Progress in clinical rehabilitation of spinal cord injury_West China Medical Journal

Authors：

YANG Yun ¹ ,  XU Guangxu ²

1. School of Rehabilitation Medicine, Nanjing Medical University, Nanjing, Jiangsu 211166, P. R. China;
2. Department of Rehabilitation Medicine, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, P. R. China;

Corresponding author：

XU Guangxu, Email: xuguangxu1@126.com

Keywords：

Spinal cord injury; Surgical intervention; Rehabilitation

DOI：

10.7507/1002-0179.201805048

Video：

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Abstract Full text Figures/Tables Video References Cited by

Spinal cord injuries (SCI) seriously impair the quality of life, functional status, and social independence of the patients. Since the last century, a series of basic research on spinal cord injury has made us a deep understanding of its mechanisms and pathophysiology. But so far, how to repair damaged nerve functions after SCI is still a neurological problem. There are still controversies surrounding some treatment strategies for SCI, including the use of magnetic resonance imaging, type and timing of anticoagulant prevention, the timing of surgical intervention, the use of corticosteroids such as methylprednisolone sodium, as well as the type and timing of rehabilitation. For patients with SCI, early surgical intervention and neuroprotective therapy may be the best treatment. At the same time, rehabilitation and psychological intervention are equally important.

Citation： YANG Yun, XU Guangxu. Progress in clinical rehabilitation of spinal cord injury. West China Medical Journal, 2018, 33(10): 1303-1310. doi: 10.7507/1002-0179.201805048 Copy

