**3.5 Occupational therapy**

Occupational therapy is a crucial process in rehabilitation since it eases societal role finding [19]. It focuses on enhancing daily life activity execution and fine movement, by searching for total independence or performing compensatory strategies to adapt [34–36] as well as patient's environment adaption (home, transportation, or workplace) to achieve total inclusion with its remaining abilities.

It demands equipment and techniques for transferring from one surface to another, dressing, bathing, grooming, feeding, cooking, respiratory exercises, and vesical and intestinal control. Besides, it also trains on wheelchair use and provides counseling for house modification like ramp addition, bath chair incorporation, and current insulation [34, 37].

### **3.6 Dry needling**

Dry needling is an invasive procedure that consists of reaching muscle myofascial trigger points (MTPs) with a needle [38]. MTPs are small, tense muscle nodules that cause pain, cause weakness, and limit range of motion [39].

It is considered that dry needling stimulation inhibits spontaneous electrical activity in MTPs by diminishing the availability of acetylcholine in the motor end plate (it is believed that MTP originates here); consequently, muscle fiber relaxes, promoting pain and spasticity reduction and improving gait speed and stability in patients with incomplete injury [39, 40]. It is worth mentioning that more studies have to be made to set the frequency, duration, and intensity of sessions to obtain desirable outcomes [41].

#### **3.7 Exoskeletons**

Exoskeletons are battery-powered robotic devices that adjust to the patients' limbs; it can be operated with manual or oral control or micromovement detector to ease mobility and gait [26, 34].

Two main objectives of exoskeletons are promoting recovery through repeated movements to increase neural plasticity and assist mobility [42]. ReWalk™ and Indego™ are two community use exoskeletons [43] that enable walking, sitting, and climbing stairs up and down [44, 45]. Their use has shown improvements in quality of life, body composition, bone density, neuropathic pain, and spasticity [42] and an increase in gait speed [43], number of steps, and distance test before and after 90 days of training [34]. Restraints for certain users are height, weight, articular rigidity, and high cost (\$80,000 USD) [43].

## **4. Electrical stimulation outcome measurement**

Electrical stimulation outcome measurement can be performed through different methods, depending on the evaluated function. After FES, cycling outcomes can be measured by tridimensional analysis of the gait, estimation of oxygen consumption by indirect calorimetry, and muscle tone evaluation with Modified Ashworth Scale [46]. To evaluate outcomes after EES, the following methods can be applied: Motor activity can be evaluated by electromyography and motor tasks, the cardiovascular status might be evaluated by blood pressure measurement after *Rehabilitation Therapies in Spinal Cord Injury Patients DOI: http://dx.doi.org/10.5772/intechopen.92825*

tilt table testing; sexual performance can be assessed by the achievement of orgasm, and for bladder control evaluation, the Neurogenic Bladder Symptom Score (NBSS) can be applied, or post-void residual volume and voluntary urination capacity can be evaluated [47]. In other studies, the outcomes have been measured through motor task performance such as sitting and balance, body fat mass measurement, and respiratory function or inspiratory function by coughing; all cases are compared before and after therapy application [30].
