prevalence and Characteristics of Neuropathic Pain in Patients With Spinal Cord Injury Referred to a Rehabilitation Center: Hae Young Kim, Hye Jin Lee, Tae-lim Kim, EunYoung Kim, Daehoon Ham, Jaejoon Lee, Tayeun Kim, Ji Won Shin, Minkyoung Son, Jun Hun Sung, Zee-A Han; Ann Rehabil Med 2020;44(6):438-449. Published online December 31, 2020; DOI: https://doi.org/10.5535/arm.20081

Abstract
PDF

Objective
To identify the prevalence and characteristics of neuropathic pain (NP) in patients with spinal cord injury (SCI) and to investigate associations between NP and demographic or disease-related variables.
Methods
We retrospectively reviewed medical records of patients with SCI whose pain was classified according to the International Spinal Cord Injury Pain classifications at a single hospital. Multiple statistical analyses were employed. Patients aged <19 years, and patients with other neurological disorders and congenital conditions were excluded.
Results
Of 366 patients, 253 patients (69.1%) with SCI had NP. Patients who were married or had traumatic injury or depressive mood had a higher prevalence rate. When other variables were controlled, marital status and depressive mood were found to be predictors of NP. There was no association between the prevalence of NP and other demographic or clinical variables. The mean Numeric Rating Scale (NRS) of NP was 4.52, and patients mainly described pain as tingling, squeezing, and painful cold. Females and those with below-level NP reported more intense pain. An NRS cut-off value of 4.5 was determined as the most appropriate value to discriminate between patients taking pain medication and those who did not.
Conclusion
In total, 69.1% of patients with SCI complained of NP, indicating that NP was a major complication. Treatment planning for patients with SCI and NP should consider that marital status, mood, sex, and pain subtype may affect NP, which should be actively managed in patients with an NRS ≥4.5.

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Sequential Activation of AMPA Receptors and Glial Cells in a Pain Model of Lumbar Spine Disc Herniation: Dong Gyu Kwak, Dong Gyu Lee; Ann Rehabil Med 2020;44(5):343-352. Published online September 28, 2020; DOI: https://doi.org/10.5535/arm.19202

Abstract
PDF

Objective
To investigate the glial cell and AMPA (alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid) receptor activity after surgery for disc herniation pain model.
Methods
In total, 83 Sprague-Dawley rats were randomly assigned to the following groups: control (n=16), sham-operated (n=4), rats for pain behavior evaluation (n=3), nucleus pulposus-exposed groups for AMPA receptors (n=30), and glial cell (n=30). The rats were tested for mechanical allodynia; immunohistochemical staining for AMPA receptors (GluA1 and GluA2) and glial cells (OX-42 and glial fibrillary acid protein [GFAP]) in the spinal dorsal horn was performed on postoperative days 3, 7, and 14.
Results
Mechanical withdrawal thresholds decreased after surgery, and this effect was maintained for up to 14 days. Immunohistochemical expression of GluA1 and GluA2 in the spinal dorsal horn had increased quantitatively on postoperative days 3 and 7 (p<0.05) to levels similar to that of the controls on postoperative day 14. Moreover, immunohistochemical expression of OX-42 and GFAP showed similar changes to AMPA receptors after surgery. Although the activity of AMPA receptors and glial cells achieved normalcy, the mechanical withdrawal threshold of the hind paw remained decreased 38 days after surgery.
Conclusion
The rat model of lumbar disc herniation showed increased expression of AMPA receptor and glial cell activity in the spinal dorsal horn 3 and 7 days after surgery, which deceased to control levels at 14 days. The AMPA receptors and glial cell activations showed similar patterns after disc herniation surgery.

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Association Between Latency of Dermatomal Sensory-Evoked Potentials and Quantitative Radiologic Findings of Narrowing in Lumbar Spinal Stenosis: Dong Chan Yang, Ho Jun Lee, Jin-Woo Park, Kiyeun Nam, Shengshu Kim, Keun-Tae Cho, Bum Sun Kwon; Ann Rehabil Med 2020;44(5):353-361. Published online September 28, 2020; DOI: https://doi.org/10.5535/arm.19164

Abstract
PDF

Objective
To identify the difference of quantitative radiologic stenosis between a normal latency group and an abnormal latency group, and to investigate the association of dermatomal somatosensory-evoked potential (DSEP) with magnetic resonance imaging (MRI) findings of narrowing in patients with lumbar spinal stenosis (LSS).
Methods
We retrospectively reviewed the clinical records and P40 latencies of L5 DSEP of 40 patients with unilateral symptoms of LSS at the L4–5 disc level. Quantitative assessments of stenosis in lumbar spine MRI were performed with measurements of the anteroposterior diameter (APD), cross-sectional area (CSA) of the dural sac, ligamentous interfacet distance (LID), CSA of the neural foramen (CSA-NF), and subarticular zone width. Analyses were conducted through comparisons of radiologic severity between the normal and abnormal latency groups and correlation between radiologic severity of stenosis and latency of DSEP in absolute (APD <10 mm) and relative (APD <13 mm) stenosis.
Results
The radiologic severities of lumbar stenosis were not significantly different between the normal and abnormal latency groups. In absolute and relative stenosis, latency showed a significant negative correlation with APD (r=-0.539, r=-0.426) and LID (r=-0.459, r=-0.494). In patients with relative stenosis, a weak significant positive correlation was found between latency and CSA-NF (r=0.371, p=0.048). LID was the only significant factor for latency (β=-0.930, p=0.011).
Conclusion
The normal and abnormal DSEP groups showed no significant differences inradiologic severity. The latency of DSEP had a negative correlation with the severity of central stenosis, and LID was an influencing factor.

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Guichande Duarte, Markus Hupp, José Spirig, Mazda Farshad, Martin Schubert, Armin Curt, Patrick Freund, Carl M. Zipser
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BMC Neurology.2022;[Epub] CrossRef

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A Fully Immersive Virtual Reality Method for Upper Limb Rehabilitation in Spinal Cord Injury: Da Young Lim, Dong Min Hwang, Kang Hee Cho, Chang Won Moon, So Young Ahn; Ann Rehabil Med 2020;44(4):311-319. Published online July 28, 2020; DOI: https://doi.org/10.5535/arm.19181; Correction in: Ann Rehabil Med 2025;49(1):60

Abstract
PDF

Objective
To determine whether a fully immersive virtual reality (VR) intervention combined with conventional rehabilitation (CR) can improve upper limb function more than CR alone in patients with spinal cord injury (SCI), we conducted a prospective, randomized, controlled clinical trial.
Methods
Participants were randomly assigned to either the control group (CG; n=10) or experimental group (EG; n=10). The participants in the CG received 60 minutes of conventional therapy per day, 4 days per week for 4 weeks, whereas those in the EG received 30 minutes of VR training and 30 minutes of conventional therapy per day, 4 days per week for 4 weeks. The clinical outcome measures included Medical Research Council grade, the American Spinal Injury Association upper extremity motor score (ASIA-UEMS), and scores in the Hand Strength Test, Box and Block Test, Nine-Hole Peg Test, Action Research Arm Test, and Korean version of the Spinal Cord Independence Measure (K-SCIM). The assessments were performed at the beginning (T0) and end of the intervention (T1).
Results
Grip power and K-SCIM score significantly improved in the EG after the intervention. When comparing differences between the groups, elbow extensor, wrist extensor, ASIA-UEMS, grip power, lateral pinch power, and palmar pinch power were all significantly improved.
Conclusion
VR training of upper limb function after SCI can provide an acceptable adjunctive rehabilitation method without significant adverse effects.

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Ultrasound Imaging of the Trunk Muscles in Acute Stroke Patients and Relations With Balance Scales: Yunho Kim, Jeeyoung Kim, Heesung Nam, Hyun Dong Kim, Mi Ja Eom, Sang Hoon Jung, Nami Han; Ann Rehabil Med 2020;44(4):273-283. Published online July 28, 2020; DOI: https://doi.org/10.5535/arm.19125

Abstract
PDF

Objective
To examine the correlation between ultrasonographic trunk muscle parameters and balance scales in mild acute stroke patients.
Methods
A total of 55 stroke patients with hemiparesis and motor power grade ≥4 in the manual motor test were included. The Scale for the Assessment and Rating of Ataxia (SARA), Berg Balance Scale (BBS), Timed Up and Go Test (TUG), and Trunk Control Test (TCT) were used to evaluate patient balance function. Ultrasonographic parameters were measured on both non-paretic and paretic sides of the rectus abdominis, external oblique, internal oblique, transversus abdominis, and erector spinae muscles. Resting thickness and contraction thickness were measured in all muscles, and contractility and contractility ratio were calculated based on measured thicknesses. The differences between paretic and non-paretic muscle parameters, and the correlation between ultrasonographic parameters and balance scales were analyzed. Stroke patients were divided into two groups according to their fall risk. Ultrasonographic measurements between the two groups were compared.
Results
All muscles’ contraction thickness and contractility were significantly different between paretic and non-paretic sides (p<0.001). Contractility ratios of all trunk muscles showed a significant correlation with SARA, BBS, TUG, and TCT (p<0.05). Contractility ratios of all muscles were significantly different between high- and low-risk fall groups (p<0.05).
Conclusion
The contractility ratio in stroke patients reflects their balance disturbance and fall risk and it may serve as a new parameter for ultrasound imaging of trunk muscles.

