BACKGROUND: Spinal cord injury (SCI) leads to spinal nerve fiber tract damage resulting in functional impairments. Volumetric muscle loss (VML), a skeletal muscle volume abnormal reduction, is represented by atrophy below the injury level. The strategies for VML management included personalized approaches, and no definite indications are available. OBJECTIVE: To identify the rehabilitation effects of VML in subjects with SCI (humans and animals). METHODS: PubMed, Scopus, and Web of Science databases were systematically searched to identify longitudinal observational studies with individuals affected by traumatic SCI as participants; rehabilitation treatment as intervention; no control, sham treatment, and electrical stimulation programs as control; total lean body and lower limb lean mass, cross-sectional area, functional gait recovery, muscle thickness, and ultrasound intensity, as outcome. RESULTS: Twenty-four longitudinal observational studies were included, evaluating different rehabilitation approaches' effects on the VML reduction in subjects affected by SCI. The data showed that electrical stimulation and treadmill training are effective in reducing the VML in this population. CONCLUSION: This systematic review underlines the need to treat subjects with traumatic SCI (humans and animals) with different rehabilitation approaches to prevent VML in the subacute and chronic phases. Further clinical observations are needed to overcome the bias and to define the intervention's timing and modalities.

Department of Health Sciences University of Eastern Piedmont A Avogadro Novara Italy

Department of Medical and Surgical Sciences Physical Medicine and Rehabilitation Unit University of Catanzaro Magna Graecia Catanzaro Italy

Department of Neurosciences Physical Medicine and Rehabilitation Unit ASST Carlo Poma Mantova Italy

Department of Rehabilitation and Sports Medicine 2nd Faculty of Medicine Charles University and University Hospital Motol Prague Czech Republic

Department of Rehabilitation Medicine 1st Faculty of Medicine Charles University and General University Hospital Prague Prague Czech Republic

Rehabilitation Unit Ospedale degli Infermi Biella Italy

Translational Medicine Dipartimento Attività Integrate Ricerca e Innovazione Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo Alessandria Italy

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