Global Research Trends on Gait Rehabilitation in Individuals With Spinal Cord Injury- A Bibliometric Analysis

Abstract

Study Design

Bibliometric analysis.

Objective

The study aims to comprehensively assess the literature related to gait rehabilitation for individuals with spinal cord injury (SCI) to identify significant contributors, and to explore the collaborations and emerging themes in the field.

Methods

Original and review articles in English using relevant keywords were searched in the Clarivate Web of Science database. The data from the selected articles were imported into R software. Bibliometric indicators were assessed to determine author contributions, country affiliations, journal sources, and thematic trends.

Results

A total of 1313 relevant articles were identified. The USA, followed by Canada and Switzerland were the most prolific countries contributing to gait rehabilitation research in SCI. The most relevant journals were Spinal Cord, Archives of Physical Medicine and Rehabilitation, Journal of Spinal Cord Medicine, Journal of NeuroEngineering, and Journal of Neurotrauma. The highest contributions came from Northwestern University, the University of Miami, and the University of Alberta. The analysis revealed an increase in research interest in gait rehabilitation after 2000, with a focus on interdisciplinary approaches and emerging technologies like robotics, exoskeletons, and neuromodulation.

Conclusion

The analysis demonstrates the importance of collaborative and interdisciplinary research in gait rehabilitation. The results indicate a shift in research focus from traditional methods to the integration of technology. The impact of publications from the USA and Europe is a notable finding. The study highlights the growth of articles related to technology-driven approaches and understanding neuroplasticity in gait rehabilitation.

Keywords

spinal cord injury gait rehabilitation bibliometrics research trends

Introduction

Each year, around 10.5 per 100,000 people in the world sustain traumatic spinal cord injury (SCI).¹ Another 6 to 76 people per million suffer due to non-traumatic causes of SCI.² In the United States (USA), there are approximately 282,000 individuals estimated to be living with SCI,³ and the number in the world is estimated to be 20.6 million.⁴

Individuals with SCI have multiple socio-economic consequences in addition to their physical and psychological outcomes.^5,6 The burden is high on the individuals with SCI and their care-givers^6,7 as they require a holistic rehabilitation program to become independent.⁸ The ability to walk independently is considered one of the most important aspects of rehabilitation to improve the quality-of-life post-injury.^9,10 Although a wheelchair can provide independence, walking on the ground provides a greater functional benefit. Walking reduces secondary complications such as pressure ulcers, edema, contractures, and bowel and bladder infections.¹¹ It also improves an individual’s mental health by improving self-esteem and confidence.^12,13

The proportion of motor-incomplete injuries is greater than the complete injuries in the developed world.¹⁴ Approximately, 50% of the sensory incomplete and 75% of motor-incomplete individuals with SCI may recover ambulatory function with orthotic assistance and appropriate training.¹⁵ There have been multiple studies that have evaluated the effectiveness of different strategies to regain walking capabilities.^16,17 The research regarding gait rehabilitation in SCI has been heterogeneous exploring various neurorehabilitation approaches, drugs, stimulation, orthosis, robotics, or exoskeletons.

Gait rehabilitation following SCI requires a multi-disciplinary approach that can be achieved by the collaboration of scientists with different expertise. The assessment of collaboration patterns across geographical, financial, or technological boundaries is essential and can be done by Bibliometric analysis. This is a systematic analysis of published literature that evaluates research trends and identifies knowledge gaps. This also helps to assess the scientific evolution of the field that occurs with technological advancements. Furthermore, bibliometrics determines the publication productivity of authors, countries, or affiliations. These assessments may provide insights for policymakers, funders, publishers, and future researchers.

Many bibliometric analyses have been undertaken in the past related to global research trends, pain, and stem cell therapy in SCI.^12,18,19 But to the best of our knowledge, a bibliometric analysis of articles related to gait rehabilitation in SCI has not been done. The purpose of the current study is to conduct a comprehensive bibliometric analysis of the literature related to the gait rehabilitation of individuals with SCI.