1.	Wilson JR, Forgione N, Fehlings MG. Emerging therapies for acute traumatic spinal cord injury. CMAJ, 2013, 185(6): 485-492.
2.	Guha A, Tator CH, Rochon J. Spinal cord blood flow and systemic blood pressure after experimental spinal cord injury in rats. Stroke, 1989, 20(3): 372-377.
3.	Schwab JM, Zhang Y, Kopp MA, et al. The paradox of chronic neuroinflammation, systemic immune suppression, autoimmunity after traumatic chronic spinal cord injury. Exp Neurol, 2014, 258: 121-129.
4.	Fehlings MG, Tetreault LA, Wilson JR, et al. A clinical practice guideline for the management of acute spinal cord injury: introduction, rationale, and scope. Global Spine J, 2017, 7(3 Suppl): 84S-94S.
5.	Kirshblum S, Milis S, McKinley W, et al. Late neurologic recovery after traumatic spinal cord injury. Arch Phys Med Rehabil, 2004, 85(11): 1811-1817.
6.	Burns AS, Ditunno JF. Establishing prognosis and maximizing functional outcomes after spinal cord injury: a review of current and future directions in rehabilitation management. Spine (Phila Pa 1976), 2001, 26(24 Suppl): S137-S145.
7.	Fawcett JW, Curt A, Steeves JD, et al. Guidelines for the conduct of clinical trials for spinal cord injury as developed by the ICCP panel: spontaneous recovery after spinal cord injury and statistical power needed for therapeutic clinical trials. Spinal Cord, 2007, 45(3): 190-205.
8.	Coleman WP, Geisler FH. Injury severity as primary predictor of outcome in acute spinal cord injury: retrospective results from a large multicenter clinical trial. Spine J, 2004, 4(4): 373-378.
9.	Belliveau T, Jette AM, Seetharama S, et al. Developing artificial neural network models to predict functioning one year after traumatic spinal cord injury. Arch Phys Med Rehabil, 2016, 97(10): 1663-1668e3.
10.	Kay ED, Deutsch A, Wuermser LA. Predicting walking at discharge from inpatient rehabilitation after a traumatic spinal cord injury. Arch Phys Med Rehabil, 2007, 88(6): 745-750.
11.	van Middendorp JJ, Hosman AJ, Donders A, et al. A clinical prediction rule for ambulation outcomes after traumatic spinal cord injury: a longitudinal cohort study. Lancet, 2011, 377(9770): 1004-1010.
12.	Wilson JR, Grossman RG, Frankowski RF, et al. A clinical prediction model for long-term functional outcome after traumatic spinal cord injury based on acute clinical and imaging factors. J Neurotrauma, 2012, 29(13): 2263-2271.
13.	Pavese C, Schneider MP, Schubert M, et al. Prediction of bladder outcomes after traumatic spinal cord injury: a longitudinal cohort study. PLoS Med, 2016, 13(6): e1002041.
14.	Ryken TC, Hurlbert RJ, Hadley MN, et al. The acute cardiopulmonary management of patients with cervical spinal cord injuries. Neurosurgery, 2013(Suppl 2): 84-92.
15.	Resnick DK. Updated guidelines for the management of acute cervical spine and spinal cord injury. Neurosurgery, 2013, 72(Suppl 2): 1.
16.	Teasell RW, Hsieh JT, Aubut J, et al. Venous thromboembolism after spinal cord injury. Arch Phys Med Rehabil, 2009, 90(2): 232-245.
17.	Carlson GD, Minato Y, Okada A, et al. Early time-dependent decompression for spinal cord injury: vascular mechanisms of recovery. J Neurotrauma, 1997, 14(12): 951-962.
18.	Batchelor PE, Wills TE, Skeers PA, et al. Meta-analysis of pre-clinical studies of early decompression in acute spinal cord injury: a battle of time and pressure. PLoS One, 2013, 8(8): e72659.
19.	Lee DY, Park YJ, Kim HJ, et al. Early surgical decompression within 8 hours for traumatic spinal cord injury: is it beneficial? A meta-analysis. Acta Orthop Traumatol Turc, 2018, 52(2): 101-108.
20.	Wilson JR, Singh A, Craven C, et al. Early versus late surgery for traumatic spinal cord injury: the results of a prospective Canadian cohort study. Spinal Cord, 2012, 50(11): 840-843.
