Balance rehabilitation and fall risk prevention in individuals with incomplete spinal cord injury or non-progressive spinal cord disease: a review of the literature

Background: Falls are frequent among individuals with incomplete spinal cord injury or disease (iSCI/D) determining many adverse consequences both physical and psychological. One of the main causes of falls is impaired balance, nevertheless in literature there is little evidence on balance rehabilitation and fall risk prevention in this neurological population. Objective: The aim of this review is to evaluate the state of the art of the literature and to produce a best evidence synthesis of rehabilitation interventions on balance to reduce fall risk in individuals with incomplete spinal cord injury or disease, non-progressive. Material and methods: This review was conducted following the PRISMA 2020 checklist and guidelines. The search was performed from January 2022 up to August 2022 in the following databases: PubMed, PEDro and Scopus. The study eligibility criteria were established according to the PICOS model: randomized controlled trials focused on rehabilitation interventions on individuals with iSCI/D. The outcomes considered were balance measures such as TUG Test, BBS, Tinetti Scale, Instrumented TUG, Instrumented Sway, Lean-and-Release Test, Mini-BESTest, CB&M, FTSST and PSL. The Cochrane Rob 2 Assessment Tool was used to assess the methodological quality of the selected studies. A qualitative analysis of the included studies was conducted. Results: Totally, 240 articles were identified and 15 RCTs fitting inclusion criteria were included. The full sample included 404 adult individuals classified as iSCI ASIA C or D, except one patient classified as iSCI ASIA B. Patients were all either at subacute or chronic stage of injury. Interventions administered were BWSTT combined with FES, IH, manual assistance, or robotic training, tDCS, walking training on various surfaces, exoskeleton-assisted gait training, PBT, WBV and MST. Conclusions: There is extremely limited research in the literature on balance rehabilitation in individuals with iSCI/D, non-progressive, and there is not literature consensus about the best rehabilitation intervention to improve balance and so reducing the fall risk in this population. The only interventions that have been demonstrated to be more effective at improving balance ability were the walking training on various surfaces and the administration of IH with BWSTT. Therefore, there is a need for further research to develop effective fall prevention protocols and balance intervention programs in iSCI rehabilitation.