Methods

Search Strategy

On 2nd August 2022, the Clarivate Web of Science (WoS) Citation Index Expanded database was searched using the keywords (“gait” OR “walking” OR “locomot* OR “Ambulat*”) AND (Spinal cord injur*)” for all articles that were published from the inception of the database till date. The WoS is considered one of the widest databases that covers various journals across 178 disciplines. For the current study, the filter for the English language was applied; and the type of articles was restricted to original articles (Randomized control and quasi-experimental trials, case studies, cohort studies, commentaries, methodological and other observational studies) and reviews. The data for all articles were extracted with their full records in excel and txt formats.

Inclusion and Exclusion Criteria

The titles and abstracts of the articles were screened to include those related to:

• Objective and subjective assessments of gait after SCI including kinematic, kinetic, and electromyographic parameters;

• Functional assessment of gait following SCI;

• Neural networking/stereotyped rhythmic motor spinal patterns responsible for gait;

• Ambulatory/locomotor training after SCI including physical therapy approaches, treadmill/overground training, assistive technology (orthosis/prosthesis), other technologies including but not limited to exoskeletons, robots, functional electrical stimulation (FES), neurostimulation, virtual reality;

• Specific drug studies that affected locomotor capabilities after SCI;

• Effects of locomotor training on other aspects of rehabilitation, and overall well-being

Relevant studies that included patients with other neurological disorders along with SCI were retained. All animal studies were excluded. Studies primarily related to other assessments/treatments for SCI with gait as one of many other outcomes were excluded.

Every article was at least reviewed by two of the co-authors of the study separately. In case of a lack of consensus between two assessors, a third assessor made the final decision.

Data Analysis

The data from all the relevant studies were imported into R software (version 4.2.1).²⁰ The Biblioshiny package²¹ was used to assess the bibliometric indicators that determine the contribution and productivity of various authors, countries, and institutions. The most significant authors were estimated by the number of publications, and the number of total citations of the articles. The impact of these authors was determined by calculating the h-index which depicts the number of articles with at least that many number of citations per article - for example, an author with an h-index of 7 has at least 7 articles that have 7 or more citations. Similarly, the frequency distribution of the number of articles and their citations from different countries and affiliations was determined.

The bibliometric analysis also included citation analysis and identification of structural indicators that assess the connections between publications and authors. The latter allowed the analysis of the most relevant themes in the field of gait rehabilitation and their global trends. Graphical representation of the results for the network analysis performed by multiple correspondence analysis allowed for assessment of the structure of the scientific field.

The sources (journals) of these articles were analyzed using Bradford’s law to identify the journals where most of the publications related to the field occur.²² The themes were identified using thematic map analysis following the Callon’s centrality and density ranks.²³ This identified four sets of themes - the motor themes indicated the established themes which are required for structuring the research; the niche themes indicated the themes of limited relevance; the emerging or declining themes indicated the less developed themes and the basic themes included the themes for transdisciplinary research.

Results

The search yielded 5630 articles out of which all animal study articles were excluded. The relevant articles after screening titles and abstracts were 1313, published from the year 1966 to 2022. Among the relevant articles, 1175 were original articles and 138 were review articles. The annual growth rate for publications was estimated at approximately 7% with the predominant growth occurring in the last decade of the last millennium. Out of the relevant articles, 1099 (83.7%) were published after 2000 (Figure 1).

Figure 1.

The number of articles published across the years.

Authors and Co-Authors

Only 63 were single-author articles. The average number of co-authors in the remaining documents was 5.12. The list of the top 20 most significant contributors with their subspecialities is provided in Table 1. The top 5 authors were Dietz V (h-index-30, University Hospital Balgrist, Zurich, Switzerland), Barbeau V (h-index-27, McGill University, Montreal, Canada), Harkema SJ (h-index-22, University of California, Los Angeles, USA), Ditunno JF (h-index-19, Thomas Jefferson University Hospital, Pennsylvania, USA:), and Scivoletto G (h-index-18, Fondazione S. Lucia, Rome, Italy). The authors who have contributed over the three decades in this field include the aforementioned authors and Curt A (Balgrist University Hospital, Zurich, Switzerland), Behrman AL (University of Louisville, USA), Field-Fote EC (University of Miami, USA) and Triolo RJ (Case Western Reserve University, Ohio, USA) (Figure 2). The details about the most cited articles are depicted in Table 2. The details of top cited articles since 2000 are described in supplementary material (Appendix 1).