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Natalia Domínguez-Sanz, Robinson Ramírez-Vélez
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Yunus Emre Doğan, Kadriye Öneş, Burak Kütük
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Emre Erol, Derya Bugdayci, Mert Cetin, Eser Kalaoglu
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Changes in the Trend in Bladder Emptying Methods in Patients With Spinal Cord Injury: A 20-Year Single-Center Retrospective Study: Sang-Wook Oh, Joo Hwan Jung, In Kyoung Cho, Hye Jin Lee, Seung Hyun Kwon, Bum Suk Lee; Ann Rehabil Med 2020;44(3):228-237. Published online June 30, 2020; DOI: https://doi.org/10.5535/arm.19107

Abstract
PDF

Objective
To review trends in bladder emptying methods over a 20-year period in patients with spinal cord injury (SCI) by severity according to the American Spinal Injury Association impairment scale (AIS).
Methods
Medical records of patients with SCI from 1994 to 1998 (group 1) and from 2012 to 2016 (group 2) were retrospectively reviewed. We classified bladder emptying methods according to the International Spinal Cord dataset. We grouped patients with normal voiding, bladder reflex triggering, and bladder expression as those using voiding without catheter.
Results
A total of 667 patients were included in the analysis. The proportion of patients using voiding without catheter and intermittent catheterization decreased from 67.0% to 30.0% and increased from 26.8% to 54.8%, respectively. In patients with AIS-A and AIS-B, the proportion of patients with intermittent catheterization increased from 32.8% to 73.3%. In patients with AIS-D, the proportion of patients using voiding without catheter and intermittent catheterization decreased from 88.5% to 68.9% and increased from 11.5% to 26.8%, respectively. In group 2, among 111 patients with AIS-D using voiding without catheter at admission, 8 (7.2%) switched to intermittent catheterization at discharge due to decreased bladder volume, increased post-voiding residual urine, or incontinence.
Conclusion
Over the past 20 years, trends in bladder emptying methods in patients with SCI changed from voiding without catheter to intermittent catheterization in Korea. This was especially prominent in patients with AIS-A, AIS-B, and AIS-C. Even in patients with AIS-D, the use of intermittent catheterization at hospital discharge increased.

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Changes in bladder emptying during inpatient rehabilitation after spinal cord injury and predicting factors: data from the Dutch Spinal Cord Injury Database
Claire G. Poublon, Eline W. M. Scholten, Michel I. A. Wyndaele, Marcel W. M. Post, Janneke M. Stolwijk-Swüste
Spinal Cord.2023; 61(11): 624. CrossRef
Should We Delay Urodynamic Study When Patients With Spinal Cord Injury Have Asymptomatic Pyuria?
EunYoung Kim, Hye Jin Lee, Onyoo Kim, In Suk Park, Bum-Suk Lee
Annals of Rehabilitation Medicine.2021; 45(3): 178. CrossRef

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Energy Efficiency and Patient Satisfaction of Gait With Knee-Ankle-Foot Orthosis and Robot (ReWalk)-Assisted Gait in Patients With Spinal Cord Injury: Seung Hyun Kwon, Bum Suk Lee, Hye Jin Lee, Eun Joo Kim, Jung Ah Lee, Sung Phil Yang, Tae Young Kim, Han Ram Pak, Hyun Ki Kim, Hae Young Kim, Joo Hwan Jung, Sang Wook Oh; Ann Rehabil Med 2020;44(2):131-141. Published online April 29, 2020; DOI: https://doi.org/10.5535/arm.2020.44.2.131

Abstract
PDF

Objective
To compare the energy efficiency of gait with knee-ankle-foot orthosis (KAFO) and robot-assisted gait and to develop a usability questionnaire to evaluate the satisfaction of walking devices in paraplegic patients with spinal cord injuries.
Methods
Thirteen patients with complete paraplegia participated and 10 completed the evaluation. They were trained to walk with KAFO (KAFO-gait) or a ReWalk robot (ReWalk-gait) for 4 weeks (20 sessions). After a 2-week wash-out period, they switched walking devices and underwent 4 additional weeks of training. Two evaluations were performed (after 2 and 4 weeks) following the training periods for each walking device, using the 6-minute walking test (6MWT) and 30-minute walking test (30MWT). The spatiotemporal variables (walking distance, velocity, and cadence) and energy expenditure (heart rate, maximal heart rate, the physiologic cost index, oxygen consumption, metabolic equivalents, and energy efficiency) were evaluated duringthe 6MWT and 30MWT. A usability evaluation questionnaire for walking devices was developed based on the International Organization for Standardization/International Electrotechnical Commission guidelines through expert consultation.
Results
The ReWalk-gait presented significant advantages in energy efficiency compared to KAFO-gait in the 6MWT and 30MWT; however, there were no differences in walking distance or speed in the 30MWT between ReWalk-gait and KAFOgait. The usability test demonstrated that ReWalk-gait was not superior to KAFO-gait in terms of safety, efficacy, efficiency, or patient satisfaction.
Conclusion
The robot (ReWalk) enabled patients with paraplegia to walk with lower energy consumption compared to KAFO, but the ReWalk-gait was not superior to KAFO-gaitin terms of patient satisfaction.

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Differences of Spinal Curvature, Thoracic Mobility, and Respiratory Strength Between Chronic Neck Pain Patients and People Without Cervical Pain: Ji Hong Cheon, Na Na Lim, Geun Su Lee, Ki Hong Won, Sung Hoon Lee, Eun Young Kang, Hyun Kyung Lee, Younkyung Cho; Ann Rehabil Med 2020;44(1):58-68. Published online February 29, 2020; DOI: https://doi.org/10.5535/arm.2020.44.1.58

Abstract
PDF

Objective
To investigate the differences of spinal curvature, thoracic sagittal mobility, and respiratory strength between patients with chronic neck pain (CNP) and people without cervical pain, and to determine the correlation between respiratory strength and thoracic mobility in CNP patients.
Methods
A total of 78 participants were finally included in this study, of whom 30 had no cervical pain and 48 had CNP. The Neck Disability Index (NDI), cervical lordotic curvature, thoracic kyphotic curvature, thoracic sagittal range of motion (ROM), maximal inspiratory pressure (MIP), and maximal expiratory pressure (MEP) were measured and analyzed.
Results
In males, thoracic sagittal ROM_MEP-MIP and MEP showed a significant difference between the no cervical pain group and the CNP group. In females, thoracic kyphotic curvature, thoracic sagittal ROM_MEP-MIP, MIP, and MEP were significantly different between the no cervical pain group and the CNP group. Thoracic kyphotic curvature was significantly correlated with MEP and MIP in all population groups, and significantly correlated with NDI in the female group. Thoracic sagittal ROM_MEP-MIP had a significant linear relationship with NDI, MEP, and MIP in all population groups.
Conclusion
The thoracic mobility during forced respiration was reduced in patients with CNP and was correlated with respiratory strength. Changes in the biomechanics of the cervicothoracic spine and rib cage due to CNP may contribute to impairment of respiratory strength.

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Intrathecal Baclofen Dosage for Long-Term Treatment of Patients With Spasticity Due to Traumatic Spinal Cord Injuries or Multiple Sclerosis: Bengt Skoog, Björn Hedman; Ann Rehabil Med 2019;43(5):555-561. Published online October 31, 2019; DOI: https://doi.org/10.5535/arm.2019.43.5.555

Abstract
PDF

Objective
To investigate dosage changes in intrathecal baclofen during long-term treatment of patients with severe leg spasticity.
Methods
We performed a retrospective chart review of 49 patients treated with an intrathecal baclofen pump (ITB) because of severe leg spasticity, for a minimum of 7 years. Eight patients were excluded due to catheter/pump failure or factors aggravating spasticity. Of the remaining 41 patients, 19 had spinal cord injury (SCI) and 22 were diagnosed with multiple sclerosis (MS). Among the SCI patients, 15 had cervical and 4 thoracic SCI, with 7 patients showing the American Spinal Injury Association impairment scale (AIS) A and 12 patients with AIS B–D. The dose was regulated by discussion among the patients and their physicians, usually 4–10 times annually, to reduce leg spasticity and also avoid leg/trunk weakness.
Results
After 1 year patients on ITB needed a median dose of 168 mg/24 hr (range, 30–725 mg) for an optimal effect. After 7 to 10 years the dosage needed to reduce leg spasticity in the MS patients was significantly increased compared with the initial dose (mean 157%, n=22 and mean 194%, n=18). In contrast, the SCI patients needed only a modest increase (mean 113% and 121%). The difference between MS and SCI patients was significant (t-test p=0.006 and p=0.004).
Conclusion
The increased dosage in MS patients compared with patients diagnosed with SCI probably reflects the progressive disease course. The need for a large dosage increase in patients with SCI suggests possible pump failure, triggering factors for spasticity or progressive spinal disease.

