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. 2025 May;46(5):2027-2039.
doi: 10.1007/s10072-025-08012-1. Epub 2025 Jan 21.

Acute intermittent hypoxia in spinal cord injury gait rehabilitation: a systematic review of randomized trials

Anas R Alashram  1   2
Affiliations

Acute intermittent hypoxia in spinal cord injury gait rehabilitation: a systematic review of randomized trials

Anas R Alashram. Neurol Sci. 2025 May.

Abstract

Background: Gait impairments are one of the popular consequences of spinal cord injury (SCI). Acute intermittent hypoxia (AIH) is an innovative treatment that has recently been used to enhance motor function in patients with neurological conditions. This review aims to examine the effects of AIH on gait post-SCI, verify who most likely would benefit from the treatment, and recognize the best treatment protocol, if possible.

Methods: The search was conducted in "PubMed, MEDLINE, The Cochrane Library, Scopus, PEDro, and Web of Science" databases from inception to October 2024. This review included randomized trials involving individuals with SCI who received AIH, alone or in combination with other interventions, compared with active or passive comparators, and evaluated at least one outcome related to gait ability. The quality of the included studies was measured using the "Physiotherapy Evidence Database (PEDro)".

Results: Nine studies met the eligibility criteria. In total, 158 individuals with SCI (mean age 44.45 years; 86% male) were involved in this analysis. The included studies' PEDro scores ranged from 5 to 10, with a median of 8. The main findings showed that AIH improves gait speed, walking endurance, dynamic balance, and plantar flexor strength in individuals with SCI.

Conclusion: AIH is a safe intervention for individuals with SCI. This review underscores the potential benefits of AIH for improving gait abilities in SCI with motor-incomplete injuries (ASIA grades C and D) at cervical, thoracic, and lumbar levels. Further studies are recommended to verify our findings.

Keywords: Acute intermittent hypoxia; Gait; Rehabilitation; Spinal cord injury; Therapy.

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Conflict of interest statement

Declarations. Ethical approval: This article is based on previously conducted studies and contains no new studies with human participants or animals performed by any of the authors. Competing interests: The author has no conflict of interest. Details of any previous presentation of the research, manuscript, or abstract in any form: None. Permission: Permissions were approved by Dr. Qusai Janada and Tareq Youssef to include their names in acknowledgments.

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