Neurorehabilitation using a voluntary driven exoskeletal robot improves trunk function in patients with chronic spinal cord injury: a single-arm study

Body weight-supported treadmill training with the voluntary driven exoskeleton(VDE-BWSTT) has been shown to improve the gait function of patients with chronic spinal cord injury. However, little is known whether VDE-BWSTT can effectively improve the trunk function of patients with chronic spinal cord injury. In this open-label, single-arm study, nine patients with chronic spinal cord injury at the cervical or thoracic level(six males and three females, aged 37.8 ± 15.6 years, and time since injury 51.1 ± 31.8 months) who underwent outpatient VDE-BWSTT training program at Keio University Hospital, Japan from September 2017 to March 2019 were included. All patients underwent twenty 60-minute gait training sessions using VDE. Trunk muscular strength, i.e., the maximum force against which patient could maintain a sitting posture without any support, was evaluated in four directions: anterior, posterior, and lateral(right and left) after 10 and 20 training sessions. After intervention, lateral muscular strength significantly improved. In addition, a significant positive correlation was detected between the change in lateral trunk muscular strength after 20 training sessions relative to baseline and gait speed. The change in trunk muscular strength after 20 training sessions relative to baseline was greatly correlated with patient age. This suggests that older adult patients with chronic spinal cord injury achieved a greater improvement in trunk muscle strength following VDE-BWSTT. All these findings suggest that VDE-BWSTT can improve the trunk function of patients with chronic spinal cord injury and the effect might be greater in older adult patients. The study was approved by the Keio University of Medicine Ethics Committee(IRB No. 20150355-3) on September 26, 2017.

iShim and Water Excitation Improves the Signal-to-Noise Ratio on q-Space Imaging: A Single-Center Clinical Study

Purpose: This study aimed to examine whether the signal-to-noise ratio (SNR) could be increased by combining integrated slice-by-slice shimming (iShim) with a fat suppression (FS) method other than short-tau inversion recovery (STIR) in diffusion-weighted imaging (DWI) and q-space imaging (qsi). Methods: We acquired DWI images (b-values: 0 and nine steps from 400 to 10,000 s/mm2 for six axes) using a prototypical single-shot echo planar imaging sequence by combining two types of shimming (3D Shim and iShim) and two types of FS (STIR and water excitation [WE]) in 10 volunteers. In the DWI study, the SNR for each b-value, FS effect in the b0 image, and distortion in the added image (b0 - b10,000) were evaluated for the above-mentioned four imaging methods. qsi involved original DWI images. In the qsi study, the SNR was evaluated. Results: With regard to both 3D Shim and iShim, the SNRs were significantly higher when using WE than when using STIR in b0 - b900 images (p Conclusion: The combination of iShim and WE has a high SNR on qsi.