# UP TO WHICH POINT COULD TECHNOLOGY TAKE A ROLE IN PHYSIOTHERAPY INTERVENTION IN SPINAL CORD INJURY (SCI)?

> Technology has taken a primordial role in society’s lives and it has shown usefulness for people’s well-being. Nowadays, it has been included in the health care system. But, could it be helpful for this pathology?

## Background
Evidence-Based Physical Therapy (EBP) uses the best research evidence with clinical expertise and user’s preferences to produce the most appropriate and effective care. During week 43 of 2023, a Blended Intensive Program (BIP) was held at Savonia University of Applied Sciences in Kuopio, Finland, focusing on EBP. More than 40 physiotherapy students and 7 teachers from Savonia University of Applied Sciences (Finland), Universidade da Coruña (Spain), and Charles University Prague (Czech Republic) participated in the program. Students collaborated on articles covering themes such as McKenzie methods, back pain, spinal cord injuries, aquatic therapy, ergonomics, Nordic walking, sports injuries, and children with disabilities.

## Spinal Cord Injury (SCI) Overview
"Spinal Cord Injury (SCI) is an injury to the spinal cord that results in temporary or permanent changes in the spinal cord’s normal, sensory-motor or autonomic function." (ISCoS, 2023).

The incidence of SCI varies globally based on economic, cultural, and traumatic versus non-traumatic factors. Damage to the spinal cord results in a loss of sensation or muscle function below the level of injury. This often leads to impaired static or dynamic balance, which significantly impacts the quality of life. Physiotherapists typically focus on intensive, repetitive training to induce activity-learning plasticity and improve gait. However, recovery is often complicated by patient fatigue, lack of motivation, depression, neuropathic pain, and pulmonary dysfunction.

## The Role of Technology in SCI Intervention
Technology is increasingly being integrated into healthcare to address these limitations. Research into extrinsic and intrinsic devices shows promising results:

*   **Exoskeletons:** Studies (e.g., Xiang et al., 2021) suggest that exoskeleton-assisted walking not only improves balance but also strengthens accessory respiratory muscles. Experimental groups showed improvements in pulmonary function (14%), maximum voluntary ventilation (10%), and forced expiratory flow (10%).
*   **Virtual Reality (VR):** VR has been utilized to address neuropathic pain and motor function. Research indicates that VR-augmented training can be beneficial for gait recovery. Additionally, VR-based sports simulations (such as soccer games) have shown positive effects on kick speed and balance, though further research with larger sample sizes is required.
*   **Electrostimulation:** This has shown optimistic outcomes for managing neuropathic pain and supporting gait recovery in incomplete SCI (iSCI) patients.

## Conclusion
While current studies show positive pathways for the use of technology in SCI physical therapy, many existing experiments are limited by small sample sizes. Future research should focus on larger, more homogenous experiments with standardized outcome measures—such as electromyography—to better quantify the impact on motor skill improvements. Technology serves as a valuable complementary aid in SCI physical therapy intervention.

## Authors
*   **Lotta Rantanen**, Physiotherapy student, Savonia-UAS
*   **Venla Hirvonen**, Physiotherapy student, Savonia-UAS
*   **Mari Eskola**, Physiotherapy student, Savonia-UAS
*   **Carmen Pilar Barra Moreno**, Physiotherapy student, Universidade da Coruña
*   **Alejandro Alonso Vicente**, Physiotherapy student, Universidade da Coruña
*   **Marja Äijö**, PhD, PhD, Principal lecturer of gerontology and rehabilitation, Savonia University of Applied Sciences, Finland
*   **Mari Tuppurainen**, physiotherapy lecture, Savonia University of Applied Sciences, Kuopio, Finland
*   **Dagmar Pavlu**, Physiotherapist, Assoc. Prof. Charles University, Czech Republic
*   **Ivana Vláčilová**, Professor, Charles University, Czech Republic
*   **Jamile Vivas Costa**, PhD, MSc, PT. Lecturer at Department of Physical Therapy, Medicine and Biomedical Sciences, Faculty of Physiotherapy and Researcher at Psychosocial intervention and functional rehabilitation group, Universidade da Coruña, Spain
*   **Montserrat Fernández Pereira**, MSc, PT. Lecturer at Department of Physical Therapy, Medicine and Biomedical Sciences, Faculty of Physiotherapy and Physiotherapist at Spinal Cord Injury Unit, A Coruña Hospital (CHUAC), Spain
*   **Verónica Robles García**, PhD, MSc, PT, OT. Lecturer at Department of Physical Therapy, Medicine and Biomedical Sciences, Faculty of Physiotherapy and Researcher at the Neuroscience and motor control group, Universidade da Coruña and Biomedical Institute of A Coruña, Spain

## References
*   ISCoS (2023). Spinal Cord Injury. In E-Learning ISCoS (Ed.)
*   Villiger M, Bohli D, Kiper D, et al. Virtual Reality Augmented Neurorehabilitation Improves Motor Function and Reduces Neuropathic Pain in Patients With Incomplete Spinal Cord Injury. *Neurorehabilitation and Neural Repair*. 2013;27(8):675-683.
*   Khurana M, Walia S, Noohu MM. Study on the Effectiveness of Virtual Reality Game-Based Training on Balance and Functional Performance in Individuals with Paraplegia. *Top Spinal Cord Inj Rehabil*. 2017 Summer;23(3):263-270.
*   Xiang XN, Zong HY, Ou Y, Yu X, Cheng H, Du CP, He HC. Exoskeleton-assisted walking improves pulmonary function and walking parameters among individuals with spinal cord injury: a randomized controlled pilot study. *J Neuroeng Rehabil*. 2021 May 24;18(1):86.
*   An Y, Park C. The effects of virtual soccer game on balance, gait function, and kick speed in chronic incomplete spinal cord injury: a randomized controlled trial. *Spinal Cord*. 2022 Jun;60(6):504-509.
*   Nair MS, Kulkarni VN, Shyam AK. Combined Effect of Virtual Reality Training (VRT) and Conventional Therapy on Sitting Balance in Patients with Spinal Cord Injury (SCI): Randomized Control Trial. *Neurol India*. 2022 Sep-Oct;70(Supplement):S245-S250.
*   Kapadia N, Masani K, Catharine Craven B, Giangregorio LM, Hitzig SL, Richards K, Popovic MR. A randomized trial of functional electrical stimulation for walking in incomplete spinal cord injury: Effects on walking competency. *J Spinal Cord Med*. 2014 Sep;37(5):511-24.