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Effects of Combined Upper Limb Robotic Therapy in Patients With Tetraplegic Spinal Cord Injury: Joo Hwan Jung, Hye Jin Lee, Duk Youn Cho, Jung-Eun Lim, Bum Suk Lee, Seung Hyun Kwon, Hae Young Kim, Su Jeong Lee; Ann Rehabil Med 2019;43(4):445-457. Published online August 31, 2019; DOI: https://doi.org/10.5535/arm.2019.43.4.445

Objective
To confirm the effects of combined upper limb robotic therapy (RT) as compared to conventional occupational therapy (OT) in tetraplegic spinal cord injury (SCI) patients and to suggest the optimized treatment guidelines of combined upper limb RT.
Methods
After subject recruitment and screening for eligibility, the baseline evaluation for outcome measures were performed. We evaluated the Graded and Redefined Assessment of Strength, Sensibility, and Prehension (GRASSP), the American Spinal Injury Association upper extremity motor score, grip and pinch strength, and the Spinal Cord Independence Measurement III (SCIM-III). In this study, the pre-tested participants were divided randomly into the RT and OT group. The utilized interventions included combined upper limb RT using ArmeoPower and Amadeo (RT group), or conventional OT (OT group) in addition to daily inpatient rehabilitation program. The participants underwent 40 minutes×3 sessions×5 weeks of interventions.
Results
A total of 30 tetraplegic SCI patients completed entire study program. After 5 weeks of intervention, both groups demonstrated increases in GRASSP-strength and SCIM-III. The manual muscle test scores of elbow flexion, elbow extension, 2-5th metacarpophalangeal extension, and SCIM-III subscores of bathing-upper, dressing-upper, and grooming as well as the GRASSP-qualitative prehension score were noted to have been significantly increased in the RT group as evaluated. The OT group showed improvements in the GRASSP-quantitative prehension score and some items in grip and pinch strength. There was no significant difference between the two groups in almost all measurements except for the SCIM-III bathing-upper subscore.
Conclusion
Combined upper limb RT demonstrated beneficial effects on the upper limb motor function in patients with tetraplegic SCI, which were comparable with conventional OT.

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The Value of MicroRNAs as an Indicator of the Severity and the Acute Phase of Spinal Cord Injury: Junyoung Park, Dongsoo Yi, Jiyoon Jang, Jiseon Hong; Ann Rehabil Med 2019;43(3):328-334. Published online June 28, 2019; DOI: https://doi.org/10.5535/arm.2019.43.3.328

Abstract
PDF

Objective
To assess the role of miRNA-21 and miRNA-223 in a balloon-compression model of spinal cord injury (SCI).
Methods
A total of 50 male Wistar rats (n=50) were divided into the three groups: the group A (n=15, insertion of the unflated Fogarty balloon catheter), the group B (n=15, insertion of the Fogarty balloon catheter at a volume of 20 μL) and the group C (n=15, insertion of the Fogarty balloon catheter at a volume of 50 μL). After the behavioral test, RNA isolation, microRNA expression profiling using microarrays and quantitative polymerase chain reaction, measurements were compared between the three groups.
Results
Despite a lack of significant differences in time-dependent changes in miRNA-21 expression levels between the three groups at 4 hours, there were significant differences in them at 1, 3, and 7 days (p<0.05). Moreover, there were significant differences in time-dependent changes in miRNA-223 expression levels between the three groups at 4 hours and 1, 3, and 7 days (p<0.05). Furthermore, miRNA-223 expression levels reached the highest at 1 day but were decreased with time thereafter in all the three groups.
Conclusion
Expression levels of miRNA-21 and miRNA-223 might be associated with the severity and acute phase of SCI, respectively. It is mandatory, however, to analyze changes in levels of inflammatory markers and the relevant biological pathways.

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Spinal Cord Injury: From MicroRNAs to Exosomal MicroRNAs
Xiangyang Xu, Ruyin Liu, Yunpeng Li, Cheng Zhang, Chuanghao Guo, Jiong Zhu, Jiaan Dong, Liyun Ouyang, Mohammad Reza Momeni
Molecular Neurobiology.2024; 61(8): 5974. CrossRef
Long non-coding RNA-small nucleolar RNA host gene 7 regulates inflammatory responses following spinal cord injury by regulating the microRNA-449a/TNF-α-induced protein 3-interacting protein 2 axis
Chunlei He, Jianhua Xiao, Yongjun Ye, Shiqiao Huang, Yanchun Zhong, Lulin Liu, Wuyang Liu, Sheng Liu
Bioengineered.2022; 13(4): 10215. CrossRef
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Simon Schading, Tim M. Emmenegger, Patrick Freund
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Serum exosomal microRNA transcriptome profiling in subacute spinal cord injured rats
Shu-Qin Ding, Yu-Qing Chen, Jing Chen, Sai-Nan Wang, Fei-Xiang Duan, Yu-Jiao Shi, Jian-Guo Hu, He-Zuo Lü
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Serum exosomal microRNA transcriptome profiling in subacute spinal cord injured rats
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Genomics.2020; 112(6): 5086. CrossRef

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Repetitive Transcranial Magnetic Stimulation Enhances Recovery in Central Cord Syndrome Patients: Hana Choi, Kyung Cheon Seo, Tae Uk Kim, Seong Jae Lee, Jung Keun Hyun; Ann Rehabil Med 2019;43(1):62-73. Published online February 28, 2019; DOI: https://doi.org/10.5535/arm.2019.43.1.62

Abstract
PDF

Objective
To investigate the effect of repetitive transcranial magnetic stimulation (rTMS) on neurological and functional recovery in patients with central cord syndrome (CCS) involving the upper extremities between the treated and non-treated sides of the treated group and whether the outcomes are comparable to that of the untreated control group.
Methods
Nineteen CCS patients were treated with high-frequency (20 Hz) rTMS over the motor cortex for 5 days. The stimulation side was randomly selected, and all the subjects received conventional occupational therapy during the rTMS-treatment period. Twenty CCS patients who did not receive rTMS were considered as controls. Clinical assessments, including those by the International Standard for Neurological Classification of Spinal Cord Injury, the Jebsen-Taylor Hand Function Test, and the O'Connor Finger Dexterity Test were performed initially and followed up for 1 month after rTMS treatment or 5 weeks after initial assessments.
Results
The motor scores for upper extremities were increased and the number of improved cases was greater for the treated side in rTMS-treated patients than for the non-treated side in rTMS-treated patients or controls. The improved cases for writing time and score measured on the Jebsen-Taylor Hand Function Test were also significantly greater in number on the rTMS-treated side compared with the non-treated side and controls. There were no adverse effects during rTMS therapy or the follow-up period.
Conclusion
The results of the application of high-frequency rTMS treatment to CCS patients suggest that rTMS can enhance the motor recovery and functional fine motor task performance of the upper extremities in such individuals.

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Therapeutic efficacy of repetitive transcranial magnetic stimulation on gait and limb balance function in patients with lower limb dysfunction post-cerebral infarction: a systematic review and meta-analysis
De-mei Jia, Xuan Li, Bin-cang Zhang, Bing-ran Zhang, Qiu-juan Zhang, Ming-wei Liu, Lin-ming Zhang
BMC Neurology.2025;[Epub] CrossRef
Stimulation Parameters Used During Repetitive Transcranial Magnetic Stimulation for Motor Recovery and Corticospinal Excitability Modulation in SCI: A Scoping Review
Nabila Brihmat, Didier Allexandre, Soha Saleh, Jian Zhong, Guang H. Yue, Gail F. Forrest
Frontiers in Human Neuroscience.2022;[Epub] CrossRef
rTMS induces analgesia and modulates neuroinflammation and neuroplasticity in neuropathic pain model rats
Roberta Ströher Toledo, Dirson João Stein, Paulo Roberto Stefani Sanches, Lisiane Santos da Silva, Helouise Richardt Medeiros, Felipe Fregni, Wolnei Caumo, Iraci L.S. Torres
Brain Research.2021; 1762: 147427. CrossRef
Research on Assisting Clinicians to Operate rTMS Precisely Based on the Coil Magnetic Field Spatial Distribution With Magnetic Resonance Imaging Navigation
Shijun Li, Yi Wang, ShengJie Li, Yanwei Lv, Lei Zhang, Jun Zou, Lin Ma
Frontiers in Neuroscience.2019;[Epub] CrossRef
Effects of Combined Upper Limb Robotic Therapy in Patients With Tetraplegic Spinal Cord Injury
Joo Hwan Jung, Hye Jin Lee, Duk Youn Cho, Jung-Eun Lim, Bum Suk Lee, Seung Hyun Kwon, Hae Young Kim, Su Jeong Lee
Annals of Rehabilitation Medicine.2019; 43(4): 445. CrossRef

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Long-Term Efficacy of Mirabegron Add-On Therapy to Antimuscarinic Agents in Patients With Spinal Cord Injury: Seok-Hee Han, In Kyoung Cho, Joo Hwan Jung, Seong Ho Jang, Bum-Suk Lee; Ann Rehabil Med 2019;43(1):54-61. Published online February 28, 2019; DOI: https://doi.org/10.5535/arm.2019.43.1.54

Abstract
PDF

Objective
To evaluate the long-term efficacy of mirabegron add-on therapy in patients with spinal cord injury (SCI) based on an urodynamic study.
Methods
This retrospective study involved a chart audit of individuals with SCI who underwent two consecutive urodynamic studies between April 1, 2015 and April 1, 2018. After adding 50 mg of mirabegron once a day to the pre-existing antimuscarinic therapy for a period of, at least 6 months, the following variables were analyzed: change in cystometric capacity, change in bladder compliance, change in maximal detrusor pressure, change in reflex volume, and presence of significant leakage during filling cystometry.
Results
A total of 31 participants with a mean age of 41±15 years were included in the analysis. A significant increase in cystometric capacity (mean, 362 to 424 mL; p=0.03), reflex volume (mean, 251 to 329 mL; p=0.02), and bladder compliance (median, 12 to 18 mL/cmH2O; p=0.04) was observed. The presence of leakage during filling cystometry was significantly reduced (29% to 10%; p=0.03). Likewise, a non-significant decrease in the change in maximal detrusor pressure was observed (mean, 31 to 27 cmH2O; p=0.39).
Conclusion
Adding mirabegron to conventional antimuscarinics further improved urodynamic parameters in patients with chronic SCI, and sustained efficacy was observed in long-term use.