21.	Bourassa-Moreau E, Mac-Thiong JM, Feldman DE, et al. Non-neurological outcomes after complete traumatic spinal cord injury: the impact of surgical timing. J Neurotrauma, 2013, 30(18): 1596-1601.
22.	Grassner L, Wutte C, Klein B, et al. Early decompression (<8 h) after traumatic cervical spinal cord injury improves functional outcome as assessed by spinal cord independence measure after one year. J Neurotrauma, 2016, 33(18): 1658-1666.
23.	Braughler JM, Hall ED. Effects of multi-dose methylprednisolone sodium succinate administration on injured cat spinal cord neurofilament degradation and energy metabolism. J Neurosurg, 1984, 61(2): 290-295.
24.	Bracken MB, Shepard MJ, Holford TR, et al. Administration of methylprednisolone for 24 or 48 hours or tirilazad mesylate for 48 hours in the treatment of acute spinal cord injury. Results of the Third National Acute Spinal Cord Injury Randomized Controlled Trial. National Acute Spinal Cord Injury Study. JAMA, 1997, 277(20): 1597-1640.
25.	Bracken MB, Shepard MJ, Collins WF, et al. A randomized, controlled trial of methylprednisolone or naloxone in the treatment of acute spinal-cord injury. N Engl J Med, 1990, 322(20): 1405-1411.
26.	Bracken MB, Collins WF, Freeman DF, et al. Efficacy of methylprednisolone in acute spinal cord injury. JAMA, 1984, 251(1): 45-52.
27.	Bracken MB. Steroids for acute spinal cord injury. Cochrane Database Syst Rev, 2012(1): CD001046.
28.	Eck JC, Nachtigall D, Humphreys SC, et al. Questionnaire survey of spine surgeons on the use of methylprednisolone for acute spinal cord injury. Spine(Phila Pa 1976), 2006, 31(9): E250-E253.
29.	Hurlbert RJ. Methylprednisolone for acute spinal cord injury: an inappropriate standard of care. J Neurosurg, 2000, 93(1 Suppl): 1-7.
30.	Hurlbert RJ, Hadley MN, Walters BC, et al. Pharmacological therapy for acute spinal cord injury. Neurosurgery, 2013, 72(Suppl 2): 93-105.
31.	Hadley MN, Walters BC, Grabb PA, et al. Pharmacological therapy after acute cervical spinal cord injury. Neurosurgery, 2002, 50(3 Suppl): S63-S72.
32.	Ahuja CS, Fehlings M. Concise review: bridging the gap: novel neuroregenerative and neuroprotective strategies in spinal cord injury. Stem Cells Transl Med, 2016, 5(7): 914-924.
33.	Khazaei M, Ahuja CS, Fehlings MG. Induced pluripotent stem cells for traumatic spinal cord injury. Front Cell Dev Biol, 2016, 4: 152.
34.	Li J, Lepski G. Cell transplantation for spinal cord injury: a systematic review. Biomed Res Int, 2013: 786475.
35.	Guo JS, Zeng YS, Li HB, et al. Cotransplant of neural stem cells and NT-3 gene modified schwann cells promote the recovery of transected spinal cord injury. Spinal Cord, 2007, 45(1): 15-24.
36.	Mackay-Sim A, Féron F, Cochrane J, et al. Autologous olfactory ensheathing cell transplantation in human paraplegia: a 3-year clinical trial. Brain, 2008, 131(Pt 9): 2376-2386.
37.	Tabakow P, Jarmundowicz W, Czapiga B, et al. Transplantation of autologous olfactory ensheathing cells in complete human spinal cord injury. Cell Transplant, 2013, 22(9): 1591-1612.
38.	Li L, Adnan H, Xu B, et al. Effects of transplantation of olfactory ensheathing cells in chronic spinal cord injury: a systematic review and meta-analysis. Eur Spine J, 2015, 24(5): 919-930.
39.	Burns AS, Marino RJ, Flanders AE, et al. Clinical diagnosis and prognosis following spinal cord injury. Handb Clin Neurol, 2012, 109: 47-62.
40.	Asamoto S, Sugiyama H, Doi H, et al. Hyperbaric oxygen (HBO) therapy for acute traumatic cervical spinal cord injury. Spinal Cord, 2000, 38(9): 538-540.
41.	Fujimoto T, Nakamura T, Ikeda T, et al. Effects of EPC-K1 on lipid peroxidation in experimental spinal cord injury. Spine (Phila Pa 1976), 2000, 25(1): 24-29.