Table 1.

The Number of Publications, Total Citations and H-Index of the Top 20 Contributing Authors in the Field of Gait Rehabilitation of SCI.

S.No.	Author	Speciality	Number of Publications	h_index	Total Citations
1	Dietz V	Neurology	37	30	4009
2	Barbeau H	Physical therapy	31	27	2436
3	Harkema SJ	Physiology	24	22	2761
4	Ditunno JF	Rehabilitation medicine	22	19	1396
5	Scivoletto G	Neurology	27	18	1143
6	Behrman Al	Physical therapy	26	17	1100
7	Triolo RJ	Engineering	26	17	690
8	Curt A	Spine surgeon	31	16	1103
9	Field-fote EC	Physical therapy	23	16	1174
10	Kobetic R	Engineering	22	16	726
11	Molinari M	Engineering	20	15	1032
12	Wirz M	Physical therapy	16	14	1700
13	Hornby TG	Physical therapy	21	13	1141
14	Lam T	Neuroscience	22	13	689
15	Bolliger M	Kinesiology and neuroscience	17	12	479
16	Colombo G	Engineering	12	12	2437
17	Knikou M	Neurophysiology	15	12	366
18	Tamburella F	Physical therapy	14	12	652
19	Van hedel HJA	Physical therapy	13	12	620
20	Yang JF	Physical therapy	15	12	486

Note: h-index depicts the number of articles with at least that many number of citations per article.

Figure 2.

Years of publications of the most prolific authors in the field. Dark blue circles represent number of articles and light blue circles represents total citation (TC) of the articles.

Table 2.

Details of the Most Cited Articles.