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Eren O. Kuris, Daniel Alsoof, Camilo Osorio, Alan H. Daniels
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Gamal Ghoniem, Dena Moskowitz, Catherine Nguyen
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Case Report

Spinal Accessory Nerve Injury Induced by Manipulation Therapy: A Case Report: Jung Ro Yoon, Yong Ki Kim, Yun Dam Ko, Soo In Yun, Dae Heon Song, Myung Eun Chung; Ann Rehabil Med 2018;42(5):773-776. Published online October 31, 2018; DOI: https://doi.org/10.5535/arm.2018.42.5.773

Abstract
PDF

Spinal accessory nerve (SAN) injury mostly occurs during surgical procedures. SAN injury caused by manipulation therapy has been rarely reported. We present a rare case of SAN injury associated with manipulation therapy showing scapular winging and droopy shoulder. A 42-year-old woman visited our outpatient clinic complaining of pain and limited active range of motion (ROM) in right shoulder and scapular winging after manipulation therapy. Needle electromyography and nerve conduction study suggested SAN injury. Physical therapy (PT) three times a week for 2 weeks were prescribed. After a total of 6 sessions of PT and modality, the patient reported that the pain was gradually relieved during shoulder flexion and abduction with improved active ROM of shoulder. Over the course of 2 months follow-up, the patient reported almost recovered shoulder ROM and strength as before. She did not complain of shoulder pain any more.

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Alper Uysal, Nimet Bilge Kalkan
European Journal of Medical Case Reports.2020;[Epub] CrossRef

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Original Articles

The Nutritional Status and the Clinical Outcomes of Patients With a Spinal Cord Injury Using Nutritional Screening Tools: Ji Cheol Shin, Shin Hye Chang, Sang Won Hwang, Jae Joong Lee; Ann Rehabil Med 2018;42(4):591-600. Published online August 31, 2018; DOI: https://doi.org/10.5535/arm.2018.42.4.591

Abstract
PDF

Objective
To assess the nutritional status of Korean patients with spinal cord injury (SCI), identify the predictors of undernutrition, and investigate the relationship between undernutrition and clinical outcomes.
Methods
A retrospective study design was used to determine the nutritional status of 130 patients over 19 years old admitted to the rehabilitation hospital of Yonsei University Health System between June 2015 and February 2017. The nutritional status was assessed using the malnutrition universal screening tool (MUST) and the spinal nutrition screening tool (SNST). The relationship between undernutrition and clinical outcomes was examined by comparing a low-risk group with an at-risk group using a t-test.
Results
Among the SCI patients, 70 (50.8%) were confirmed with undernutrition based on the MUST scores, while 60 (46.2%) had undernutrition based on the SNST scores. It was found that undernutrition has an effect on functional outcomes.
Conclusion
We assessed the undernutrition risk in Korean SCI patients, and found that approximately 50% of the patients were at risk of undernutrition. We also found that undernutrition can affect functional recovery.

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Astrid M.H. Horstman, Janneke M. Stolwijk-Swüste, Luc J.C. van Loon, Sonja de Groot
The Journal of Spinal Cord Medicine.2025; : 1. CrossRef
Priority setting for nutrition research in individuals with spinal cord injury: A protocol for Delphi study among health professionals
Marija Glisic, Shashivadan P. Hirani, Hanne Bjørg Slettahjell, Willemijn Faber, Yannis Dionyssiotis, Alastair Forbes, Anthony Twist, Emil Moga, Jackie McRae, Firas Sarhan, Sharon Leigh, Samford Wong, Nicola Diviani
PLOS One.2025; 20(7): e0327612. CrossRef
Foodservice Models and Nutrition Practices in Spinal Facilities: Insights and Opportunities for Improvement From a Pilot Multinational Survey
Isabella B. Morgan, Yilin Wang, Murray Fisher, Peter F. Collins, Priya Iyer
Journal of Human Nutrition and Dietetics.2025;[Epub] CrossRef
Defining malnutrition in persons with spinal cord injury – does the Global Criteria for Malnutrition work?
Hanne Bjørg Slettahjell, Maria Bastakis, Fin Biering-Sørensen, Vegard Strøm, Christine Henriksen
Food & Nutrition Research.2024;[Epub] CrossRef
Significance of physical factors on activities of daily living in patients with tetraplegia after spinal cord injury: a retrospective study
Kimin Yun, Jin-cheol Lim, Onyoo Kim
BMC Sports Science, Medicine and Rehabilitation.2024;[Epub] CrossRef
The risk of malnutrition in patients with spinal cord injury during inpatient rehabilitation–A longitudinal cohort study
Irene Flury, Gabi Mueller, Claudio Perret
Frontiers in Nutrition.2023;[Epub] CrossRef
Predictive validity of the Mini Nutritional Assessment Short‐Form for rehabilitation patients: A retrospective analysis of the Japan Rehabilitation Nutrition Database
Shinta Nishioka, Hidetaka Wakabayashi, Jun Kayashita, Yutaka Taketani, Ryo Momosaki
Journal of Human Nutrition and Dietetics.2021; 34(5): 881. CrossRef

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A Dynamic Magnetic Resonance Imaging Study of Changes in Severity of Cervical Spinal Stenosis in Flexion and Extension: Yookyung Lee, Seung Yeun Kim, Keewon Kim; Ann Rehabil Med 2018;42(4):584-590. Published online August 31, 2018; DOI: https://doi.org/10.5535/arm.2018.42.4.584

Abstract
PDF

Objective
To evaluate changes in the severity of cervical spinal stenosis (CSS) in flexion and extension and determine whether the rate of change with motion varied with severity.
Methods
The study included 92 symptomatic patients with a mean age of 57.80±10.41, who underwent cervical spine dynamic magnetic resonance imaging. The severity of stenosis was evaluated using a semi-quantitative CSS score, ranging from 0 (no spinal stenosis) to 18 (severe stenosis). Radiological evaluation included flexion, neutral, and extension measurements, as determined by the C2–C7 Cobb angle. The severity of stenosis was represented by the total CSS score. The total CSS score in flexion, neutral, and extension positions was compared using repeated measures one-way analysis of variance. The change rate of stenosis per angle motion (CRSPAM) was defined as change in total CSS score divided by change in Cobb angle. The correlation of CRSPAM with severity of stenosis, represented by total CSS score in neutral position, was evaluated using Pearson correlation analysis.
Results
The total CSS score was significantly higher in extension (6.04±2.68) than in neutral position (5.25±2.47) (p<0.001), and significantly higher in neutral than in flexion position (4.40±2.45) (p<0.001). The CRSPAM was significantly and positively correlated with total CSS score in neutral position in the flexion-extension range (r=0.22, p=0.04) and flexion-neutral range (r=0.27, p=0.01).
Conclusion
In symptomatic CSS patients, the radiological severity of stenosis increases with extension and decreases with flexion. In patients with CSS, the rate of variation in spinal stenosis increases with increased severity.

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Does the degree of stenosis affect cervical proprioception in patients with cervical pain?
Onur Engin, Ayse Sezgi Kizilirmak Karatas, Betul Taspinar, Ferruh Taspinar
Journal of Back and Musculoskeletal Rehabilitation.2026; 39(1): 85. CrossRef
Utility of Dynamic MRI in Surgical Outcome of Patients With Degenerative Cervical Myelopathy: A Single-Center, Randomized Controlled Trial
Alangsungyu Ajem, Arunkumar Sekar, Suprava Naik, Sumit Bansal, Mantu Jain, Ashis Patnaik, Rabi Narayan Sahu
Neurosurgery.2026;[Epub] CrossRef
Predictive value of magnetic resonance imaging indications of spinal cord swelling for cervical spondylotic myelopathy prognosis
Xiao-Nan Tian, Li Zhang, Hong-Ran Liu, Xue-Song Zhang, Ying-Cai Sun, Yong Wang
Technology and Health Care.2024; 32(1): 151. CrossRef
Favorable cervical extension capacity preventing loss of cervical lordosis after laminoplasty due to spontaneous restoration of initial lordosis
Xiaofei Cheng, Zhiqian Chen, Xiaojiang Sun, Changqing Zhao, Jie Zhao
The Spine Journal.2024; 24(1): 94. CrossRef
Dynamic Flexion-Extension Magnetic Resonance Imaging of the Cervical Spine: An Evolutionary Tool for Diagnosis and Management of Cervical Spondylotic Myelopathy
Ali Mahdavi, Sina Rasti
World Neurosurgery.2024; 184: 138. CrossRef
Added value of dynamic MRI in assessment of cervical spondylodegenerative diseases
Menna Ahmad Mohamed Abdalhak, Hossam Mousa Sakr, Mennatallah Hatem Shalaby, Shaimaa Elmetwally El diasty
Egyptian Journal of Radiology and Nuclear Medicine.2023;[Epub] CrossRef
Flexion/Extension Cervical Magnetic Resonance Imaging: A Potentially Useful Tool for Decision-Making in Patients with Symptomatic Degenerative Cervical Spine
Hazem M.A. Alkosha, Mohamed A. El Adalany, Hesham Elsobky, Asharaf S. Zidan, Amin Sabry, Basem I. Awad
World Neurosurgery.2022; 164: e1078. CrossRef
Best cutoff score of cervical-pedicle thickness as a morphological parameter for predicting cervical central stenosis
Jungho Choi, Hyung-Bok Park, Taeha Lim, Shin Wook Yi, Sooho Lee, Sukhee Park, SoYoon Park, Jungmin Yi, Young Uk Kim
Medicine.2022; 101(33): e30014. CrossRef
Multidimensional assessment of cervical spondylotic myelopathy patients. Usefulness of a comprehensive score system
Fabio Pilato, Rosalinda Calandrelli, Marisa Distefano, Francesco Ciro Tamburrelli
Neurological Sciences.2021; 42(4): 1507. CrossRef
The value of dynamic MRI in the treatment of cervical spondylotic myelopathy: a protocol for a prospective randomized clinical trial
Nanfang Xu, Youyu Zhang, Guangjin Zhou, Qiang Zhao, Shaobo Wang
BMC Musculoskeletal Disorders.2020;[Epub] CrossRef
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Andrei Fernandes Joaquim, Griffin R. Baum, Lee A. Tan, K. Daniel Riew
Neurospine.2019; 16(3): 448. CrossRef