42.	Cristante AF, Damasceno ML, Barros Filho TE, et al. Evaluation of the effects of hyperbaric oxygen therapy for spinal cord lesion in correlation with the moment of intervention. Spinal Cord, 2012, 50(7): 502-506.
43.	Kahraman S, Düz B, Kayali H, et al. Effects of methylprednisolone and hyperbaric oxygen on oxidative status after experimental spinal cord injury: a comparative study in rats. Neurochem Res, 2007, 32(9): 1547-1551.
44.	高山. 高压氧辅助治疗脊髓损伤的疗效及影响因素. 中国实用神经疾病杂志, 2017, 20(16): 81-83.
45.	Adams MM, Hicks AL. Spasticity after spinal cord injury. Spinal Cord, 2005, 43(10): 577-586.
46.	Sezer N, Akkuş S, Uğurlu FG. Chronic complications of spinal cord injury. World J Orthop, 2015, 6(1): 24-33.
47.	Claydon VE, Steeves JD, Krassioukov A. Orthostatic hypotension following spinal cord injury: understanding clinical pathophysiology. Spinal Cord, 2006, 44(6): 341-351.
48.	Krassioukov A, Eng JJ, Warburton DE, et al. A systematic review of the management of orthostatic hypotension after spinal cord injury. Arch Phys Med Rehabil, 2009, 90(5): 876-885.
49.	Krassioukov A, Warburton DE, Teasell R, et al. A systematic review of the management of autonomic dysreflexia after spinal cord injury. Arch Phys Med Rehabil, 2009, 90(4): 682-695.
50.	Brown R, DiMarco AF, Hoit JD, et al. Respiratory dysfunction and management in spinal cord injury. Respir Care, 2006, 51(8): 853-868.
51.	Winslow C, Rozovsky J. Effect of spinal cord injury on the respiratory system. Am J Phys Med Rehabil, 2003, 82(10): 803-814.
52.	Taweel WA, Seyam R. Neurogenic bladder in spinal cord injury patients. Res RepUrol, 2015, 7: 85-89.
53.	Hess MJ, Hough S. Impact of spinal cord injury on sexuality: broad-based clinical practice intervention and practical application. J Spinal Cord Med, 2012, 35(4): 211-218.
54.	Ho CH, Triolo RJ, Elias AL, et al. Functional electrical stimulation and spinal cord injury. Phys Med Rehabil Clin N Am, 2014, 25(3): 631-654.
55.	Kakebeeke TH, Hofer PJ, Frotzler A, et al. Training and detraining of a tetraplegic subject: high-volume FES cycle training. Am J Phys Med Rehabil, 2008, 87(1): 56-64.
56.	Ragnarsson KT. Functional electrical stimulation after spinal cord injury: current use, therapeutic effects and future directions. Spinal Cord, 2008, 46(4): 255-274.
57.	Winchester P, McColl R, Querry R, et al. Changes in supraspinal activation patterns following robotic locomotor therapy in motor-incomplete spinal cord injury. Neurorehabil Neural Repair, 2005, 19(4): 313-324.
58.	Dobkin, B H. Spinal and supraspinal plasticity after incomplete spinal cord injury: correlations between functional magnetic resonance imaging and engaged locomotor networks. Prog Brain Res, 2000, 128: 99-111.
59.	Dobkin BH, Apple D, Barbeau H, et al. Methods for a randomized trial of weight-supported treadmill training versus conventional training for walking during inpatient rehabilitation after incomplete traumatic spinal cord injury. Neurorehabil Neural Repair, 2016, 17(3): 153-167.
60.	Miller LE, Zimmermann AK, Herbert WG. Clinical effectiveness and safety of powered exoskeleton-assisted walking in patients with spinal cord injury: systematic review with meta-analysis. Med Devices (Auckl), 2016, 9: 455-466.
61.	Wu CH, Mao HF, Hu JS, et al. The effects of gait training using powered lower limb exoskeleton robot on individuals with complete spinal cord injury. J Neuroeng Rehabil, 2018, 15(1): 14.
62.	Puentes S, Kadone H, Kubota S, et al. Reshaping of gait coordination by robotic intervention in myelopathy patients after surgery. Front Neurosci, 2018, 12: 99.
63.	Harrington P. Prevention of surgical site infection. Nurs Stand, 2014, 28(48): 50-58.
64.	Nezu AM, Perri MG. Social problem-solving therapy for unipolar depression: an initial dismantling investigation. J Consult Clin Psychol, 1989, 57(3): 408-413.