S No	Author	Article Title	Citations	Journal	Year
1	Colombo G; joerg M; schreier R; Dietz V	Treadmill training of paraplegic patients using a robotic orthosis	774	Journal of rehabilitation research and development	2000
2	Waters RL; mulroy S	The energy expenditure of normal and pathologic gait	631	Gait and posture	1999
3	Dimitrijevic MR; Gerasimenko Y; pinter MM	Evidence for a spinal central pattern generator in humans	499	Neuronal mechanisms for generating locomotor activity	1998
4	Esquenazi A; talaty M; packel A; saulino M	The rewalk powered exoskeleton to restore ambulatory function to individuals with thoracic-level motor-complete spinal cord injury	478	American journal of physical medicine and rehabilitation	2012
5	Harkema SJ; hurley SL; patel UK; requejo PS; Dobkin BH; Edgerton VR	Human lumbosacral spinal cord interprets loading during stepping	455	Journal of neurophysiology	1997
6	Dietz V; Colombo G; Jensen L; Baumgartner L	Locomotor capacity of spinal-cord in paraplegic patients	410	Annals of neurology	1995
7	Behmran AL; harkema SJ	Locomotor training after human spinal cord injury: a Series of case studies	402	Physical therapy	2000
8	Wernig A; phys SM	Laufband locomotion with body-weight support improved walking in persons with severe spinal-cord injuries	361	Paraplegia	1992
9	Dobkin B; Apple D; Barbeau H; Basso M; Behrman A; Deforge D; Ditunno J; Dudley G; Elashoff R; Fugate L; harkema S; saulino M; scott M	Weight-supported treadmill vs overground training for walking after acute incomplete SCI	360	Neurology	2006
10	Wirz M; Zemon DH; rupp R; scheel A; Colombo G; Dietz V; hornby TG	Effectiveness of automated locomotor training in patients with chronic incomplete spinal cord injury: a Multicenter trial	320	Archives of physical medicine and rehabilitation	2005
11	Van hedel HJ; Wirz M; Dietz V	Assessing walking ability in subjects with spinal cord injury: Validity and reliability of 3 walking tests	312	Archives of physical medicine and rehabilitation	2005
12	Zehr EP; Duysens J	Regulation of arm and leg movement during human locomotion	281	Neuroscientist	2004
13	Calancie B; needhamshropshire B; jacobs P; Willer K; Zych G; Green BA	Involuntary stepping after chronic spinal-cord injury - evidence for a central rhythm generator for locomotion in man	265	Brain	1994
14	Zeilig G; Weingarden H; Zwecker M; Dudkiewicz I; Bloch A; Esquenazi A	Safety and tolerance of the rewalk (TM) exoskeleton suit for ambulation by people with complete spinal cord injury: a pilot study	263	Journal of spinal cord medicine	2012
15	Colombo G; Wirz M; Dietz V	Driven gait orthosis for improvement of locomotor training in paraplegic patients	254	Spinal cord	2001
16	Hamers FPT; Koopmans GC; joosten EAJ	Catwalk-assisted gait analysis in the assessment of spinal cord injury	246	Journal of neurotrauma	2006
17	Dietz V; harkema SJ	Locomotor activity in spinal cord-injured persons	244	Journal of applied physiology	2004
18	Duschau-Wicke A; Von Zitzewitz J; Caprez A; Lunenburger L; riener R	Path control: a Method for patient-cooperative robot-aided gait rehabilitation	242	IEEE transactions on neural systems and rehabilitation engineering	2010
19	Ditunno pl; Dittuno Jf	Walking index for spinal cord injury (WISCI II): Scale revision	234	Spinal cord	2001
20	Dobkin Bh; Firestine A; West M; Saremi K; Woods R	Ankle dorsiflexion as an fMRI paradigm to assay motor control for walking during rehabilitation	229	Neuroimage	2004

Sources (Journals)

Using Bradford’s law for publications, the core journals that publish the main content related to the field were Spinal Cord (153 publications), Archives of Physical Medicine and Rehabilitation (APMR) (109 publications), Journal of Spinal Cord Medicine (76 publications), Journal of Neuroengineering (71 publications) and Journal of Neurotrauma (37 publications) (Figure 3). The number of relevant articles in other journals reduces exponentially after these 5 core journals. APMR has published results from the 1970s whereas the other journals have predominantly published in this millennium (Figure 4). The journals with the highest impact factor among the top contributors were the Journal of Neuroengineering and Rehabilitation (5.208), Neurorehabilitation and Neural Repair (4.895), and IEEE Transactions on Neural Systems and Rehabilitation Engineering (4.528) (Table 3).

Figure 3.

Bradford’s law identifying the core journals where most publications are made in the field.

Figure 4.

The cumulative occurrence of articles published in the core journals across the years.

Table 3.

List of Top 20 Journals With Highest Number of Publications in the Field of Gait Rehabilitation and Their Current Impact Factor.

S No	Sources	Articles	Impact Factor
1	Spinal cord	153	2.22
2	Archives of physical medicine and rehabilitation	109	3.62
3	Journal of spinal cord medicine	76	1.80
4	Journal of neuroengineering and rehabilitation	71	5.208
5	Journal of neurotrauma	37	4.2
6	Neurorehabilitation and neural repair	37	4.895
7	Journal of rehabilitation research and development	33	1.043
8	Physical therapy	31	3.671
9	IEEE transactions on neural systems and rehabilitation engineering	29	4.528
10	Journal of neurophysiology	29	2.714
11	Prosthetics and orthotics international	29	1.672
12	Paraplegia	27
13	Gait and posture	25	2.746
14	Journal of rehabilitation medicine	23	2.912
15	Experimental brain research	22	2.064
16	Neurorehabilitation	21	1.986
17	American journal of physical medicine and rehabilitation	17	3.412
18	Frontiers in human neuroscience	17	3.473
19	Clinical biomechanics	16	2.034
20	Artificial organs	13	2.663