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Motor and Sensory Function as a Predictor of Respiratory Function Associated With Ventilator Weaning After High Cervical Cord Injury: Tae Wan Kim, Jung Hyun Yang, Sung Chul Huh, Bon Il Koo, Jin A Yoon, Je Sang Lee, Hyun-Yoon Ko, Yong Beom Shin; Ann Rehabil Med 2018;42(3):457-464. Published online June 27, 2018; DOI: https://doi.org/10.5535/arm.2018.42.3.457

Abstract
PDF

Objective
To analyze the respiratory function of high cervical cord injury according to ventilator dependence and to examine the correlations between diaphragm movement found on fluoroscopy and sensory and motor functions.
Methods
A total of 67 patients with high cervical spinal cord injury (SCI), admitted to our hospital were enrolled in the study. One rehabilitation physician performed sensory and motor examinations on all patients while each patient was in the supine position on the American Spinal Injury Association (ASIA) standard. In addition, fluoroscopic diaphragm movement studies and bedside spirometry were performed.
Results
Bedside spirometry and diaphragm fluoroscopic tests were analyzed according to ventilator dependence. Forced vital capacity and maximal inspiratory pressure were significantly higher in the ventilator weaned group. Natural breathing during the fluoroscopic diaphragm examinations and ventilator weaning showed statistical significance with the movement on the right, while deep breathing showed statistical significance with the movement on both sides. Deep breathing movement has correlation with the C5 key muscle. Diaphragm movement has correlation with right C3 and bilateral C4 sensory functions.
Conclusion
The present expansion study showed that, through simple bedside physical examinations, rehabilitation physicians could relatively easily predict diaphragm movement and respiratory function recovery, which showed significance with ventilator weaning in patients with high cervical SCI.

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A multimodal respiratory weaning intervention for adult critical care patients mechanically ventilated with cervical spinal cord injury: a quality improvement project
Tammy J. Lea, Adam J. C. Harriman, James Hodson, Jonathan Weblin
Spinal Cord.2025; 63(11): 579. CrossRef
Predicting extubation in patients with traumatic cervical spinal cord injury using the diaphragm electrical activity during a single maximal maneuver
Rui Zhang, Xiaoting Xu, Hui Chen, Jennifer Beck, Christer Sinderby, Haibo Qiu, Yi Yang, Ling Liu
Annals of Intensive Care.2023; 13(1): 122. CrossRef
Respiratory Complications and Weaning Considerations for Patients with Spinal Cord Injuries: A Narrative Review
Kristopher A. Hendershot, Kristine H. O’Phelan
Journal of Personalized Medicine.2022; 13(1): 97. CrossRef
Separation from mechanical ventilation and survival after spinal cord injury: a systematic review and meta-analysis
Annia F. Schreiber, Jacopo Garlasco, Fernando Vieira, Yie Hui Lau, Dekel Stavi, David Lightfoot, Andrea Rigamonti, Karen Burns, Jan O. Friedrich, Jeffrey M. Singh, Laurent J. Brochard
Annals of Intensive Care.2021;[Epub] CrossRef

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Pressure Relieving Effect of Adding a Pelvic Well Pad to a Wheelchair Cushion in Individuals With Spinal Cord Injury: Hyunsoo Shin, Junsik Kim, Jin-Ju Kim, Hye-Ri Kim, Hye-Jin Lee, Bum-Suk Lee, Zee-A Han; Ann Rehabil Med 2018;42(2):270-276. Published online April 30, 2018; DOI: https://doi.org/10.5535/arm.2018.42.2.270

Abstract
PDF

Objective

To identify the pressure relieving effect of adding a pelvic well pad, a firm pad that is cut in the ischial area, to a wheelchair cushion on the ischium.

Methods

Medical records of 77 individuals with SCI, who underwent interface pressure mapping of the buttock-thigh area, were retrospectively reviewed. The pelvic well pad is a 2.5-cm thick firm pad and has a cut in the ischial area. Expecting additional pressure relief, it can be inserted under a wheelchair cushion. Subjects underwent interface pressure mapping in the subject's wheelchair utilizing the subject's pre-existing pressure relieving cushion and subsequently on a combination of a pelvic well pad and the cushion. The average pressure, peak pressure, and contact area of the buttock-thigh were evaluated.

Results

Adding a pelvic well pad, under the pressure relieving cushion, resulted in a decrease in the average and peak pressures and increase in the contact area of the buttock-thigh area when compared with applying only pressure relieving cushions (p<0.05). The mean of the average pressure decreased from 46.10±10.26 to 44.09±9.92 mmHg and peak pressure decreased from 155.03±48.02 to 131.42±45.86 mmHg when adding a pelvic well pad. The mean of the contact area increased from 1,136.44±262.46 to 1,216.99±255.29 cm².

Conclusion

When a pelvic well pad was applied, in addition to a pre-existing pressure relieving cushion, the average and peak pressures of the buttock-thigh area decreased and the contact area increased. These results suggest that adding a pelvic well pad to wheelchair cushion may be effective in preventing a pressure ulcer of the buttock area.

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Effects of Wheelchair Seat Sagging on Seat Interface Pressure and Shear, and Its Relationship with Changes in Sitting Posture
Kiyo Sasaki, Yoshiyuki Yoshikawa, Kyoko Nagayoshi, Kodai Yamazaki, Kenta Nagai, Koji Ikeda, Yasutomo Jono, Noriaki Maeshige
Biomechanics.2025; 5(2): 41. CrossRef
Stability of ischial pressure with 3D thermoplastic elastomer cushion and the characteristics of four types of cushions in pressure redistribution
Yoshiyuki Yoshikawa, Kyoko Nagayoshi, Noriaki Maeshige, Atomu Yamaguchi, Yuki Aoyama, Shuto Takita, Teppei Wada, Masayuki Tanaka, Hiroto Terashi, Yuma Sonoda
Drug Discoveries & Therapeutics.2024; 18(3): 188. CrossRef
Padding the seat of a wheelchair reduces ischial pressure and improves sitting comfort
Yoshiyuki Yoshikawa, Kiyo Sasaki, Kyoko Nagayoshi, Kenta Nagai, Yuki Aoyama, Shuto Takita, Teppei Wada, Yoshinori Kitade
Drug Discoveries & Therapeutics.2024; 18(5): 314. CrossRef
3D finite-element modeling of air-cell-based cushions and buttock tissues during prolonged sitting
Chenhao Yu, Joel Martin Sacris, Yan Gai, Chi Hou Lei
Computers in Biology and Medicine.2022; 142: 105229. CrossRef
Evaluation of interface pressure and temperature management in five wheelchair seat cushions and their effects on user satisfaction
Pablo García-Molina, Sergio Roig Casasus, Enrique Sanchis-Sánchez, Evelin Balaguer-López, Manuel Ruescas-López, José-María Blasco
Journal of Tissue Viability.2021; 30(3): 402. CrossRef

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Effect of Family Caregiving on Depression in the First 3 Months After Spinal Cord Injury: Min-Gu Kang, Chul-Hyun Kim, Eunhee Park, Jae-Won Huh, Won-Jong Yang, Tae-Woo Nam, Yu-Sun Min, Tae-Du Jung; Ann Rehabil Med 2018;42(1):130-136. Published online February 28, 2018; DOI: https://doi.org/10.5535/arm.2018.42.1.130

Abstract
PDF

Objective

To investigate the effect of family caregiving on depression in the first 3 months after spinal cord injury (SCI).

Methods

A retrospective study was carried out on 76 patients diagnosed with an SCI from January 2013 to December 2016 at the Department of Physical Medicine and Rehabilitation of Kyungpook National University Hospital, Korea. Clinical characteristics including age, gender, level of injury, completeness of the injury, time since injury, caregiver information, etiology, and functional data were collected through a retrospective review of medical records. Depression was assessed using the Beck Depression Inventory (BDI). Patients with 14 or more points were classified as depressed and those with scores of 13 or less as non-depressed group.