1. Wilson JR, Forgione N, Fehlings MG. Emerging therapies for acute traumatic spinal cord injury. CMAJ, 2013, 185(6): 485-492.
2. Guha A, Tator CH, Rochon J. Spinal cord blood flow and systemic blood pressure after experimental spinal cord injury in rats. Stroke, 1989, 20(3): 372-377.
3. Schwab JM, Zhang Y, Kopp MA, et al. The paradox of chronic neuroinflammation, systemic immune suppression, autoimmunity after traumatic chronic spinal cord injury. Exp Neurol, 2014, 258: 121-129.
4. Fehlings MG, Tetreault LA, Wilson JR, et al. A clinical practice guideline for the management of acute spinal cord injury: introduction, rationale, and scope. Global Spine J, 2017, 7(3 Suppl): 84S-94S.
5. Kirshblum S, Milis S, McKinley W, et al. Late neurologic recovery after traumatic spinal cord injury. Arch Phys Med Rehabil, 2004, 85(11): 1811-1817.
6. Burns AS, Ditunno JF. Establishing prognosis and maximizing functional outcomes after spinal cord injury: a review of current and future directions in rehabilitation management. Spine (Phila Pa 1976), 2001, 26(24 Suppl): S137-S145.
7. Fawcett JW, Curt A, Steeves JD, et al. Guidelines for the conduct of clinical trials for spinal cord injury as developed by the ICCP panel: spontaneous recovery after spinal cord injury and statistical power needed for therapeutic clinical trials. Spinal Cord, 2007, 45(3): 190-205.
8. Coleman WP, Geisler FH. Injury severity as primary predictor of outcome in acute spinal cord injury: retrospective results from a large multicenter clinical trial. Spine J, 2004, 4(4): 373-378.
9. Belliveau T, Jette AM, Seetharama S, et al. Developing artificial neural network models to predict functioning one year after traumatic spinal cord injury. Arch Phys Med Rehabil, 2016, 97(10): 1663-1668e3.
10. Kay ED, Deutsch A, Wuermser LA. Predicting walking at discharge from inpatient rehabilitation after a traumatic spinal cord injury. Arch Phys Med Rehabil, 2007, 88(6): 745-750.
11. van Middendorp JJ, Hosman AJ, Donders A, et al. A clinical prediction rule for ambulation outcomes after traumatic spinal cord injury: a longitudinal cohort study. Lancet, 2011, 377(9770): 1004-1010.
12. Wilson JR, Grossman RG, Frankowski RF, et al. A clinical prediction model for long-term functional outcome after traumatic spinal cord injury based on acute clinical and imaging factors. J Neurotrauma, 2012, 29(13): 2263-2271.
13. Pavese C, Schneider MP, Schubert M, et al. Prediction of bladder outcomes after traumatic spinal cord injury: a longitudinal cohort study. PLoS Med, 2016, 13(6): e1002041.
14. Ryken TC, Hurlbert RJ, Hadley MN, et al. The acute cardiopulmonary management of patients with cervical spinal cord injuries. Neurosurgery, 2013(Suppl 2): 84-92.
15. Resnick DK. Updated guidelines for the management of acute cervical spine and spinal cord injury. Neurosurgery, 2013, 72(Suppl 2): 1.
16. Teasell RW, Hsieh JT, Aubut J, et al. Venous thromboembolism after spinal cord injury. Arch Phys Med Rehabil, 2009, 90(2): 232-245.
17. Carlson GD, Minato Y, Okada A, et al. Early time-dependent decompression for spinal cord injury: vascular mechanisms of recovery. J Neurotrauma, 1997, 14(12): 951-962.
18. Batchelor PE, Wills TE, Skeers PA, et al. Meta-analysis of pre-clinical studies of early decompression in acute spinal cord injury: a battle of time and pressure. PLoS One, 2013, 8(8): e72659.
19. Lee DY, Park YJ, Kim HJ, et al. Early surgical decompression within 8 hours for traumatic spinal cord injury: is it beneficial? A meta-analysis. Acta Orthop Traumatol Turc, 2018, 52(2): 101-108.
20. Wilson JR, Singh A, Craven C, et al. Early versus late surgery for traumatic spinal cord injury: the results of a prospective Canadian cohort study. Spinal Cord, 2012, 50(11): 840-843.