Affiliations, Countries and Collaborations

Nine of the top twenty affiliations publishing in this field were from the USA, 5 from Canada, and 3 from Switzerland (Table 4). The top three affiliations contributing to the field are Northwestern University USA (103 publications), the University of Miami, USA (83 publications), and the University of Alberta, Canada (82 publications) (Table 4). The USA, Canada, and Switzerland were also the top contributors for the publications with 453, 156, and 94 publications respectively. The USA published the greatest number of articles which is more than the sum of all articles published by the top 5 countries. The representation was majority from North America, Europe, and Asia. When adjusted for population, the countries with the top contribution per million population were Switzerland (10.6), Slovenia (5.7), and Canada (3.9) (Table 5). The analysis of collaboration between countries is shown in Figure 5. The number of articles with authors from more than one country is assessed to calculate the MCP: SCP (multiple country publication: single country publication) ratios depicted in Table 5. Austria, Netherlands, and Iran have the highest ratios whereas Thailand, Turkey and Japan have the lowest ratios from top 20 contributing countries. The top 3 contributing countries also had the most citations. The average citations per article were highest for publications from Switzerland (60.72), followed by France (48.67) and Germany (47.40), Israel (44.80), and Austria (42.00) (Table 5).

Table 4.

List of Top 20 Affiliations Around the World With Their Number of Articles.

S No	Affiliation	Articles
1	Northwestern University, USA	103
2	University of Miami, USA	83
3	University of Alberta, Canada	82
4	University of British Columbia, Canada	77
5	University of Florida, USA	75
6	Khon Kaen University, Thailand	68
7	University California of Los Angeles, USA	64
8	University of Toronto, Canada	64
9	Rehabilitation institute of Chicago, USA	59
10	Case Western reserve University, USA	49
11	University of tsukuba, Japan	47
12	Balgrist University hospital, Switzerland	41
13	University of Illinois, USA	38
14	University of Zurich, Switzerland	37
15	University of Louisville, USA	35
16	University of sydney, Australia	34
17	University of Montreal, Canada	31
18	McGill University, Canada	29
19	Swiss Federal institute of technology, Switzerland	29
20	Thomas jefferson University, USA	29

Table 5.

List of Top 20 Countries Contributing to the Field With Their Number of Articles, Citations, Articles per Million of Population and Their Collaborations Measured as the Ratio of Multiple Country to Single Country Publications (Higher Number Denotes More Collaborative Work).

SNo	Country	Population (Million)	Articles	Articles/per Million	Multiple Country: Single Country Publication Ratio	Citations	Average Citations/Article
1	USA	339.10	453	1.3	.108	18626	41.12
2	Canada	39.57	156	3.9	.199	5860	37.56
3	Switzerland	8.84	94	10.6	.33	5708	60.72
4	United Kingdom	68.93	58	0.8	.259	1614	27.83
5	Italy	60.20	57	0.9	.228	1766	30.98
6	China	1455.52	52	0.0	.154	640	12.31
7	Japan	125.35	49	0.4	.061	849	17.33
8	Australia	26.36	35	1.3	0.2	638	18.23
9	Netherlands	17.25	35	2.0	.286	1043	29.8
10	Iran	87.90	33	0.4	.636	291	8.82
11	Germany	84.30	30	0.4	0.3	1422	47.4
12	Spain	47.40	29	0.6	.207	796	27.45
13	Thailand	71.60	24	0.3	0	274	11.42
14	South Korea	51.40	21	0.4	.143	347	16.52
15	Brazil	216.96	18	0.1	.111	251	13.94
16	Austria	8.96	13	1.5	.692	546	42.00
17	France	65.69	12	0.2	.167	584	48.67
18	Slovenia	2.11	12	5.7	.167	151	12.58
19	Turkey	84.80	11	0.1	0	69	6.27
20	Israel	9.36	10	1.1	0.2	448	44.8

Figure 5.

The world map showing the collaboration between countries.