Results

Of the 76 patients, 33 were in the depressed group with an average BDI of 21.27±6.17 and 43 patients included in the non-depressed group with an average BDI of 4.56±4.20. The BDI score of patients cared by unlicensed assistive personnel (UAP) was significantly higher than that of patients cared by their families (p=0.020). Univariate regression analysis showed that motor complete injury (p=0.027), UAP caregiving (p=0.022), and Ambulatory Motor Index (p=0.019) were associated with depression after SCI. Multivariate binary logistic regression analysis showed that motor completeness (p=0.002) and UAP caregiving (p=0.002) were independent risk factors.

Conclusion

Compared with UAP, family caregivers lowered the prevalence of depression in the first 3 months after SCI.

Citations

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Identification of Mood and Body Mass Index as Modifiable Factors for Health Improvement in Spinal Cord Injury
Ruby Aikat, Varsha Singh
Archives of Rehabilitation Research and Clinical Translation.2022; 4(1): 100174. CrossRef
Comparison Between Comprehensive Nursing Care Ward and Private Care Ward on Functional Recovery in Stroke Patients
Yang Rok Hur, Woo Sup Song, Kyung Min Kim, Ki Hun Hwang
Brain & Neurorehabilitation.2022;[Epub] CrossRef
Differential eligibility for paid leave benefits in OECD countries: the impact of tenure requirements for young workers
Nicolas de Guzman Chorny, Amy Raub, Alison Earle, Jody Heymann
Community, Work & Family.2021; 24(2): 193. CrossRef
Factors associated with discharge destination following inpatient functional rehabilitation in patients with traumatic spinal cord injury
Antoine Dionne, Andréane Richard-Denis, Victor Lim, Jean-Marc Mac-Thiong
Spinal Cord.2021; 59(6): 642. CrossRef
The psychological and psychiatric care for the children after severe spinal cord injury in the framework of the combined early rehabilitative treatment
S. A. Valiullina, Yu. G. Sidneva, E. A. Lvova
Voprosy kurortologii, fizioterapii i lechebnoi fizicheskoi kul'tury.2019; 96(2): 45. CrossRef
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Ivan R. Molton, Anne Ordway
Journal of Aging and Health.2019; 31(10_suppl): 3S. CrossRef

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Degree of Contribution of Motor and Sensory Scores to Predict Gait Ability in Patients With Incomplete Spinal Cord Injury: Jinkyoo Moon, Junghoon Yu, Jaewoo Choi, MinYoung Kim, Kyunghoon Min; Ann Rehabil Med 2017;41(6):969-978. Published online December 28, 2017; DOI: https://doi.org/10.5535/arm.2017.41.6.969

Abstract
PDF

Objective

To identify different contributions of motor and sensory variables for independent ambulation of patients with incomplete spinal cord injury (SCI), and reveal the most significant contributors among the variables.

Methods

The retrospective study included 30 patients with incomplete SCI and lesions were confirmed by magnetic resonance imaging. Motor and sensory scores were collected according to the International Standards for Neurological Classification of Spinal Cord Injury. The variables were analyzed by plotting ROC (receiver operating characteristic) curves to estimate their differential contributions for independent walking. The most significant functional determinant was identified through the subsequent logistic regression analysis.

Results

Motor and sensory scores were significantly different between the ambulators and non-ambulators. The majority was associated to the function of lower extremities. Calculation of area under ROC curves (AUC) revealed that strength of hip flexor (L2) (AUC=0.905, p<0.001) and knee extensor (L3) (AUC=0.820, p=0.006) contributed the greatest to independent walking. Also, hip flexor strength (L2) was the single most powerful predictor of ambulation by the logistic regression analysis (odds ratio=6.3, p=0.049), and the model fit well to the data.

Conclusion

The most important potential contributor for independent walking in patients with incomplete SCI is the muscle strength of hip flexors, followed by knee extensors compared with other sensory and motor variables.

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Gait recovery in patients with late assessment of incomplete spinal cord injury: A retrospective study in Argentina
Marcelo A. Gatti, Yamila Dieni, Lucia Yaccuzzi, María E. Rivas, Daniela G. L. Terson de Paleville
The Journal of Spinal Cord Medicine.2025; 48(6): 1124. CrossRef
Classifying clinical phenotypes of functional recovery for acute traumatic spinal cord injury. An observational cohort study
Pascal Mputu Mputu, Marie Beauséjour, Andréane Richard-Denis, Nader Fallah, Vanessa K. Noonan, Jean-Marc Mac-Thiong
Disability and Rehabilitation.2024; 46(25): 6069. CrossRef
Walking Outcome After Traumatic Paraplegic Spinal Cord Injury: The Function of Which Myotomes Makes a Difference?
Adrian Cathomen, Doris Maier, Jiri Kriz, Rainer Abel, Frank Röhrich, Michael Baumberger, Giorgio Scivoletto, Norbert Weidner, Rüdiger Rupp, Catherine R. Jutzeler, John D. Steeves, Armin Curt, Marc Bolliger
Neurorehabilitation and Neural Repair.2023; 37(5): 316. CrossRef
Development of an unsupervised machine learning algorithm for the prognostication of walking ability in spinal cord injury patients
Zachary DeVries, Mohamad Hoda, Carly S Rivers, Audrey Maher, Eugene Wai, Dita Moravek, Alexandra Stratton, Stephen Kingwell, Nader Fallah, Jérôme Paquet, Philippe Phan
The Spine Journal.2020; 20(2): 213. CrossRef
Does prolonged walking cause greater muscle fatigability in individuals with incomplete spinal cord injury compared with matched-controls?
Jefferson Rodrigues Dorneles, Frederico Ribeiro Neto, Carlos Wellington Gonçalves, Rodrigo Rodrigues Gomes Costa, Rodrigo Luiz Carregaro
Gait & Posture.2020; 78: 65. CrossRef
Gait rehabilitation in persons with spinal cord injury using innovative technologies: an observational study
Giulia Stampacchia, Matteo Olivieri, Alessandro Rustici, Carla D’Avino, Adriana Gerini, Stefano Mazzoleni
Spinal Cord.2020; 58(9): 988. CrossRef

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Asymmetric Atrophy of Paraspinal Muscles in Patients With Chronic Unilateral Lumbar Radiculopathy: Jinmann Chon, Hee-Sang Kim, Jong Ha Lee, Seung Don Yoo, Dong Hwan Yun, Dong Hwan Kim, Seung Ah Lee, Yoo Jin Han, Hyun Seok Lee, Young Rok Han, Seonyoung Han, Yong Kim; Ann Rehabil Med 2017;41(5):801-807. Published online October 31, 2017; DOI: https://doi.org/10.5535/arm.2017.41.5.801

Abstract
PDF

Objective

To assess the cross-sectional area (CSA) of the muscles for investigating the occurrence of asymmetry of the paraspinal (multifidus and erector spinae) and psoas muscles and its relation to the chronicity of unilateral lumbar radiculopathy using magnetic resonance imaging (MRI).

Methods

This retrospective study was conducted between January 2012 to December 2014. Sixty one patients with unilateral L5 radiculopathy were enrolled: 30 patients had a symptom duration less than 3 months (group A) and 31 patients had a symptom duration of 3 months or more (group B). Axial MRI measured the CSA of the paraspinal and psoas muscles at the middle between the lower margin of the upper vertebra and upper margin of the lower vertebra, and obtained the relative CSA (rCSA) which is the ratio of the CSA of muscles to that of the lower margin of L4 vertebra.

Results

There were no differences in the demographics between the two groups. In group B, rCSA of the erector spinae at the L4–5 level, and that of multifidus at the L4–5 and L5–S1 levels, were significantly smaller on the involved side as compared with the uninvolved side. In contrast, no significant muscle asymmetry was observed in group A. The rCSA of the psoas was not affected in either group.

Conclusion

The atrophy of the multifidus and erector spinae ipsilateral to the lumbar radiculopathy was observed only in patients suffering from unilateral radiculopathy for 3 months or more.

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Rishab Jain, Subhashree Dash, Shruti Chandak, Ankur Malhotra, Amit Saraf, Ashutosh Kumar
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Jacopo Vitale, Luca Maria Sconfienza, Fabio Galbusera
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Effect of Patient Education on Reducing Medication in Spinal Cord Injury Patients With Neuropathic Pain: Ji Cheol Shin, Na Young Kim, Shin Hye Chang, Jae Joong Lee, Han Kyul Park; Ann Rehabil Med 2017;41(4):621-630. Published online August 31, 2017; DOI: https://doi.org/10.5535/arm.2017.41.4.621

Abstract
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Objective

To determine whether providing education about the disease pathophysiology and drug mechanisms and side effects, would be effective for reducing the use of pain medication while appropriately managing neurogenic pain in spinal cord injury (SCI) patients.

Methods

In this prospective study, 109 patients with an SCI and neuropathic pain, participated in an educational pain management program. This comprehensive program was specifically created, for patients with an SCI and neuropathic pain. It consisted of 6 sessions, including educational training, over a 6-week period.

Results

Of 109 patients, 79 (72.5%) initially took more than two types of pain medication, and this decreased to 36 (33.0%) after the educational pain management program was completed. The mean pain scale score and the number of pain medications decreased, compared to the baseline values. Compared to the non-response group, the response group had a shorter duration of pain onset (p=0.004), and a higher initial number of different medications (p<0.001) and certain types of medications.

Conclusion

This study results imply that an educational pain management program, can be a valuable complement to the treatment of spinal cord injured patients with neuropathic pain. Early intervention is important, to prevent patients from developing chronic SCI-related pain.