21. Bourassa-Moreau E, Mac-Thiong JM, Feldman DE, et al. Non-neurological outcomes after complete traumatic spinal cord injury: the impact of surgical timing. J Neurotrauma, 2013, 30(18): 1596-1601.
22. Grassner L, Wutte C, Klein B, et al. Early decompression (<8 h) after traumatic cervical spinal cord injury improves functional outcome as assessed by spinal cord independence measure after one year. J Neurotrauma, 2016, 33(18): 1658-1666.
23. Braughler JM, Hall ED. Effects of multi-dose methylprednisolone sodium succinate administration on injured cat spinal cord neurofilament degradation and energy metabolism. J Neurosurg, 1984, 61(2): 290-295.
24. Bracken MB, Shepard MJ, Holford TR, et al. Administration of methylprednisolone for 24 or 48 hours or tirilazad mesylate for 48 hours in the treatment of acute spinal cord injury. Results of the Third National Acute Spinal Cord Injury Randomized Controlled Trial. National Acute Spinal Cord Injury Study. JAMA, 1997, 277(20): 1597-1640.
25. Bracken MB, Shepard MJ, Collins WF, et al. A randomized, controlled trial of methylprednisolone or naloxone in the treatment of acute spinal-cord injury. N Engl J Med, 1990, 322(20): 1405-1411.
26. Bracken MB, Collins WF, Freeman DF, et al. Efficacy of methylprednisolone in acute spinal cord injury. JAMA, 1984, 251(1): 45-52.
27. Bracken MB. Steroids for acute spinal cord injury. Cochrane Database Syst Rev, 2012(1): CD001046.
28. Eck JC, Nachtigall D, Humphreys SC, et al. Questionnaire survey of spine surgeons on the use of methylprednisolone for acute spinal cord injury. Spine(Phila Pa 1976), 2006, 31(9): E250-E253.
29. Hurlbert RJ. Methylprednisolone for acute spinal cord injury: an inappropriate standard of care. J Neurosurg, 2000, 93(1 Suppl): 1-7.
30. Hurlbert RJ, Hadley MN, Walters BC, et al. Pharmacological therapy for acute spinal cord injury. Neurosurgery, 2013, 72(Suppl 2): 93-105.
31. Hadley MN, Walters BC, Grabb PA, et al. Pharmacological therapy after acute cervical spinal cord injury. Neurosurgery, 2002, 50(3 Suppl): S63-S72.
32. Ahuja CS, Fehlings M. Concise review: bridging the gap: novel neuroregenerative and neuroprotective strategies in spinal cord injury. Stem Cells Transl Med, 2016, 5(7): 914-924.
33. Khazaei M, Ahuja CS, Fehlings MG. Induced pluripotent stem cells for traumatic spinal cord injury. Front Cell Dev Biol, 2016, 4: 152.
34. Li J, Lepski G. Cell transplantation for spinal cord injury: a systematic review. Biomed Res Int, 2013: 786475.
35. Guo JS, Zeng YS, Li HB, et al. Cotransplant of neural stem cells and NT-3 gene modified schwann cells promote the recovery of transected spinal cord injury. Spinal Cord, 2007, 45(1): 15-24.
36. Mackay-Sim A, Féron F, Cochrane J, et al. Autologous olfactory ensheathing cell transplantation in human paraplegia: a 3-year clinical trial. Brain, 2008, 131(Pt 9): 2376-2386.
37. Tabakow P, Jarmundowicz W, Czapiga B, et al. Transplantation of autologous olfactory ensheathing cells in complete human spinal cord injury. Cell Transplant, 2013, 22(9): 1591-1612.
38. Li L, Adnan H, Xu B, et al. Effects of transplantation of olfactory ensheathing cells in chronic spinal cord injury: a systematic review and meta-analysis. Eur Spine J, 2015, 24(5): 919-930.
39. Burns AS, Marino RJ, Flanders AE, et al. Clinical diagnosis and prognosis following spinal cord injury. Handb Clin Neurol, 2012, 109: 47-62.
40. Asamoto S, Sugiyama H, Doi H, et al. Hyperbaric oxygen (HBO) therapy for acute traumatic cervical spinal cord injury. Spinal Cord, 2000, 38(9): 538-540.
41. Fujimoto T, Nakamura T, Ikeda T, et al. Effects of EPC-K1 on lipid peroxidation in experimental spinal cord injury. Spine (Phila Pa 1976), 2000, 25(1): 24-29.