Keyword Analysis

The predominant author-chosen keywords from the relevant articles (apart from gait, locomotion, and ambulation) were FES, exoskeleton, and robotics as depicted in Figure 6. A total of 2075 keywords were analyzed from the total publications for the cluster analysis. Certain common keywords such as SCI, SCI patients, paraplegia, tetraplegia, and walking were excluded and synonyms merged to make the analysis more relevant. The keyword analysis showed four distinct clusters. One cluster included reciprocating gait orthosis, biomechanics, FES, and robotics; a second cluster included physical therapy, treadmill walking, body weight supported treadmill training (BWSTT), ambulation and locomotor training; third cluster included exoskeleton, neuromodulation, central pattern generator (CPG), neuroplasticity, and electromyography; and another cluster including quality of life, pain and stimulation. The thematic analysis is depicted in Figure 7 where the main motor theme in gait rehabilitation was the effect on quality of life and recovery; the basic themes (for transdisciplinary research) were related to FES, robotics, and CPG. The niche themes were identified as studies related to exoskeletons.

Figure 6.

Author keyword co-occurrence network identifying four distinct clusters.

Figure 7.

Thematic analysis of author keywords.

Nearly half (46%) of studies had declared a formal source of funding. These were from various national and international funding agencies.

Discussion

The relative importance of achieving ambulation for the spinal injured has resulted in making it an actively researched area. Similar to other bibliometric analyses in various health and allied fields, the USA tops as the most contributing country with its authors and affiliations as the most prolific in the field. However, the high average citations per article for publications from Europe suggest that they have been more impactful in this field. Despite a significant number of publications from Asian countries including China, Japan, Korea, and Thailand, their articles have a relatively lower average citation (<20). Switzerland had higher publications per million population and the second highest MCP: SCP ratio among European nations suggesting that it had one of the most prolific, and collaborative research as compared to its North American counterparts.

There may be multiple reasons for the relatively lesser multiple-country publications from the USA and other high-contributing countries. The relatively lower collaboration may be due to the high expenses involved in using certain technologies such as exoskeletons, FES, and BWSTT, or the relative dearth of motor incomplete individuals with SCI in less developed nations²⁴ (AIS A individuals with SCI choose wheelchair-based mobility instead of walking). These reasons may suggest that more research is required for finding low-cost solutions viable in developing nations and finding solutions that can be transferred across different geographical regions more effectively.

As depicted in Table 1 with author contributions - there is a diversity among the authors with physical therapists, surgeons, neuro physicians, neuroscientists, and engineers contributing to the field of gait rehab in SCI. This further corroborates the strengthening of interdisciplinary research for gait rehabilitation in SCI.

The current analysis regarding sources suggests that more predominant journals that are publishing results are related to spinal cord and engineering as compared to journals related to gait or biomechanics. The choice of journals suggests that the results are relevant for the group of clinicians and researchers working in the field of SCI.

An analysis of the most cited articles (Table 2) includes the following: An article by Colombo G. et al in 2000 was the most cited article on ‘Treadmill training of paraplegics using a robotic orthosis’ that described an adjustable gait orthosis for individuals with SCI with different degrees of paresis and spasticity to walk on a treadmill and attain physiological gait patterns. The second most cited article was a review by Robert L. Waters and Sara Mulroyin published in Gait and Posture journal in 1999 on ‘The energy expenditure of normal and pathologic gait’. This overview discusses the fundamentals of exercise physiology as it relates to human gait, the energy used during regular walking, and the findings of research done on the energy used in specific neurological and orthopedic impairments. The third most cited article was titled ‘Evidence for a Spinal Central Pattern Generator in Humans’ published by Milan R. Dimitrijevic et al in 1998. The results imply that human spinal circuitry can generate locomotor-like activity that can take the place of the tonic drive produced by the brain. This is possible even when it is not under the brain control or externally controlled sustained electrical stimulation, such as epidural stimulation of the spinal cord, can take the place of the tonic drive produced by the brain. The high citations for these articles also suggest the research trends among scientists around the world.