Citations

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Approaches to self-management integration and influencing factors in everyday life after spinal cord injury: A qualitative narrative analysis
Enxhi Qama, Nicola Diviani, Clara Häfliger, Xavier Jordan, Anke Scheel-Sailer, Claudia Zanini, Sara Rubinelli
Patient Education and Counseling.2025; 136: 108763. CrossRef
Cervicalgia and cervicobrachialgia in periarticular cyst at the cervical level. Case report
Ekaterina K. Kerimova, Aleksei I. Isaikin, Anastasia S. Romanova, Mikhail G. Bashlachev, Kinan Mouki
Consilium Medicum.2025; 27(02): 94. CrossRef
The Diagnostic Odyssey of Patients with Chronic Neuropathic Pain—Expert Opinion of Greek Pain Specialists
Persefoni Kritikou, Athina Vadalouca, Martina Rekatsina, Giustino Varrassi, Ioanna Siafaka
Clinics and Practice.2023; 13(1): 166. CrossRef
A scoping review of medication self-management intervention tools to support persons with traumatic spinal cord injury
Lauren Cadel, Stephanie R. Cimino, Glyneva Bradley-Ridout, Sander L. Hitzig, Tanya L. Packer, Lisa M. McCarthy, Tejal Patel, Aisha K. Lofters, Shoshana Hahn-Goldberg, Chester H. Ho, Sara J. T. Guilcher, Saeed Ahmed
PLOS ONE.2023; 18(4): e0284199. CrossRef
Aging with spinal cord injury: A narrative review of consequences and challenges
Gabriel Guízar-Sahagún, Israel Grijalva, Rebecca E. Franco-Bourland, Ignacio Madrazo
Ageing Research Reviews.2023; 90: 102020. CrossRef
Spinal cord injury/dysfunction and medication management: a qualitative study exploring the experiences of community-dwelling adults in Ontario, Canada
Lauren Cadel, Sander L. Hitzig, Tanya L. Packer, Tejal Patel, Aisha K. Lofters, Alison Thompson, Sara J. T. Guilcher
Disability and Rehabilitation.2022; 44(1): 24. CrossRef
Preventing pediatric chronic postsurgical pain: Time for increased rigor
Christine B. Sieberg, Keerthana Deepti Karunakaran, Barry Kussman, David Borsook
Canadian Journal of Pain.2022; 6(2): 73. CrossRef
Diagnosis and management of persistent posttraumatic trigeminal neuropathic pain secondary to implant therapy
Divya Kohli, Giannina Katzmann, Rafael Benoliel, Olga A. Korczeniewska
The Journal of the American Dental Association.2021; 152(6): 483. CrossRef
Spinal cord injury and polypharmacy: a scoping review
Lauren Cadel, Amanda C. Everall, Sander L. Hitzig, Tanya L. Packer, Tejal Patel, Aisha Lofters, Sara J. T. Guilcher
Disability and Rehabilitation.2020; 42(26): 3858. CrossRef
Subgroup Perspectives on Chronic Pain and Its Management After Spinal Cord Injury
Eva Widerström-Noga, Kim D. Anderson, Salomé Perez, Alberto Martinez-Arizala, Jessica M. Cambridge
The Journal of Pain.2018; 19(12): 1480. CrossRef

8,370 View
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10 Web of Science
10 Crossref

Intraoperative Neurophysiological Monitoring for Spinal Cord Tumor Surgery: Comparison of Motor and Somatosensory Evoked Potentials According to Tumor Types: Taeha Park, Jinyoung Park, Yoon Ghil Park, Joowon Lee; Ann Rehabil Med 2017;41(4):610-620. Published online August 31, 2017; DOI: https://doi.org/10.5535/arm.2017.41.4.610

Abstract
PDF

Objective

To identify which combination of motor evoked potentials (MEPs) and somatosensory evoked potentials (SEPs) is most reliable for postoperative motor deterioration during spinal cord tumor surgery, according to anatomical and pathologic type.

Methods

MEPs and SEPs were monitored in patients who underwent spinal cord tumor surgery between November 2012 and August 2016. Muscle strength was examined in all patients before surgery, within 48 hours postoperatively and 4 weeks later. We analyzed sensitivity, specificity, positive and negative predictive values of each significant change in SEPs and MEPs.

Results

The overall sensitivity and specificity of SEPs or MEPs were 100% and 61.3%, respectively. The intraoperative MEP monitoring alone showed both higher sensitivity (67.9%) and specificity (83.2%) than SEP monitoring alone for postoperative motor deterioration. Two patients with persistent motor deterioration had significant changes only in SEPs. There are no significant differences in reliabilities between anatomical types, except with hemangioma, where SEPs were more specific than MEPs for postoperative motor deterioration. Both overall positive and negative predictive values of MEPs were higher than the predictive values of SEPs. However, the positive predictive value was higher by the dual monitoring of MEPs and SEPs, compared to MEPs alone.

Conclusion

For spinal cord tumor surgery, combined MEP and SEP monitoring showed the highest sensitivity for the postoperative motor deterioration. Although MEPs are more specific than SEPs in most types of spinal cord tumor surgery, SEPs should still be monitored, especially in hemangioma surgery.

Citations

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Intraoperative Neurophysiological Monitoring During Spinal Cord Tumor Surgery
Alessandro Boaro, Federica Basaldella, Francesco Sala
Neurosurgery Clinics of North America.2026; 37(3): 305. CrossRef
Utility of intraoperative neuromonitoring in surgery for spinal cord tumors
Avinash Lakha, Arunkumar Sekar, Sumit Bansal, Ashis Patnaik, Priyadarshini Mishra, Rabi Narayan Sahu
Journal of Neurosciences in Rural Practice.2026; 0: 1. CrossRef
Local tumor control and neurological outcomes after surgery for spinal hemangioblastomas in sporadic and von Hippel–Lindau disease: A multicenter study
Johannes Wach, Alim Emre Basaran, Martin Vychopen, Tarik Tihan, Maria Wostrack, Vicki M Butenschoen, Bernhard Meyer, Sebastian Siller, Nils Ole Schmidt, Julia Onken, Peter Vajkoczy, Alejandro N Santos, Laurèl Rauschenbach, Philipp Dammann, Ulrich Sure, Ja
Neuro-Oncology.2025; 27(6): 1567. CrossRef
Letter to the editor: precision medicine in spinal tumor surgical care
Favour Tope Adebusoye, Simran Karkhanis, Alwin Jose, Krishna Sai Kiran Sakalabaktula, Usama Saeed, Rohan S. Mane, Brandon Lucke-Wold, Paul R. Krafft, Julie L. Chan
Egyptian Journal of Neurosurgery.2025;[Epub] CrossRef
Resection of an Intradural Intramedullary C7-T1 Tumor: Technical Nuances and Complication Management
Giovanni Barbagli, Amna Hussein, Esteban Quiceno, Michael Prim, Diego Soto Rubio, Ali Baaj
World Neurosurgery.2024; 184: 41. CrossRef
Intraoperative changes in electrophysiological monitoring can be used to predict clinical outcomes in patients with spinal cavernous malformation
Xiaoyu Li, Hongqi Zhang, Jian Ren
Open Medicine.2024;[Epub] CrossRef
Intradural extramedullary tumor location in the axial view affects the alert timing of intraoperative neurophysiologic monitoring
Shinji Morito, Kei Yamada, Ichirou Nakae, Kimiaki Sato, Kimiaki Yokosuka, Tatsuhiro Yoshida, Takahiro Shimazaki, Yutaro Hazemoto, Rikiya Saruwatari, Kota Nishida, Shingo Okazaki, Koji Hiraoka
Journal of Clinical Monitoring and Computing.2023; 37(3): 775. CrossRef
The role of intraoperative neurophysiological monitoring in intramedullary spinal cord tumor surgery
Kai Liu, Chengyuan Ma, Dapeng Li, Haisong Li, Xuechao Dong, Bo Liu, Ying Yu, Yuxiang Fan, Hongmei Song
Chinese Neurosurgical Journal.2023;[Epub] CrossRef
Intraoperative evoked potentials in patients with ossification of posterior longitudinal ligament
Myungeun Yoo, Yoon Ghil Park, Yong Eun Cho, Chae Hwan Lim, Seok Young Chung, Dawoon Kim, Jinyoung Park
Journal of Clinical Monitoring and Computing.2022; 36(1): 247. CrossRef
The feasibility of intra-operative neurophysiologic monitoring using rectus abdominis muscles during thoracic tumor surgery: a case report
Hee Tae Shin, Jin Soo Park, Seung Hak Lee
Journal of Intraoperative Neurophysiology.2022; 4(2): 60. CrossRef
Correlation between preoperative somatosensory evoked potentials and intraoperative neurophysiological monitoring in spinal cord tumors
Jinyoung Park, Yong Eun Cho, Mina Park, Joowon Lee, Dawoon Kim, Yoon Ghil Park
Journal of Clinical Monitoring and Computing.2021; 35(5): 979. CrossRef
Surgical and Radiologic Prognostic Factors in Intramedullary Spinal Cord Lesions
Pietro Mortini, Carlotta Morselli, Alfio Spina, Michele Bailo, Ubaldo del Carro, Nicola Boari
World Neurosurgery.2021; 150: e550. CrossRef
Age at Diagnosis and Baseline Myelomalacia Sign Predict Functional Outcome After Spinal Meningioma Surgery
Johannes Wach, Mohammed Banat, Patrick Schuss, Erdem Güresir, Hartmut Vatter, Jasmin Scorzin
Frontiers in Surgery.2021;[Epub] CrossRef
Intraoperative neurophysiological monitoring in spinal cord tumor surgery
Jinyoung Park, Yoon Ghil Park
Journal of Intraoperative Neurophysiology.2021; 3(1): 10. CrossRef
Sudden onset temporary loss of SSEP and MEP as a result to positional neck changes in an intradural extramedullary cervical spine schwannoma: A case report
Mohammed Zahid Alkhatib, Turki Elarjani, Abdulrahman Majed Alkhalefah, Faisal Farrash
Interdisciplinary Neurosurgery.2020; 21: 100717. CrossRef
Differences in the Electrophysiological Monitoring Results of Spinal Cord Arteriovenous and Intramedullary Spinal Cord Cavernous Malformations
Xiaoyu Li, Hong-Qi Zhang, Feng Ling, Chuan He, Jian Ren
World Neurosurgery.2019; 122: e315. CrossRef
A spinal cord tumor removal case with somatosensory evoked potential change more severe than motor evoked potential change
Jong Hyeon Ahn, Jeong Jin Park, Dan A Oh, Byung-Nam Yoon
Journal of Intraoperative Neurophysiology.2019; 1(2): 44. CrossRef
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Ursalan Ahmed Khan, Ghiath Ismayl, Irfan Malik
World Neurosurgery.2018; 115: 65. CrossRef