42. Cristante AF, Damasceno ML, Barros Filho TE, et al. Evaluation of the effects of hyperbaric oxygen therapy for spinal cord lesion in correlation with the moment of intervention. Spinal Cord, 2012, 50(7): 502-506.
43. Kahraman S, Düz B, Kayali H, et al. Effects of methylprednisolone and hyperbaric oxygen on oxidative status after experimental spinal cord injury: a comparative study in rats. Neurochem Res, 2007, 32(9): 1547-1551.
44. 高山. 高压氧辅助治疗脊髓损伤的疗效及影响因素. 中国实用神经疾病杂志, 2017, 20(16): 81-83.
45. Adams MM, Hicks AL. Spasticity after spinal cord injury. Spinal Cord, 2005, 43(10): 577-586.
46. Sezer N, Akkuş S, Uğurlu FG. Chronic complications of spinal cord injury. World J Orthop, 2015, 6(1): 24-33.
47. Claydon VE, Steeves JD, Krassioukov A. Orthostatic hypotension following spinal cord injury: understanding clinical pathophysiology. Spinal Cord, 2006, 44(6): 341-351.
48. Krassioukov A, Eng JJ, Warburton DE, et al. A systematic review of the management of orthostatic hypotension after spinal cord injury. Arch Phys Med Rehabil, 2009, 90(5): 876-885.
49. Krassioukov A, Warburton DE, Teasell R, et al. A systematic review of the management of autonomic dysreflexia after spinal cord injury. Arch Phys Med Rehabil, 2009, 90(4): 682-695.
50. Brown R, DiMarco AF, Hoit JD, et al. Respiratory dysfunction and management in spinal cord injury. Respir Care, 2006, 51(8): 853-868.
51. Winslow C, Rozovsky J. Effect of spinal cord injury on the respiratory system. Am J Phys Med Rehabil, 2003, 82(10): 803-814.
52. Taweel WA, Seyam R. Neurogenic bladder in spinal cord injury patients. Res RepUrol, 2015, 7: 85-89.
53. Hess MJ, Hough S. Impact of spinal cord injury on sexuality: broad-based clinical practice intervention and practical application. J Spinal Cord Med, 2012, 35(4): 211-218.
54. Ho CH, Triolo RJ, Elias AL, et al. Functional electrical stimulation and spinal cord injury. Phys Med Rehabil Clin N Am, 2014, 25(3): 631-654.
55. Kakebeeke TH, Hofer PJ, Frotzler A, et al. Training and detraining of a tetraplegic subject: high-volume FES cycle training. Am J Phys Med Rehabil, 2008, 87(1): 56-64.
56. Ragnarsson KT. Functional electrical stimulation after spinal cord injury: current use, therapeutic effects and future directions. Spinal Cord, 2008, 46(4): 255-274.
57. Winchester P, McColl R, Querry R, et al. Changes in supraspinal activation patterns following robotic locomotor therapy in motor-incomplete spinal cord injury. Neurorehabil Neural Repair, 2005, 19(4): 313-324.
58. Dobkin, B H. Spinal and supraspinal plasticity after incomplete spinal cord injury: correlations between functional magnetic resonance imaging and engaged locomotor networks. Prog Brain Res, 2000, 128: 99-111.
59. Dobkin BH, Apple D, Barbeau H, et al. Methods for a randomized trial of weight-supported treadmill training versus conventional training for walking during inpatient rehabilitation after incomplete traumatic spinal cord injury. Neurorehabil Neural Repair, 2016, 17(3): 153-167.
60. Miller LE, Zimmermann AK, Herbert WG. Clinical effectiveness and safety of powered exoskeleton-assisted walking in patients with spinal cord injury: systematic review with meta-analysis. Med Devices (Auckl), 2016, 9: 455-466.
61. Wu CH, Mao HF, Hu JS, et al. The effects of gait training using powered lower limb exoskeleton robot on individuals with complete spinal cord injury. J Neuroeng Rehabil, 2018, 15(1): 14.
62. Puentes S, Kadone H, Kubota S, et al. Reshaping of gait coordination by robotic intervention in myelopathy patients after surgery. Front Neurosci, 2018, 12: 99.
63. Harrington P. Prevention of surgical site infection. Nurs Stand, 2014, 28(48): 50-58.
64. Nezu AM, Perri MG. Social problem-solving therapy for unipolar depression: an initial dismantling investigation. J Consult Clin Psychol, 1989, 57(3): 408-413.

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