There has been a surge in the number of publications related to gait rehabilitation in SCI after 2000 with a steep rise in contributions from various countries rising only in the last decade. Beyond an increase in interest and awareness about gait rehabilitation, this may indicate the use of technology that provide a wide range of solutions. Similarly, there has been an improved understanding of neuro-plasticity and motor-control strategies for the rehabilitation of SCI that focuses on training for functional ambulation using repetitive goal-oriented tasks.^25,26

The keyword analysis and the thematic analysis show that gait training in SCI has evolved over the years with emerging interdisciplinary technologies.²⁷ Previous literature shows that rehabilitative approaches for improving gait have evolved from those that counterbalance impaired or lost function to approaches based on the concepts of activity-dependent neuroplasticity and neural control of walking after SCI.^28–30 Traditionally gait training included strengthening of lower limb muscles followed by parallel bar walking and using walking-aids to complement the residual muscle power. Over time technological advances have supplemented or replaced traditional gait rehabilitation³¹ with newer techniques like low-weight exoskeletons or robotics, neuromodulation by spinal stimulation, electrical stimulation of muscles using algorithms to simulate gait, orthosis that provide adequate stability and controlled mobility of joints, partial weight-bearing treadmill walking capabilities, stem cell therapy, virtual reality therapy etcetera. Gait training has seen a paradigm shift from traditional methods to the amalgamation of technology with traditional methods.^32,33

The articles about orthotic supports and ‘walking appliances’ appear as early as in the 1970s. After almost 20 years, studies related to energy expenditure, biomechanically analyzed walking styles, reciprocating gait orthosis and effectiveness of FES for gait got published. In the late 90s and early 2000, articles related to BWSTT and objective outcome measures were published. These are followed by articles that assess factors for the prediction of ambulation in individuals with SCI and robotic exoskeletons, neuroplasticity, and CPGs in the last decade.

An interesting observation in the thematic map analysis showed the shift of FES as the technique for gait rehabilitation from the basic themes to the motor themes. The results indicated that FES is now an established technique for gait rehabilitation. Similarly, the concepts of CPGs and robotics especially in incomplete injuries are the areas requiring trans-disciplinary research. Exoskeletons as a treatment option is a basic theme requiring transdisciplinary research, though powered exoskeletons as a treatment option may have limited relevance in gait rehabilitation indicating the high finances involved in conducting such study.

The strength of the current analysis is the comprehensiveness that spans over 6 decades. The study is however limited due to the following reasons: the analysis excluded animal studies where a bulk of research work is focused. The analysis is limited to articles published in English and those which are available on the WoS database. Only full-length original articles and reviews were considered that excluded conference proceedings and theses which are a source for finding the recent developments in the field. The articles that may be very relevant but recent may not get highlighted by this analysis as it depends on the number of citations. The more recent works may not be cited as many times as the older articles.

The results of the current analysis may find use with researchers to assess trends, know collaborators, and determine where to publish gait-related studies in SCI. The results may be useful for publishers and journal editors to know research hot spots. The funding agencies may use the analyses to know the direction of future research work and focus on developing suitable collaborations. The committees deciding promotions/tenure of faculties may use the information about scientific productivity.

Conclusion

The results from the current analysis identify the contributors across the globe. The role of rehabilitation in improving the walking capabilities of individuals with SCI has become very significant and has seen transformations over the years. The study reinforces the importance of a collaborative, multi-disciplinary approach to gait rehabilitation.

Supplemental Material

Supplemental Material - Global Research Trends on Gait Rehabilitation in Individuals With Spinal Cord Injury- A Bibliometric Analysis

Supplemental Material for Global Research Trends on Gait Rehabilitation in Individuals With Spinal Cord Injury- A Bibliometric Analysis by Vandana Phadke, Ridhi Sharma, Navita Sharma, and Shambhovi Mitra in Global Spine Journal.

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iD

Shambhovi Mitra

Supplemental Material

Supplemental material for this article is available online.

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