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Case Report

Extravasation of the Contrast Material During Voiding Cystourethrography in a Chronic Spinal Cord Injury Patient: A Case Report: Sohyun Kwon, Donghwi Park, Hoon Hoon Lee, Ju Seok Ryu; Ann Rehabil Med 2017;41(2):323-327. Published online April 27, 2017; DOI: https://doi.org/10.5535/arm.2017.41.2.323

Abstract
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Neurogenic bladder is common in most spinal cord injury patients. Voiding cystourethrography (VCUG) is recommended in these patients to detect urinary tract complications. However, rare but serious complications may occur during VCUG, although VCUG is generally safe. There are several case reports of bladder rupture occurring in pediatric patients. Here, we report the first case of iatrogenic bladder rupture in an adult spinal cord injury patient in Korea. Particularly, extravasation of contrast without manual instillation has hardly ever been reported. To the best of our knowledge, this is the first reported case of bladder rupture without manual instillation during VCUG. We report a case of a 59-year-old female with paraplegia due to tuberculous spondylitis who underwent VCUG as a part of routine evaluation of neurogenic bladder. Extravasation of the contrast media during VCUG developed as a complication and the patient recovered spontaneously without any intervention. Therefore, VCUG should be performed properly in chronic spinal cord injury patients.

Citations

Citations to this article as recorded by

Iatrogenic bladder rupture in individuals with disability related to spinal cord injury and chronic indwelling urethral catheters
Seth L. Teplitsky, Joon Yau Leong, Patrick J. Shenot
Spinal Cord Series and Cases.2020;[Epub] CrossRef

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1 Crossref

Original Articles

Quantitative Assessment of Proprioception Using Dynamometer in Incomplete Spinal Cord Injury Patients: A Preliminary Study: Won Kee Chang, Yun Suk Jung, Mi-Kyoung Oh, Keewon Kim; Ann Rehabil Med 2017;41(2):218-224. Published online April 27, 2017; DOI: https://doi.org/10.5535/arm.2017.41.2.218

Abstract
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Objective

To investigate the feasibility of a knee proprioception evaluation using a dynamometer as a tool for evaluating proprioception of the lower extremities in patients with incomplete spinal cord injury (SCI), and to explore its usefulness in predicting the ambulatory outcome.

Methods

A total of 14 SCI patients (10 tetraplegic, 4 paraplegic; all AIS D) were included in this study. The passive repositioning error (PRE) and active repositioning error (ARE) were measured with a dynamometer, along with tibial somatosensory evoked potential (SSEP) and abductor hallucis motor-evoked potential (MEP). Ambulatory capacity was assessed with the Walking Index for Spinal Cord Injury II (WISCI-II), both at the time of the proprioception test (WISCI_i) and at least 6 months after the test (WISCI_6mo).

Results

The PRE showed a negative correlation with WISCI_i (r=-0.440, p=0.034) and WISCI_6mo (r=-0.568, p=0.010). Linear multiple regression showed the type of injury, lower extremities motor score, MEP, and PRE accounted for 75.4% of the WISCI_6mo variance (p=0.080).

Conclusion

Proprioception of the knee can be measured quantitatively with a dynamometer in patients with incomplete SCI, and PRE was related to the outcome of the ambulatory capacity. Along with the neurological and electrophysiological examinations, a proprioception test using a dynamometer may have supplementary value in predicting the ambulatory capacity in patients with incomplete SCI.

Citations

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A new balance assessment tool for quantifying balance impairment in patients with motor incomplete spinal cord injury: Pilot study
Tae Sung Park, Myung-Jun Shin, Yong Beom Shin, Sang Hun Kim
The Journal of Spinal Cord Medicine.2023; 46(6): 941. CrossRef
Comparison of Trunk Flexion Proprioception Between Healthy Athletes and Athletes With Patellofemoral Pain
Reza Heydari Armaki, Keramatollah Abbasnia, Alireza Motealleh
Journal of Sport Rehabilitation.2021; 30(3): 430. CrossRef
Associations between upper extremity functioning and kinematics in people with spinal cord injury
Lamprini Lili, Katharina S Sunnerhagen, Tiina Rekand, Margit Alt Murphy
Journal of NeuroEngineering and Rehabilitation.2021;[Epub] CrossRef
Ankle proprioception during gait in individuals with incomplete spinal cord injury
Charline Dambreville, Benoit Pairot de Fontenay, Andreanne K. Blanchette, Jean‐Sebastien Roy, Catherine Mercier, Laurent Bouyer
Physiological Reports.2019;[Epub] CrossRef
Mechanism of Activating the Proprioceptive NT-3/TrkC Signalling Pathway by Reverse Intervention for the Anterior Cruciate Ligament–Hamstring Reflex Arc with Electroacupuncture
Lei Zhang, Yan Zeng, Ji Qi, Taiyuan Guan, Xin Zhou, Yancheng He, Guoyou Wang, Shijie Fu
BioMed Research International.2018; 2018: 1. CrossRef

8,070 View
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5 Crossref

Relationship Between Motor Evoked Potential Response and the Severity of Paralysis in Spinal Cord Injury Patients: Mi-Kyoung Oh, Hye-Ri Kim, Won-Seok Kim, Hyung Ik Shin; Ann Rehabil Med 2017;41(2):211-217. Published online April 27, 2017; DOI: https://doi.org/10.5535/arm.2017.41.2.211

Abstract
PDF

Objective

To investigate the relationship between motor evoked potential (MEP) response and the severity of motor paralysis, evaluated according to the Korean disability evaluation system in patients with spinal cord injury (SCI).

Methods

We analyzed 192 lower limbs of 96 SCI patients. Lower limbs were classified according to their motor scores, as determined by the International Standards for Neurological Classification of Spinal Cord Injury: motor score <10 (group 1); ≥10 and <15 (group 2); ≥15 and <20 (group 3); and ≥20 (group 4). MEP responses were classified as ‘normal’, ‘delayed’ or ‘absent’, based on their onset latency, which was compared between the different motor score groups.

Results

MEP responses and limb motor scores were highly correlated (p<0.001). There was a significant difference of MEP responses between the motor score groups (p<0.001). MEP response was markedly poorer in motor group 1 (limb motor score <10) than in the other three groups (p<0.0001). However, there were no differences between the three groups with motor scores of 10 or above.

Conclusion

Clinical utility of MEP as a complimentary tool to manual muscle tests could be limited to discriminating motor score groups with severe paralysis, i.e., single lower limb motor power grades of 0 or 1, and from grade 2, 3, and 4, or above, in the Korean disability evaluation system.

Citations

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Effects of repetitive transcranial magnetic stimulation on motor ability, neurophysiological changes, mental health, and activities of daily living in spinal cord injury: a systematic review and meta-analysis
Xing Ye, Yidi Liu, Renyi Liu
European Spine Journal.2026; 35(7): 4470. CrossRef
Transcranial Electrical Motor Evoked Potential in Predicting Positive Functional Outcome of Patients after Decompressive Spine Surgery: Review on Challenges and Recommendations towards Objective Interpretation
Mohd Redzuan Jamaludin, Khin Wee Lai, Joon Huang Chuah, Muhammad Afiq Zaki, Yan Chai Hum, Yee Kai Tee, Maheza Irna Mohd Salim, Lim Beng Saw, Hong Lin
Behavioural Neurology.2021; 2021: 1. CrossRef
Blocking of BDNF-TrkB signaling inhibits the promotion effect of neurological function recovery after treadmill training in rats with spinal cord injury
Xiangzhe Li, Qinfeng Wu, Caizhong Xie, Can Wang, Qinghua Wang, Chuanming Dong, Lu Fang, Jie Ding, Tong Wang
Spinal Cord.2019; 57(1): 65. CrossRef
Paired associative stimulation after spinal cord injury: who should undergo?
Eduard Novak, Daminov VD
International Physical Medicine & Rehabilitation Journal.2018;[Epub] CrossRef

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